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DocuSign Envelope ID:31D3934C-CE6C-4B6A-A77D-A2C78EC2A7A3 <br /> Client#: 1793600 20MENGHAG <br /> ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/dD/YYYY) <br /> 02/22/2016 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT:If the certificate holder is art ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> BB&T Insurance Services, Inc. PHONE <br /> N mot,919 2814500 FAX,No): <br /> 8887468761 <br /> Post Office Box 13941 E-MAIL <br /> Durham, NC 27709 ADDRESS: <br /> INSURER(S)AFFORDING COVERAGE NAIC# <br /> 919 281-4500 <br /> INSURER A,Cincinnati insurance Company 10677 <br /> INSURED <br /> INSURER B: <br /> Meng Monica Meng-Haggerty D.D.S, <br /> 215 Bluefield Road INSURER C: <br /> Chapel Hill, NC 27517 INSURER D: <br /> INSURER E: <br /> INSURER F <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR ADDCSUBR O r-•...... _._ <br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER JMWDD/YYYYlMM/DD/YYYY) LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE <br /> CLAIMS-MADE OCCUR DRMGEO a EoNED e <br /> e) $_ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO- <br /> _ POLICY f JECT I LOC PRODUCTS-COMP/OPAGG $ <br /> OTHER: <br /> $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT <br /> a accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALLOWNED SCHEDULED - <br /> AUTOS AUTOS ' BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS (Per accident) <br /> UMBRELLA LIAB OCCUR 'EACH OCCURRENCE $ <br /> EXCESS LIAR ; CLAIMS-MADE AGGREGATE $ <br /> DEC l RETENTION$ $ <br /> WORKERS COMPENSATION ! PER OTH- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE SR ..._ <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT <br /> OFFICER/MEMBER EXCLUDED? L NIA ... .$ <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Professional ENP0374709 104/09/2016 04/09/201 $1,000,000/Occurrence <br /> Liability <br /> $3,000,000/Aggregate <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Meng Monica Meng-Haggerty,DDS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> 215 Bluefield Rd. ACCORDANCE WITH THE POLICY PROVISIONS. <br /> Chapel Hill, NC 27517 <br /> AUTHORIZED REPRESENTATIVE <br /> i V - <br /> ©1988-2014 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD <br /> #S156456111M15645608 KYW <br />