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DocuSign Envelope ID: COE7277A -DF52- 4508- 985D- E6BEFF540E10 <br />AV M A I P L I T' Veterinary Professional Liability <br />p1=aWetifiy yott tillydttgh it till Insurance Policy <br />Certificate of Insurance <br />This policy provides occurrence coverage. Please review the policy carefully. <br />ITEM 1: Insured by the stock company below and hereinafter called the Company <br />Zurich American Insurance Company <br />ITEM 2: Named Certificate Holder, member number, species, and address I Master Policy Number; <br />EOL 5241302 -13 <br />Clarissa Green Nollreddine, DVM <br />D <br />ZURICH <br />U- VPL- 103 -A -CW (07104) <br />Certificate Number: <br />VETPR0037091 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228 -7548 <br />ITEM 3: Policy Period <br />From: 01/01/2018 <br />To: 01/01/2019 <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. Species Type Each claim $ 2,000,000 <br />Clarissa Noureddine 211908 [IV] Small Animal Exclusive Aggregate $ 4,000,000 <br />ITEM 5: Premium and coverage summary <br />Primary Professional Liability <br />$238.00 <br />Excess Professional Liability <br />$102.00 <br />Veterinary License Defense <br />$85.00 <br />Professional Extension Endorsement (Animal Bailee) <br />$86.00 <br />TOTAL DUE: <br />$511.00 <br />ITEM 6: Forms Attached at Issuance: <br />U -VPL -100 -A CW (07104); U- VPL -I03 -A CW (07/04); GU- 1191 -A -CW (3115); U- <br />VPL -128 -A NC (10104); U- VPL -155 -ANC (10/04); U- VPL -101 -A CW (07/04); U- <br />VPL -102 -B CW (06/11); U -GU -319 -F (01109); U -GU -I 194 -A CW (08/15) <br />ITEM 7: Schedule of Plan Numbers and location(s) for Professional Extension <br />Endorsement (Animal Bailee) / Embryo and Semen Storage (if purchased): <br />For additional locations, please see the attached page <br />Location Number /Address <br />Extension Plan Embryo Plan <br />Plan 8 <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 />of its representatives relating to this insurance. <br />A-1 �' /��' - <br />Neil R. Hughes, President <br />HUB International Midwest Limited <br />Notice to the Company: Zurich American Insurance Company <br />P.O. Box 968041 <br />Schaumburg, IL 60196 -8041 <br />