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DocuSign Envelope ID: B7DABF9A- D92E- 48BA- BCOB- AFFC399D4D85 <br />CERTIFICATE OF INSURANCE <br />Certificate issued to: <br />Name and mailing address of insured: <br />Dain E. Vines, M.D. <br />P.O. Box 1119 <br />Hillsborough, North Carolina 27278 <br />MAG Mutual Insurance Company <br />This is to certify that MAG Mutual Insurance Company has issued a Medical Professional Liability Policy to the <br />insured listed above, subject to the provisions of the current policy contract and any endorsements. <br />Policy Number: <br />PSL 1701979 10 <br />Total Limits: <br />Effective Date: <br />2/1/2o18 <br />Limits of Liability: <br />$1,000,000/$3,000,000 <br />(Each loss /Aggregate limit) <br />$1,000,000/$3,000,000 <br />Expiration Date: <br />2/1/2019 <br />Retroactive Date: <br />4/9/2002 <br />This document is issued as a matter of information only and confers no rights upon the document holder. This <br />document does not amend, extend, or alter the coverage, terms, exclusions, conditions, or other provisions <br />afforded by the policies referenced herein. <br />Please inquire directly with the insured for individual restrictive endorsements that may apply. In the event of <br />cancellation of the described policy, MAG Mutual will make reasonable effort to notify the parry at whose <br />request this certificate was issued, but MAG Mutual shall not be liable in any way for failure to give such notice. <br />CINS Ed. o8/16 <br />AP <br />Ed Lynch <br />Authorized Representative <br />February 8, 2018 <br />MAG Mutual Insurance Company <br />P.O. Box 52979 <br />Atlanta, GA 30355-0979 <br />