<br />"""~ : Dr. David Hartl
<br />~3/24/200G 04:44
<br />
<br />714572gSa0
<br />
<br />FRX NO. :714-633-1299
<br />LPL INSURANCE
<br />
<br />Mar. 27 2006 11:32RM Pi
<br />p~. 01
<br />
<br />.~CORD.
<br />l ""OOUOCA
<br />
<br />. CtRTlI''''''TI!OF~IAIILII'V''_1!
<br />
<br />i;;.n. Z...."'M<:I. AgeIl.ey I.."
<br />'.l.~ &=eIoa _ '11'
<br />..~"" Lir.da Q.\ 9281<<
<br />. n.;.-,n'12'.\'700 PU:7U-572-taao
<br />A-':;>065'- /"i'J
<br />~":':"'i~t~::~~a CLn.lA-~S A-~-oS;;l..
<br />~ BOX 27SP"-
<br />OaAN=Z Ch ;2B5~-0788
<br />
<br />all
<br />T~1ll Ql!1lT1FICATl! "!NUID AS A MATTIII OF INI'tlRI.1ATICN
<br />OlIi..V ANO CONFGal NO RIOIIT8 UPON TlIE CERTIJIIC4T1
<br />ItOI..Dell THI$ <:IiRTII'IeATi _ NOT AMaiO. _0 DR
<br />~~ THliC:ave_ AJI'llIlDEP \lY THI! POlJClI!&_.
<br />
<br />
<br />DAl5(WIID1N'\flll'Y)
<br />
<br />----...._~.--,
<br />
<br />1N&UIUlRll AfFOROINCI COV'!!IU.<lII!
<br />IN5uREftA: ..eJO.2I: ~ON lift: ~
<br />"1"'$iJflER!; ~ CAsUA.1.n INS CO
<br />INSlJ"~A;:
<br />IN'tJRGIt~i
<br />-<:
<br />
<br />HAle .
<br />
<br />29424
<br />
<br />'eOYEllAO~ .
<br />
<br />.Hi POLoICllliR 61 ~ l.t8n!oelS.ow HAvt= ~~t:" ISSIJl~TO 1l1E ~lVlI:ec joIAMED AliKNi JOR 1'l4! 1lIOLIe'l' PutIOD INOHOA'ff.a. NO'I'WlfHI'I'AHCING
<br />^"j....R!CUlfU!!~, 'l'U:AifQR c:oHDrl'tOl-lCF'~Y CONT'AAC:TOFl OTH~ ~wrrl1 R6Peer TOWI-IICI1 TMSSC'*'lII'~1"Ii......... .liIUC;:D (ll
<br />I .."" ~T^N. T""lIJGURAHCE ^~fOROCD IV THe I:oOLIClU DIii;cJtI!lEO WlrllelN Fa SlJBJI/;'T 'l'Q "LL. ,..111; 'l'E:RMS, D:UJstCNS ANO COHDfTlCN$ 0' iUCH
<br />"'Q~C:'u, NOi~aIilIltoTi IJIlllt'!'S SI10WIrl"",...~\ie;lIIlftiN RGC\IeED BY P~IClCI..At4
<br />
<br />NSR IN Ne! PCLICV NUala
<br />
<br />, -.........,.
<br />
<br />I ~ I X X COMMIIt(hllQ!iJijRALLlAU,1'fV "2~922S
<br />
<br />___--: e~Jl.UIII4 ~ ~ OCctR
<br />
<br />'~_ ~.J,~t",:".."_01fnert'J;
<br />
<br />~Il.t-'n- 'ill:_
<br />
<br />
<br />04/01/06
<br />
<br />04/01/0?
<br />
<br />EAeI1 OCIOURRi;N(:E
<br />f$ "OCII,,"~
<br />MEDiX.("",ClItt~)
<br />P~$Otrl~ & Amt INJlJIno
<br />MHIll.t.l "4alU!C;^~
<br />'AO!)IJefA. r;:~PIOP AaQ
<br />
<br />,.....
<br />. 1000000
<br />. 300000
<br />'10 00
<br />. 1000000
<br />.2000000
<br />, aoooooo
<br />
<br />l-o;N'l,.Ae:~~IM'T ^P'l'I.IESPErl
<br />POl.lCV 11', ~QQ
<br />lWfCMIOM.lUA_ruTV
<br />NN AUTO!
<br />A:J.OWI'E>"lJTOt
<br />1C1-I!DUl,CQ M.i'tOa
<br />HI"II:)~lf'GQS
<br />~O~'OWNf.O MJTOS
<br />
<br />COMIUNEO eol"~LE t.1MlT
<br />Ifl!a<<1cllml
<br />
<br />80011. 'l' ~JUA'l'
<br />('......01'1)
<br />
<br />I'
<br />
<br />
<br />,'. ..' ,....~~" :
<br />
<br />
<br />BOeIItVIN.l.lst"f
<br />(~lIocl~
<br />~~lY tH\W,Oe
<br />cp",_
<br />
<br />.
<br />
<br />'..::~!-4l)11~,1L!T'"
<br />
<br />OTNi"T11.\H
<br />AU1'OON'LY:
<br />
<br />AUtOONlV. &. ~~T I
<br />'A Ace .
<br />_eo I
<br />
<br />i:~I~<'..~!"m.l.JIJ~TY I
<br />, 0'''''' 0 ClAIM' "'~'I
<br />
<br />t ceooOlWU
<br />. RI!"l'eMTION j
<br />; YJO~M~1tQN ""0
<br />I' WlWl\.cwtlW'LIA8lUTT
<br />^ ;,t./\fMiCIPIltIEl"OFflf'MiNER.oI!XECUTIYE
<br />OFF~~EXCL.UCKitl'
<br />: gJl~:~~'fcm8 bellow
<br />....
<br />
<br />!A,,(:H OCClJ'tIle'NC! I
<br />I 48U1aA.'ftI I
<br />,
<br />,
<br />
<br />1443S63
<br />
<br />a%l/OS
<br />
<br />04/0;1,/06
<br />
<br />
<br />'1000000
<br />1iO,~,Dt8iA."i"'iMPI.O"'" '1000000
<br />'.L."=,I'OI.leYUWT '1000000
<br />
<br />- ------~-:::-;T;;~~'i!'5A1IC)!rI IVI... I 1II.~ D..,aw /SNeW;;PROY'II
<br />~"C?J'I":O!<" OF TIlE ll<_ AS eowlllP ~ TII!lell POLlCns. lUll COIfSllLl::nl\'l
<br />C,:':;;cS, U1. c:t!!!: 0.. BlIN'U.~. I:T$ Oi'S':tCUlS, AGl:l4'J:S, SMl.'LOftZs, l\NC
<br />. ":;""''''''''RS AIllO _ll Al)IlUrOItl\Z, DlI1IUlD I1!ia< Al:UCIIIIl <:1:2010 10/!/3. TlIN DA~
<br />"'c:'t.~ ~i' CANCl:LLlA'flOIII 1\.PPLflS FOR llON-l>Al'HllIll: or l'RIlllIllM.
<br />
<br />:'l:tI!~ATeHDUJIR
<br />
<br />C;ro:rYOi'B
<br />
<br />CANOIil.l.ATI(IN
<br />IHOULDMf'{Qrf'WlMIitWD*IllIUb 1"Q1&I"~1.SiI ~ TMlImIU.
<br />~TJ:~.TMlIlIUIN8ll.1""-.c. _ 30 DNl'S~
<br />. '" : .-.-
<br />NOTfGCiWTMlloetnJJrIc.""~UJEltNAl!E~101MI'LDT,8Cn'''' .~ aJoIN.&,
<br />....NQ D~"J1lilIN - ~~"'NwIQNDt.IIOItrlllSU~m AOCfft1 011
<br />lIlY _.IATIVn. , "
<br />IUIJlOf(iI !Viii ..,1"
<br />
<br />
<br />/
<br />
<br />cny or MllrA ANI'.
<br />AIm, czn CI.IlRK
<br />20 c:tVrc CI\IWDll ~
<br />~!\Jlv. JINlI> CO"' 92?01
<br />
<br />~'::';-:;.--:;-:TI~"'-".
<br />
<br />II ACOIID CO"POIIA1'IOH'!18
<br />
<br />[X
<br />
|