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Ge MINNESOTA LAWYERS MUTUAL <br />INSURANCE COMPANY <br />DECLARATIONS <br />Policy Number 281179 <br />333 South Seventh Street, Suite 22M Minneapolis, MN 55412 <br />(612) 341-4530 (800) 422-1370 fax(800)305-1510 <br />LAWYERS PROFESSIONAL LTABILXrY POLICY <br />(THIS IS A CLAIMS -MADE POLICY — READ CAREFULLY) <br />.Y) <br />Item 1. <br />Named Insured: <br />Kenneth N. Potts, PA <br />Office Address: <br />5101 Thimsen Ave Ste 200 <br />Minnetonka, MN 55345 <br />Item 2. <br />Policy Period: 1/2/2016 to 1/212017 <br />(the Effective Date) (the Expiration Date) <br />12:01 A. M., standard time at the address of the Named Insured stated herein <br />Item 3. <br />Limits of Liability: $500,000.00 Per Claim <br />$1,500,000.00 Aggregate <br />Item 4. <br />Deductible Amount: $5,000.00 Per Claim <br />Item 5. <br />Total Number of Lawyers: 1 Total Premium: $2,490.00 <br />Item 6. <br />Applicable Forms and Endorsements: <br />MLM-019 (11-13) Prior Acts Retroactive Bate, MLM-032 (11-13) Minnesota Changes, MLM-2000 (11-13) Policy <br />Form <br />In witness whereof, Minnesota Lawyers Mutual Insurance Company has caused this policy to be signed by its President and Secretary <br />and countersigned by a duly authorized agent ofthe ConVany. <br />M WME SOTA LAWYERS MUI~UAL INSURANCECOMPANY <br />I -AD Id-7zho'V P"4"- r <br />'/' /" / <br />John J. Bowden, Secretary Kristina 8imuns, Authorized Agent Paul M. Ablan, president <br />MLM-34 (05-94) <br />