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DocuSign Envelope ID:3DAF2DFC-999B-4C15-9AAF-83B41A879CDB <br /> Medical Mutual <br /> ADDITIONAL INTEREST(Coverage B) ENDORSEMENT <br /> THIS ENDORSEMENT CHANGES YOUR POLICY <br /> PLEASE FILE WITH YOUR POLICY <br /> Raleigh Pathology Laboratory Associates PA Policy Number: PG112061 <br /> PO Box 14045 Effective Date of Policy: August 15, 2016 <br /> Raleigh,NC 27620 <br /> Endorsement Effective Date: August 15,2016 <br /> Date Endorsement Issued: June 3,2016 <br /> All dates herein as of 12:01 AM. Standard Time at the <br /> Principal Address of the above Named Insured <br /> In consideration of the premium, it is agreed that in Section I. PROFESSIONAL LIABILITY COVERAGE,paragraph <br /> (b)Coverage B. Medical Practice Professional Liability, is amended to include, as an Insured, the professional <br /> corporation named below, except that the Limits of Liability shown in the Declarations for Coverage B are shared by the <br /> Insured covered in Coverage B and the professional corporation named below: <br /> Wake Medical Lab Consultants Inc <br /> All other terms and conditions of the policy remain unchanged. <br /> Signed By: *ate: Jane <br /> Authorized C P any Representattc <br /> MEDICAL MUTUAL INSURANCE COMPANY SPRA <br /> PE39(OM 6) OF NORTH CAROLINA Page of 1 <br />