2014-386 Health - Robert E. Dupuis for Direct Pharmacy Services at the two pharmacy sites of the Health Department $12,397

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IN ALASKA: All return premiums will be computed pro-rata. Pursuant to the Alaska Division of Insurance,we must provide to you and comply with the following notice: Your policy contains a provision relating to "Other Insurance". If any other valid insurance is primary, and permits contributions by equal shares,we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limits of insurance or none of the loss remains,which ever comes first. IN ARKANSAS, contact: Arkansas Insurance Department Consumer Services Division Third and Cross Streets Little Rock,Arkansas 72201 Phone: (501) 371-2640 IN INDIANA: Should you have a valid claim and feel you are not being treated fairly; you may contact the Indiana Department of Insurance at the address and phone number below with your complaint and seek assistance from the governmental agency that regulates insurance. Indiana Department of Insurance Consumer Services Division Phone: Consumer Hotline: 1-800-622-4461 311 West Washington Street, Suite 300 In Indianapolis area: 1-317-232-2395 Indianapolis, IN 46204-2787 IN MAINE. This policy will pay such post-judgment interest as provided by Maine law. IN MONTANA: Conformity with Montana statutes. The provisions of this policy conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of this policy. IN NORTH CAROLINA: Within 45 days after receipt of a written request from the Named Insured the Company shall mail or deliver loss information on open and closed claims covering a three-year period. In the event of policy cancellation or non-renewal, the Insured may elect to purchase coverage for the extending reporting period. The Insured may choose a limit of liability in the policy aggregate for the extended reporting period which is one hundred percent(100%) of the expiring policy aggregate that was in effect at the inception of the policy. IN TEXAS:COMPLAINT NOTICE: Should any dispute arise about your premium or about a claim that you have filed, contact the agent or write to the company that issued the policy or certificate. If the problem is not resolved, you may also write the Texas Department of Insurance, Consumer Protection Program, P.O. Box 149091, (333 Guadalupe, Austin, TX 78701). Austin, Texas 78714- 9091, Fax # (512) 475-1771. This notice of complaint procedure is for information only and does not become a part or condition of this policy or certificate. Please be advised that the insurance company issuing your policy[nay not be subject to all insurance laws and regulations of the State of Texas. FOR INFORMATION, OR TO MAKE A COMPLAINT, CALL.: 1-800-628-8574 IN SOUTH DAKOTA, contact: South Dakota Division of Insurance Consumer Services 445 E. Capitol Avenue Pierre, South Dakota Phone: 1-605-773-3563 IN VIRGINIA, contact: State of Virginia Bureau of Insurance Consumer Service Division Phone: (In-state toll free): 1-800-552-7945 P.O. Box 1157 (Out-of-state calls): 1-877-310-6560 Richmond,Virginia 23218 PON-2003(03/10) Page 2 of 3