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The University of North Carolina Liability Insurance Trust Fund <br /> Legal Department Telephone:(919)966-3041 <br /> UNIVERSITY OF NORTH CAROLINA HOSPITALS Facsimile:(919)966-6285 <br /> 101 Manning Drive,2nd Floor,Wing E <br /> Chapel Hill,NC 27514 <br /> CONFIRMATION OF INSURANCE COVERAGE FOR PROFESSIONAL LIABILITY <br /> This Confirmation of Insurance Coverage is being issued specifically to verify professional liability <br /> coverage for the referenced insureds while practicing within the scope of their employment <br /> responsibilities during the dates of coverage noted. This information should be treated confidentially. <br /> INSURED: Adam Jason Zolotor, MD <br /> DATES OF COVERAGE: 08/15/01 —06/30/15 <br /> NAME OF CARRIER: UNC Liability Insurance Trust Fund <br /> AMOUNT OF COVERAGE: 07/01/04—06130/15 <br /> Covered individuals are subject to a limit of$3 million for <br /> all damages against a covered individual arising out of a <br /> single claim. The total limit of liability for all loss arising <br /> out of a single claim is$7 million regardless of the number <br /> of insureds involved. <br /> 05/01/03—06/30/04 <br /> $7 million of professional liability self-insurance coverage <br /> for each individual. <br /> 07/01/02—05/01/03 <br /> $7 million of professional liability self-insurance retention per <br /> claim. <br /> Additional self-insurance and commercial excess insurance <br /> over and above the primary retention. <br /> 08/15/01 —06/30/02 <br /> $3.5 million of professional liability self-insurance <br /> coverage for each individual. <br /> Plus commercial excess insurance over and above the self- <br /> insured coverage. <br /> CURRENT POLICY TYPE: Occurrence basis <br /> POLICY NUMBER: Not applicable <br /> CLAIMS HISTORY: None <br /> ,Ali <br /> Completed by: Date: f' <br /> J' Himer en, BSN, JD <br /> Associate V.P. of Risk Management, <br /> Accreditation & Regulatory Affairs <br /> University of North Carolina Hospitals and the School of Medicine of the University of North Carolina at Chapel Hill <br />