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<br />Declaration Number: 001 <br />EITecHve Dale: 07/1912006 <br /> <br />Policy Number: SBP204616-1 <br />Luis E Rivera MD, Ine <br /> <br />Page 3 <br /> <br />1-- <br /> <br />PROPERTY DECLARATIONS <br /> <br />I <br /> <br />, <br /> <br />Cause of Luss <br /> <br />Limit Deductible <br /> <br />Location: <br />Risk: <br /> <br />I <br />I <br /> <br />2222 S Main Street, Santa Ana, CA 92707 <br />Medical office-dnlg pre screening <br /> <br />Business IJersonal Property <br />Replacement Cost <br />Seasonal Limit lncrease - 0% <br /> <br />Spedal Form <br /> <br />S 250,000 <br /> <br />$ ],000 <br /> <br />Business Income (Actualluss sustained) <br />Up to 12 Month Periuu uf Restoration <br /> <br />Special form <br /> <br />Date Printed 07/25/200G <br /> <br />INSURED <br /> <br />BOPPrupDw"ll-~ <br />