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DocuSign Envelope ID:045AF678-3763-4394-A072-D12B1Ell3359 <br /> F <br /> THE NCANT) N COMPANY, <br /> P.O. Boo A5319 Pir, 843-669-7223 <br /> I�1 ,01,HHCr, 'k)UTIT CUGLENA 29,902 F.,vX 843-669-7165 <br /> F` TI;RRTESnUw»rn RR,C L),M CERTIFICATE OF INSURANCE 'COT,r,FREE 1-866-502-615� <br /> Named Insured: North Carolina Association of Local Health Directors <br /> Mamance County health Department <br /> #_ This is to certify that the policies of insurance listed.below have bee issued to the insured <br /> roamed(above for the policy period indicated, Notwiths tan(ling any requirement,term or <br /> condition of ally contract or document Witt'respect to Which this.certificate may be issued <br /> or may pertain,the insurance afforded by the policies described herein is subject to tall <br /> terms,exclusions, and conditions ofsuch policies. <br /> Company.: Policy# Policy Term <br /> ACE Medical Risk-Ace American.Insurance MLP G21.686037-1.3 71112015-71112016 <br /> Coverage; Claims Made/Miscellaneous Medical Professional Liability <br /> Limit. $1,000,000 each claimW,000.,000 annual aggregate <br /> $20,000,000 policy aggregate <br /> Deductible: $5,000 per claim <br /> R etroactive Date: 7%11200.0 <br /> Additional Named Insured: Retroactive Dater <br /> 1Can ll Saxer,CNM . 9/1/2005 CNM <br /> Carla Seam Hampton.,.PA 7/V2000 PA <br /> Kathleen Shaple.y-Quinn,MD 5/5/2001 MD <br /> Elizabeth A. -Sciora,CNM 7/1/2000 CNM <br /> Westside OB/CTYN Additional Insured <br /> Elizabeth Krzysztofoa-ska, DDS 5/1/1998 DDS <br /> UNC,Chapel Ml S ofNursuig 11/512005 <br /> UNC, Chapel Hill S of Dentistry Additional Insured <br /> UNC G S ofNursing Additional Insured <br /> L Isa Cheren, MD/LT 8/1(2007 MD/LT <br /> Cass Emery,Hygentist 1113/2010 <br /> James Fetner,DDS 7/9/2012 DDS <br /> Suzanne Walter;RPh 12(112006 RPh <br /> Amanda Marvin,LCSW-A 9/2/2014 LCSW-A <br /> Nicole Alston, RD 5/3/2010 RD <br /> Janice Putman.,RD 12/31120/2 RD <br /> 1 <br /> Donna Dotson,RD <br /> �E 4/1 3/1994 RD ` <br /> Should the above described policy be canceller] before tile expiration(late thereof,the issuing <br /> company will endeavor to mail 30(Thirty)days.written notice to the Insured named above, <br /> The coverage represented by this certificate is subject to the teruts,conditions and limitations of the <br /> policies in current use by the carrier narned above. <br /> The Snowdim C.pmany, LG Date 5/1S/2015 <br /> Ter��—ef, t(t v n C�CP[1 <br /> f <br />