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DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF <br /> k?$V cr?M cmpany <br /> 1 South Wacker DriVe, Suite 2380 <br /> Chicago, IL 60606 <br /> 312-715-3010 <br /> UMBRELLAUABILITYPOUCY <br /> C 5NERAl..DECLARATIONS <br /> Policy Number.: NAm sioo=3 oo Producer i f Fy ,t a ce nr. <br /> 'Renewal of Policy Nufhber.: Now <br /> 1. Named Insured: Ewthesda care LLc <br /> 1.1312 Hwy 15-501 North <br /> Main t th ix s: Cheaham Crossing Ste 400 <br /> Chapel Hilt N0,27514 <br /> 2. Policy Penod: From: I(YW2o14 To: tat ols <br /> 12:01 a.m. Local Time at Mailing.Address Above <br /> 3. Annual Pren ium- <br /> 4. Limits of Insurance and Retention: <br /> a. 1.170000 Each' occurrence Limit <br /> b. 1,00o,00o General Aggregate Limit <br /> C' - � Retained Limit <br /> Underlying Policies and Limits: <br /> Coverage Limits Insurer T. <br /> �,aoo,a�o Grcc+i�eRCa B iota naxee- 1q;�r�sta <br /> General <br /> Liability t06JTfPi 5 <br /> NPP1006= 3;a00000 1Gener Ay®reyaae <br /> Employees <br /> . SQp.ifUi) .AtaefiACCidaiit. Stmsswaoq 7!i}12E7t4 , <br /> Liability <br /> W0100-009512 5£30.000 f0i®eese Po y L ! <br /> Other.Liability 500.000 Uwase Ewh EffOoyee <br /> Additional Farms Applicable To This Policy At Issuance: <br /> 8 ' <br /> Date:1"M14 Br_ <br /> Authorit0d Representative <br /> Fi t lit rofit i,rraure lr r p€tny <br />