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DocuSign Envelope ID: ED70ABD7-FFE4-4C25-B3D1-84A819C70CE2 <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. 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 U-VPL-103-A-CW(07/04) <br /> ITEM 2:Named Certificate Holder,member number,rating code and address Master Policy Number: Certificate Number: <br /> EOL 5241302-14 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 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 Holder <br /> as stated herein <br /> ITEM 4:Limits of Liability <br /> Member Name Member No. Rating Code Each claim $ 1,000,000 <br /> Amanda Chapman 265520 [IV]Small 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-VPL-100-A CW(07/04);U-VPL-103-A CW(07/04);U-GU-1191-A CW(03/15); <br /> Veterinary License Defense $94.00 U-VPL-128-A NC(10/04);U-VPL-I55-A NC(10/04);U-VPL-102-B CW(06/11); <br /> U-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: $342.00 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 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 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 /> s 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 <br /> Schaumburg,IL 60196-8041 <br /> HUB International Midwest Limited <br />