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000uSign Envelope ID:uraou400'ons5-44 oFosos <br /> CERTIFICATE OF INSURANCE MAG Mutual U Compay <br /> Certificate issued to: <br /> University Of North Carolina Hospital <br /> Attn: Medical Staff Office <br /> 101 Manning Drive <br /> Chapel Hill NC27514-4335 <br /> Name and mailing address of insured: <br /> [>ain E Vines, M.D. <br /> 4OU Millstone Dr. <br /> Ste. 100 <br /> Hillsborough, North Carolina 27278 <br /> This into certify that K8A8 Mutual Insurance Company has issued e Medical Professional Liability Policy tothe insured <br /> listed above, subject to the provisions to the current policy contract and any endorsements. <br /> Policy Number: Effective Date: Expiration Date: <br /> PSL170197& O8 February 1' 2O18 February 1. 2U17 <br /> Limits <br /> Each loss/Aggregate limit Retroactive Date: <br /> 1.000.000/3.000.000 04/08/2002 <br /> TOTAL LIMITS 1,000.000/3.000.000 <br /> This document is issued as a matter ofinformation only and confers no rights upon the document holder. This document <br /> does not amend, extend, or alter the coverage, terms, exo|uoione, oonditinna, ur 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 of cancellation <br /> of the described policy, K4AG Mutual will make reasonable effort to notify the party at whose request this certificate was <br /> isaued, but yWAG Mutual shall not be |iob|o in any way for failure to give such notice. <br /> MAG Mutual Insurance Company <br /> PO Box 5297S <br /> Atlanta, GA30355'OH79 <br /> Page I of <br /> CINS Ed.01/14 12/22/2015 <br />