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JJ1089 <br />OtherInterest: <br />ProcessedOn:03/19/2018(SeeReverseSide)27 <br />MailingNameandAddressforInsured: <br />UltrapackPlusPolicyDeclarations <br />RenewalCertificate <br />ErieInsuranceExchange <br />ADVANCEDDENTALASSOCIATES <br />INC <br />11312US15-501NORTH <br />STE107-139 <br />CHAPELHILLNC27517 <br />NamedInsured'sFullName: <br />AdvancedDentalAssociatesInc. <br />Agent:PolicyPeriod:PolicyNumber: <br />JJ1095THESORGIINSURANCEAGENCYINC06/02/2018to06/02/2019Q971310636 <br />AgentAddressandPhone <br />THESORGIINSURANCEAGENCYINC <br />16CONSULTANTPLSTE102 <br />DURHAMNC27707-6313 <br />919-682-4814 <br />Policybeginsat12:01A.M.standardtimeonthe <br />effectivedateandendsat12:01A.M.standard <br />timeontheexpirationdate.Standardtimeis <br />determinedatthestatedaddressofthenamed <br />insured. <br />Theinsuranceappliestothosepremisesdescribedbelow.Thisissubjecttoallapplicabletermsofthepolicyand <br />attachedformsandendorsements. <br />PremiumSummary <br />PayPlanDiscountApplies <br />TotalAnnualPolicyPremium:$348.00 <br />(Thisisnotabill.Yourinvoicewillfollowinaseparatemailing.) <br />x <br />PropertyProtection-AsPerAttachedSupplementalDeclarations <br />Deductible(PropertyProtectionOnly)$500 <br />Policy-LevelCoverages <br />LiabilityProtectionLimitsofInsurance <br />CommercialGeneralLiabilityLimitsofInsurance <br />EachOccurrenceLimit $1,000,000 <br />DamagetoPremisesRentedtoYou $1,000,000AnyOnePremises <br />MedicalExpenselimit $5,000AnyOnePerson <br />Personal&AdvertisingInjuryLimit Excluded <br />GeneralAggregateLimit $2,000,000 <br />Products/CompletedOperationsAggregateLimit $2,000,000 <br />DocuSign Envelope ID: 9F2C2FF6-C184-4821-B124-5C284105DD0A