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0 6 i-26 12 U 16 1 1b: 4J <br />A � PROFESSIONAL UNDERWRITERS <br />NLIABI,UTY [INSURANCE COMPANY <br />A TDC. twpmq <br />12121 W00ire BoUlevOrd, Suite 601 Lce Ang", Califoffft 9W25 <br />^ -Hkmr- <br />CERTIFICATE-OF INSURANCE <br />This is iD cority that the, Porcyof insurance liewd,beiaw has been issued to the Insured Nan-#W 404 o in %rGe st"tin-a. <br />NoWhstancing any requirement, term w oondcon of any contract 6r other cloournent*& rasped to V411]011 this 06(tilluffb <br />rr&y be Immod or may pertain, the Insurance afforded by the Polley dewAbed ]cocain in subject ID All thm tanTm OmduSlone <br />and cmdrdOM Of such PdicY. <br />NAME AND ADDRESS OF <br />NAMED INSURED: <br />Luis E Rivers, MZ <br />2222 9, Hain Shoe. <br />Santa Ann, CA 92707 <br />ADDITIONAL INSURED$' <br />(sharad 11111111119 of 0~890 <br />POLICY NUMB0. <br />p9se0sw <br />]LIMITS OF LLABIIJTY: <br />sl'ow.000-00 per cklm <br />MOD0.000.00 agonwato <br />SPECIALTY: <br />OccupAtional Medloirm - No Surgery <br />POLICY ErFrICTIVE DATE' POUCY EXPIRATION DATA <br />September 1, 2008 SeptoMW 1, 2007 <br />lzfl 41.m. omnewd amm <br />POLICY REtROACTIV9 C*M' <br />SepWnbar 1.21305 <br />120* ItA, IftrOwd M* <br />TYFrr OF INSURANCE. MEDICAL MOFMIONAL LIABILITY <br />NAME AND ADDREW OF <br />CERTIFICATE HOLDER: <br />Luis E. Rivet*, M.D. <br />Pots Issued: !!=ft—ber 0.2006 <br />NAME! AND ADDRESS Of BROKER: <br />RGI Immm nice Swim <br />23241 SOW III Pointe DTIO <br />Lawle Hwq. cok 928>!49 <br />Authartmd ftprmnlkwB; <br />A' <br />Ab.,isLa,ii City Attor7-Lcy <br />