2017-263-E Health - Robert Dupuis for pharmacy services

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DocuSign Envelope ID:90CC09F4-5057-4B 1 F-AC03-CF23967BA7A0 Client# 484672 MEMORANDUM OF INSURANCE Date Issued 11/11/2016 Producer This memorandum is issued as a matter of information only and confers no rights upon the holder. This Mercer Consumer, a service of memorandum does not amend, extend or alter—the- Mercer Health & Benefits Administration LLC coverages afforded by the Certificate listed below. P.O. Box 14576 Des Moines, IA 50306-3576 1-800-503-9230 Company Affording Coverage Insured Liberty Insurance Underwriters Inc North Carolina Assoc of Ins Agents Inc Robert E. Dupuis 101 Weston Oaks Court c/o NCAIA Cary NC 27513 PO Box 1165 Cary NC 27512 This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated, not withstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of such Certificate. The limits shown may have been reduced by paid claims. Type of Insurance Certificate Number Effective Date Expiration Date Limits Professional Liability AHY-768247003 12/22/2016 12/22/2017 Per Incident/ $2,000,000 Pharmacist E Occurrence Pharmacist Annual Aggregate $4,000,000 PROOF OF INSURANCE Memorandum Holder: Should the above describe Certificate be cancelled before the expiration date thereof, the issuing company PROOF OF COVERAGE ONLY will endeavor to mail 30 days written notice to the Memorandum Holder named to the left, but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives. Authorized Representative Mark Brostowitz Of-K _a. 1 Mercer Consumer,a service of Mercer Health &Benefits Administration LLC. In CA d/b/a Mercer Health &Benefits Insurance Services LLC. CA Ins Lic. #0G39709