Department of Insurance | |
Limited Liability Company | |
Certification of Coverage Under Section 1647.5 of the California Insurance Code | |
I hereby certify that the insurance company listed below has issued a policy or policies of insurance as follows: | |
Insured Name: | |
License Number: | |
Company Name: | |
Address: | |
Policy Number(s): | |
Insurance Company: | |
Policy Effective Date: | |
Policy Expiration Date: | |
Specify whether blanket or individual policy: | |
Specify number of licensees rendering services: | |
I hereby certify that the limited liability company named above is insured against claims arising from errors and omissions as defined and described in the amounts and limits set forth in Section 1647.5 of the California Insurance Code. I understand and agree that the insurance coverage for the entity and person(s) insured under this policy or policies may not be terminated, canceled, or nonrenewed, regardless of cause or reason, without providing written notice to the commissioner within ten (10) days. | |
Signature:Date: ___________ | |
(Insurance Company Representative) | |
Title: |
Ca. Ins. Code § 1647.5