|
DocuSign Envelope ID:3DAF2DFC-999B-4C15-9AAF-83B41A879CDB
<br /> oltsZ,`N
<br /> ‘.—V1
<br /> Nictlical Milt tiai
<br /> M.E.',: ICAL PR C_TESSIONAL LIABILITY INSURANCE POLICY
<br /> DECLARATIONS PAGE
<br /> ,
<br /> Raleigh Pathology Labo story A. ociates .11l'A Mr:idical Mutual Insurance Company Of.' orth Carolina
<br /> PO Box 14045 700 Spring Forest Rd. Suite 400
<br /> Raleigh,NC 27620 IIIIIIII7Raleigh, NC 27609
<br /> , .....
<br /> Nien..m.„.11 M Ilium insurance Company OC Nonth Carolina Policy Number: I ,..1 l i 4 6 1
<br /> 700 Spring Forest Rd. Suite 400 E•,tective Date: August 1115,2016
<br /> Raleigh, NC 27609 Expiration Date: August 15,2017
<br /> 411 dates-herein as of 12,01 A,M Standard Te. ,II the
<br /> of the above Named Insured
<br /> [-- S ,, '
<br /> _....,... j, cl:imeb11 abi ntars1 e Medical Rm dical Expenses:
<br /> C-)od a . S10,000 Maximum Reimbursable Amount
<br /> c10„0C - -eimbursable. mm it i
<br /> , 1
<br /> , .
<br /> mmem■ -- - =. - - -
<br /> Covc[ .:., - li-Medic a ..ractice Professional Lialliliiy
<br /> k'Lileip-1" f;drhol02.,.--1 .,iiiorory I 7 T---E1 '$8,000,000
<br /> 1
<br /> Cu,,k'niti'-, A-Individual Profession .,I Liat,ih“
<br /> arke, MD 07/01/2016 $6,000,(i0048,000,000
<br /> Di L Dookhan, 1 it) 11 1 '42013 $6,000.000,48,000,000
<br /> ..._
<br /> ll Mienaei t' , 1 , ' °' mr rY /20P", li'' r'09.000/S8,000,000
<br /> 11 Matthew LLIty lLy1-1\Cl, tvii.■; I 'Uk......'j/20t' •••i:'• .11(.0,000/S8,000,000 .-
<br /> 1 Shrim vas Raingo;.. ti, Ml) 03/15/19'' 1,, ..i, i i. )00:S8,000.000
<br /> _ __..
<br /> Ahren Charles Rittershaus, MD 07/11/2011 111 1:1 ) 000,58:000.000
<br /> [ Dawsi HI ,,, , rson Scarborough,Jr, MD 02/01/1976 2,0,nr.o0.(111',11, , ' ,:t10111.11111)r i
<br /> ..., _ .._
<br /> Christ ' Ion Sinn, ,s, MD
<br /> With/ .1„111 , -"nyder, MD
<br /> Cheryl ',milt ..),.i..iak, MI) 01/03/1991 OW01/2010
<br /> 07/18/2005
<br /> S6,000,000,'1,,'.(00,000
<br /> S6,0110,()0/, , inch poo
<br /> .:,,,,,6 ,0iin.
<br /> _
<br /> I Michael Iloward Weinstein, MD 07/01;2002 $6,000,0100/$K,000,000
<br /> I. Ming Yin„ MD 01/13/2014 $6,000,000/S8,000.000 1 .....
<br /> TOTAL PREMIUM:
<br /> ,
<br /> \4
<br /> .1'...DICA I,MUTUAL INSURANCE COMPANY ':PR A MT
<br /> PIXY!(OM 6) OF NORTH CAROLINA IIN 5176c)I 77:>
<br /> Page 0 of;
<br /> , (
<br /> /
<br />
|