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DocuSign Envelope ID:977F9724-0D69-4F35-BE42-796A38945969 <br /> CERTIFICATE OF INSURANCE MAG Mutual Insurance Company <br /> Certificate issued to: <br /> Blue Cross/Blue Shield - North Carolina <br /> Attn: Credentialing <br /> P.O. Box 2291 <br /> Durham NC 27702 <br /> Name and mailing address of insured: <br /> Family Centered Healthcare, PA <br /> 400 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 to the insured <br /> listed above, subject to the provisions to the current policy contract and any endorsements. <br /> Policy Number: Effective Date: Expiration Date: <br /> PSL 1701979 08 February 1, 2016 February 1, 2017 <br /> Limits <br /> Each loss/Aggregate limit Retroactive Date: <br /> 1,000,000/3,000,000 02/01/2009 <br /> TOTAL LIMITS $1,000,000/$3,000,000 <br /> This document is issued as a matter of information only and confers no rights upon the document holder. This document <br /> does not amend, extend, or alter the coverage, terms, exclusions, conditions, 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 of cancellation <br /> of the described policy, MAG Mutual will make reasonable effort to notify the party at whose request this certificate was <br /> issued, but MAG Mutual shall not be liable in any way for failure to give such notice. <br /> i"a t.. (c 1. & ;h , <br /> i <br /> Authorized Representative <br /> MAG Mutual Insurance Company <br /> PO Box 52979 <br /> Atlanta, GA 30355-0979 <br /> Page 1 of 1 <br /> CINS Ed.01/14 12/22/2015 <br /> __._..., ..._.-_._._..._..........__... <br />