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DocuSign Envelope ID: 58340D10-53F7-460D-9D47-DA2ED9BEB980 <br /> Medical Mutuar ^ <br /> PROTECTING OUR PROFESSION <br /> CERTIFICATE OF INSURANCE <br /> This certificate is issued as a matter of information only and confers no rights upon the certificate holder. <br /> This certificate does not amend,extend, or alter the coverage afforded by the policies listed below. <br /> INSURED: <br /> Triangle Urology Associates PA <br /> 205 Frasier St <br /> Durham,NC 27704 <br /> COMPANY AFFORDING COVERAGE: <br /> Medical Mutual Insurance Company of North Carolina <br /> 700 Spring Forest Road 4th Floor <br /> Raleigh,NC 27609 <br /> TYPE OF INSURANCE: Claims-Made Professional Liability <br /> POLICY NUMBER: PG113371 RETROACTIVE DATE: March 1, 1978 <br /> ( POLICY PERIOD: <br /> FROM: January 1,2016;12:01 A.M. TO: January 1,2017;12:01 A.M. <br /> LIMITS OF LIABILITY: <br /> EACH CLAIM ANNUAL AGGREGATE <br /> 3,000,000 5,000,000 <br /> Date: October 29,2015 <br /> Authori et •epresentative <br /> Certificate Holder: <br /> MEDICAL MUTUAL INSURANCE COMPANY <br /> PM0901NC(06/08) OF NORTH CAROLINA SPRATLT <br />