Orange County NC Website
Browse       Search
DocuSign Envelope ID: DCBF9B19-4560-44DC-A9D0-71 F645AC8BDC <br /> AVMA I PL1T& Veterinary Professional Liability <br /> Protecting you through it all Insurance Policy <br /> Certificate of Insurance rr��rr <br /> This policy provides occurrence coverage.Please review the policy carefully. L 4 <br /> ITEM t:Insured by tine stock company below and lie rein after caned the Company 4 <br /> Zurich American Insurance Company U-VPt.•iO3-A-CIV(07104) <br /> ITEM 2:Ahmed Certificate Holder,in ember number,species,and address Master Policy Number; Certificate 1Vurnber: <br /> EOL 5241302-13 VETPR0069825 <br /> Amanda Leah Chapman,DVM FOR INFORMATION OR TO FILE A CLAIM <br /> 104 Mullin Court PLEASE CALL(800)228-7548 <br /> Chapel Hill,NC 27514 <br /> ITEM 3:Policy Perind <br /> From; 01/01/2018 <br /> To: 01/01/2019 <br /> 12:0 1 am Standard time at the address of the Named Certificate Holder <br /> as stated herein <br /> ITEM 4:Limits or Liability <br /> Member Name Member Na. ecies Tyue Each claim. $1,000,000 <br /> Amanda Chapman 265520 [IV]Small Animal l xclusive Aggregate $3,000,000 <br /> ITEM 5:Premium and coverage summary ITEM 6:Forms Attached at lssunnce: <br /> Primary Professional Liability $238.00 U-VPLr100-A CW(07/04);U-VPL-103-A CW(07/04).GU-I 191-A-CW(3/15);U- i <br /> Veterinary License Defense $85.00 VPL-128-A NC(10/04).U-VPL-155-A NC(10104);U-VPL-102-B CW(0611 1),U- <br /> GU-319-F(01/09);U-GU-1194-A CW(08/15) <br /> ITEM 7:Schedule of Pfail Nutnbees and location(s)for ProrssionaI Extension 1 <br /> TOTAL DUE: $323.00 Fndorsement(Animal Bailee)/Embryo and Semen Storage(irpurchased): <br /> For additional locations,please see die attached page <br /> Location NumherlAddress <br /> Extension Plan Etnh o Plan € <br /> {fF <br /> 1 <br /> ITEM 8:Veterinary Professional Liability Regulatory Action License Derense <br /> Coverage endorsernenI(if purchased); This Certificate of Insurance is issued off the Master Policy held by[he American <br /> Veterinary Medical Associating(AVMA)Proressional Liability Insurance Trust.By <br /> Limit: $25,090 acceptance of this policy the Named Cerlificate Holder agrees that the sratemenrls in <br /> the certificate and lite application and any attachmenis hereto are the Named <br /> Authorized Signature Cet•ti Rea le Holdci's agreements and represertmtions and that Iltis policy emhodies all <br /> agreements existing between the Named Certificate b older&the Company or any <br /> 1 or its representatives relating to this insurance. <br /> 11 Notice to the Company; Zurich American insurance Connpany <br /> Neil R,Hughes,President P.0,nox 968041 <br /> HUR International Midwest United <br /> Schaumburg,iL 6019fi-8041 <br /> I <br />