PROOF OF INSURANCE (2017) CLOSEDTRANSACTION NO.:N /A
VERIFICATION OF INSURANCE
Endorsement # 855026
"ale, the undersigned insurance brokers, herebyy certifyyr that the following described insurance is in force at this date of
which — percent is insured with UNDER"" RIT,7RS AT LLOYD'S, LG N'IXON
RTA 91 s:,.... • i . It:, .
RICHARD R. TERZIAN
265 Bronwood Avenue
Los Angeles, CA 90049
"'TANKIN
ARBITRATORS, HEARING OFFICERS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE
�► ► I l 111 l*"1
Service fee: $25.00
1 , Several Liability Notice, LSW' 1001 #6 -Data Security Breach LII 14 -1 E
2 - Small Additional or Return Premiums Clause NMA 11$68
3 - Radioactive Contamination Exclusion Clause NMA 1477
#4 - Nuclear 'Incident Exclusion Clause NMA 1256
#5 . Sanction Limitation and Exclusion Clause LMA 3100
Cove A. - Professional Liability and Personal Injury Coverage $100,000.00
Each clairw $300,000.00
Aggregate:
Coverage B - Defense Cast Coverage
Each claim: $100,000.00
Aggregate:'�'�
Aggregate Limit of Lsabilit
Maximum insurance available for Coverages A and B combined: $600,000•00
Deductible - each claim including Cost of Defense: N ,000.00
Retroactive Date:
ER
January 1, 2016 12:01 a.m. to January 1, 201712:01 a.m.
This document is furnished to you as a matter of information only. The issuance of this document does not, mare the
person or organization to whom it is issued an additional assured, nor does it modify in any manner the contract of
insurance between the Assured and the Insurers. Any amendment, change or extension of such contract can only be
effected by specific Endorsement attached thereto.
Should the above mentioned contract of insurance be cancelled, assi tied or changed during the above named policy period
in such manner as to affect this. document, vats, the undersigned, wit endeavor to give written notice to the holder of this
document, but failure to give such notice shall impose no obligation of any kind upon the undersigned or upon the
Insurers.
Print Date: December 17, 2015 dba Complete uu Markets,
arke tIrAur race Agency. I' tt..ASL #O 4411773
Lib*467
By
Lawrence T.P. Molloy