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Sponsored by A V M A Veterinary Professional Liability <br />LE Insurance Policy 0 <br />Certificate of Insurance <br />Ths policy provides occurrence avuag. Plane review the policy aroNlly. ZURICH <br />ITBM I: Insured by the stork company below and hereinafter called the Company U- VPL•103- A.Cw(07104) <br />P L I T Zurich American Insurance Company <br />ITBM 2: Named Certificate Holder, member number, IRC, and address <br />Lome B. Boldrick DVM <br />1330 North Glassell Street <br />Suite M <br />Orange, CA 92867 <br />Iltl�rllerirnll.rlerrllrrl,l <br />Master Policy Number: Certificate Number: <br />PAL 1 07309 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228 -7548 <br />1TEM3: Policy Period From: 1 /01/2007To: 1/0112008 <br />12VI am standard time at the address of the Named Certificate Holder as <br />awed batch <br />I ITEM 4: Limits of Liability <br />w <br />Member Name Me No Each dabs 31,000,000 <br />BOLDRICK LORRIE DR 21185 16 111 Aggregate $3,000.000 <br />rrBM 5: Premium and coverage summary <br />Liability $ 347.00 <br />TOTAL DUE: $ 347.00 <br />ITBM 6: Forms Attached at lasuence: U- VPL-103 -A CW (07/04), U- VPGI00 -A CW (07/04), <br />U- VP4109 -A CA (09/04) <br />ITiM 7: Schedule of Plan Numbers and location(s) for <br />Veterinary Professional Bailoc Exlensicn Endorsement (if purchased): <br />For sddit(mtal locations, please see the attecbed page <br />ITBM & Veterinary License Defense Coverage eodmaemmt (if <br />ptechnsed): Limit $ <br />Asobesieed eipu me <br />This Certificate of Insurance is issued off the Mason Policy hold by the American Veterinary <br />Medial Asaocislion (AV.M.A) Professiwl liability Inunsaoe TnuL By acceptance of this <br />Policy the Namstl Csrtlaeate Balder egrea that the detemma in the oseifiate and the <br />appliatton and any attaohnema bw*o m the Named Certificate RaMes's apeemere and <br />ropnsaeNOm cad that this policy embodied all apeemeNa Odding between the Named <br />Certificate IwMw mad the Company or cry of he repreamativae relsemS to this humama. <br />Nona to the Company: Zurich North AmeriateSpoaWia Claim. <br />Amt: Professional Liability Claim Doparaoent <br />P.O. Boa 307010, lunch. NY 11430-7010 <br />