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DocuSign Envelope ID: BDC7A23B-OD7B-4786-B452-D97DA48C507E <br /> Client#: 1793600 20MENGHAG <br /> ACOR©m, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD/YYYY) <br /> 02/22/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.TH1S <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> BB&T Insurance Services,Inc. PHONE 919 281-4500 FAX 8887468761 <br /> Post.Office Box 13941 E-MAIio,Ext): (A C,No): <br /> ADDRESS: <br /> Durham, NC 27709 INSURER(S)AFFORDING COVERAGE NAIC# <br /> 919 281-4500 NsuRERA:Cincinnati Insurance Company 10677 <br /> INSURED INSURER B <br /> Meng Monica Meng-Haggerty D.D.S. <br /> 215 Bluefield Road INSURER C <br /> Chapel Hill, NC 27517 INSURER D: <br /> INSURER E <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE INSR WVD POLICY NUMBER JMIWDD/YYYYUMM/DD/YYYY) LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE <br /> CLAIMS-MADE OCCUR _ PREMISES(Ea RENTED $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GE 'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO- <br /> POLICY JECT LOC PRODUCTS-COMP/OP AGG $ <br /> OTHER: _ $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE <br /> HIRED AUTOS AUTOS Per accidenll <br /> UMBRELLA LIAR - OCCUR EACH OCCURRENCE $ _ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE - ER , <br /> ANY PROPRIETOR(PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBEREXCLUDED? N/A <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Professional ENP0374709 04/09/2016 04/09/2019 $1,000,000/Occurrence <br /> Liability $3,000,000/Aggregate <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Meng Monica Men Ha art DDS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> 9 g gg ys THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 215 Bluefield Rd. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Chapel Hill,NC 27517 <br /> AUTHORIZED 7.f REPRESENTATIVE <br /> C 7.f„_ <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S15645611/M15645608 KYW <br />