HomeMy WebLinkAbout07050002 Certificate of Insurance
'APR-16-2007 MON 11:32 AM
FAX NO,
p, 02/02
I
ALLIED PROFESSIONALS INSURANCE COMPANY,
A Risk Retention Group, Inc,
~
AMERICAN
MASSAGE
COUNCIL.
;'1
Declarations to Claims-Made Profes! 'onal Liability Policy
Named lnslIred Member: Jane A. Hughey, L. .'1'.
Member Policy No.: APTM-6270n
Master Policy Held By: American Massilge :ouncil
Master Policy No.: APtC-AMC-IOO]
Policy fssued In: CA
Claims Reporting Basis: Claims-Made
Professional Services: Massage
Exclllsions: As stated in Section v of Endorsement to POlicy
Limitations: None
Tcn.jtory: United States - The N med InsUl\!d must milintain profcsllion/:tIlicensing al1i re<juircd
by each state ill which the Named Insured practicc::s for coverage to apply in lhat state.
IndiYidual Deductible per claim: None
Endorsement(s): Massage (APIe-AM '-1001)
Limits of Liability: $1,000,000.00 Each _Iaim / $3,000,000.00 Aggregate
Total Annual Cost Basis: $ 99.00 (Pt'milln1 -lll,1 I: Polley Fec- .I"MS: M,mbershlp r<<. .I60,OOj
Premium Based On: Annual RepOIting Pe 'iod
Payment Term / Plan Type: Annually / A- J
Lapse Pates: None
Retroactive Pale: 4/9107
Policy Period: From: 4/9/07 To: 4/9 08
(All dates are at 12:01 a.m, at addrcBs of Named IIlBured as stated h reill. This Declarntilllls page covers One year
policy period ending on Expiration Dute,)
General: This Declaralions Page idenlifles the person(.) named herein as " nnm ~ insored under the terms and COnditiOIlS of. policy
issued to the membe,'s of Ule American Massage Council. The temlS and cOlld tions of the policy apply to all members who hold a
certificate of insurance. The tems and conditioas of this certificate apply oniy to th pe"on(s) named herein and U,e in'orer. I
Coverage: Coverage is afforded to person(s) named herein as Named Insoreds I ccording to the terms and conditions of the policYI to
which thi, certificate refers. No other I'ights or conditions, except as specifically '11 ted herein are granted or inferred, When your Ctaims
Reporting Basis is "Claims Made" the Policy affords defense and damage covera e only for claims made against the Named Tnsured, J)
arising from the performance of Profos~ional services rendered during the 'Ub'eq ent to the Retroactive Date and 2) m,de against the
Nomed Insured and reported to the Company during the Policy Period, Plea,c view the policy carefully and discuss any question'
regarding coverage with the insurance broker at (800) 500-3930,
Extendell Cllver"ge: ffyour Claim. Reporting Basi, is "Claims Made" and the P licy is terminated either by you or the Company you
may apply for Extended Coverage so that you can submit claims after your poilc period end. for incidents that occurred during your
policy period, An application for Extended Coverage must be received within 30 days of termination Of your policy, unless otherwise
modified by any applicable State Mandatory Endorsement anached hereto.
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Notice~ Report in writing within 48 ham, any & all claim' against you and any , all incidents that you believe may result in a claim
agaiost you, even if groundless, to American Massage Cowncii, 1851 E. First Stre"~ ~uite J 160, Santa Ana, CA 92705. I
Notice, Thi. policy is issued by your ,.;sk Mention group. Your risk retention gro p may not be subject to ail of the insurance laws and
regulaliolls of your Stille. State insurance insolvency guaranty funds are not availllble fol' your risk retention group
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Countersigned by:
P/iifip Stump
Authorized Ropre,entative
l'rinl;:tf:'l/ltil:!1I07
l''lIII;:lofl
AP1C-AMC-400 1