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AVMA I PLIT T Veterinary Professional Liability <br />Protecting you through it all Insurance Policy 19 <br />Certificate of Insurance <br />This policy provides occurrence coverage. Please review the policy care filly. ZURICH <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, IRC, and address <br />Scott Henry Weldy, DVM <br />Serrano Animal & Bird Hosp <br />21771 Lake Forest, Suite 111 <br />Lake Forest, CA 92630-2782 <br />Member Name <br />Scott_ Weldy <br />Member No, IRC <br />24154 17 <br />ITEM 5: Premium and coverage summary <br />Primary Professional Liability <br />Veterinary License Defense <br />TOTAL DUE: <br />$222.00 <br />$69.00 <br />$291.00 <br />ITEM 8: Veterinary Professional Liability Regulatory Action License <br />Coverage endorsement (if purchased): <br />Limit: $ 25,000 <br />Authorized Signature <br />A/ <br />Neil R. Hughes, President <br />HUB International Midwest Limited <br />Master Policy Number: Certifleate Number: <br />EOL 3241302 d2 VETPROD51077 <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: 01/01/2018 <br />12:01 am Standard tune at the address ofthe Named Certificate Holder <br />ITEM 4: Limits of Liability <br />Class Each claim S 1,000,000 <br />TV Aggregate $ 3,000,000 <br />ITEM 6: Forms Attached at Issuance: <br />U-VPL-100-A CW (07/04); U-VPL-103-A CW (07/04); U -GU -1041-A (03111); U. <br />VPL-109-5 CA (01/12); U-VPL-102-B CW (06/11); U -GU -319-F (01/09) <br />ITEM 7: Schedule of Plan Numbers and locations) for Professional Extension <br />Endorsement (Animal Bailee) / Embryo and Semen Storage (f purchased); <br />For additional locations, please see the attached page <br />LQ adOn Number Address <br />Extension Plan Em¢Iyo Plan <br />This Certificate afInsurance 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 Nomad Certificate Holder agrees that the statements in <br />the certificate and the application and any attachments hereto are the Named <br />Carlin on to Holder's agreements and representations and that this policy embodies all <br />agraements existing between the Named Certificate holder & the Company or any <br />of lis represemmlives relating to this insurance. <br />Notice to the Company: Zmwh North American-Specianies Claims <br />Amu Professional Liablity Claim Deportment <br />P.e. Box 307010, Jamaica, NY 11430-7010 <br />