2014-566-E Health - Rachel Sigmon for Dental Services $35,000

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FORTRESS SENT VIA CERTIFICATE OF MAILING September 26,2014 Rachel Anne Gregg Sigmon, DDS Policy Number: 3017314 4045 Cleburne Court Renewal Date: 12/1/2014 Haw River, NC 27258 Agency: Asset Protection Group, Inc Phone Number: (804)423-7700 SUMMARY OF CHANGES TO YOUR NORTH CAROLINA FORTRESS PROFESSIONAL LIABILITY POLICY This notice is to inform you of the changes made to the Fortress Dental Professional Liability insurance policy. Such revisions will take effect upon the renewal date of your Fortress policy. We would like to take this opportunity to review your policy changes. This summary is intended to provide general information concerning your insurance policy and is not complete. All coverages are subject to the limits of liability,conditions and other terms of the policy form and endorsements. Please read this notice carefully to understand the changes that have been made to your policy. If you have any questions, please contact your Fortress agent. Your agent will provide you with a copy of your new Fortress policy along with your renewal documents shortly. PREMIUM NOTICE Your renewal premium will be$817.00. You will be invoiced approximately 30 days prior to the effective date of your new policy term. SUMMARY OF POLICY CHANGES The Fortress policy can be issued to an individual (Fortress Individual Policy)or a corporate entity(Fortress Entity Policy)as defined in the policy and outlined on the Declarations Page. Please see the revisions to the Fortress policy outlined in each section below. Sectia 1.Coverage Aafeemefif - -- — —• The consent to settle provision no longer contains the condition that the named insured must be a current Fortress insured to exercise their right to consent to settle. • The policy clarifies that Fortress has the right, but not the duty,to appeal any judgments,findings, orders or rulings. _Section Il.Supplementary Payments (New section specific to a Fortress Individual Policy) • The policy will pay$250 per day in actual lost wages, not to exceed$5,000 in any policy period,for attendance at trial or depositions, other than his/her own.This benefit has been expanded to include depositions other than his/her own and been increased by$50 per day. • The First Aid Expenses have been increased from$5,000 to$10,000. Section Ill. Persons Insured(This sections replaces the Protected Parties section of existing oolicY) ■ The definition of an Additional Insured Entity(ies)has been modified to provide coverage only to a named insured's sole shareholder entity. If the sole shareholder entity becomes a multi-shareholder entity, coverage will be afforded as outlined in the policy. CN-NC(01/14)