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DocuSign Envelope ID:8F6AD7AB-CE9D-40C4-B5FA-6FCBA99F62F3 <br /> LA FRS LIABILITY INSURANCE "i020 VVeston Parkway, Suite 200 910.677.8900 t <br /> Cary, North Carana 2751 i 800.662.8843 TO <br /> k0 <br /> 4 COM PA N Y OF 919.677.9641 tAX <br /> MUTUAL NORTH CAROLINA Post Office Box 1929 <br /> (ary, North Carolma 27512-1929 www.lawyersmuttiainccom <br /> Insured Listing / Prior Acts. Date Endorsement <br /> This Endorsement, effective 12:01 A.M. on 07/01/2016 forms a part of Policy No. 31629-4 (the <br /> "Policy") issued by LAWYERS MUTUAL LIABILITY INSURANCE COMPANY OF NORTH CAROLINA and <br /> applies to HOLCOMB&CABE LIP(the "Named Insured"). <br /> It is hereby understood and agreed that as to each Insured listed below, this Policy shall not apply <br /> to such Insured's act(s) or omission(s), or series of related act(s) or omission(s), occuring or <br /> beginning prior to the date listed individually for each Insured below("Prior Acts Date"). <br /> All Policy provisions, terms, exclusions, and conditions, except as provided otherwise in this <br /> Endorsement, remain in full force and effect. <br /> Name Licensing State License Prior Acts Date <br /> (or Other), Number <br /> 1. SAMANTHA HYA I I CABE NC 28461 09/03/2002 <br /> 2. CAROL JAN HOLCOMB NC 16357 04/30/1989 <br /> Authorized Agent <br /> END#: 012 (0a/01/2015) Page 1 of 1 AttyLiStPALE 31629 2016 <br />