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AC° CERTIFICATE OF LIABILITY INSURANCE DATE(ME!EIDD <br /> 1OJ10/2013 013 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the i <br /> certificate holder In lieu of such endorsement(s). <br /> PRODUCER CONTACT Jennifer Hartman <br /> Asset Protection Group, Inc. PHONE (904)423-7700 FAX ;R804)423-??01 <br /> 10800 Midlothian Turnpike nDDiisss jhartman @apgroupinc,com <br /> Suite 220 INSURER S)AFFORDING COVERAGE NAIL x <br /> Richmond VA 23235 INSURERA:Fortress Insurance c an <br /> INSURED <br /> INSURER 8: <br /> INSURER C; <br /> William S. Yeung, resident )NBURERD: <br /> PO Box 1165 INSURER E: <br /> Cary NC 27512 INSURERF: <br /> COVERAGES CERTIFICATE NUMBER:CL1310100 8 855 REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE Of INSURANCE DL S 8 POLICY EFF POLICY EXP LIMITS <br /> LTR POLICY NUMBER M1DDiY 1lh <br /> GENERAL LIABILITY EACH OCCURRENCE b <br /> t <br /> t,OT4ME R AL GENERAL LL4BILITY FR Az'E E.^rx tar-. $ <br /> CL AIMS-AIADE OCCUR VIED EXP-,Aerf one;arson) $ <br /> PEP.SONAL S ACA,'INJURY 3 <br /> GENERAL AGGREGATE $ <br /> GFJ`I'L AGGREGATE Lid11T APPLIES PER: FROINJCTS-COMP%OP ACC, I <br /> POLICY PRO- LGC S <br /> COMM NED SINGLE LIMIT <br /> AUFt3k10BiLE UABILITV <br /> ANY AUTO BOD9LY#•t1URY;Pew parson) S <br /> ALL ONNED SCHEDULED SCDLY gQ'.JRY(PerarcJdenr) 5 <br /> AUTOS AUTOS <br /> NorlawN.-O PROPERTY OAh?AGE g <br /> ;-➢RED AUTOS AUTOS 'Perau:ident <br /> 5 <br /> UMBRELLA L1A8 OCCUR EACH OCC$JRREP4CE $ <br /> EXCESS UAB CtA1EI.&MADE AGGP.EG.4TE $ <br /> QED RET£ i 3 I <br /> WORMERS COMPENSATION T" OFH- <br /> AND EMPLOYERS'LIABILITY <br /> ANY PROPR,'EfOPJPARTNER'EXECUTIVE a N:A E.L.EACH ACCIDENT $ <br /> OFFICENMEMBER EXCLUDED9 <br /> (Mandatory In NH) E .DISEASE-EA EMPLOYEE S <br /> tf yes,desxibo under <br /> OES611FTION OF OPERATICtiNS below t DISEASE-POLICY LIAIrT 5 <br /> A UNC School of Dentistry 002046 ratro 7/1/2013 011/2023 0/1/2924 ;AdMLIONls3MILLION <br /> DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(Attach ACORD tOi.Additional Remarks Sehsdule.it more space is required) <br /> Professional Liabilitiy Coverage: $1,000,000 per claim/$3,000,000 annual aggregate <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Coverage for work @UNC School of <br /> Dentistry only <br /> FO Box 1165 AUTHORREOREPRESENTATlVE <br /> Cary, NC 27512 <br /> Jennifer Hartman/3W 11 fi <br /> ACORD 25(2010105) iD 1888-2010 ACORD CORPORATION. All rights reserved. <br /> INS075!?.^.trrm-,i Tha ArnDn noma arm tnnn nra raniaf—rl morka of of AArl <br /> I <br />