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DocuSign Envelope ID:440B28DD-5CC9-4584-A4BA-B6C20A397882 <br /> 06/09/2017 13:15 9199671050 PAKMAIL PAGE 02 <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 coverage afforded by the policies listed <br /> below. <br /> INSURED: <br /> Diane C. Shugars, DDS <br /> 136 Owen Towne Road <br /> Chapel Hill, NC 27516 <br /> COMPANY A VFORDING COVERAGE: <br /> Eastern Dentists Insurance Company <br /> 200 Friberg Parkway, Suite 2002 <br /> Westborough,MA 01581 <br /> TYPE OF INSURANCE: Claims Made Professional Liability <br /> POLICY NUMBER; NCC1700363 <br /> RETROACTIVE DATE: 06101/2011 <br /> POLICY PERIOD: <br /> FROM: 06/0112017 ; 12:01 A.M TO:06/0112018 ; 12:01 A.M. <br /> LIMITS OF LIABILITY: <br /> EACH CLAIM ANNUAL AGGREGATE <br /> 1,000,000 $ 3,000,000 <br /> •0. .1 r . L r Date Issued: April 11, 2017 • <br /> H.ee Maxwell <br /> President and CEO <br /> Eastern Dentists Insurance Company <br /> 200 Friberg Parkway,Suite 2002,Westborough,MA 01581-3999 <br /> 1-300-898-3342 •508-836-4204. S08-836-9910 Fax• www.edic.com <br /> 0-A5 <br />