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DocuSign Envelope ID:045AF678-3763-4394-A072-D12B1 El 13359 <br /> THE, NCANT)EN COMPANY, LLV--" <br /> P.O. Boo 5319 Pi:, 843-669-7223 <br /> 1�1 ,01,HNCr, '-30UTIT CAROLINA 29,902 Fvx 843-6139-7165 <br /> F TI;RRIESnUwDrn(C-i'SCi.RR,C(),M CERTIFICATE OF .MSURAN E 'Cnr,L,L+'REE 1-866-502-61527 <br /> Named Insured: North Carolina Association of Local Health Directors <br /> Alaniatrce County Health Department <br /> This is to certify that the policies of insrir•ance listed below have bee issued to the insured <br /> named above for the policy period indicated. Notwiths tan(ling any requirement,term or <br /> condition of any contract or document with respect to which this certificate may be issued <br /> or may pertain,the insurance afforded by the policies described herein is subject to tall <br /> terms,exclusions, and conditions ofst(ch policies. <br /> Company: Policy# Policy Term <br /> ACE Medical Risk-Ace American Insurance MLP G21686037-1.3 7/1/20.15-7/1/2016 <br /> Coverage: Claims Made Miscellaneous Medical Professional Liability <br /> Limit. $1,000,000 each claim/n3,000,000 annual aggregate <br /> $20,000,000 policy aggregate <br /> Deductible: $5,000 per claim <br /> Retroactive Date: 7/1/2000 <br /> Additional Named Insureds Retroactive Date: <br /> Kann Saxer,CNM 8/1/2005 CNM <br /> Carla Seam Hampton,PA 7/1/2000 PA <br /> 11 Kathleen Shaple.y-Quin,MD 5/5/2001 MD <br /> Elizabeth A. Sciora,CNM 7l112000 CNM <br /> Westside OB/GYN Additional Insured <br /> Elizabeth Krzysztofoa-ska, DDS 5/1/1998 DDS <br /> UNC,Chapel Ml 8 ofNursnig 11/5/2005 <br /> :f UNC, Chapel Hill S of Dentistry Additional Insured <br /> UNC-G S ofNursing Additional Insured <br /> L Isa Cheren, MD/LT 8/l/2007 MD/LT <br /> Cass Emery,Hygentist 1J13/2010 <br /> James Fetner, DDS 7/9/2012 DDS <br /> Suzanne Walter,RPh 12(1/2006 RPh <br /> Amanda Marvin,LCSW-A 9/2/2014 LCSW-A <br /> Nicole Alston, RD 5/3/2010 RD <br /> Janice Putman,RD 12/3112012 RD <br /> Donna Dotson,RD <br /> it 4/13/1994 RD <br /> Should the above described policy be cancelled before the expiration(late thereof,the issuing <br /> company will endeavor to mail 30(Thirty)(lays written notice to the Insured named above, <br /> The coverage represented by this certificate is subject to the terms,conditions and limitations of the <br /> policies in current use by the carrier named above. <br /> The Snowdeq Company,LLC Date 5/I5/2015 <br /> Tet ie I Situ v n,CPCII <br /> f <br />