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DocuSign Envelope ID: 30CC97DC-995F-48ED-9245-A640EBC3CAOC <br /> firS <br /> .,refit <br /> bsurance Company <br /> i South Wacker drive; Suite 2380 <br /> Chitgo, IL 80 <br /> 31Z-11.5-3010 <br /> MULTIPLE PERIL POLICY <br /> DECLARATIONS <br /> Policy Number: RPM 06032 00 Producer:InWrance.service Center of Fayetteville,Inc., <br /> Rene lot,Policy Number: New <br /> Named Insured: Bethesda Care Lt_C <br /> :Keston Care <br /> lirwg Ad it ; <br /> 11312 Hit 15-501,North <br /> Chatham Crossing Ste 400 <br /> Chapr i Hill NC 27514 <br /> Coverage. From 1,3/612014 To 10/6/2015 <br /> 12:Q'i e.rrt.Local 1 I �t.Your <br /> Tett�t of - <br /> .Mailing,Addrass 8hovtun Above <br /> First Annual Premium: <br /> Coverages Provided <br /> In reW rn to your poyment:Of the required prorniurn,We provide the coverage.described In this,polloy <br /> 112gigdod <br /> A- General.Conditions <br /> Property insurances <br /> B. Terms.&Condftns Alt Property and Related Coverages <br /> . Optional Coverages <br /> C. General Property <br /> D. Income Protection&.Extra Expense El <br /> E Shied>Personal.Property I <br /> F. Compoters E3 �. <br /> Go Crime. d - <br /> `Primary Liability,insurances <br /> H. Teams::&.Condifioii*-Prknary Inability Coverage a <br /> Optional Coverages: <br /> t. Bodily1rajutyar1d".P'roprty Darrage,t.iability <br /> J. Sexual Abtase-LiaibWty " <br /> K. Social Work,fosWr Care and Counseing:Liability <br /> L Medical Liability <br /> I <br /> M. Personal-and Adverftiqg Injury Liability I <br /> N, Mort4>wned and Hired Auto Lfabiflty <br /> 0. Medical:Payments <br /> P. Employes"Benefits Administration Liability <br /> Additional Corms applicable to this policy: <br /> Bate: 4:- by: L{ ' <br /> First Nonprofit Insureraee.'iCOM rvy <br /> Authorized Rapre ntalive <br /> ]kV ,0412.0110 PKG 1000 <br /> Page 1 o 5 <br />