BOSCH, WESLEY A., M.A. MFT-2017 - Laserfiche WebLink

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Certificate of Insurance (Proof of Coverage) Date Issued: 11/09/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured Name and Mailing Address* Cancellation Program Administrator Wesley A Dosch Employees Administered By: 24331 Muirlands Blvd #D4-123 notice will be delivered in accordance with the policy provisions. CPH and Associates N-2017-246 Holder has also been added to the policy as an additional insured:** [ 3� Yes/No ] 711 S. Dearborn, Suite 205 Lake Forest, CA 92630 /Y ' P Chicago, IL 60605 P.312-987-9823 F.312-987-0902 endorsed. A statement on this certificate does not confer rights to the certificate holder *Additional insured locations are often requested by individual business owners who have more than 'nL fql< hius com one office. Your coverage is portable, meaning that you are covered at any location for practice under Underwritten By: he occupation(s) listed on your policy. Philadelphia Indemnity Insurance Company Coverage Policy #:081041 IEffective Date: 08/21/2017 [Expiration Date: 08/21/2018 HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liability EACH OCCURRENCE AGGREGATE Coverage Part (Per individual claim) (Total amount per policy year $1,000,000 $3,00 000 Professional Liability Commercial General Liability $1,000,000 $3,000,000 Includes: General Liability, Fire & Water Legal Liability and Personal Liability N/A N/A Pr2gerty Coverage $1000,000 $3,000,000 Supplemental Liabili Unlimited Unlimited Defense Expense Coverage $35,000 $35,000 State Licensing Board Investigation Defense Coverage $15,000 $15,000 Assault Coverage $10,000 $35,000 Deposition Expense Benefit $5,000/person $50,000 Medical Ex ense Coverage $15,000 $15,000 First Aid Coverage Description/Special Provisions: General Liability Insured Location(s): 25283 Cabot Rd., Ste. 204 Lacuna Hills, CA 92653 : 1000 E. Santa Ann Blvd.. Ste. 200 Santa Ana, CA 92701 Certificate Holder Cancellation City of Santa Ana, its Officers, Agents, and Employees Should any of the above described policies be cancelled before the expiration date thereof, 0 Civic Center Plaza notice will be delivered in accordance with the policy provisions. Santa Ana, CA 92702 Holder has also been added to the policy as an additional insured:** [ 3� Yes/No ] t j wore /Y ' P **If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder Authorized Representative in lieu of such endorsement(s). C. Philip Hodson DISCLAIMER:The Certificate of Insurance does not constitute a contract between the issuing Insurer(s), authorized representative or producer, and the certificate holder, nor does It affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.