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Sponsored by A V M A Veterinary Professional Liability <br />Insurance Policy <br />Certificate of Insurance ZURICH <br />This policy provides occurrence coverage. Pleas review the policy carefully. <br />ITEM 1: Insured by the stock company below and hereinafter called the Company U- VPL- 103 -AA (07104) <br />P L I T Zurich American Insurance Company <br />ITEM 2: Named Certificate Holder, member number, IBC, and address <br />Lome B. Boldrick DVM <br />1330 North Glassell Street <br />Suite M <br />Oran gge, CA 92867 <br />1141rtnrinlinrlrrllnrlrnrllrrl rl <br />Master Policy Number: Certificate Number: <br />PAL 5241302 -02 07309 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228 -7548 <br />1TEM3: Policy Period From: 1/01/2007To: 1/01/2008 <br />1201 am standard time a the address of the Named Certificate Holder as <br />datad haxin. <br />I rrEM 4: Limits of Liability <br />Member Name Member No 16 Each claim S 1,000,000 <br />BOLDRICK LORRIE DR 21185 16 Clam Aggregate $3,000.000 <br />ITEM 5: Premium and coverage summary <br />Liability $ 347.00 <br />TOTAL DUE: $ 347.00 <br />ITEM 6: Forms Attached at issuance: U -VPL -103 -A CW (07/04), U -VPL -100 -A CW (07/04), <br />U -VPL -109 -ACA (09/04) <br />ITEM 7: Schedule of Plan Numbers and location(s) for <br />Veterinary Professional Bailee Extension Endorsement (if purchased): <br />For additional locations, please see the atNcbed page <br />ITEM 8: Veterinary License Defense Coverage endorsement (if <br />purchased): Limit $ <br />Authorized signature <br />Tbis Certificate of Inawnce is issued off the Mater Policy held by the American Veterinary <br />Medical Association (AV.M.A) Proferioml Usbility, Insurance Trust- By aocepWee of this <br />policy the Named Catlaeate Holder agrees that the aatementa in the ca Beale and the <br />apPlionion and any emolument t hereto arc the Named Cermtica4 Holder's agreements and <br />repraaadauom and that this policy embodier all agreements existing between the Named <br />Ca.YSate holder and the Company or my of he reprawmatives relating to this insurance. <br />Notim to the Company: Zurich North AmerieanSpeaalries Claims <br />Ater: Professional Liability Claim D parmen. <br />P.O. Box 307010, Jamaica, NY 11430.7010 <br />