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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 /> Name and mailing address of insured: <br /> Family Centered Healthcare, PA <br /> 400 Millstone Drive <br /> Suite 100 <br /> Hillsborough,NC 27278 <br /> This is to certify that MAG Mutual Insurance Company has issued a Blanket Employee <br /> Endorsement under the Medical Professional Liability Policy to the insured listed above, subject <br /> to the provisions of the current policy contract. <br /> Policy Number: Effective Date: Expiration Date: <br /> PSL 1701979 08 2/1/2016 2/1/2017 <br /> Shared Limits of Liability with the Organization: <br /> $1,000,000 Each loss limit <br /> $3,000,000 Aggregate limit <br /> Covered Employee(s): <br /> Tracy Bennett McLeod, NP <br /> James Wright, NP <br /> This document is issued as a matter of information only and confers no rights upon the document <br /> holder. This document does not amend, extend, or alter the coverage, terms, exclusions, <br /> conditions, or other provisions afforded by the policies referenced herein. <br /> Please inquire directly with the insured for individual restrictive endorsements that may apply. <br /> In the event of cancellation of the described policy, MAG Mutual will make reasonable effort to <br /> notify the party at whose request this certificate was issued, but MAG Mutual shall not be liable <br /> in any way for failure to give such notice. <br /> C>26- 11) alfp <br /> Lisa Coppolino <br /> Authorized Representative <br /> June 22, 2016 <br /> MAG Mutual Insurance Company <br /> P.O. Box 52979 <br /> CI-ESPB Ed. 01/14 Atlanta, GA 30355-0979 <br />