2015-102-E Health - Wake Med Health and Hospitals and Wake Medical Laboratory Consultants for laboratory testing

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DocuSign Envelope ID: 72574FBA-38BB-482F-A711-18C4CFEC2EDF.,' umber Polic`"Number S 19408851V1 S 1940885 BUSINESS AUTOMOBILE COVERAGE DECLARATION Policy Effective Date: JUNE 7, 2014 Coverage Effective Date: JUNE 7, 2014 Business of Named Insured: MEDICAL Item Two-SCHEDULE OF COVERAGES AND COVERED AUTOS. This policy provides only those coverages where a charge is shown in the premium column below. Each of these coverages will apply only to those"autos"shown as covered"autos." "Autos"are shown as covered"autos"for a particular coverage by the entry of one or more of the symbols from the COVERED AUTO Section of the Business Auto Coverage Form nest to the name of the coverage. Covera a Schedule Coverages Covered Limit Premium Autos The Yost we Ivill Pay For Any One Accident or Loss Symbols Liability 7,8,9 $1,000,000 CSL — Personal Injury Protection(or First Party Benefits) Separately stated in each P.I.P.Endorsement. Added Personal Injury Protection Separately stated in each P.I.P.Added Endorsement (or Added First Party Benefits) Auto Medical Payments 7 $5,000 — Uninsured Motorists 7 SEE ENDORSEMENT: CA-2107 — Underinsured Motorists Physical Damage Comprehensive Coverage 7 Actual Cash Value or Cost of Repair,whichever is less - minus any applicable deductible shown on the Auto Schedule for Each Covered Auto for all Loss except Fire or Lightning. Physical Damage Specified Causes of Loss Coverage Actual Cash value or Cost of Repair,whichever is less minus $25 deductible for Each Covered Auto for Loss caused by Mischief or vandalism. Physical Damage Collision Coverage 7 Actual Cash value or Cost of Repair,whichever is less - minus the applicable deductible shown on the Auto Schedule for Each Covered Auto. Physical Damage Towing and Labor Coverage Alto. for Each Disablement of a Private Passenger Hired Auto and Non-Owned Auto Coverage INCL. Auto Schedule Trade Body Type vehicle Id.No. Size Use/Class/Radius List Purchased by Insured No. Name I Year Truck Size (N"IN) Class Code Symbol Year I N/U Cost NC 1 HOND 12 FIT SPORT 118295 22 NC 2 HOND 10 FIT SPORT 118295 22 Liability Add. lied. um uim Physical Damage Insurance Towing P.I.P or Prem. No. Terr. Insurance P.I.P.or Paymts. Motorists Comprehensive Specified Causes of Collision Premium F.P.B. F.P.B.. Prem. Premium Ded. Prem. Loss Ded, Prem. NC 1 016 ■ 1,000 ■ 1,000 - NC 2 016 ■ , 1,000 ■ 1,000 - Totals S AN Items Three—Schedule of Covered Autos You Own(see Auto Schedule)—Loss Payees Subject to Loss Payable Clause: Vehicle No Name and Address of Loss Payee Forms and Endorsements: Total Premium Refer to "Commercial Policy Forms and Endorsement Schedule" - (This premium may be subject to adjustment.) CA-7057(02/92) INSURED'S COPY