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I' -7 <br />Sponsored by A V M A Veterinary Professional Liability _- <br />Insurance Policy <br />Certificate of Insurance ZURICH <br />This policy provides occurrence coverage. Please review the policy carefully. <br />ITEM 1: Insured by the stock company below and hereinafter called the U-YPL- 103 -A -CIA' (07/07) <br />P L I T Company Zurich American Insurance Company <br />ITEM 2: Named Certificate Holder, member number, IRC, and address <br />Lorne B. Boldrick DVM <br />1330 North Glassell Street <br />Suite M <br />Orange, CA 92867 <br />Iltltt�tl�ll�tlt ,lltt)t�tllttitl <br />Member Name Member No. IRC Class <br />BOLDRICK LORRIE DR 21185 16 II1 <br />ITEM 5: Premium and coverage summary <br />Liability $ 364.00 <br />TOTAL DUE: $ 364.00 <br />Master Policy Number: Certificate Number: <br />EOL 524130 1 07309 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228 -7548 <br />ITEM 3: Policy Period From: 1 /0I /2008 To: 1/01/2009 <br />12:01 am Standard time at the address of the Named Certificate Holder as <br />stated herein <br />ITEM 4: Limits of Liability <br />Each claim $1,000,000 <br />Aggregate $ 3,000,000 <br />ITEM 6: Forms Attached at Issuance: U -VPL -103 -A CW (07/07), U -VPL -100 -A CW (07/04), <br />U- VPL -109 -A CA (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 attached page <br />Location Number /Address <br />ITEM 8: Veterinary License Defense Coverage endorsement (if <br />purchased): Limit: $ <br />Authorized Signature <br />Plan Number <br />This Certificate of Insurance is issued offthe Master Policy held by the American Veterinary <br />Medical Association (A.V.M.A) Professional Liabilit }• Insurance Trust. By acceptance ofthit <br />policy the Named Certificate Holder agrees that the statements in the certificate and the <br />application and any attachments hereto are the Named Certificate Holder's agreements and <br />representations and that this policy embodies all agreements existing between the Named <br />Certificate holder & the Company or any of its representatives relating to this insurance. <br />Notice to the Company: Zurich North .American- Specialties Claims <br />Ann: Professional Liability Claim Department <br />P.O. Box 307010, Jamaica, NV 11430-7010 <br />C/ <br />