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TRANSACTION NO.:NiA <br />VERIFICATION OF INSURANCE' <br />Endorsement #852534 <br />We the undersigned insurance brokers, herebyy certifyy that the following described insurance is in force at this <br />date of which --LOU_ percent is Insured with UNISERWRITERS AT LLOYD'S, LONDON <br />NAME AlyD ADD QBRL?I <br />Ms. Ember Say Stites <br />Ember Soy Stites <br />P.O. Box 61644 <br />Irvine, CA 92602 <br />F <br />STEPHEN Fl. SOLOMON <br />4471 Henderson Way <br />Villa Park, CA 92861 <br />E QF INX AHM <br />ARBITRATORS AND MEDIATORS PROFESSIONAL LIABILITY INSURANCE <br />L47eATIONSd,fSJyi3 G)°.R sr•'tet?.D?rt.?-? <br />Service fee $25:00 <br />#I - Several Liability Notice LSW 1001 <br />#2 - Small Additional and Return Premiums Clause NMA 1168 <br />#3 - Radioactive Contamination Exclusion Clause NMA 1477 <br />#4 - Nuclear Incident Exclusion Clause NMA 1256 <br />#5 - Arbitration Proceedings Exclusion AIF 2640 <br />LIMITS OR AMM11S OF COVERAGE <br />$1,0M,000,00 per claim/$I,0W,000.00 aggregate including costs and expenses <br />$1,000.00 deductible each and every claim including costs and expenses <br />$468.00 premium plus Purchasing Group Tax for CA @ 3% $14.04 <br />Retroactive Date: NONE <br />June 1, 201212:01 a.m, to June 1, 201312:01 a.m. <br />The insured listed above has no claim record with our company. <br />This document is furnished to you as a matter of information only. The issuance of this document does not <br />make the person or organization to whom it is issued an additional assured, nor does it modify in any manner <br />the contract of insurance between the Assured and the Insurers. Any amendment, change or extension of such <br />contract can only be effected by specific Endorsement attached thereto-. <br />Should the above mentioned contract of insurance be cancelled, assigned or changed during the above named <br />policy period in such manner as to affect this document, we, the undersigned, will endeavor to give written <br />notice to the holder of this document, but failure to give such notice shall impose no obligation of any kind <br />upon the undersigned or upon the Insurers. <br />Complete E city Markets, Inc. <br />Print Date: June 20,2M2 dba Complete uity Markets Insurance Apeneg, Im, iCASUOD40177- <br />Lb°41 > rz-PX4*? <br />By f-e. <br />Lawrence T.P. Molloy