HomeMy WebLinkAbout07040080 Certificate of Insurance
.
ALLIED PROFESSIONALS INSURANCE COMPANY,
A R i s k R e ten t io n G r 0 up, In c .
~
AMERICAN
MASSAGE
COUNCIL
Declarations to Claims-Made Professional Liability Policy
Elizabeth A. Olsen, L.M.T.
APIM-621097
American Massage Council
APIC-AMC-I 00 I
CA
Claims-Made
Massage
As stated in Section V of Endorsement to Policy
None
United States - The Named Insured must maintain professional licensing as required
by each state in which the Named Insured practices for coverage to apply in that state.
Idividual Deductible per claim: None
ndorsement(s): Massage (APIC-AMC-IOOI) .
imits of Liability: $1,000,000.00 Each Claim / $3,000,000.00 Aggregate
otal Annual Cost Basis: $ 99.00 (Prem;um - $3315; Pol;cy Fee- $5.85; Membership Fee - $60.00)
remium Based On: Annual Reporting Period
ayment Tenn / Plan Type: Annually / A-I
apse Dates: None
etroactive Date: 9118/06
olicy Period: From: 9/18/06 To: 9118/07
\11 dates are at 12:01 a.m. at address of Named Insured as stated herein. This Declarations page covers one year
olicy period ending on Expiration Date.)
amed Insured/Certificate Holder:
ertificate No:
laster Policy Held By:
olicy No:
olicy Issued In:
laims Reporting Basis:
rofessional Services:
xclusions:
imitations:
erritory:
:eneral: This Declarations Page identifies the person(s) named herein as a named insured under the terms and conditions of a policy
sued to the members of the American Massage Council. The terms and conditions of the policy apply to all members who hold a
,rtificate of insurance. The terms and conditions of this certificate apply only to the person(s) named herein and the insurer.
'overage: Coverage is afforded to person(s) named herein as Named Insureds according to the terms and conditions of the policy to
"hich this certificate refers. No other rights or conditions, except as specifically stated herein are granted or inferred. When your Claims
eporting Basis is "Claims Made" the Policy affords defense and damage coverage only for claims made against the Named Insured I)
'ising from the performance of Professional services rendered during the subsequent to the Retroactive Date and 2) made again~t the
amed Insured and reported to the Company during the Policy Period. Please review the policy carefully and discuss any questions
:garding coverage with the insurance broker at (800) 500-3930.
xtended Coverage: If your Claims Reporting Basis is "Claims Made" and the Policy is terminated either by you or the Company you
lay apply for Extended Coverage so that you can submit claims after your policy period ends for incidents that occurred during'your
olicy period. An application for Extended Coverage must be received within 30 days of termination of your policy, unless otherwise
lodified by any applicable State Mandatory Endorsement attached hereto.
otice: Report in writing within 48 hours any & all claims against you and any & all incidents that you believe may result in a claim
sainst you, even if groundless, to American Massage Council, 1851 E. First Street, Suite 1160, Santa Ana, CA 92705.
otice: This policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and
:gulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group.
ountersigned by:
Pnifip Stump
Authorized Representative
inted:09nOn006
Page] ofl
APIC-AMC-400l