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04/17/2009 09:15 FAX 9096272652 <br />•m:,o.nna Cnlem To:Androw T. Fischer Jr.x (18096276668) <br />CHINOVALLEVEQUINE <br />12:17 04117109GMT -04 Pg 02-03 <br />200 <br />Spor irad by A V M A Veterinary Professional Liability <br />Insurance Policy <br />Certificate of Insurance ZURICH., <br />Thib pulioy provider ocoltrranow coverugo. Floude rev'icw Ihv policy careJi►LJy- <br />ITEM 1; insured by the stock company below and hereinafter celled the <br />P L I T Company Zurich American bsumnce C.oMpany 1U-VPL- 103 -A -CW (07107) <br />ITEM 2: Named CertyflcateHoldcr, member numbcr, 1RC, and addrm <br />Andrew T, Fischer Jr, <br />2945 English Place <br />Chino Hills, CA 91709 <br />*917094* <br />4 < <br />Mcmbcr Ninic Mcm cr N <br />FISCHER ANDREW THEODORE D 41215 <br />ITEM 5: Prerriu li and coverage summary <br />Liability $2,921.00 <br />Excess Liability $1,417.00 <br />Bailee $ 86,00 <br />TOTAL DUE; $ 9, 424 .0 0 <br />Master Policy Ntnttbcr I Certificate Number; <br />EOL 5241302-04 36456 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228 -7548 <br />IrrEM3: Policy Period from: 1/01/2009 To: 1 101 /2010 <br />12:0 1 am Standard'Liam A tba addreos of the Named Cortifieate Solder as <br />stated herein <br />ITEM 4; Limits of Liability <br />Class Each claim $ 6.000,000 <br />11 I 1 Aggregate $ 8,000,000 <br />ITEM6: Pornt::ALLu.1irdatT"L4Uancc: 11. vPLio3.-kCwl07M). u. vp{r IW .^Cwfo7Na),U.vpn.i0i•♦Cwlouoat. <br />u-VPL.109-w C• (09/",U-GU-3194 (Di" <br />ITEM 7: 'Schedule of Plan Numbers Lad location() for <br />Veresilmi} Professional Bailee Mdension Lndorsement (if purchasdd): <br />For additional locatiotls. please sec the attached Wsc <br />oco ' <br />L 13385 YArba Avenue, Chino, CA <br />ITEM 8: Veterinary Licensc Defense Coverage endorsemem. (if <br />puremoccl): Limit; S <br />Authorized Signature <br />Thin Paymral uvKsoe IM bol cvnmil rrd Pkirk ol-lhr <br />E1an.1�11mh�I <br />S <br />Thib GatifiLatc orinmm"oa in iMmad oli lha Awwr Policy held by Lha Amcriwm VuLurinury <br />M04041 AMMintion (.1 V,M.A) Profoaeioael Liability iourance Taut. BY accoptanoo of this <br />policy dlu Named CertW -Ate Holder agtvas that the stMoaaonu in the certiiiosou and the <br />uWlication andLLny attachments hereto are the Named Cortlikate llolder n altraomento and <br />representatlons and that thl.9 policy embodies aL agreements eslsttng between the Xnmm <br />CertMeate hukier & the Compmy or any of it% ZP[muntalives relating to this uisurFutoo. <br />Notim to tho Company_ Zurich North Amsriona- Spccixltizs Claims <br />Attu; Profe"i*vd Liability Claim r)cpartmuut <br />P.U- Box 307010. Jamaica, NY 11430 -7010 <br />4/1.7/2009 AXC n Amount L/ iclosed/Clu ged; <br />Paynitmt Oprions: - Chnck etlalosed (Payable to the AVMA PLOT) 0 Moaey Order 0 Visa L NfttrnerCard <br />To pay by credit Lwd, plcasc Mnrlcn: Lha ridlowing: <br />Tatar.-LbMm <br />DUE DATE; 1/01/2009 <br />rnrumd SignuLurq t PPROVED AS TO FORM <br />Laura St1tt eedy <br />Assistant C. Attorney <br />Do not withikold paymcat pending <br />receipt ofadjuaeed ►Wine n thin cook <br />L'aure caneaDatlon urcnvcruge. <br />AVMA, PL1T Paymenl Address <br />P.O. Box 4389 <br />C,3r01 Stre&n, IL 60197 -4389 <br />Nv_ayw- av1na111it,,c�1 nn <br />036456 090101 00442400 0013766000 4 <br />