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2019/07/12 Nancy K. Bohl, Inc. Certificate of Liability InsuranceDocuSign Envelope ID: 0947A4DA-24FC-49CA-98E5-190F80CE876A 0 DATE(MMIDD/YYYY) Ac'�W" CERTIFICATE OF LIABILITY INSURANCE 12/17/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NA_ME:_ _ Stayfarm SKALA INSURANCE AGENCY INC PHONE 909-883-8861 1 (AIC No: 4214 N SIERRA WAY A DR9 s, GENE@GENESKALA.COM SAN BERAIARDINO, �A 92407 GENE SKALA, AGEN LIC.#0587032 INSURED NANCY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK INSURERS AFFORDING COVERAGE NAIC # INSURER A: State Farm General Insurance Company 25151 INSURER B: State Farm Mutual Automobile Insurance Company 25178 INSURER C : INSURER D : INSURER E: i INSURER F. COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE 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 TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE A DL INqD SUB WVvD POLICY NUMBER POLICY EFF IMMMDNYYVI POLICY E%P (MMIDONYYYILIMITS COMMERCIAL GENERAL LIABILITY LEACH OCCURRENCE $ 1,000,000 _ CLAIMS -MADE X OCCUR A GE TO RENTED PRE - a Dourlemal $ 300,000 MED EXP (Any one person) $ 5,000 HIRED AUTO A X1 ENOL 92LB14261 &92YD04220 07/12/2019 07/12/2020 PERSONAL & ADV INJURY $ \\\\GjEEjjjNj'LAGGREGATE LIMIT APPLIES PER: POLICY JERiT LOG GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ $ y,T�J I� OTHER: AUTOMOBILE LIABILITY 4414187F2475 12/24/2019 06/24/2020 COM4iIIdED SINGLE LIMIT $ BODILY INJURY (Per person) $ 1,000,000 ANY AUTO BODILY INJURY (Per accident) $ 1,000,000 B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE P en $ 1,000,000 $ I UMBRELLA LIAB OCCUR H EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A PER;TAR - E.L EACH ACCIDENT - $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Business Office Policy Property Locations: 1881 Business Center Dr, San Bernardino, CA 92408 39755 Murrieta Hot Springs Rd, Ste 0160, Murrieta, CA 92563 1545 Anacapa Rd Ste 7C, Victorville, CA 92392 135 S State College Blvd Ste 200, Brea, CA 92821 444 Camino Del Rio Ste 2015,San Diego, CA 92108 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 74075 El Paseo Ste A9, Palm Desert, CA 92260 232 Harrison Ave Ste D, Claremont, CA 91711 270 E HWY 246 Ste 11, Buellton, CA 93427 4160 Temescal Canyon Rd., Suite 309, Corona, CA 92883 T1O N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Insurance Verification Purpose. ACCORDANCE WITH THE POLICY PROVISIONS. NANCY K BOHL INC DBA THE COUNSELING TEAM l AUTH Z EPRI=SENTAT INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK " " "—/" @ 1988-2015 ACORD CORPO A N. I[ rblits reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 1001486 132849 12 03-16-2016 DocuSign Envelope ID: 0947A4DA-24FC-49CA-98E5-190F80CE876A CPH PHILADELPHIA INSURANCE COMPANIES & ASSOCIATES Certificate of Liability Insurance Date Issued: 07/29/2019 Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 • NAIC #: 18058 Administered by: CPH & Associates • 711 S. Dearborn St. Ste 205 - Chicago, IL 60605 • P 800.875.1911 • F 312.987.0902 • info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder 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 Insured: Nancy K. BON Inc. dba The Counseling Team International Nancy Bohl 1881 Business Center Drive #11 San Bernardino, CA 92408 Covered Locations Policy Number: 025826 Policy Term: 08/31/2019 to 08/31/2020 Professional Liability: Portable coverage, not location specific Coverage Type Per Incident Aggregate (Occurrence Form) (Per individual claim) (Total amount per year) Professional Liability $ 1,000,000 $ 5,000,000 Supplemental Liability $ 1,000,000 $ 5,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General N/A N/A Liability N/A N/A Fire/Water Legal Liability Business Personal Property N/A N/A Vicarious Sexual $ 1,000,000 $ 1,000,000 Misconduct Cyber Liability (Claims Made Form) $ 25,000 $ 25,000 Retroactive Date: 08/31 /2018 Comments/Special Descriptions: Certificate Holder PROOF OF COVERAGE 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 in lieu of such endorsement(s). Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. Authorized Representative C. Philip Hodson DocuSign Envelope ID: 0947A4DA-24FC-49CA-98E5-190F80CE876A POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-15-2020 CITY OF MENIFEE SP 29844 HAUN RD MENIFEE CA 92586-6539 GROUP: POLICY NUMBER: 0702761-2019 CERTIFICATE ID: 115 CERTIFICATE EXPIRES: 08-12-2020 08-12-2019/08-12-2020 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 #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2020-06-15 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF MENIFEE -� ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2020-06-15 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF MENIFEE ENDORSEMENT #1651 - NANCY K BOHL P,S,T - EXCLUDED. EMPLOYER NANCY K BOHL INC SP 1881 BUS CTR OR STE 11 SAN BERNADINO CA 92408 [P1 X, HOj (REV.7-2014) PRINTED : 06-15-2020 DocuSign Envelope ID: 0947A4DA-24FC-49CA-98E5-190F80CE876A ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE AUGUST 12, 2019 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING AUGUST 12, 2020 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME NANCY K BOHL INC 1881 BUS CTR DR STE 11 SAN BERNADINO, CA 92408 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. RC14F.TITTT. F. PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER BLANKET WAIVER OF SUBROGATION 702761-19 RENEWAL SP 2-47-86-99 PAGE 1 OF NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 1, 20/199 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.4-2018) 2572 OLD DP 217 1