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---------- <br /> Healthcare Professional Liability <br /> I iitc-ri-mitior,alk <br /> LIBERTY INSURANCE UNDERWRITERS INC. <br /> (A Stock Insurance Company,hereinafter the"Company' <br /> 55 Water Street,18th Floor <br /> New York-,NTY 10041 <br /> CERTIFICATE OF INSURANCE <br /> HEALTHCARE PROFESSIONAL LIABILITY <br /> CLAIMS-MADE INSURANCE POLICY FOR MEMBERS OF THE FEDERATION <br /> Item CERTIFICATE NUMBER: AHX-102357003 RENEWAL OF: ARX-1 02357002 <br /> 1. NAMED INSURED Lorraine Lewis <br /> 2. I\LkILING ADDRESS 107 Morningside Drive <br /> Caffboro,NC 27510-1254 <br /> 3. Policy Period 12:01 A.M.Standard Time From: 06/01/2014 To: 06/01/2015 <br /> At Location of Designated Premises <br /> 4. Prior Acts Date: 06/13/1993 <br /> 5. COVERAGE LIMITS OF LIABILITY PREMIUM <br /> Professional Liability $1,000,060 each Incident 1 $3,000,000 Aggregatx:- 93_00 <br /> Terrorism Risk Insurance Act $0.00 <br /> G. Deductible(if applicable) $0 each Incident Total: $93.00 <br /> 1 —-----=---- <br /> 7. The Named Insured is: ER Sole Proprietor(including Independent Contractors) ❑Partnership 0 Corporation <br /> ❑Other. Affiliation: 3410-Trager Approach Prof Liability, <br /> 8. Business or Occupation of the Named Insured:AS STATED IN THE'T\LkSTER POLICY DECLAIL�,TIONS OR,IF <br /> APPLICABLE,AS ENDORSED HEREON <br /> 9. This policy is made and accepted subject to the printed conditions of this policy together with the provisions,stipulations and <br /> agreements contained in the following form(s)or endorsement(s): <br /> HCPL-2026(11/09),HCPL-2038(11/09),HCPL-8002 (11/09),HCPL-8004(11/09) <br /> HCPL-8005(11/09),HCPL-8086(11/09),HCPL-8001 (11/09), <br /> OFAC (08/09),HCPL-2026-9000-NC(4/10) <br /> REPRESENTATIVE-: <br /> Agent. Mercer Consumer,a service of <br /> Mercer Health&Benefits Administration LLC <br /> Office Address: P.O.Box 14576 <br /> Des Moines,IA 50306-3576 <br />