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DocuSign Envelope ID: o240er38-3r84-4*4e'e0e8-C4r5eAC37487 <br /> C ^81 *02/22/ 16~MAC5O25102'00^511354745 ~D/8° ORIG IMAGE COPY <br /> 0410446 GREAT AMERICAN E&S |NS CO <br /> Administrative Offices <br /> CG 74 00 (Ed. 07 01) <br /> no/cwxmmm <br /> G«mEmAm ER2CAN | Cincinnati on4am2-4m1 Policy No. MAC 502'51 '82 - 00 <br /> INSURANCE GROUP | mxx6onnoupx ' <br /> GENERAL LIABILITY COVERAGE PART <br /> DECLARATIONS PAGE <br /> • <br /> NAMED INSURED: KAH CARE, LLC POLICY PERIOD: <br /> 02/ 16/ 16 to 02/16/ 17 <br /> LIMITS OF INSURANCE: <br /> General Aggregate Limit (Other Than Products - <br /> Completed Operations) $ 3, 000, 000 <br /> Products - Completed Operations Aggregate Limit $ 3, 000, 000 <br /> Personal and Advertising Injury Limit $ 1 , 000 , 0 O 0 <br /> Each Occurrence Limit $ 1 , UOD DOO <br /> Damage to Premises Rented to You Limit $ 1 0 O 000 Any One Premises <br /> Medical Expense Limit 5, OOO Any One Person <br /> FORM OF BUSINESS: <br /> TOTAL ESTIMATED PREMIUM: $ 1 , 5 7 2 <br /> Products/Completed Operations All Other <br /> $ INCL $ INCL <br /> SCHEDULE OF LOCATIONS: <br /> LOCATION 1 : 4905 PINE CONE DRIVE, STE 2 ; DURHAM, NC 27707 <br /> CODE NUMBER: PREMIUM BASIS: <br /> CLASSIFICATION: <br /> PER CG7401 <br /> Products/Completed Operations All Other <br /> Exposure: Exposure: <br /> Rate: Rate: <br /> Premium: Premium: <br /> FORMS AND ENDORSEMENTS applicable to this Coverage Part and made a part of this Policy at the time of <br /> issue are listed on the attached Forms and Endorsements Schedule CG 88 01 (11/85). <br /> CG 74 00 (Ed. 07/01) PRO (Page 1 of 1) <br />