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DocuSign Envelope ID:72D276E7-8F57-4025-B4DE-37E18OCE2BOD <br /> AV M A I P L I T° Veterinary Professional Liability <br /> Protecting you through it all Insurance Policy <br /> Certificate of Insurance i i <br /> This policy provides occurrence coverage.Please review the policy carefully. Z l J R I C H <br /> ITEM 1:Insured by the stock company below and hereinafter called the Company �✓ <br /> Zurich American Insurance Company UATI.-103 A-CW(07.04) <br /> ITEM 2:Named Certlfleate Holder,member number,rating code and address Master Policy Number: Certificate Number: <br /> EdL 5241302-14 VETPRp008742 <br /> Claudia H. Sheppard,DVM FOR INFORMATION OR TO FILE A CLAIM <br /> 101 Auttmul Lane PLEASE CALL(800)228-7548 <br /> Chapel Hill.NC 27516-1101 ITEM 3:Polley Period <br /> From: 01/0112019 <br /> To: 01/01/2020 <br /> 12:01 am Standard time at the address of the Named Certificate Bolder <br /> as stated herein <br /> ITEM 4:Limits of Liability <br /> Member Name Member No. Rating Code Each claim $1,000,000 <br /> Claudia Sheppard 120285 [IV]Small Animal Exclusive Aggregate S 3,000,000 <br /> ITEM 5: Pmmium and coverage summary ITEM 6:Forms Attached at Issuance: <br /> Primary Professional Liability S248.00 U-VPL-100-A CW(07/04);U-vTL-103-A CW(07104);U-GU-1191-A CW(03115); <br /> Veterinary License Defense g94.00 U-VPL-128-A NC(10/04),U-vTL-155-A NC(10104):U-VPL-102-B CW(06111); <br /> U-GU-319-F(01109);U-GU-1194-A CW(08/15) <br /> ITEM 7:Schedule of Plan Numbers and location(s)for Professional Extension <br /> TOTAL DUE: S342 00 Endorsement(Animal Bailee)I Embryo and Semen Storage(if purchased): <br /> For additional locations.please see the attached page <br /> Location Number/Address Extension Plan Embryo Plan <br /> i <br /> i <br /> i <br /> i <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 liiedical Association(AVMA)Professional Liability Insurance Trust_By <br /> Limit: S 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 She Named <br /> Authorized Signature Certificate Holder's agreements and representations and that this policy embodies all <br /> agreements existing behreen 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 />