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DocuSign Envelope ID: DAAE2CBD-CD76-4858-84F5-E9B3F7DOOBBC <br /> EASTERN DENTISTS INSURANCE COMPANY <br /> (A Dental Society Risk Retention Group) <br /> CERTIFICATE OF INSURANCE <br /> This certificate is issued as a matter of information only and confers no rights upon the certificate <br /> holder.This certificate does not amend, extend, or alter the Ucovera�eafhzr6eJbythepu|iciessted <br /> below. <br /> INSURED: <br /> Diane C, Shugars, DDS <br /> 136 Owen Towne Road <br /> Chapel Hill, NC 27516 <br /> COMPANY AFFORDING COVERAGE: <br /> Eastern Dentist Insurance Company <br /> 200 Friberg Parkway, Suite 2002 <br /> Westborough, MA 01581 <br /> TYPE OF INSURANCE: Claims Made Professional Liability <br /> POLICY NUMBER: NCC1800363 <br /> RETROACTIVE DATE: 06B01/2011 <br /> POLICY PERIOD: <br /> FROM: 06/01/2016 ; l2:OIA`K8 TO: 06/01/2017 ; 12:O1A.M. <br /> LIMITS OF LIABILITY: <br /> EACH CLAIM ANNUAL AGGREGATE <br /> $ 1.00O.O0O $ 3.00O.000 <br /> 111_ Date Issued: May 20, 2016 <br /> Hope Maxwell <br /> President and CEO <br /> Eastern Dentists Insurance Company <br /> 200 Friberg Parkway, SUhc2U0lWestborough, MA 01581-3899 <br /> 1-800-898-3342 • 508-836-4204 • 5Ox'856-99lU Fax w www.edic.com <br />