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JAN-01-1396 06:22 P.02i02 <br />Spoiuorcd by A V M A veterinary Professional Liability <br />Insurance Policy <br />Certificate of Insurance Z U Ri C H <br />This policy providoa occurrence coverage, plesse review the policy carefully. <br />ITEM 1: Insured by the stock company below and hereinafter called the <br />F L I T Company Zurich American Insurance Company U-VPL-103-A-Cw(07,'07) <br />ITEM 2: Named Certificate Holder, member number, IRC, and address <br />Scott Henry Weldy, DVM <br />c/o Serrano Animal & Bird Hosp <br />21771 Lake Forest, Suite 11 l <br />Lake Forest, CA 92630-2782 <br />Iltlttitltltll11 tell tlltttttltllt►tllttltttltlltttltttllttlitl <br />Master Policy Number: I Certificate Number: <br />EOL 5241302-03 36548 <br />I FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (900) 229-7548 <br />ITEM 3: Policy Period Fran: 1 /01 /2008 To: 1/01/2009 <br />12:01 am Standard time at the address ofthe Named Certificate Holder as <br />stated heroin <br />ITEM 4: Limits of Liability <br />Member Namn Member No. iRC Class Each claim $1,000,000 <br />W ELDY SCOTT HENRY DR 24154 17 IV Aggregate $ 3,000,000 <br />ITEM 5: Premitun and coveragc surmnary <br />Liability $ 246.00 <br />TOTAL DUE: $ 246.00 <br />p.�.a <br />ITEMS: Veterinary <br />purchawd): limit: S <br />Authorizod Signmurc <br />Fax from <br />ITEM 6: Forms Attached at Issuance: U-VPL-103-A CW (07107), U-VPL-I00-A CW (07104), <br />U-VPL-109-A CA (09/04) <br />ITEM 7: Schedule of Plan Numbers and location(s) for <br />Veter nmy Professional Bailee ExUrtsion Endorsemztu (if p=hased): <br />k or additional locations, please see the attached page <br />Ent (if <br />Plan Number <br />This Ccrtiftoate ofirtaunau:e is ismtod offlhe Master Policy held by the Arnarlcan Vattainary, <br />Medical Association (A. V.M.A) Profoulonml Liability lummoe Trust, ay kLco lac of this <br />Policy tho Named Certificate Holder agrees that the statements in the certificate and the <br />appti"ion and any attachments hereto are the Nmnwd Cerlifieate Holder's agreements and <br />reprosotitations and that this policy embodies All agraentents cdsting between the Named <br />Certificate holder A the Company or any of its rcprosenttttivtra relating to this instrruncc. <br />Notice to the Company; Zurich North American-Spacialties Ctaitna <br />Ann: Prafeasional Liability Claim DarnMijetlt <br />T TOTAL P.02 <br />99/03/09 11:19 Pg: 2 <br />