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<br />Declaratiun Nnmber: 001 <br />Effective Date: 07/19/2006 <br /> <br />Policy Number: SBP204616-1 <br />Luis E Rivera MD, lnc <br /> <br />Page 5 <br /> <br />~ <br /> <br />,--- <br />I <br />L <br /> <br />LIABILITY DECLARATIONS <br /> <br />Limit <br /> <br />Coverage <br /> <br />Liahility and l\'ledical Payment Limit - per occurrence <br />Gem:\ral Aggregate LiTIlit <br />Products/Completed Operations Aggregate Limit <br />Personal & Advertising Injury - anyone persoll or organization <br />Dilmage to Premises Rented to Y uu Limit - anyone fire <br />Medical Expense Limil- any Oile person <br /> <br />$ 1,000,000 <br />$ 2,000,000 <br />$ 2.000,000 <br />Induded <br />S 300,000 <br />$ 10,000 <br /> <br />I Business Liability Classifications <br /> <br />Localion: <br />Risk: <br /> <br />1 <br />1 <br /> <br />2222 S l\lain Street, Santa Ana, CA 92707 <br />Medical office-drug pre screening <br /> <br />Class. <br />Code: <br />Exposure: <br /> <br />Offices of Physicians. <br />6211000 <br />S 250,000 Contents Limit <br /> <br />Rusiness Liahilit), Covcrages <br /> <br />Location: <br />Risk: <br /> <br />1 <br />1 <br /> <br />2222 S IVrain Street, Santa Ana, t:A 92707 <br />Medical office-drug pre screening <br /> <br />Form Number and Coverage: <br />BP 0003 Business l.iability <br /> <br />Referenced Description!; and Schedules <br /> <br />Exclusion _ Designated Professional Services (SEQ 0561) <br />Excluded Designated Professional Services: <br />medical office <br /> <br />Date Printerl 07/25/2006 <br /> <br />INSURED <br /> <br />~Uf'Li"Mr:.,"-. <br />