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DOOuSign Envelope ID: 111672FC-E5A1-4E39-A023-8AC8C18839C7 <br /> , 4n° <br /> Hanover <br /> Insurance Group. <br /> OD6 A005679 1902820 <br /> '`' I" SCHEDULE A - SCHEDULE OF UNDERLYING POLICIES <br /> 11 Insured: TRIANGLE UROLOGY ASSOCIATES, <br /> ,,i/ Effective on and after: 06/25/2017 , 12:01 AM Standard Time <br /> 1:, This schedule is part of Policy Number: OD6-A005679-04 <br /> CARRIER, POLICY NUMBER & PERIOD TYPE OF POLICY APPLICABLE LIMITS OR <br /> AMOUNT OF INSURANCE <br /> (a)Carrier: <br /> Commercial 1.000'000 Each Occurrence <br /> MASSACHUSETTS BAY INSURANCE COMPANY czcneral Liability $ 2, General Aggregat <br /> Policy Number: ODG��OO587g-O4 L�UNon-owned & $ 2.000.000 Product/Complete <br /> Po|i�yP�riod� � Hired Autos Operations <br /> 06/25/2017 TO 06/25/2018 <br /> Aggregate <br /> (b) Carrier:� Comprehennive Bodily Injury and Property <br /> Automobile Liability Damage Liability Combined <br /> Policy Number: $ Each Accident <br /> Policy Period: Bodily Injury <br /> $ Each Person <br /> $ Each Accident <br /> Property Damage <br /> $ Each Accident <br /> (c)Carrier:� Sbandard Workers Coverage B - Employers Liability <br /> Compensation & Bodily Injury <br /> t ALLNER|CAHNANOALBEN|F|TS /NSURANCECDWPANy Employers Liability $ 500. Each Accident <br /> cident Po|icyNumber' y2GAOD428OU4 Please Note: The Bodily Injury by Disease Period: 06/25/2017 TO 06/25/2018 Umbrella Coverage <br /> $ 500,000 Aggregate <br /> for W <br /> or k -- <br /> ero $ 500,000 Each Employee <br /> Compensation d <br /> Employers Liability <br /> is not applicable in <br /> situations where an <br /> employee is subject <br /> to the New York <br /> Workers <br /> Compensation Law. 1 <br /> (d)Carrier: <br /> Liquor Liability $ Limit of Liability <br /> Policy Number: <br /> Policy Period: <br /> (e)Carrier: <br /> Professional $ Limit of Liability <br /> Liability <br /> Policy Number: <br /> Policy Period: <br /> An "X" marked in the box provided indicates these broadening uroptiond coverages are provided in the <br /> Underlying Insurance <br /> (D Carrier: Directors & Officers $ Limit of Liability <br /> Liability <br /> Policy Number: <br /> Policy Period: <br /> (g)Carrier: Employee Benefits $ Limit of Liability_ <br /> Liability <br /> Policy Number: <br /> Policy Period: <br /> ~--ItewsJ�medB� <br /> 0 -- <br /> : — <br /> . orized Representative of the Company <br /> 001344 <br /> 473-1103 (11/08) <br />