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DocuSign Envelope ID:9937DF18-lC51-4D9B-95B2-08C609E00193 <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 /> T1iis policy provides occurrence coverage.Please review the policy carerully. Z u R I C H <br /> ITEM 1:Insured by the stock company below and hereinafter•called the Company <br /> Zurich American Insurance Company UNFL-103-A-Ctv(07104) <br /> ITEM 2:Named Certificate Holder,member number,rating code and address Master Policy plumber: Certificate Number: <br /> EOL 5241302-14 VETPRO154151 <br /> Mikaela P Archambeault,DVM FOR INFORMATION OR TO FILE A CLAIM <br /> 835 Ember Drive PLEASE CALL(800)228-7548 <br /> Durham,NC 27703 ITEM 3:Policy Period <br /> From: 01/01/2019 <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. Rate Each plaim $1,000,000 <br /> Mikaela Archanrbeault 275855 [IV]Sinai[Animal Exclusive Aggregate $3,000,000 <br /> ITEM 5:Premium and coverage summary ITEM 6:Forms Attached at Issuance: <br /> Primary Professional Liability $248.00 U-VPI,100-A CW(07/04);U-VPLr103-A CW(07/04);U-GU-1191-A CW(03/15); <br /> Veterinary License Defense $109.00 U-VPL-128-A NC(10104);U-VPL-155-A NC(10/04);U-VPL-IO2-B CW(06/11); <br /> IJ-GU-319-F(01/09);U-GU-1194-A CW(08/15) <br /> ITEM 7:Schedule of Plan Numbers and location(s)for Professional Extension <br /> TOTAL DUE: $357.00 Endorsement(Animal Bailee)/Embryo and Semen Storage(if purchased): <br /> For additional locations,please see the attached page <br /> Location Number/Address Extension Plan Embryo Plan <br /> ITEM 8:Veterinary Professional Liability Regulatory Action License Defense <br /> Coverage endorsement(if purchased): This Certificate arInsurance 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(lie 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 balder&the Company or any <br /> of its representatives relating to this insurance. <br /> ANotim to the ComPa Y=n Zurich American insurance Company <br /> 11.0.Box 968041 <br /> Neil R.Hughes,President Schaumburg,IL 60 1 96-804 1 <br /> HUB International Midwest Limited <br />