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DocuSign Envelope ID: DC772236-D8A9-4F9B-9103-015EA03E6B9A <br /> AV M A I P L I T" Veterinary Professional Liability. � <br /> pidlectitiq"ti t1iidtigh 11 all In a ra nce Policy <br /> Certificate of Insurance <br /> This policy provides occurrence coverage.Please review the policy carefully. ZURICH <br /> ITEM 1.Insured by the stack company below and hereinafter called the Company <br /> Zurich Ameriean Insurance Company U-VPL-103-A-CW(07/04) <br /> t <br /> ITEM 2:Named Certificate Holder,member number,species,and address Master Policy Number. Certificate Number: <br /> EOL 5241302-13 VBTPR0037091 <br /> Clarissa Green Nvureddine,DVM FOR INFORMATION OR TO FILE A CLAIM <br /> PLEASE CALL(840)228-7548 <br /> ITEM 3:Policy Period 1, <br /> From: 01/01/2018 <br /> To: 01/01/2019 <br /> 12:01 am Standard time at the address of the blamed Certificate Holder <br /> as stated herein <br /> IT RN 4:Litnits of Liability 1 <br /> Mi-mber Name Mornher No. Species TyM 1 each claim $2,000,000 <br /> Clarissa Noureddine 211908 [IV]Small Animal Exclusive Aggregate $4,0011,000 <br /> ITEM 5:Premium and coverage summary ITEM 6:Forms Attached at Issuance. <br /> Primary Professional Liability $238.00 U-VPL-100-A CW(07104);U-VPL-I03-A CW(07/04);GU-1191-A-CW(3115);U`- <br /> Excess Professional Liability $102,00 VPL-128-A NC(10104);U-VPL-l55-A NC(10/04);U-VPL-101-A CW(07104);License Defense $85•®0 U- <br /> Veierinar VPL-102-B CW(06111);U-GU-319-F(01/01);U-GU-1194-A CW(08/15) <br /> �+ <br /> ITEM 7:Schedule of Plan Numbers and location(s) � <br /> Professional Extension Endorsement(Animal Bailee) $$6.00 )for Professional Extension <br /> Endorsement(Animal Bailee)/Embryo and Semen Storage(if purchased): <br /> For additional locations,please see the attached page <br /> TOTAL DUE: $511.00 <br /> Location Number/Address Extension Plan Embryo Plan <br /> I: Plan 8 <br /> ITEM 8:Veterinary Professional Liability Regulatory Action License Defense <br /> Coverage endorsement(if purchased): This Corti ficato 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 llolder.agrcas that the statements in <br /> the certificate and the application and any attachments hereto aro the named <br /> Authorized Signature Certincate Holder's agreements and representations and that this policy embodies all <br /> agreements existing between the Named Certificate holder&the Company or any <br /> a of its representatives relating to this insurance, <br /> Notice to the Company: Zurich American Insurance Company l <br /> P.O.Box 96:8041 i <br /> Neil R.Hughes,President <br /> Schaumburg,IL 60196-8041 <br /> HUB International Midwest Limited <br />