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DocuSign Envelope ID: 72574FBA-38BB-482F-A711-18C4CFEC2EDF <br /> X33«,,u Uy —� .�LV, -—3Uxance Company Policy Number <br /> S 1940885 <br /> SELECTIVE INSURANCE COMPANY OF SOUTH CAROLINA <br /> 3426 TORINGDON WAY, CHARLOTTE,NC 28277 <br /> COMMERCIAL POLICY COMMON DECLARATION <br /> Named Insured and Address Policy Period <br /> RALEIGH PATHOLOGY LABORATORY ASSOCIATES PA & WAKE MED From: JUNE 7, 2014 <br /> LABORATORY CORP To: JUNE 7, 2015 <br /> PO BOX 14045 <br /> RALEIGH, NC 27620-4045 12:01 AM Standard Time At <br /> Location of Designated Premises. <br /> Named Insured is: Producer Number: <br /> CORPORATION 00-07265-00000 <br /> Producer: <br /> MMIC AGENCY, LLC <br /> NORTH CAROLINA <br /> Schedule of Coverage <br /> COMMERCIAL AUTOMOBILE COVERAGE <br /> BUSINESSOWNERS COVERAGE <br /> COMMERCIAL UMBRELLA COVERAGE <br /> PREMIUM INCLUDES TERRORISM COVERAGE - <br /> In return for payment of the premium,and subject to all the terms of this policy, we agree with <br /> you to provide the insurance indicated in the schedule above. Insurance is provided only for <br /> those coverages for which a specific limit is shown on the attached coverage declaration(s). <br /> PAYMENT METHOD Total Policy Premium - <br /> D/B - 4 (This premium may be subject to adjustment.) <br /> Date Issued: MAY 13, 2014 <br /> Issuing Office: SERVICE CENTER <br /> Authorized Representative <br /> IL-7025 (11/89) <br /> INSURED'S COPY <br />