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DocuSign Envelope ID:390B2169-33EB-4DAB-9E22-31B302CF919C <br /> AV M A I P L I T Veterinary Professional Liability <br /> Protecting you through it all Insurance Policy <br /> Certificate of Insurance <br /> This policy provides occurrence coverage.Please review the policy carefully. ZURICH <br /> ITEM 1:Insured by the stock company below and hereinafter called the Company <br /> Zurich American Insurance Company U-VPL-103-A-CW(07/04) <br /> ITEM 2:Named Certificate Holder,member number,IRC,and address Master Policy Number: Certificate Number: <br /> EOL 5241302-12 VETPR0008742 <br /> Claudia H. Sheppard,DVM FOR INFORMATION OR TO FILE A CLAIM <br /> 101 Autumn Lane PLEASE CALL(800)228-7548 <br /> Chapel Hill,NC 27516-1101 ITEM 3:Policy Period <br /> From: 01/01/2017 <br /> To: 01/01/2018 <br /> 12:01 am Standard time at the address of the Named Certificate Holder <br /> as stated herein <br /> ITEM 4:Limits of Liability <br /> Member Name Member No. IRC Class Each claim $ 1,000,000 <br /> Claudia Sheppard 120285 17 IV Aggregate $3,000,000 <br /> ITEM 5:Premium and coverage summary ITEM 6:Forms Attached at Issuance: <br /> Primary Professional Liability $238.00 U-VPL-100-A CW(07/04);U-VPL-103-A CW(07/04);U-GU-1041-A(03/11);U- <br /> Veterinary License Defense $85.00 VPL-128-A NC(10/04);U-VPL-155-A NC(10/04);U-VPL-102-B CW(06/11);U- <br /> GU-319-F(01/09) <br /> ITEM 7: Schedule of Plan Numbers and location(s)for Professional Extension <br /> TOTAL DUE: $323.00 Endorsement(Animal Bailee)/Embryo and Semen Storage(if purchased): <br /> For additional locations,please see the attached page <br /> Location Number/Address Extension Plan Embryo Plan <br /> ITEM 8:Veterinary Professional Liability Regulatory Action License Defense <br /> Coverage endorsement(if purchased): This Certificate of Insurance is issued off the Master Policy held by the American <br /> Veterinary Medical Association(AVMA)Professional Liability Insurance Trust.By <br /> Limit: $25,000 acceptance of this policy the Named Certificate Holder agrees that the statements in <br /> the certificate and the application and any attachments hereto are the Named <br /> Authorized Signature Certificate Holder's agreements and representations and that this policy embodies all <br /> agreements existing between the Named Certificate holder&the Company or any <br /> l/s 42_ geitts.___ of its representatives relating to this insurance. <br /> Notice to the Company: Zurich North American-Specialties Claims <br /> Attn:Professional Liability Claim Department <br /> Neil R.Hughes,President P.O.Box 307010,Jamaica,NY 11430-7010 <br /> HUB International Midwest Limited <br />