Laserfiche WebLink
AVMA I p U 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. <br />ITEM 1: Insured by the stock company below and hereinafter called the Compauy <br />Zurich American Insurance Company <br />ITEM 2: Named Certificate Holder, member number, SRC, and address <br />Scott Henry Weldy, DVM <br />Serrano Animal & Jird Hosp <br />21771 Lake Forest, Suite I I I <br />Lake Forest, CA 92630-2782 <br />Master Policy Number: <br />EOL 5241302 -12 <br />UNPL-Wa�A-CW (07104) <br />Certificate Number: <br />VETPROO51077 <br />FOR INFORMATION OR TO FILE A CLAIM <br />PLEASE CALL (800) 228-7548 <br />ITEM 3; Policy Period <br />From: 01/01/2017 <br />To: 01101/2018 <br />12:01 am Standard time at the address oPthe Named Ceftiticote Holder <br />. <br />ITEM 4: Limits of Liability <br />Member Name Member No, LRC Class <br />Each claim - $1,000,000 <br />Scott Weldy . 24154 17 IV <br />Aggregate $ 3,000,000 <br />ITEM( 5: Premium and coverage sumtnary <br />I'T'EM 6; Forms Attached at Issuance: <br />Primary Professional Liability $222.00 <br />U-VPL-100-A CW (07/04); U-VPL-103-A CW (07/04); U -OU -1041-A(03/11); U. <br />Veterinary License Defense $69.00 <br />VPL•109-13 CA (01/12); U-VPL-102-B CW (06/11); U -OU -319-F (01/09) <br />ITEM 7: Schedule of Plan Numbers and location(s) for Professional Extension <br />Endorsement (Animal Bailee) / Embryo and Semen Storage (if purchased): <br />TOTAL DUE: $291.00 <br />For additional locations, please see the attached page <br />ITEM 8: Veterinary Professional Liability Regulatory Action License <br />Coverage endorsement (if purchased): <br />Limit: $ 25,000 <br />Authorized Signature <br />Neil R. Hughes, President <br />HUB Intemational Midwest Limited <br />Extension Plan Embryo Plan <br />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 />acceptance of this policy the Named Certificate Holder agrees that the statements in <br />the certificate and the applkation and any ac..h hcras hereto are the Named <br />CertiBeate Holder's agreements and representations and that this policy embodies all <br />agreements existing between the Named Certincate holder & the Company or any <br />of its represethatives relating to this insurance. <br />Notice to the co npany! Zarich North Americmt-Specialties Claims <br />Atm: Profesolonel Liability Claim Department <br />- P.O. Box 307010, Jamaica; NY 11430-7010 <br />