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ACO• _®im CERTIFICATE OF LIABILITY INSURANCE <br />DATE 11/09/17 I/17 <br />11/0 <br />PRODUCER <br />Jaymes & Jaymes, Inc. <br />314 Center Street, Suite 202 <br />Healdsburg, CA 95448 <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSURED <br />Scott J. Grossberg, APC DBA Grossberg & Hoehn <br />1026 W. Foothill Blvd. <br />Upland, CA 91786 <br />INSURERA, National, Liability & Fire Insurance Co. 2_0052 <br />INSURER B: <br />INSURERC: <br />INSURERD: <br />INSURERE: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING <br />ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, <br />NS <br />P' <br />HIS <br />TYPEOFINSURANCE <br />POLICVNUMBER <br />POLICY EFPECTIVE <br />POLICY EXPIRATIONLTR <br />ATE I <br />LIMITS <br />Dale: 2017.1109 9.;2]:18 -.W <br />GENERALLIABILITY <br />EACHOOCURRENCE $ <br />PREMISES Ell occurence $ <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS MADE ❑ OCCUR <br />MED EXP(An one person) $ <br />PERSONAL&ADV INJURY $ <br />GENERALAGGREGATE $ <br />GEN'LAGGREGATE LIMIT APPUES PER: <br />PRODUCTS-COMP/OPAGG $ <br />POUl PRO- LOC <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />ANYAUTO <br />(E $ <br />a accident) <br />BODILYINJURY <br />ALLOWNEDAUTOS <br />SCHEDULEDAUTOS <br />(Per person) $ <br />BODaccide $ <br />HIREDAUTOB <br />NON -OWNED AUTOS <br />(Peraccident) <br />t) <br />PROPERTYDAMAGE $ <br />(Peraccident) <br />GARAGELIABILITY <br />AUTO ONLY -EA ACCIDENT $ <br />OTHERTHAN EAACC $ <br />ANYAUTO <br />AUTOONLY: AGG $ <br />EXCESSIUMBRELLALIABILITY <br />EACHOCCURRENCE $ <br />AGGREGATE $ <br />OCCUR CLAIMS MADE <br />$ <br />DEDUCTIBLE <br />$ <br />RETENTION $ <br />WORKERS COMPENSATION AND <br />I T RSTTATU- 0 H - <br />LIMITS a <br />EMPLOYERS' LIABILITY <br />ANY PROPRIRIPARTNCUTIVE <br />E.L. EACH ACCIDENT $ <br />E.L. DISEASE -EA EMPLOYEE $ <br />OFFICERIMEMBEMBER EXCLUDED?DED? <br />describe antler <br />Syes, <br />SPECIAL PROVISIONS below <br />E.L. DISEASE -POLICY LIMIT I $ <br />OTHER <br />OX <br />Professional Liability <br />LP002290 <br />06/15/17 <br />06/15/18 <br />$2,000,000/$2,000,000 <br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS <br />Law Firm <br />CERTIFICATE HOLDER CANCELLATION <br />ACORD 25 (2001/08) ©ACORD CORPORATION 1988 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION <br />DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN <br />Scott J. Grossberg, APC DBA Grossberg & Hoehn <br />NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL <br />1026 W. Foothill Blvd. <br />Upland, CA 91786 <br />IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR <br />REPRESENTATIVES. <br />AUTHORIZED REPRESENTATIVE Digitally signed by Craig N. gill <br />MCn Cmlg W. Egli o ad, <br />I TBil-C,alg(AjCyal a=18 <br />Dale: 2017.1109 9.;2]:18 -.W <br />ACORD 25 (2001/08) ©ACORD CORPORATION 1988 <br />