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000uSign Envelope ID:uraou400'ons5-44 oFosos <br /> CERTIFICATE OF INSURANCE MAG Mutual Insurance Company <br /> Certificate issued to: <br /> Blue Cross/Blue Shield - North Carolina <br /> Attn: CredenUa|ing <br /> P.{}. Box 2281 <br /> Durham NC27703 <br /> Name and mailing address of insured: <br /> Family Centered Healthcare, PA <br /> 4OO Millstone Dr. <br /> Ste. 100 <br /> Hillsborough, North Carolina 27270 <br /> This is to certify that K4AG Mutual Insurance Company has issued a Medical Professional Liability Policy bothe insured <br /> listed above, subject to the provisions to the current policy contract and any endorsements. <br /> Policy Number: Effective Date: Expiration Date: <br /> PSL170187S08 February 1, 201M February 1. 2O17 <br /> Limits <br /> Each loss/Aggregate limit Retroactive Date:: <br /> 1.000,000/3.000'000 02/01/2009 <br /> TOTAL L|Q8ll[S $1.000'000/$3.000'000 <br /> This document is issued as matter ofinformation only and confers no rights upon the document holder. This document <br /> does not amend, extend, or alter the coverage, terms, exo|usinne, oondiiiona, or other provisions afforded by the policies <br /> referenced herein. <br /> Please inquire directly with the insured for individual restrictive endorsements that may apply. In the event ofcancellation <br /> of the described policy, N1AG Mutual will make reasonable effort to notify the party at whose request this certificate was <br /> issued, but PWAG Mutual shall not be liable in any way for failure to give such notice. <br /> K4A{S K4UtU@| Insurance Company <br /> P[] Box 52Q7S <br /> Atlanta, GA3O355-007& <br /> Page I of <br /> CINS Ed.01/14 12/22/2015 <br />