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DocuSign Envelope ID: F6A443CE- 4CB1- 4DE4- AA82- 616F9B13AOCO <br />Cl i ent # 484672 <br />MEMORANDUM OF INSURANCE <br />ID ate Issued 10/24/2017 <br />Producer <br />This memorandum is issued as a matter of information <br />only and confers no rights upon the holder. This <br />Mercer Consumer, a service of <br />Mercer Health & Benef i ts Admi ni strati on L L C <br />memorandum does not amend, extend or alter <br />coverages afforded by the Certificate listed below. <br />P.O. Box 14576 <br />Des M of nes, I A 50306 -3576 <br />Company Affording Coverage <br />L i berty Insurance U nderwriters Inc <br />1- 800 - 503 -9230 <br />Insured <br />North Carol i na Assoc of I ns Agents I nc <br />Robert E. Dupuis <br />c/o NCAIA <br />101 Weston Oaks Court <br />Cary NC 27513 <br />PO Box 1165 <br />Cary NC 27512 <br />This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated, not <br />withstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be <br />issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of <br />such Certificate. The limits shown may have been reduced by paid claims. <br />The Memorandum of Insurance and verification of payment are your evidence of coverage. No coverage is afforded unless the premium <br />is successfully paid in full. <br />Type of Insurance <br />Certificate Number <br />Effective Date <br />Expiration Date <br />Limits <br />rofessional Liability <br />Pharmacist E <br />AHY- 768247004 <br />12/22/2017 <br />12/2222018 <br />Per Incident/ <br />Occurrence <br />$2,000,000 <br />Pharmacist <br />Annual Aggregate <br />$4, 000, 000 <br />ROOF OF INSURANCE <br />Memorandum Holder: <br />Should the above describe Certificate be cancelled <br />PROOF OF COVERAGE ONLY <br />before the expiration date thereof, the issuing company <br />will endeavor to mail 30 days written notice to the <br />Memorandum Holder named to the left, but failure to <br />ail such notice shall impose no obligation or liability <br />of any kind upon the company, its agents or <br />representatives. <br />Authorized Representative <br />Mark Brostowitz <br />G�VIa,.QL�Q.. <br />Mercer Consumer, aserviceof Mercer Health & Benefits Administration LLC. In CA d /b /a Mercer Health & Benefits Insurance Services LLC. CA InsLic. #OG39709 <br />