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COI 1000 01/11 <br />CERTIFICATE OF LIABILITY INSURANCE DATE: 06/12/2018 <br />PRODUCER: TRELOAR & HEISEL INC. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY <br /> 134 E WASHINGTON ST AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br /> NEW CASTLE, PA 16101 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />AFFORDED BY THE POLICIES BELOW. <br />INSURED: JANICE KO, DDS INSURERS AFFORDING COVERAGE <br /> 350 N COX ST STE 18 INSURER A: The Medical Protective Company <br /> ASHEBORO, NC 27203 5814 Reed Road, Fort Wayne, IN 46835 <br /> NAIC number - 11843; www.medpro.com <br />Specialty: GENERAL DENTIST <br />COVERAGES <br />THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. <br />NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE <br />MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND <br />CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR <br />LTR <br />TYPE OF INSURANCE POLICY <br />NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(MM/DD/YY) <br />POLICY <br />EXPIRATION <br />DATE <br />(MM/DD/YY) <br />LIMITS <br />GENERAL LIABILITY <br /> COMMERCIAL GENERAL LIABILITY <br /> CLAIMS MADE OCCUR <br /> _________________ <br /> _________________ <br /> GENL AGGREGATE LIMIT APPLIES PER: <br /> POLICY PROJECT LOC <br /> <br />EACH OCCURRENCE $ <br />PER CLAIM $ <br />FIRE DAMAGE (Any one fire) $ <br />MED EXP (Any one person) $ <br />PERSONAL & ADV INJURY $ <br />GENERAL AGGREGATE $ <br />PRODUCTS-COMP/OP AGG $ <br />AUTOMOBILE LIABILITY <br /> ANY AUTO <br /> ALL OWNED AUTOS <br /> SCHEDULED AUTOS <br /> HIRED AUTOS <br /> NON-OWNED AUTOS <br /> _______________ <br />COMBINED SINGLE LIMIT <br />(Each accident) $ <br />BODILY INJURY <br />(Per person) $ <br />BODILY INJURY <br />(Per accident) $ <br />PROPERTY DAMAGE <br />(Per accident) $ <br />PROFESSIONAL LIABILITY <br /> OCCURRENCE <br /> CLAIMS MADE <br /> RETRO DATE: <br />829292 06/12/2018 06/12/2019 PER OCCURRENCE $ 2,000,000 <br />PER CLAIM $ <br /> <br />ANNUAL AGGREGATE $ 4,000,000 <br />EXCESS LIABILITY <br /> OCCURRENCE CLAIMS MADE <br /> DEDUCTIBLE <br /> RETENTION $ <br />EACH OCCURRENCE $ <br />AGGREGATE $ <br /> $ <br /> $ <br />WORKERS COMPENSATION AND <br />EMPLOYER'S LIABILITY <br /> WC STATUTORY LIMITS OTHER <br />E.L. EA ACCIDENT $ <br />E.L. DISEASE-EA EMPLOYEE $ <br />E.L. DISEASE-POLICY LIMIT $ <br />OTHER: <br />EMPLOYMENT PRACTICES LIABILITY <br />DEFENSE COVERAGE <br />RETRO DATE: <br />PER OCCURRENCE LIMIT <br />OF DEFENSE $ <br />AGGREGATE LIMIT OF <br />DEFENSE $ <br />DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SEE POLICY FOR SPECIFIC COVERAGE INFORMATION/SPECIAL PROVISIONS <br /> <br /> <br /> <br /> <br /> <br />CERTIFICATE HOLDER:CANCELLATION <br /> JANICE KO, DDS <br /> 350 N COX ST STE 18 <br /> ASHEBORO, NC 27203 <br />THE MEDICAL PROTECTIVE COMPANY WILL NOT <br />BE RESPONSIBLE FOR INFORMING THE <br />CERTIFICATE HOLDER OF ANY CHANGES IN <br />COVERAGE OR IN THE LIMITS OF LIABILITY OR IN <br />THE EVENT OF THE TERMINATION OR <br />CANCELLATION OF THE POLICY. <br />The Medical Protective Company Representative <br /> <br />DocuSign Envelope ID: 99F1EAF2-3FCA-45E2-B94D-040440203D4F