THE COUNSELING TEAM INTERNATIONAL - 2014

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ISSUE DATE: 08-12-2016 POLICYHOLDER COPY CERTIFICATE OF WORKERS' COMPENSATION' INSURANCE SANTA ANA POLICY DEPARTMENT SIP ATTN: TAYLOR GEIL-CHIEFS OFFICE M-97 60 CIVIC CENTER PLZ SANTA ANA CA 92701-4050 GROUP: POLICY NUMBER: 0702761-2016 CERTIFICATE 10: 38 CERTIFICATE EXPIRES: 08-12-2017 08-12-2016/08-12-2017 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT 1#0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2015-08-12 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: SANTA ANA POLICY DEPARTMENT ENDORSEMENT #1600 - NANCY K. BOHL, PRESI,SEC,TRES - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER NANCY K BOHL INC DBA; INTERNATIONAL 1881 BUS CTR DR STE 11 SAN BERNADINO CA 92408 THE COUNSELING TEAM SIP M0410 PRINTED : 07-16-2016 (REV. 7- 2'0141 -M