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Fireman's Fund"' <br /> mil".19D Insurance Company <br /> CHICAGO INSURANCE COMPANY <br /> Executive Offices 33 W.MONROE STREET <br /> CHICAGO,ILLINOIS 60603 <br /> MEDICAL PROFESSIONAL LIABILITY OCCURRENCE INSURANCE POLICY <br /> Region Producer Issued I Prior Certificate Number Purchasing G-oup Policy Number <br /> 23 0004656 12/30-2012 1 AHL6800038 44-2010129 <br /> OFFERED THROUGH THE:Allied Health Purchasing Group Association <br /> DECLARATIONS <br /> SECTION I <br /> Item CERTIFICATE NUMBER: AHL 6800038 <br /> 1. Named Insured: Robert E. Dupuis <br /> 2. Mailing Address: 104 Airport Drive <br /> Suite 2700 <br /> Campus Box 1100 <br /> Chapel Hill, NC 27599 <br /> 3. Policy Period: From: 12/22/2013 To: 12/22/2014 <br /> 12:01 A.M.Standard Time At Location of Designated Premises <br /> 4. Business or Profession: Pharmacist <br /> 5. The Named Insured is a(n): Individual-Employed <br /> 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 forms(s)or endorsement(s): <br /> PLJ-2037(05198) (Ed. 09111), PLE-2087 (04/00), PON-2003 (03/10), POE-2151 (10198) <br /> SECTION 11 <br /> Item COVERAGE Premium <br /> A. Professional Liability X $151.00 <br /> B. General Liability <br /> Endorsements <br /> TOTAL PREMIUM: $151.00 <br /> LIMITS OF LIABILITY <br /> $1,000,000.00 each Incident and each Occurrence $3,000,000.00 Aggregate <br /> SECTION III <br /> SUPPLEMENTARY PAYMENTS <br /> A. First Party Assault <br /> B. Licensing Board Reimbursement <br /> C. Wage Loss and Expense <br /> D. Deposition Expense <br /> E. First Aid Reimbursement <br /> Administered by: Hays Affinity Group Broker: NCAIA <br /> 1400 Renaissance Drive,Suite 300 P.O.Box 1165 <br /> Park Ridge,IL 60068 Cary,NC 27512 <br /> (847)939-8300 <br /> PLP-2037(05/98)(Ed.09109) 0 2009, Fireman's Fund Insurance Company, Novato,CA.All rights reserved. <br />