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. �' <br /> DocuSign Envelope|o:errFeru4-0ose4Fa5-Bs42-7esAaoe45ese <br /> o <br /> PREMIER BUSINESSOWNERS POLICY <br /> PREMIER OFFICE <br /> PROPERTY DECLARATIONS Policy Period: <br /> Policy Number: ACPBPOK2273711Y51 From 11-04-15 To 11-04-16 <br /> Description of Premises Number: 003 Building Number: 001 Construction: FRAME <br /> Premises Address 400 MILLSTONE DR STE 100 HILLSBOROUGH NC 37278'9007 <br /> Occupancy T Classification: PHYSICIANS & SURGEONS <br /> Described as: MEDICAL CLINIC <br /> � <br /> WE PROVIDE INSURANCE ONLY FOR THOSE COVERAGES INDICATED BY A LIMIT OR BY "INCLUDED'. <br /> The Property Coverage provided at this premises is subject to a $ 500 Deductible. unles otherwise stated. <br /> COVERAGES LIMITS OF INSURANCE <br /> Building - <br /> NOT PROVIDED <br /> Business Personal Property - Replacement cost $183,600 <br /> AD00[IONALCOVERA«3ES ' theCovaraQmFonn |nc|udemcthmrAdditiona| Covmnugwonotshovvm <br /> Buoinoss|ncomw'ALG' 12 Months- NOHourVVaitingPeriod 0UDay Ordinary Payroll Limit shown. INCLUDED <br /> Extra Expense - Actual Loss Sustained (ALS) - 12 Months - NOHourVVaiting Period INCLUDED <br /> Equipment Breakdown <br /> INCLUDED <br /> Automatic Increase in Insurance - Building NOT PROVIDED <br /> Automatic Increase in Insurance - Business Personal Property 2.9% <br /> Back Up of Sewer and Drain Water (limit shown per Bui|ding, subject to $26.000 policy aggregate) <br /> ^ <br /> $5,000 <br /> OPTIONAL INCREASED LIMITS Included Limit Additional Limit <br /> Account Receivable $25,000'OQ $25 000 <br /> Valuable Papers and Records (At the Described Premises) $25'000 $25"000 <br /> - <br /> Forgery and Alteration $10,000 $I0"000 <br /> y�onoyand Securities ' Inside the Premises VlU » <br /> ' o ���"000 <br /> Outside the Premises (Limited) $I0,000 $10,000 <br /> Outdoor Signs $2,500 " <br /> ' �� 500 <br /> Outdoor Trees Shrubs, Plants and Lawns $IV [ � ] " <br /> . . v,ouu �l� 000 <br /> Business Personal Property Away From Premises ! I� UOU ` <br /> + ' �X� W00 <br /> Business Personal Propo�yAvvayFrom Premises Transit *I� -V' ` <br /> - -�'v»» $15000 <br /> ' �%D <br /> Electronic Data $10,000 , <br /> $10,000 <br /> Interruption of Computer Operations $10,000' $10,000 <br /> Building Prope�ynfOthers $10,000 10`0O0 <br /> OPTIONAL COVERAGES - Other frequently purchased coverage options <br /> $5,000 Policy Occurrence ' <br /> Employee Dishonesty $5 <br /> ' INCLUDED <br /> Ordinance or Law - 1 - Loss to Undamaged Portion NOT PROVIDED <br /> 2 - Demolition Cost and Broadened Increased Cost of Construction NOT PROVIDED <br /> Ordinance or Law Broadened NOT PROVIDED <br /> � . <br /> PROTECTIVE SAFEGUARDS <br /> This premise has Protective Safeguards identified by symbols below. Insurance for Fire or Burglary and Robbery <br /> at this premise will be excluded if you do not notify us immediately if any of these safeguards are impaired <br /> See PB 04 30 for a description of each symbol. APPLICABLE SYMBOLS: P-2; P-7; <br /> - <br /> PB 81 01 (04-11) NATIONWIDE PIROPERTY & CASUALTY INS CO Page 1 of 2 <br /> DIRECT BILL MACH MAC INSURED COPY UID 63 22 33006 <br />