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/"~Cyr`®`" CERTIFiC~1TE aF LI~I,BfLiTY INSURANCE DA~t{MtNDDlYYYY) <br />bPRIMAiT~-1-1 02/D9/10 <br />`~ <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION <br />PROaucER <br />Brakke Sahafnitz West ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE <br />License #0428915 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR <br />ite 150 <br />S <br />t ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. <br />u <br />, <br />B 40 Apo11o Stree <br />El Segundo CA 90245 <br />Phone :310-524-1340 INSURERS AFFORDING COVERAGE NAIC # <br />INSURED INSURER A: Aaatchaetas auxply^ LLnee Ine <br />N-201 ~-013 INSURER B: <br /> INSURER C: <br />Dr. Maureen Bassoon <br />P O $OX 2O9B INSURER D: <br />Palos Verdes Peninsula CA 90274 <br /> INSURER E: <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH£ POLICY PHRIDD INO1l:Ai tu. nw m, na i nnwnw <br />TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Wi7H RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR <br />ANY REQUIREMENT <br />, <br />MAY PERTAIN, THE INSURANCE AFFORDED HY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO Alt THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH <br />POLICIES. AGGREGATE LIM17S SHOWN MAY HAVE BEEN REDUCED 0Y PAID CLAIMS. <br />LTR NSR TYPE OF INSURANCE POLICY NUMBER PATE MM/DD DATE MMlDDlYYYY LIMCfS <br /> GENERALLUU31L1TY EACH OCCURRENCE S 1 OOO OOO <br /> x COMMERCIAL GENERAL LIABILITY 624061814001 02/17/09 05/01/10 PREMISES Eaoca,rence S 50 000 <br />A ]{ CLAIMS MADE a OCCUR MED EXP (Any one parson} S 5 000 <br /> PERSONAL 8 ADV INJURY 5 1 ~ OOO OOO <br /> X 500 Ded/Occur <br />$2 GENERAL AGGREGATE 52 OOO 000 <br /> GEN , <br />'LAGGREGATELIMITAPPLIE5PER: PRODUCTS-COMPfOPAGG S2 DOO,000 <br /> <br /> POLICY PRO LOC <br />JECT <br /> <br /> AUT OMOBILE LU1&LITY COMBINED SINGLE LIMIT S <br /> <br />ANY AlfrO (Es accident} <br /> <br /> ALL OWNED AUTOS BODILY INJURY S <br /> <br />SCHEDULED AUTOS {Per person} <br /> <br /> HIRED AUTOS BODILY INJURY S <br /> NON-0WNED AUTOS (Per accident) <br /> <br /> PROPERTY DAMAGE S <br /> (Per aeeldent} <br /> GARAGE LUU31LlTY AUTO pNLY - EA ACCIDENT S <br /> ANY AUTO OTHER THAN ~` ACC S <br /> AUTO ONLY: AGG 5 <br /> D(CESSlUMBRELLALIABWTY r EACH OCCURRENCE S <br /> OCCUR ~ CLAIMS MADE ~' ~~ ~~ AGGREGATE S <br /> y <br /> ~t S <br /> <br /> o£DUCnBLE ~' Joseph traka ~ <br /> <br /> RETENTION S S <br /> riOR KER B COMPENSA710N TORY LIMITS ER <br /> ANO EMPLOYERS' LUU3ILITY <br />ANY PROPRIETORfPARTNERlEXECUTIV~ <br />EL EACH ACCIDENT <br />S <br /> OFFICERIMFJdHER EXCLUDED? <br />(Mandatory In NH) E.L DISEASE - EA EMPLOYEE S <br /> If yes, dasai6e under <br />SPECIAL PROVISIONS bebw <br />EL DISEASE -POLICY LIMIT <br />S <br /> OTHER <br />A Professional Liab. 624061614001 02/17/09 05/01/10 Prof Liab $lmm$2mmP,gg <br /> Incls. Pollution 6 AseEazoe cwci~*•~ eons Deduct. $5 000/Clm <br />DESCRlp710N OF OPERATIONS I LOCATIONS I VEHICLES! EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVI9IDNS <br />*10 Days IF aaacelled for nonpayment of premium. The Certificate Holder is <br />recognized as Additional Insured per endorsement ENV-3100 attached. <br />u+arm uro non CONCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7HE EXPIRATION <br />~.S,~rr~ DATE THEREDF, THE ISSUING INSURER WILL ENDEAYORTD MAIL 3O * DAYS WRITTEN <br />City Of Banta Ana NDTICE TO THE CERTIFlCATE HOLDER NAMED TD THE LEFT, BUT FAILURE TO DO SO SHALL <br />Risk Management Division IMPOSE NO OBLIGATION OR LIAHILrfY DF ANY KIND UPON THE W SURER, ITS AGENTS OR <br />Attn: Carolyn Richard REPRESENTATIVES. <br />P.O. BOX 1988 AUTHOF~D:EDREPRESENTA7NE <br />Santa Ana CA 92702 )1 ~q~ <br /> <br />ACORD 25 (2009101) t6+ lano-soon /avvrw ~.vtcrvrw, rv~~. nn r,yrna rwn~rou. <br />The ACORD name and logo are registered marks of ACORD <br />