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?_ <br />T___J <br />YOI,IC?Y NlJMI3IsR Previous Policyy Numbers COVERAGE IS PROVIDED BY <br />8 H4 WZP 81004127 8 H4 W2P 81D02867 AMERICAN AUTOMOBILE <br />INSURANCE COMPANY <br />EARTH CITY, MO 63045 <br />A STOCK INSURANCE CO. (15) <br />NCCI Carrier Code 10022 <br />Producer Name and Address <br />VETERINARY INS., SERVICES CO <br />1400 RIVER PARK DRIVE, SUITE 1 <br />SACRAMENTO CA 95815 <br />WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE <br />INFORMATION PAGE <br />1 The Insured and Mailing Address <br />DEDICATED VETERINARY CARE, iNC. <br />FEIN 454816146 <br />3021 EDINGER AVE <br />TUSTIN CA 92780 <br />The Insured is a CORPORATION <br />Other workplaces not shown above: <br />DEDICATED VETERINARY CARE, INC. <br />FEIN 454816146 <br />3021 EDINGER AVE <br />TUSTIN CA 92780 <br />mLL <br />O <br />O <br />8 <br />2. The Polioy Period is from 07-01-12 to 07-01-13 <br />12: 01 A.M. Standard Time at the insureds .Mailing Address <br />3. A_ Workers' Compensation Insurance: Part one ofi the policy applies to the <br /> Workers' Compensation laws of the states listed here: <br /> CALIFORNIA <br />B. Employers' Liability Insurance: Part two of the policy applies to work <br /> in each state listed in item 3.A. <br /> The Limits of our Lia bility under part two are: <br /> BODILY INJURY BY ACCIDENT X1,000,000 EACH ACCIDENT <br /> BODILY INJURY BY DISEASE $1,000,000 POLICY LIMIT <br />LL BODILY INJURY SY DISEASE $1,000,000 EACH EMPLOYEE <br />8 <br />u <br />ArlROVED AS TO FORM <br /> <br />c? <br />U <br />LL <br />W <br />m <br />O <br /> ESA L. JU <br />N <br />? W C 0 0 O O O 1 A A?istant City Atto <br /> WC - 1 07/11 <br />u <br />h