PROOF OF INSURANCE (2023 - 2023) CLOSED0 [ DATE (MMIDDrrrM
CERTIFICATE OF LIABILITY INSURANCE
06/07/2023
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 endorsements .
OHTACT
PRODUCER .,Gw»�.=,. Robert Sichmeller
Independent Executive Insurance Brokers
144 Los Angeles Ave., #106-363
CA 93021
INSURED
Holman Group of Arizona, Holman Professional Counseling, Inc.
Holman Professional Counseling Centers, Inc.
8501 Fallbrook Ave, #100
West Hills CA 91304
rnVFRor1=S � r-RTIFlr'Y"ATI= NIIIMRFR-
(805) 624-4815
INSURER(S) AFFORDING COVERAGE
iNwSURERwnw: TDC SPECIALTY INS CO
INSURER B : PROGRESSIVE COMMERCIAL CAS CO
INSURER c : HARTFORD WFIRE & CAS GRP
......................................................................._
INSURER D : FEDERAL INS CO
REVISION NUMBER!
579-6103
34487
28�9
..........
914
20281
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 AfYDL.'SI.IiR. POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBER MM/DD M/DD
......______________..
LIMITS
y" COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 2,000,000
-
CLAIMS -MADE FX1 OCCUR
GE TO RENTED .�..__.
DAMA....._.
mPREMISE9,(Ea occurrence,),,,,,,,,,, $ 100,000
MED EXP (And oneerson)
. $ ^ 5,000
A MFP-01502-22-02 08/01/2022 08/01/2023
PERSONAL& ADV INJURY
$ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 6,000,000
..._._. JOT
X POLICY LOC
PRODUCTS - COMP/OP AGG
$ 2,000,000
.,....,.,_.........._....._..
OTHER:
$
AUTOMOBILE LIABILITY
..........
COMBINED SINGLE LIMIT
'NO a data
$
.....................................
ANY AUTO
BODILY INJURY (Per person)
$ 1.000,000
B
......-. OWNED ......_ SCHEDULED
X
02149349-6
05/27/2023 11/27/2023
..
BODILY INJURY (Per accident)
............
$ 1 000 000
AUTOS ONLY ^_ AUTOS
HIRED ..... NON -OWNED
AUTOS ONLY ....... AUTOS ONLY
PROPERTY DAMAGE
Pot accidpll,,),
$ 1 OOO,OOO
.............................,-.,
$
UMBRELLA LIAB OCCUR
mmmmm
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
AGGREGATE
DED RETENTION $
$
WORKERS COMPENSATION
PER OT'H-
sTATUT R
AND EMPLOEEOR/PARBILITY YIN
.......1,
C
ANY ECUTIVE
OFFICERIMEMBEREXCLUDED? Y�
NIA
72WECAD4RRK
08/01/2022 08/01/2023
E.L.EACHACCIDENT
$ 000,000
(Mandatory In NH)
E.L. DISEASE - EA EMPLOYE -
$ 1,000,000
..
............._
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
EACH CLAIM
$1,000,000
Crime
D
8172-9949
05/14/2022 05/14/2023
AGGREGATE
$1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
rG0T11=1rATF Wnl r19:12
rANrl=1 I ATInm
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
City of El Segundo
AUTHORIZED REPRESENTATIVE
A A'.
74 wW L/ (�al'ma
U 19SB-21J75 AGUKU GUKPUKA 1 IUN. All rlgnis reserves.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD