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??„ PROFESSIONAL UN©ERWRtTERS <br />?LtABILITY INSURANCE COMPANY <br />A TOC Company <br />1888 Century Park E, Ste. 850 <br />Los Angeles, California 90087-'1737 <br />NAME AND ADDRESS OF <br />NAMED INSURED: <br />Luis E. R{vera, M.Q. <br />800 North Tuslln Avenue, Suite A <br />Ssnta Ana, CA 92705 <br />ADDITIONAL NAMED INSUREDS: <br />ADDITIONAL INSUREDS: <br />(shared limits of coverage) <br />BINDER NUMBER: <br />B 83605-13 <br />LIMITS OF LIABILITY: <br />$7,000,000.00 per clain7 <br />$3,000,000.00 aggregate <br />PROFESSIONAL LIABILITY INSURANCE BINDER <br />SPECfALTY: <br />General Surgery <br />EFFECTIVE DATE: <br />September 1, 2012 <br />12:OS a.m. standard Ilma <br />PER CLAIM DEDUCTIBLE: <br />$ 7 0,000.00 <br />BINDER EXPIRATION DATE: <br />October 37, 2072 <br />12:01 a.m. standard time <br />RETROACTIVE DATE: <br />September 1, 2006 <br />12:OS a.m. standard time <br />CONDITIONS: <br />The coverage provided by this binder Is subJecl to ell the terms antl contlitlons of the applicable Professional Underwriters <br />Liability Insurance Company Professional Liability Policy and any applicable Endorsements or Llmilallon Clauses. <br />The binder will cease upon the iasuence of a duly executed policy and/or 60 days from the data of coverage, whichever <br />occurs first. <br />Unless a policy for the coverage noted above is accepted by the Insured, an earned premium shall be tlue and payable for <br />the time the Binder Is In Force. <br />Date issued:. August 30,_ 2012 NAME AND ADDRESS OF BROKER: <br />nn _ ? ? /? \ Tha Doctors' Company Insurance Services, LLC. <br />_?-__K_ r{??<u7? ?/-?i9 vcAv???-_--'-?'- -? 185 Greenwood Road <br />Sluthodzed Represantatfva f`1apa, CA 94558-0900