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DocuSign Envelope ID: 155D1985-9FE0-4EA7-B67C-F2531BFF9621 .....„rance Company Policy Number <br /> S 1940885 <br /> SELECTIVE INSURANCE COMPANY OF SOUTH CAROLINA <br /> 3426 TORINGDON WAY, CHARLOTTE, NC 28277 <br /> COMMERCIAL POLICY COMMON DECLARATION <br /> Named Insured and Address Policy Period <br /> RALEIGH PATHOLOGY LABORATORY ASSOCIATES PA & WAKE MED From: JUNE 7, 2016 <br /> LABORATORY CORP <br /> To: JUNE 7, 2017 <br /> PO BOX 14045 <br /> RALEIGH, NC 27620-4045 <br /> 12:01 A.M. Standard Time At <br /> Location of'Designated Premises. <br /> Named Insured is: <br /> Producer Number; <br /> CORPORATION <br /> 00-07265-00000 <br /> Producer: <br /> SENTINEL RISK ADVISORS, L LC <br /> NORTH CAROLINA <br /> Schedule of Coverage <br /> BUSINESSOWNERS COVERAGE <br /> COMMERCIAL UMBRELLA COVERAGE <br /> hmimmm <br />■•=m1 <br />••■=1M <br />=mom= <br /> PREMIUM INCLUDES TERRORISM — CERTIFIED ACTS $35 . 00 <br /> In return for payment of the premium, and subject to all the terms of this policy, we agree with <br /> you to provide the insurance indicated in the schedule above. Insurance is provided only for those <br /> coverages for which a specific limit is shown on the attached coverage declaration(s). <br /> PAYMENT METHOD Total Policy Premium $1,831 .00 <br /> D/B — 4 <br /> (Ibis premium may he subject to 'adjustment.) <br /> Date Issued: MAY 10, 2016 <br /> Issuing Office: SERVICE CENTER <br /> Authorized Representative <br /> IL-7025 (11/89) <br /> INSURED'S COPY <br />