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000uSign Envelope ID:uraou400'ons5-44 oFosos <br /> CERTIFICATE OF INSURANCE MAG Mutual Y Company <br /> Certificate issued to: <br /> Duke University Hospital <br /> Cnedentia|ing Services Office <br /> Box 3251 <br /> Durham NC 27710 <br /> Name and mailing address of insured: <br /> C>aiO E. Vines, M.D. <br /> 4O0 Millstone Dr. <br /> Ste. 100 <br /> Hillsborough, North Carolina 27278 <br /> This is to certify that MAG 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 /> PSL17O107Q08 February 1. 2O10 February 1' 2017 <br /> Limits <br /> Each loss/Aggregate limi Retroactive Date: <br /> 1,000.000/3.000'000 04/09/2002 <br /> TOTAL LIMITS 1'000,000/3'000.000 <br /> This document is issued as n matter nfinformation only and confers no rights upon the document holder. This document <br /> does not amend, exbsnd, or alter the ooveraQe, harmo, oxo|usione, oondibona, 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, MAG Mutual will make reasonable effort to notify the party atwhose request this certificate was <br /> issued, but MAG Mutual shall not be liable in any way for failure to give such notice. <br /> Authorized F�6presentative <br /> K4AG Mutual Insurance Company <br /> PD Box 52979 <br /> Atlanta, GA3O355-0079 <br /> Page of <br /> CINS Ed.01/14 12/22/2015 <br />