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<br />B~/29/2B06 11:43 <br /> <br />241339B <br /> <br />PAGE 04/05 <br /> <br />Declaration Number: 001 <br />Effecti.e Dale: 07119/2006 <br /> <br />Poli~y Number: SBP204616-1 <br />, <br />Luis E Rivera MD, lnc <br /> <br />,Pa~e 2 <br /> <br />II <br /> <br />LIABILITY DECLARATIONS <br /> <br />Co'teragf' <br /> <br />Liability and Medical Paymenl Limil - per occuITence <br />General Aggregate Lwut; <br />Products/Completed Opd.tiom; Aggregate LLmrt <br />Per~onal & Advemsmg l~ljury ~ a.ny one person or organization <br />Damage to Prcmi!los Ren~d to You Limit" anyone fife <br />Medical Ex.pen~l': Lirrlit. _Iany one person <br /> <br />Limit: <br /> <br />$ 1.000.000 <br />,~ 2.000,000 <br />$ 2000,000 <br />Induded <br />$ 300.000 <br />$ 10.000 <br /> <br />Business Liability CI.ssificlt~ODS <br /> <br />I <br />, <br />1 <br /> <br />LocatiDn: <br />Rl'k: <br /> <br />I <br />1 <br /> <br />22~ SMaln Street., Sonbl Ano, CA 92707 <br />Medlca~ office-drug pre !';creening: <br /> <br />Class: <br />Cude: <br />Bllpo6ure: <br /> <br />CClffices of PhY9tcians <br />6211000 <br />$ 250.000 Contents Limjt <br /> <br />1 <br />'I <br /> <br />BWlnesg Liability CO'lle..-agesl <br /> <br />Loc.a.tion! <br />Risk: <br /> <br />1 <br />1 <br /> <br />2222 S Main Slreet., Sonlll Ano, CA 92707 <br />Me.dicaU office-drug pre screening <br /> <br />Fonn Numba a~ Coverage: <br />BPOOO3 BU,l;mef'~ Llabillfy <br /> <br />Referenced Deseription~ andScbedules <br /> <br />Exclusion - Designated PtofessionaJ Servlce.~ (SEQ 0561) <br />E:tcludcd DC~lgnatc'~ ProfessiC'lnal ScfVICC~. <br />medical office <br /> <br />';163 ? f) <br />I <br /> <br />DalC Printed 07/2.5/2006 <br /> <br />ADDITIONAL INSURED <br /> <br />.__J <br />I <br />! <br /> <br />~O"UollDo... <br />