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DocuSign Envelope ID 0208AF55-755a4sF2eF17es6o613e5e33 <br /> C|ient # 1705681 <br /> MEMORANDUM OF INSURANCE Date Issued 05/05/2016 <br /> Producer This memorandum is issued as a matter of information <br /> only and confers no rights upon the holder. This <br /> Mercer Consumer, a service of memorandum does not amend, extend or alter the <br /> Mercer Health & Benefits Administration LLC coverages afforded by the Certificate listed below. <br /> P.O. Box 1457G <br /> Des Moines, |A5O3OG'357G <br /> 1'800'503'8230 Company Affording Coverage <br /> Insured Liberty Insurance Underwriters Inc <br /> Ryan N Lavalley <br /> 100 Rock Haven Road <br /> Apartment 203P <br /> Carrboro NC 27510 <br /> This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated, <br /> not withstanding any requirement, term or condition of any contract or other document with respect to which this <br /> memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the <br /> terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. <br /> Type of Insurance Certificate Number Effective Date Expiration Date Limits <br /> Professional Liability AHY-823973001 05/05/2016 05/05/2017 Per Incident/ �2 ��� 000 <br /> []CCUpThpSE Occurrence - ' ' <br /> Occupational Therapist <br /> Annual Aggregate $4,000,000 <br /> PROOF OF INSURANCE <br /> Memorandum Holder: Should the above describe Certificate be cancelled <br /> before the expiration date thereof, the issuing company <br /> PROOF OF COVERAGE ONLY <br /> will endeavor to mail 30 days written notice to the <br /> Memorandum Holder named to the left, but failure to <br /> mail such notice shall impose no obligation or liability <br /> of any kind upon the company, its agents or <br /> representatives. <br /> Authorized Representative <br /> Mark Brostowitz <br /> Olnk66,-Ut. k)shfr <br /> Mercer Consumer,a service of Mercer Health& Benefits Administration LLC. In CA d/b/a Mercer Health& Benefits Insurance Services LLC. CA Ins Lic. #0G39709 <br /> - ~ <br />