PAIN REFERRAL SERVICE, LLC

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1 PAIN REFERRAL SERVICE, LLC 2544 N. STATE ROAD 7 (441), HOLLYWOOD, FLORIDA PH#: FAX#: September 27, 2012 Tameika Gainous Administrative Secretary Lawyer Regulation The Florida Bar 651 Jefferson Street Tallahassee, FL Dear Ms. Gainous, Enclosed please find our quarterly submission for the quarter ending September 30, I have also enclosed a copy of the letter you sent me, dated July 9, 2012, regarding our quarterly submission for quarter ending June 30, I had listed, incorrectly, the law firm of Prieto, Prieto & Goen under Florida Bar No I have fixed this entry on this submission. The correct law firm is Preito, Prieto & Goan. I have listed the attorneys on this submission individually, along with their correct Florida Bar number. And please not I have corrected the last name of attorney Goan. Also, for the law firm Morgan and Morgan out of Tampa, Florida. I have attached their insurance Dec page, along with a list of the attorneys in that firm, and their Florida Bar numbers. I have also included them on my quarterly report, but I wanted you to know which attorneys are associated with that firm since it is a large list. have any questions please do not hesitate to call me at rds. Fogaros Pain Referral Service, Inc. Enclosures cc: Tim Chinaris Lawyer Referral Service SEP 2 8

2 RULE (LAWYER REFERRAL SERVICE) This form is submitted pursuant to Rule of the Rules Regulating The Florida Bar for the quarter ending ^\? )( I>OUX I hereby certify the following: _ 1. The names and bar numbers of all attorneys associated with the lawyer referral service is attached as Exhibit "A"; and _ 2. This service only refers clients to persons lawfully permitted to practice law in Florida when the services to be rendered constitute the practice of law in Florida; and _ 3. This service carries or requires each lawyer participating in the service to carry m~an~affl Date Name of Referral Service nifte- \ ~^^>~ HA V Representative^ (C~ ' Print Name Address ag"mm M ^Vc\.V^ "%A-~"l VWKM&kft A Phone Number C^vy-O^b "l\a l ^> Please furnish contact information if different than listed above. Contact Name Addres Phone Return to: The Florida Bar Attention: Tameika Gainous, Lawyer Regulation 651 East Jefferson Street Tallahassee, Florida If you have any questions, please contact Tameika Gainous at (850) or at

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14 PO Box 22343, St Petersburg, FL VOICE (727) FAX: f DATE. June 28,2012 To: Michael C. Blidwnsderfer, Attorney & Counselor at Law Atta: Michael C. Biickensderfer Via CONFIRMATION OF COVERAGE Insured: Michael C. BHekensderfesr, Attorney & Counselor at Law, Effective Date: 7/9/2012 Limits: 1,000,000/1,000,000 Deductible: 5,000 a^regale Premium $5, FHCF (Admitted) $67.00 Total Premium $5, Retro Date: 07/09/2008 Endorsements/Exclusions: Florida Amendatory Endorsement Addition to Section IV. Past Acts Exclusion Addition to Section EL Extended Reporting Period - This is an endorsement offered by Agency Marketing & Carolina only, the endorsement includes many enhancements such as aggregate deductible. Please REVIEW THIS endorsement it is a new enhancement endorsement An additional surcharge equal to 1.3% will be applied &r a Hurricane Assessment Fund. There is no commission paid on this fee. Policy Number Carrier: Carolina Casualty Ins Co, A. M, Best Rating A+ X! 11 This is to confirm that we have accented an order on behalf of the above-referenced carrier for Lawyers Professional Liability insurance on the above captioned risk. This confirmation letter does not waive or change any additional information requirements of the indication/quote. Coverage is subject to tke receipt and acceptance of thefouowwg information documents: This confirmation does not supersede, change or replace the policy wording. The insurance is subject to the terms, conditions and limitations of the policy in current use by the company. Thank you for your valued business and if you have any questions, please feel free to call. Sincerely,

15 CATA&CA-01 MARLANDA ~ 2* Kg^ CERTIFICATE OFLIABILITY INSURANCE "ISST THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NX) RIGHTS UPON THE CERTIFICATE HOLDER. THJS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poticyfies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the PRODUCER Insurance Office of America, Inc. P.O. Box Attamonte Springs, FL INSURED Catania & Catania PA 101 E Kennedy BlvdSte 2400 Tampa, FL SSSe 01 Andrea Marland SC"&E«* (800) ADDRESS: INSURERS) AFFORDING COVERAGE msurera:otd Dominion Insurance Company INSURER B: Owners Insurance Company INSURERC :Southern-Qv«iers Insurance Company INSURER o: Zenith Ins Co INSURER E : Colony Insurance Company INSURER?: f <. ** (407) 788^933 NAK# COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WfTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRiBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPEOF INSURANCE IH5R jsxa POLICY NUMBER larrs GENERAL UABUTY COMMERCIAL GENERAL LIABILITY OCCUR EACH OCCURRENCE BPG /1/2012 9/1/2013 PREMISES <Ea eeeuiranort UEDEXP(Anyonepereofi) PERSONAL & AW INJURY GENERAL AGGREGATE PRODUCTS-COMP/OP AGG 1,000, ,000 5,000 1,000,000 2,000,000 2,000,000 AUTOMOBILE LIABILITY SI MGLE LIMIT 1,000,000 ANY ALTO ALL OWNED AUTOS WREO AUTOS UMBRELLA 1MB SCHEDULED AUTOS NOHOWNED AUTOS OCCUR /1/2012 1/1/2013 BOOO.Y INJURY (P«r person] BODB.Y INJURY (P<racdd«rt) PROPERTY DAMAGE (Peracddent) EACH OCCURRENCE 5,000,000 EXCESS UAB CLA1MS4IAOE *1960S4108 9/1/2012 9/1/2013 ASGSEGATE PEP RETENTIONS 5,000 5,000,000 ADOK AND EMPLOYERS' LIABILITY TWCSTATU- I I TORY LIMITS I Y/K Z /1/ /1/ LEACHACCJDENT 100,000 N/A (UtatKtotoiylnNH) E.L DISEASE - EA EMPLOYEE 100,000 Wyes, describe undw ASCRIPTION Of OPERATIONS imtow E.L DISEASE-POLICY UMIT 500,000 E General Liability EO /2W2012 7/28/2013 Perdaan 1,000,000 DeSCMPTIOHOfOPERATIOMS/LOCATIONS/Vl CERTIFICATE HOLDER CANCELLATION SHOULD AMY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Florida Injury AUTHORREO REPRESENTATIVE Attn: Judy Lopez 6220 S Orange Blossom Trail Suite 196 loriando.fl ACORD CORPORATION. All rights reserved. ACORO 25 (2010/05) The ACORD name and logo are registered marks of ACORD

16 Lawyers Professional Liability Insurance Policy Declarations Darwin National Assurance Company Policy Number Main Administrative Office Address: 9 Farm Springs Road Farmington, CT Corporate Address: 1807 North Market Street Wilmington, DE THIS IS A CLAIMS MADE POLICY WHICH APPLIES ONLY TO CLAIMS RRST MADE DURING THE POLICY PERIOD OR ANY EXTENDED REPORTING PERIOD, AND REPORTED IN ACCORDANCE WITH SECTION IV.L OF THE POLICY. THE LWIT OF LIABILITY AVAILABLE TO PAY DAMAGES WUJL BE REDUCED AND MAY BE EXHAUSTED BY CLAIMS EXPENSES AND CLAIMS EXPENSES WILL BE APPLIED AGAINST THE RETENTION AMOUNT. IN NO EVENT WILL THE INSURER BE LIABLE FOR CLAIMS EXPENSES OR DAMAGES IN EXCESS OF THE APPLICABLE LIMIT OF LIABILITY. PLEASE READ THE ENTIRE POLICY CAREFULLY. Item 1. Name and Maiing Address of Named Insured: Pawlowski & Brewer, PA 1718 East Tlh Avenue, Suite 201 Tampa, FL Item 2. Policy Period: Inception Date: Expiration Date: July 23,2012 July 23, 2013 At 12^1 AM Standard Time at the Mailing Address shown above Item 3. Limit of Liability {inclusive of Claims Expenses): (a) $1,000,000 maximum limit of liability per CLAIM (b) $1,000,000 maximum aggregate limit of liability for ail CLAIMS Hem 4. Retention: $20,000 each and every CLAIM Hern 5. Notices required to be given to the Insurer must be addressed to: For Notice of Claims and Circumstances: For AH Other Notices: 9 Farm Springs Road Famnington, CT item 6. Premium: Total Premium: $6,252 FHCF1.30% $81.28 DRWN E4405 (9/2008)

17 Item 7. Retroactive Date: June 1,1996 item 8. Endorsements Attached at Issuance: 1. e1032 (06/2009) Florida State Amendatory 2. v2115 (05/2009) Privacy Wrongful Acts Coverage, With Notice And Credit Monitoring Costs 3. v2671 (01/2011) Omnibus Endorsement THESE DECLARATIONS, THE POLICY FORM, ANY ENDORSEMENTS AND THE APPLICATION CONSTITUTE THE ENTIRE AGREEMENT BETWEEN THE INSURER AND THE INSURED RELATING TO THIS INSURANCE. In Witness Whereof, the Insurer has caused this Policy to be executed by its authorized officers. SECRETARY PRESIDENT AUTHORIZED SIGNATURE Licensed Agent License Number if the policyholder wishes to present inquiries or obtain information about coverage or to provide assistance in resolving complaints, please contact Darwin Professional Underwriters at {860} DRWN E4405 (9/2008)

18 SEP-12-E012(BED3 13:55 SRUCHULfl STflTE BflNK P. 002 If S POUWI«J.:CCP 3705 N HiMESAVE _.,,_. «TAMPA 78tt59 FL Century Surety Company 465 CleveJond Avenue *Jxtttusyivntr.c CQWHWOMPOUCY DECLARATIONS Renewal of 1 CCF* 7229S3 CODE Na:5ra8AJ; 1 1NSUREDS AGENT: i j COMMONWEALTH JNSLRANC^ ACSBJCy LtG JCBrtN HARRINGTON S } " 3360? 144^HiTAICRRQAD, SUITE B ivsteneiarafime «t yo* maflin^address shown above. ;'; s Bi^riass Desorifrtion: pfrceajii^3cnff I QSidMfflial QJ««1«ft»ir»: OR*Ws*K» Uj«MU«)Kiy.cai»««(yW;O O**»nla^KiBte»^kB$ifa4$^^^!!i^!!^^!^ ^^l*^?^p fffllfl^ T^11? WM^CW«aS»fOPTfts^TOI^W^l»VBlAl^>AimJ^WWOI ^PREMIUM IS INDICATED. Oxntnefcial PiBj*ttJ3rCen»«6Qe Pact SwviceFee insitmt *.K.^ -3 JKJriKWBj Romfal!' ;LtGa;Csmtttt!» _..._erfl».- S 1 Gtttrsarty-Aettotte a "T'TFr. itws:! I i:i PREWQPM ^OP " f f i> i f J $3500 S126J1D ' S2SS2 $32% EMPA 25 %oft»-p^ypf«niumfeftil^eart!edasrfihb ; e*fei^b datetf_ihis pd.i^jand.is not subject tcr return qr rafurxi. TOTAL" I MacNeJIJ Group^ inc. SunrtaS FL ormc3}arh3btdorsa7ient(^madba part of thte policy attime of issue*: OOb'C32 02 itai^>ecmcc53vbrb8e.ponasj^n^formpcertfstlorrfe i -: I : r Any.pcr^*ho.i»jm»ilenttocleftm»dortoi3w^.mathcfafe^^^ (iocephvsststement'is guilty oilitsijni«eo!toiiij, * ' t! i- =«K,«nc. Suite 0 Sunrise FL $308/2012- IKVWTOESSWHEREOF, thbccnjpbnvrhwex«^edot(l 8««^Uw^pPWents;to*bpo^ <toi>ntnffhte tvnin«>.v<«ikp, a~-ri^jfc.:.-^>«rf>.~»»aini.art ^ ' '--i' i* I I I I! <' Jl J CSCP10010S03 P99 tofl

19 Policy Number ACP BPOZ581S PREMIER BUSINESSOWNERS POLICY PREMIER OFFICE PROPERTY DECLARATIONS Description of Premises Number 001 Building Number: 001 Premises Address 1*550 N DALE MABRY HWY Occupancy OO Classification: ATTORNEYS Described as: ATTORNEYS - OFFICE-NO PL Policy Period: From To Construction: FRAME LUTZ FL WE PROVIDE INSURANCE ONLY FOR THOSE COVERAGES INDICATED BY A LIMIT OR BY HNCLUDEP*. The Property Coverage provided at this premises is subject to a $2,500 Deductible, unless otherwise slated. COVERAGES Building- Replacement cost Business Personal Property - Replacement cost ADDITIONAL COVERAGES - the Coverage Fonn Includes other AAfiflonaf Coverages not shown. Business Income-ALS-12 Months-72 HourWaitingPeriod-60Day Ordinary Payroll Limit Extra Expense - Actual Loss Sustained {ALS} - 12 Months - 72 Hour Watting Period Equipment Breakdown Automatic Increase in Insurance - Building Automatic increase in Insurance - Business Personal Property Back Up of Sewer and Drain Water {limit shown per Building, subject to $ policy aggregate) Appurtenant Structures -10% of Building Limit of Insurance - maximum $50,000 any one structure LIMITS OF INSURANCE $990,818 *100,000 INCLUDED INCLUDED INCLUDED 6* 2.9% 45,000 INCLUDED OPTIONAL INCREASED LIMITS Included Limit Account Receivable 25,000 Valuable Papers and Records (At the Described Premises) $25,000 Forgery and Alteration $10,080 Money and Securities - inside the Premises $10,090 Outside the Premises (Limited) *10, 000 Outdoor Signs $2,500 Outdoor Trees, Shrubs, Plants and Lawns $10/000 Business Personal Property Away From Premises $15,000 Business Personal Property Away From Premises - Transit $15,000 Additional Limit $25,000 $25,000 $10,000 10,000 $10,000 #2, , ,000 *15,000 OPTIONAL COVERAGES - Otter frequently purchased coverage options. Employee Dishonesty Ordinance or Law -1 - Loss to Undamaged Portion 2 - Demolition Cost and Broadened Increased Cost of Construction Hurricane Deductible - PB % Sinkhole Loss Coverage NOT PROVIDED INCLUDED $198,164 INCLUDED INCLUDED PROTECTIVE SAFEGUARDS This premise has one or more PROTECTIVE SAFEGUARDS identified by symbols herein. Insurance at this premise will be suspended if you do not notify us immediately if any of these safeguards are impaired. See PB for a description of each symbol. APPLICABLE SYMBOLS: NOT APPLICABLE PB (01-01) DIRECT HU- OSS WSURBiCOPY UKt 18 Page 1 of 2 SB M017

20 - S 541 E ' Mitchel1 Hammock Road Oviedo, Florida phone: ' 6458 * Fax: wwwjmic.com Insurance Company,, Created by The Florida Bar for its members. Lawyers Professional Liability Policy This is a Claims Made and Reported Policy. Please read it carefully. Declarations Policy Number: Item I. Named Insured: Dan Zohar, P. A. Mailing Address: 2529 W. Busch Blvd., Suite 100 Tampa, Florida Item 2. Policy Period: From 09/15/2012 to 09/15/2013 at 12:01 AM, Standard Time at Your Address Shown Above ItemS. Limit of Liability: $1,000,000 Per Claim $1,000,000 TotalLimit Item 4. Deductible: $5,000 Annual Aggregate Item 5. Premium: $6419 Item 6. Forms and Endorsements Attached at Policy Issuance: FLPL-101 (R.08/01/2011) FLPL-200R (R.08/01/2011) FLPL-103 (R.08/01/2011) FLPL-109 (R.08/01/2011) The Policy is not valid until signed by Our authorized representative. August 30,2012 Date Issued FLPL-100 (R.08/01/2011) Page 1 of I

21 CHARTIS National Onion Fire Insurance Company of Pittsburgh, Pa,* 175 Water Street POLICY NUMBER; REPLACEMENT OF: PROFESSIONAL LIABILITY POLICY THtStSA CLAt8IS-!«ASe AftJ REPGfHHJ FQ» E.^-gpTTOSBCH EJCISfT &S5SAY OTOSSSKE BEPRQVifJHJ THECQyERASe OF THIS TOUCY!S G ^'H4JT yiistet) T0 UABiUTYKSR THOSE CiAJSSS THAT ARE FtRSf MASS AfiAIMST INSU8EDS 0USRWS THE P0U< f>er!oo AJ«3 f^pcwtmj TO THE BSSURER AS THE POLICY REQUIRES. DEFSNSE COSTS I^JOCE Tl«UWT OF OAaSLfTY, PJJEASE I«M> THE POUCY CAREFUttT AKD OlSOi^ the COVERAGE WJT«YOUR»»UISWICE ASQCr OR STOKER TO OETERMttie WHAT IS JW WWAT IS NOT pa^s^eqfflisf ADDRESS: fnferrasriaj H^iway Suaei04 Tamp. Ft it &. PRH)gC^SSQR_FfflaKa POLICY PS^Oe.(tie inception Date: 11/ r30t1 Exptafoa Oafec 1MJ2/2G12 12:Olj t A.M..gt the ay.;^ess stated ifl Hero 1. above. 1? Narne acsd Address for Nbf3cs/ akns AFPD Cfcs HoJtew Lane. Suite 284 Late Suosess, l^ws? York Reference Maws and Address Mglloraf Uatoa Fira fnstirance Gomf^Kjy of Pttsbur^- *&. AFPO Aikirsss:.Ore Hojiow Lake Suces^y *W f (4/0&) 1012

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23 IH1S INSURANCE eissuhjpursumrrto THE FLORIDA SURPLUS LINES IAW. PERSONS INSURE) BY SURPUUS LINES CARRIERS DO NOT HAVE THE PTOTECTIOM OF TOE FLORIDA ANYRHSHfTOFREOOVSiYFORTHEOBUGATIOM OFAMWSOLVeWTOHUCKSW- - Karen B. Lampson 433 Centra! Ave, 4" flr a. Petersburg, FL License* D IRONSHORE SPECIALTY INSURANCE COMPANY 75 Federal St Boston, MA ToU Free: (877) IRON4J1 SURPLUS UNES INSURERS' POUCY RATES AND FORMS ARE NOT APPROVED BY ANY FLORIDA REGULATORY AGENCY. Policy *fc Expiring Policy * THIS IS ISSUED BY THE INSURANCE COMPANY SELECTED ABOVE Premium: $ Policy Fee: $35.00 State Tax; $ Service Fae: $14.60 Hurricane Fee: $ Total: $15, LAWYERS PROFESSIONAL LIABILITY POUCY WITH OAIM EXPENSES INCLUDED IN THE LIMIT OF LIABILITY DECLARATIONS PRODUCER: Janice HMery 1115 US 98 S Lakeland FL # This 'a a Claims Made and Reported Policy, please read ft carefully. Amounts incurred as Oalm Expenses shatt reduce the limftoflfawrtyavaualtetopayjudsrneirtsot ITEM 1. NAMED INSURED AND PRINCIPAL ADDRESS: Brush, Pujol & Coyte, P.A. 825 E. Main Street Lakeland, FL ITEM 3. LIMIT OF UABIUTY (inclusive of Claim Expenses) Item 2. POLICY PERIOD (a) Inception Date: April 03, 2012 (b) Expiration Date: April 03, 2013 at 12:01 a.m. both dates at the Principal $3,000,000 Each Claim $3,000,000 aggregate limit of tiabuity for all Claims made or deemed made during Policy Period ITEM 4. DEDUCTIBLE: $10,000 ITEMS. Premium: Praimirrc Coffipfencew^a^st^toOnespfecem^re^renwnfs, trxadi^ stamping tf» Potoyand eofedion and payment of surpfte toes taxes, in me responsaaty of tfe flroter. r Toted Amount Due: ITEM 6, RETROACTIVE DATE: JHiH Prior Acts See Invoice for the date Premium is due and payable. Failure to pay WeprennuminftJfmayresrft/nHjidanceofcoveraoe. LPLDEC002 (05/09) Page 1 of 2

24 541 Fi. Mitchell Hammock Road * Oviedo, Horida Phoae: Fax;8Q&-?8i-20lO 1 n & v. f a r. < e C o nt p,i i Created by The Florida Bar for its members. Lsmyers Professional Liability Policy This a a CMms Made and Reported Polity, Please read it Decl&r&tiom carefitffy. Policy Number: ItemL Named f mured: Matting Address: P.O. Box Tampa, Florida Hem Z PoUey Periods From 08^7/2012 to 08^27^W3 at 12&1 AM. Standard Time at &ar Address Shown Above, Limit of Liability Item 4, Deductible: ftems, Premium: $100,000 $300,000 55,000 $3230 Per Claim Total Limit Annual Aggregate item 6, Forms and Endorsements Attacked at Ptttity issuance: FLPL-IOI (R.08/01/20! I) FLPT.-200R (R.08/OI/201 1) FLPL-103 (R.08/01/201 1) The Policy is not valtd until signed by Oar GtttJt&rized representative. Dais Issued FLPL-100 fr.os^j/20! 1) X / of I _

25 CERTIFICATE OF LIABILITY INSURANCE DATE (MWW30/VYYY) 07/1W2C12 JTHIS CERTIFICATE ISISSUED AS A SHATTER OF INFORMATION ONLY ANO CONFERSNORIGHTSUPON THE CERTIFICATE HOLDER. itws CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELV AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE (POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 8*$UKER{S> AUTHORIZED REPRgSairrATIVg OR PRODUCgR. AMD THE CERTIFICATE HOLDER ; IMPORTANT: If the oerfificaks holder Is an ADDITIONAL INSURED, the po»cy{fes) mast bs endorsed. If SUBROGATION f S WAIVED, sobje«to ithe teims and condjsoas of ttie policy, certain policies may require an endorsement A statement on tws certiorate does «ot confer rights to jtfre certificate iioktermjfeaof such endorsements). irooouesa First ZniSesnity insurance 67 Oxford Street T8T iyiui, as INSURED 6H 5 Csstmseree Drive Suite 205 Lafceiand, FL 33SI3 1NSURSRB: KStiSERS AFKJRDiNO COVERAGE State National Insurance COVERAGES CERTIFiCATE NUMBER: REVISION NUMBER: : THiS IS TO CERTIFY THAT THE POUC'-ES CF INSURANCE USTEO BELOWMAVE BEEN ISSUED TO THE JNSURED NAMES ABOVE FOR TOE POLCY PERIOD j MDtCATHO. N0TWMS7 ANOiNG ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VMTH RESPECT TO WHICH THIS CERTIFICATE MAY SS ISSUED OR MAY PERTAIN, THE INSURANCE AFFGSDED BY THS PQUaES OESCR5SE3 H5?EfN is SUBJECT TO ALL THE TERMS, XC^.US:O«S AND CQNDiTIONS OF SUCH POLICES. UM-TS SHOVMN MAYHAVE BEEN REDUCED 3Y PAID C1A«S. I j*^, K j TYPECFffSURANCS n GEN w AGC^E^ATE USSlT APlfXIES PER; v^"i ^3OutC v : t^roject 1 "!U3C n WORKERS COMP6JJSAT!CN ANO SMPLOlfEHS 1 UAfflLlTY O=ERATK3KS 01SOW * Docc " W..V. ^^, KHOfi. isuck j a-,..,.,...,- WSRO t«9v0 «"««P0UCYSFF PCSJCYEXP Lawyers Frofessional i 07/22/ j "" ; Owi«flS/Vggr«^Ms: 5GGy GOO DgSCRJFnON OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACCORD 101, Additional Remarks Sc&edute,» more space is required} Ciaiwa J'ade Coverage, Covering 3 Attoraeys, Sstroactive Date: G7/22/2C-09. Deductible i.s 510, Per Claira and applies to toss and Oefease, Claims Expenses inside the Units of liability. CERTIFICATE HOLDS? CANCELLATION utms %!, - * U«S«A 5t TO KfcNSta BiED EXP (Aiy aa&fetmfi PfeSSO^LSANOaciUfW GSMEBAI-AGGRSS^TS PRraaCTB - COMFVOP A3G cowai\ O SINGLE UKIT ;sa SOStYoaURVtPefpw^) SOOtY INJURY por actstenr JwopeRrt o«w«5s (PW WCOBril] 6ACH OCCURAKCE AOSBSGA^ i TORYUMlTS { OTH R Ei. EACH ACCIDENT EMPLOYEE i.1- -DSSSIVS6 -POCOV OWT; SMUU3 AWT OF THE A8CVE0 DEKT^SO POUCKS 6E OWOEUJED ffi«3«6 THE BS^RATWIK CWT T^RgQF TrlE ISSMSG!NS!WESR Wa EJO6AVOR TO VAtt. W QAYS WSStTSK KOTaX TO T>«C8R*inC*'EHOU S NAMB5 TO IHEL&T, «IT AUTHORSZED REPRES^JTATiVE i ACORD 25 {2009/01} The ACCORD name and logo ara registered marks of ACCORD

26 _ ~ CERTIFICATE OF LIABILITY INSURANCE "J CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES SELOW. THIS CERTIFICATE OF INSURANCE DOES MOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERfS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: tf*eci^fica!eht«erbanaddrrk)n^b«ured.ftepcicy^}mustbeandofsed. if SU8RCKWTION IS WAIVED, subject to tie terms and oondffions of the policy, certain polities may require an endorsement A statement on this certificate does ma confer rights to 8w certificate holder in fieu of such endorsements). PRODUCER Dean Insurance Agency, Inc. 230 N Westroonte Or Suite 2100 Altasonte Springs, FL INSURED Boyette, Cunnrins & Nailos, PLLC 1635 E Highway 50 SuiteSOO aenaont, FL IE(MMfW»mY) 9/11/2012 gsl* CT Steven Majowitz git, **»: C407)86S-7477 x-112 [ 8. (407) ^poftess: PRODUCER CUSTOMER n^f: INSURER A: INSURERS i INSURER C: INSURER D: INSURER E: INSURERS) AFFORDING COVERAGE i HAIC» Medmarc Casualty Insurance Cam j INSURER F: COVERAGES CERTIFICATE NUMBER: 12/13 REVISION NUMBER: CERTIFICATE MAY BE ISSUED OR MAYPERTA9I, THE WSURANCE AFFORDED BYTHE POLICES DESCRIBED HEREW IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDmONS OF SUCH POLICIES. LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. 1;nf! TYP60FWSURANI X. f 001 SUSfi POLICY 6FF PGUCYECP m» POLICY NUIH8ER «B«pBYyVYt LIMITS ' GENERAL LIABILITY EACHOcaiRfffiNce > s - A "1 COMMERCIAL GENERAL LIABILITY I j 1 CLAIMS-MADE j j OCCUR - i. L. G»f L AGGREGATE LIMIT APPLIES PER' AUTOMOBILE U ABILITY _] ALLOWED AUTOS { SCHEDULED AUTOS H HIRED AUTOS NC*KDWNED AUTOS j UMBRELLA UAS i EXCSSSU4B! DEDUCTBLE OCCUR CLAIMS4IAOE ] RETEMtiON S WORKERS COMPENSATION AND EMPLOYERS" LIABILITY -f, N ANY PROPBETOi»PARTOER«EXeCUTO«^~\ K1A if yes, descnbe und«cfescriptlon OF OPERATIONS twkw Professional Liability Claims Made Coverage UAMAGS VO«HNTED PREMISES {=9 ocomom! MED S<P <Anj one pereoni PERSONAL iadv INJURY GSHERAL AGGREGATE PRODUCTS -COWW AGG COMBINED SINGLE LIMIT (Ea acciaart} BOXY HURT {Per pa-son] BODILY INJURY {PttacOasnQ PROPERTY DAMAGE EACH OCCURRENCE AGGREGATE Ei. DISEASE -EA EMPLOYES &L DISEASE -POUCY LIMIT 12HCFL !SJ/14/26l2 r 09/14/2013 s s J : s * s s s S j WCSTATU- j IOTH- FTOftYLHSTS! I 6R L.EACHACC(D6(4T s s 3 S $ J $ s s $1,000,000 Each Claim $1,000,000 Aggregate OESCfOFTIOM Of OPERATIONS (LOCATK3NS/ VEHICLES (Attach ACORD 101, AdaJfion"! (tenariasschcduto. If more apace 15 rcqu)r«i) Legal Services include acts as a title insurance agent, 'olicy covers attorneys: Norman C. Cunnrins, Heath B. Nailos.Kenneth W. Boyette, Kristen C. Nailos, Jinny 0. Crawford, Nancy A. Oavito, Paul Cipparone, Ernesto Bait rain, Aileen Mazanetz CERTIFICATE HOLDER CANCEUATON Insured 's Copy Boyette, Cunnrins & Nailos, PLLC 1635 E. Highway 50 Suite 300 Clerraont, FL ACORD 25 (2009/09) SHOULD ANY OF THE ABOVE DESCRIBED POUCES BE CANCELLED BEFORE THE EXPJRAT1ON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHWUZED REPRESENTATIVE C~\, n / ^.ii-^pt. Deborah Turner/MKH ACORD CORPORATION. AB rights reserved. The ACORD name and logo are registered marks of ACORD

27 Market Insurance Company fa Stock Company") Deertekl. IL Lawyers ProfessionalLiability Declarations This is a cbims made and reported policy. e read this poncy and a* endorsements and attachments carefully. THE POtJOTBUWTH) TO UABflJTY FOR ONLY THOSE CUUM^ INSURED AND REPORTED TO THE COMPANY DURMG THE POLICY PERIOD OR AUTOMATIC EXTENDED REPORTING PERIOD, UNLESS, AND TO THE EXTENT, THE EXTENDED REPORTING PERIOD OPTION APPLIES. PofeyNwnta: LA Renewal rfpofcy: NS0 1. NAMEDWSURGD: PoWsLawFlrrnDBA:PoOtis&Matov8ia.RA. luung ADDRESS: 730 Duntewton Ave Port Orange, FL POLICY PERIOD: From 254ue4M2 to IN RETURN FOR THE PAYMENT OF THE PREMUM, AND SUBJECT TO ALL THE TERMS OF THB POLICY, WE AGREE WTO YOU TO PROVIDE THE INSURANCE AS STATED M THE POLICY. UHrrOFUAOLITY: BKhCfdm $1, $1,000, DEDOCTBBLE $ MOHMLPRamM: $ FHCF $13041 Total Premkim $ RETROMCHMEOATE: August^ tfadate teindkated, this insurance w«not^jiy to any act, error, ofrtssion or Peraonal tojuiy which occuired before such date MLP OanageeOnfyDedudMe MLP pofcy*th^ ME8-54(»(»10MU>140Wn.0412 MLP 0001 (TOO) 061 Cfaima Expenses in MSion lota Umt of Uab»y Claims SenfceCMtar: MvkdSwtoftlnc; Ten Partcway North, DeerfieW, Bncw80015 Fac (847) maft neincumsoniattatgoiiuxm Ptwie: (847) ; (888) 5<»3200 TbeeeDm^ntfiai^togetlwrwBlitlwCammcinPelcy The Plus Cotnf»ntes,lnc^ 520USHglMny22. Martcel Producer* MOIH1000Q211 _ Cowitetaitpwdby Date

28 daruiin 1690 New Britain Avenue. Suite 101 Forminfton, CT To: From: Re: Patfi French Date: 05/30/2012 Darwin Direct Lakewind Drive Clermont, FL Lawrence Gonzalez Account #: Law Offices of Franklin T. Walden - Lawyers Professional Liability VIA BINDER Insured: Address: Policy Number: Policy Period: Limit $1,000,000 Aggregate Omit $1,000,000 Law Offices of Franklin T. Walden 1936 Lee Road, Suite 100 Winter Park, FL From: 07/01/2012 To: 07/01/2013 Per Claim Retention Aggregate Retention Premium $10,000 N/A $3,312 Retro Date 07/01/2001 Premium Due Date: Carrier/Form: 30 Days from effective date of policy Darwin National Assurance Company / DRWN E4400 (9/2008) Endorsements: 1. PN 9036 (6/2007)-Florida Important Notice 2. e1092(06/2009)-florida State Amendatory 3. v21 IS (5/2009) - Privacy Wrongful Acts Coverage, With Notice And Credit Moratoring Costs 4. v267t (01/2011) - Omnibus Endorsement Binder Subject to Insurer's receipt, review and acceptance of: Please ALL subjectivities to AH subjectivities to be resolved within 30 days after binding, Failure to do so may result in the voidance of any binder or coverage. Commission: 0% Surcharges): The Ftoridfe Hurricane Cat Fund Assessment is 1.3% of the policy premium for most fines of coverage. This fee appears on the invoice in addition to ttie stated poficy premium. Commission wib be paid on the premium amount only. Thank yousfor choosing Darwin National Assurance Company

29 Lawyers 5 Professional Liability Insurance LAW ' Protective Policy Declarations Insurance Company Hereinafter known as the Company THIS IS A CLAIMS MADE AND REPORTED POLICY. PLEASE REVIEW THE POUCY CAREFULLY. NOTICE: EXCEPT AS MAY BE OTHERWISE PROVIDED HEREIN, THE COVERAGE OF THIS POLICY IS LIMITED TO LIABILITY FOR COVERED ACTS COMMITTED SUBSEQUENT TO THE RETROACTIVE DATE, IF APPLICABLE, FOR WHICH CLAIMS ARE FIRST MADE AGAINST YOU WHILE THE POLICY IS IN FORCE AND WHICH ARE REPORTED TO US NO LATER THAN SIXTY (60) DAYS AFTER THE TERMINATION OF THIS POLICY. THE COVERAGE OF THIS POUCY DOES NOT APPLY TO CLAMS FIRST MADE AGAINST YOU AFTER THE TERMINATION OF THIS POLICY UNLESS, AND IN SUCH EVENT ONLY TO TH EXTENT, AN EXTENDED REPORTING PERIOD OPTION APPLIES. POUCY NUMBER: LPL NAMED INSURED: Law Offices of Chalik & Chaiik, PA. ADDRESS: N. W. 1 st Court Plantation, FL Replacing: LPL Producer Code: COASTAL 2. PERIOD OF INSURANCE FROM: 08/10/12 TO: 08/10/13 teoiam STANDARD TIME AT THE ADDRESS SHOWN IN ITEM 1 ABOVE. 3. UMTS OF LIABILITY (a) $1,000, EACH CLAIM (b) $ in the AGGREGATE including Defense Costs 4. DEDUCTIBLE {a) $26, EACH CLAIM (b) $0.00 in the AGGREGATE including Defense Costs 5. PREMIUM US $10, plus applicable taxes 6. RETROACTIVE DATE: Full Prior Acts 7. Notice to insurer Protective Insurance Company P.O. Box 7099 Tel.: (800) Indianapolis, IN Fax: (800) Forms and endorsements attached at inception of coverage. Refer to schedule of forms. Disclosure LPLPOL 01 LPLNOT 01 LPLNOT02 LPLENOO LPLEN39 Issued on: August 17,2012 at Aliendale, New Jersey for Jorgensen & Company Authorized Representative artf Managers forthe Legal Professionals' Purchasing Group, Countersigned st Aliendale. New Jersey on: August ' by:. LPLDEC 01 {10/101 Page 1 of 1

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