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Mar.26.2015 11:42 AM Eric W. Gruver, Ph.D. 17145444996 PAGE. 1/ 1 <br />Account Number: CA GRUE 1440 Date: 3/24/15 Initials: QTMHHTTP <br />CERTIFICATE OF INSURANCE <br />DARWIN NATIONAL ASSURANCE COMPANY <br />C/O: American Professional Agency, Inc. <br />95 Broadway, Amityville, NY 11701 <br />800-421-6694 <br />This is to certify that the ineuranco policies specified below have been issued by the company indicated <br />above to the ineured nosed heroin and that, eubyect to their provisions and oonditions, such policies afford <br />the ooverajee indicated insofar as nO coverages apply to the occupation or business of the Yarned ineured(1) <br />as stated. <br />THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR <br />ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. <br />Name and Address of Insured: <br />ERIC WAYNE GRUVER, PH.D. <br />2021 E 4TH STREET <br />SUITE 116 <br />SANTA ANA CA 92705 <br />Type of Work Covered: PROFESSIONAL PSYCHOLOGIST <br />Location of OperationS: N/A <br />(If different than addrosa listed above) <br />Claim History: None <br />P7 +rnnn*ilyo dA+a ism Oi/01 /799'1 <br />Additional Named insureds: <br />Coverages <br />Policy <br />Number <br />Effective <br />Date <br />Expiration <br />Date <br />Limits o <br />Liability <br />PROFESSIONAL/ <br />LIABILITY <br />5010-7473 <br />3/01/15 <br />3/01/16 <br />2,000,000 <br />4,0'N' 000 <br />NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS <br />POLICY AND HE OR SME SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING <br />OR RECEIV114G NOTICE OF CANCELLATION. <br />avi wed <br />Comments: P <br />Thi <br />Name: ERIC WAYNE GRUVER, PH.D. <br />2021 E 4TH STREET <br />Address: SUITE 116 <br />SANTA ANA CA 92705 <br />APA 00049 00 (05/2012) <br />