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DocuSign Envelope ID: 984lA83A- 9421 - 4883 - 8867- 7170C15EC4EB <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. <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 Master Policy Number: <br />EOL 5241302 -13 <br />Mikaela P Archambeault, DVM <br />836 Ember Drive <br />Durham, NC 27703 <br />Member Name Member No. <br />Mikaela Archambeault 275855 <br />ITEM 5: Premium and coverage summary <br />Primary Professional Liability <br />Veterinary License Defense <br />TOTAL DUE; <br />Species Tyne <br />[IV] Small Animal Exclusive <br />ZURICH <br />U- VPL- 103 -A -CW (07104) <br />Certificate Number: <br />VETPRO154151 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228 -7548 <br />ITEM 3: Policy Period <br />From; 06/21/2018 <br />To: 01/01/2019 <br />12:01 am Standard time at the address orthe Named Certificate Holder <br />ITEM 4: Limits of Liability <br />Each claim <br />Aggregate <br />ITEM 6: Forms Attached at Issuance: <br />$ 1,000,000 <br />$ 3,000,000 <br />$126.00 U- VPL -100 -A CW (07104); U- VPL -103 -A CW (07104); GU- 1191 -A -CW (311[5); U- <br />$53.00 VPL -128 -A NC (10104); U- VPL -155 -A NC (10104); U -VPL -102 -B CW (06111); V- <br />I GU-319-F (01109); U -GU- 1194 -A CW (08115); U- GU- 1147 -A (01114) <br />$179.00 <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 />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: $ 50,000 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 />Notice to the Company: Zurich American Insurance Company <br />P.O. Box 968041 <br />Neil R. Hughes, President Schaumburg, IL 60196 -8041 <br />HUB International Midwest Limited <br />