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DocuSign Envelope ID:6B1B2B90-460D-4C49-8782-4A366509E11D 22 >> 919 644 3019 P 2/2 <br /> • LA YI C LIABILITY INSURANCE 5020 Weston Parkway,Suite 200 919,677,8900 ne <br /> �✓ COMPANY OF Cary,North Carolina 27513 000,662.8843 roil rues: <br /> MUTUAL NORTH CAROLINA Post Office Box 1929 919.677,9641 r�x <br /> Cary,North Carolina 27512.1929 www,lawyersmutualnc.com <br /> Declarations <br /> LEIGH PEEK, ATTORNEY AT LAW, P.C. Location: <br /> PO BOX 1059 307 MEADOWLANDS DR, SUITE 101 <br /> HILLSBOROUGH, NC 27278 HILLSBOROUGH NC 27278 <br /> Policy Number: 31219-5 <br /> Policy Period: 05/18/2016 to 05/18/2017 <br /> 12:01 A.M.Standard Time at the address of the Named Insured stated herein <br /> Prior Acts Date of <br /> Named Insured: 05/18/2012 <br /> Limits of Liability; A. $ 100,000 A, Applicable to any claim or one or more related <br /> claims, <br /> B. $ 300,000 13, Aggregate limit of the Company's liability for all <br /> damages and claims expenses without regard to <br /> the number of insureds, Extended Reporting <br /> Endorsements, claims, suits, or claimants. <br /> Deductible: C. $ 5,000 C. See INSURING AGREEMENT VI. Deductible and <br /> (including claims expenses) Limit of Liability. <br /> Premium: $ 2,12E <br /> Endorsement Attachments: <br /> 012 <br /> In witness whereof,Lawyers Mutual Liability Insurance Company of North Carolina has caused this Policy to be signed by its President and <br /> Secretary and countersigned by a duly authorized agent of the Company. <br /> Secretary <br /> / <br /> 4„0,, <br /> Pre ident Authorized Agent <br /> Lawyers Professional Liability Policy (This is a Claims-Made and Reported Policy. Defense costs are a part <br /> of the Policy Limits and reduce the amount available to pay losses.You should read your Policy for a <br /> complete understanding of its Terms,Conditions&Coverages). <br /> (08/01/2915,2) PolicyForm 31219 • 2016 <br />