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DocuSign Envelope ID: B368014E- 191B- 48DC- 8144- E5DF6E9FA4E2 <br />Aug 14 2018 10 :34AM RXelly Faulk DDS 9197741405 <br />PAGE THREE <br />page 4 <br />7 This policy maybe cancelled by the Insured by mailing to the Company or any of its authorized representatives, written <br />notice, stating when thereafter the cancellation shall be effective. This policy may be cancelled by the Company by mailing, <br />postage prepaid, to the Insured at the last address on record with the Company written notice stating when, not less than 30 days <br />thereafter, such cancellation shall be effective. If thelnsured cancels, earned premium shall be computed in accordance with the <br />standard short rate tables and procedure. If the Company cancels, earned premium shall be computed pro rata, Premium <br />adjustments shall be made within a reasonable period of time after cancellation, but payment of or tender of such unearned <br />premium shall not be a condition of cancellation. <br />8 By acceptance of this policy the Insured agrees that this policy embodies all agreements existing beriveen himself and the <br />Company or any of its agents relating to this insurance. <br />9 The following space is intended for waivers, exceptions and endorsements. If any, they shall become part of this policy. <br />89 125 128 137 252 295 320 321 328 430 443 531 549 590 773 <br />809 820 825 828 831 997 <br />insureds procession. DENTISTRY <br />Retroactive Date: 08/12/1991 The Insured: <br />Policy No. 783308 RANDOLPH K FAULK, JR . DDS <br />ThePremfum $ 932 1806 DOCTORS DR <br />TOTAL 932 SANFORD NC 27330 <br />Per Claim Filed $ 2,000,000 Annual Aggregate $ 4,000,000 <br />The teen of this policy shall begin and end at 12 :01 a.m., standard 6fie, at the place where the Insured resides <br />I DAY YEAR MO. [JAY YEAR <br />and be from 06 01 2018 t° 06 01, 2019 <br />In Vitneo Iftered, The Medical Pro- s� <br />tectiveCompanyhascausedthispolicytobesignedbyitsPresident <br />and its Secretary and countersigned by its duly authorized <br />representative - PRESI NT <br />'v SECRETARY <br />COUNTERSIGNED <br />CM-10-86 <br />in ft Event ddsl m, Threatwwd or Filed, <br />iWECNTELYNOTIFYTHEMEDICALPAOTECTNECOtAPAHY, FORMAYFIE, INDIANA <br />FOR SERVICE CALL: ANGELA ACKERMAN @ 800 - 463 -3776 <br />PROFESSIONAL LIABILITY POLICY R <br />Continuous service to the profession since 1899 <br />