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I `~ _ , <br />SpousoredM' A V M A Veterinary Professional Liability •~~ ` ` ~ /I _- ` ~ <br />Insurance Policy <br />Certificate of Insurance Z U RI C H <br />This policy provides occurrence coverage. Please review the policy carefully. <br />ITEM 1: Insured by the stock company below and hereinafter called the ti-`PL-tos-A-cu' (07/07) <br />P L I T Company Zurich American Insurance Company <br />ITEM 2: Named Certificate Molder, member number, IRC, and address <br />Lorrie B. Boldrick DVM <br />1330 North Glassell Street <br />Suite M <br />Orange, CA 92867 <br />Ilrlttrrlrlltrlt,llrr)rrrllttitl <br /> <br />Member Name Member No. IRC Class <br />BOLDRICK LORRIE DR 21185 16 III <br />ITEM 5: Premium and coverage summary <br />Liability $ 364.00 <br />TOTAL DUE: $ 3 6 4. 0 0 <br />Master Policy Number: Certificate Number: <br />EOL 5241302-03 07309 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228-7548 <br />ITEM 3: Police Period From: 1/OI/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 Liabilirir <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 Ntunbers and location(s) for <br />Veterinary Professional Bailee Ea~tension Endorsement (if purchased): <br />For additional locations; please see the attached page <br />Location Number/Address <br />Plan Number <br />ITEM S: Veterinary License Defense Coverage endorsement (if <br />purchased): Limit: $ <br />Authorized Sigtature <br /> <br />This Certificate of Insurance is issued offthe Master Policy held by the American Veterinary <br />Medical Association (A.V.M.A) Professiottal Liability Insurance Trust. Bp 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 ageemeuts and <br />representations and that this policy embodies all agreements existing between the Named <br />Certificate holder & the Company or anv of i[s representatives relating to this insurance. <br />Notice to the Company: Zurich North .American-Specialties Claims <br />Attn: Professional Liability Claim Department <br />P.O. Box 30701Q, Jamaica, Nl' 1 1 43 0-70 1 0 <br />C/ <br />`~ ~~ ~ ?~ <br />