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CONTRACT #: L- 201q--1-2-:-1
<br />/Ag-c-"«' CERTIFICATE OF LIABILITY INSURANCE DATEI IDDNYYY)
<br />~"� 02/03/2020
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this Certificate does not confer rights to the. certificate holder In lieu of such endersannenwAL
<br />PRODUCER
<br />"Osd+.".LP-CTrn;
<br />C
<br />INSURED
<br />SKALA INSURANCE AGENCY INC
<br />GENE SKALD. AGENT LIC. 0587032
<br />4214 N SIERRA WAY
<br />SAN BERNARDINO, CA 92407
<br />NANCY K BOI IL INC
<br />DBA THE COUNSELING TEAM INTERNATIONAL
<br />AND DBA THE ORGANIZATIONAL NFTA/ORK
<br />'CONTACT
<br />NAMel __
<br />.PHONE
<br />LAIC No $Ye'
<br />909-B83-8861
<br />E-MAIL
<br />APpRe}s:
<br />_
<br />GENE GENESKALA.COM
<br />@
<br />INSURERS) AFFORDING COVI
<br />INSURERA:
<br />INSURER B:
<br />State Farm General Insurance
<br />State Farm Mutual Automobile
<br />INSURER C
<br />: _
<br />INSURER D:
<br />covFaer.Fc rvorlvlrar� _— __.
<br />- "" cvIJIV1Y IY W1Y16r,-{(:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN ISSUED TO THE INSURED NAMED
<br />A8OVE FOR THE POLICY PERIOD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT
<br />TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
<br />IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONSAN) CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR A LSUeR
<br />LTR TYPE OF IN5URANCE POLIDYEFF P C ERP
<br />POLICY NUMBER MN110D/YYYY MMnrvvYW LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />-
<br />EACH OCCURRENCE
<br />1,000,000
<br />RF101270-ITFRT neeca
<br />3
<br />S 30g000
<br />CLAIMSMADE®OCCUR
<br />HIRED AUTO
<br />MED EX= n( lie Una pu,surd
<br />5 5 000
<br />A
<br />ENOL
<br />Y
<br />Y
<br />92LE14261 & 92YD04220
<br />07112/2019
<br />(0711212020
<br />PRsDNat. sAnV-NUURy
<br />s
<br />GEN'L AGGREGATE LIMITAPrrPLIEIIS PER
<br />PDLICY ❑
<br />AGCRECA.TE
<br />5 2,000,OOD
<br />PRODUCTS-COMPIOP AGG
<br />`
<br />lea u LOG
<br />(GENERAL
<br />OTHER'.
<br />—
<br />a
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />Y
<br />4414187F2475
<br />12/24/2019
<br />06/24/2020
<br />COMBwEDs1NGlE cltalT
<br />Eu r"Cldent
<br />3
<br />BODILY INJURY IPmpe see)
<br />S 1.000.000
<br />B
<br />]ANYAUTO
<br />AUTOSSCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accitlunl)
<br />3
<br />10AIRED
<br />NON -OWNED
<br />AUTOS CALTOE ONLY
<br />PV[J-0.4GE
<br />palrr"P,
<br />a „
<br />—'I---'
<br />1000,000
<br />3
<br />UMBRELLA LIAO
<br />OCCUR
<br />-•
<br />EACH OCCURRENCE
<br />-___:..�..
<br />5
<br />-EXLESsi
<br />O-AIMS-NADE
<br />AGGREGATE
<br />§
<br />'QED RETENTIONS
<br />^i -
<br />WORKERS FftN I ION
<br />PER OTH..
<br />s
<br />AND EMPLOYERS' LIABILITY YIN
<br />Ee
<br />ANv PROPRIETORIPARTNEIR EXECUTIVE
<br />OFFICERMEMBER EXCLUDED? �.
<br />MIA
<br />F I EACH ACCIDENT
<br />_HACCI
<br />s "
<br />IMandatery in NH) -
<br />If yee, descdbe under
<br />El. DISEA.SE-EA EMPLOYE-5
<br />EL DISEASE-POLIOYLIYt"
<br />3 -T_-
<br />DESCRIPTION Of OFERATION$below
<br />t
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tat, Amfiflm al Remarks Schedule, maybe aeached if mare space is required) '
<br />Business Office Policy Property Locations:
<br />1881 Business Center Dr, San Bernardino, CA 92408 39755 Murriete Hot Springs Rd, Ste D160, Murrieta, CA 92563
<br />1545 Anacapa Rd Ste 7C, Victorville, CA 92392 135 S State College Blvd Ste 200, Brea, CA 92821
<br />444 Camino Del Rio Ste 2015,San Diego, CA 92108 701 Palomar Airport Rd, #300, Carlsbad, CA 92011
<br />74075 El Pasco Ste A9, Palm Desert, CA 92260 232 I-lanisor Ave Ste D, Claremont: CA 91711
<br />270 E Hwy 246. Ste 11, Buellton, CA 9342'
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />CITY OF SANTA ANA O ANCE WITH THE POLICY PROVISIONS.
<br />RISK MANAGEMENT DIVISION
<br />20 CIVIC CENTER PLAZA 4th FLOOR A Tu D EPRESEN Alive - "—
<br />SANTA ANA, 8 Fc Y 7, ^ t"-70'VED
<br />y .CiDk ; te,;. ,=. �: o-,�;.-'I'I ©1988-20 Dft0 GORP A 10 .
<br />ht eserved.
<br />ACORD 25 (2016103) 4D: TheORD ame ogq are E�gistered marks of ACORD4RF 132849,12 031G2�1c
<br />BIE SC�.1 r_m ijz 4
<br />
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