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DocuSign Envelope ID:COE92964-lD40-431E-B3C2-48EE5F39527D <br /> insurance Group- <br /> Fv BUSINESSOWNERS DECLARATION <br /> BUSINESSOWNERS RENEWAL DECLARATIONS <br /> RENEWAL OF OD6 A005679 <br /> EOD6-A005679-05 <br /> cy Number Policy Period Coverage is Provided in the Agency Code <br /> From To <br /> 06/2512018 06/25/2019 MASSACHUSETTS BAY INSURANCE COMPANY 190282000 <br /> Named Insured and Address Agent <br /> TRIANGLE UROLOGY ASSOCIATES, 844-367-7899 <br /> ATTN: ❑AVIN ASSUREDPARTNERS OF NC LLC <br /> 205 FRASIER ST. CL HANOVER CSCISTE 350 <br /> DURHAM, NC 27704 4505 FALLS OF NEUSE RD <br /> RALEIGH, NC 27609 <br /> Policy Period: Beginning and Ending at 12:01 a.m. Standard Time at the Location of the Described Premises. <br /> Business Type: CORPORATION (SINGLE). <br /> Mortgagee/Loss Payable- <br /> SEE ADDITIONAL INTEREST SCHEDULE <br /> Business of the Named Insured: <br /> OFFICE, <br /> In consideration of the premium, insurance is provided the Named Insured with respect to those premises described in the <br /> Schedule below and with respect to those coverages and kinds of property for which a specific Limit of Insurance is shown, <br /> subject to all of the terms of this policy including forms and endorsements made a part hereof: <br /> LOCATION SCHEDULE <br /> Described Premises: <br /> NO.001 001 205 FRASIER ST., ❑URHAM,NC 27704 <br /> NO.002 001 10321 LUMLEY RD. #201, RALEIGH, NC 27617 <br /> NO. 003 001 101 CONNER DRIVER,SUITE 201,CHAPEL HILL, NC 27514 <br /> SECTION I- PROPERTY LIMITS OF INSURANCE <br /> Loc No Oat Bldg No 001 Loc No 002 Bldg No 001 Loc No 003 Bldg No 001 <br /> Deductible Amount $ 11000 $ 11000 $ 11000 <br /> Building Amount $ 2,825,207 NOT COVERED NOT COVERED <br /> Valuation RC <br /> Business Personal $ 540,750 $ 129,780 $ 189,000 <br /> Property Valuation RC RC RC <br /> Business Income ACTUAL BUSINESS LOSS SUSTAINED NOT EXCEEDING 12 CONSECUTIVE MONTHS <br /> Business Interne Excluded 1 None 124 hours 148 hours 172 hours <br /> Waiting.Period 48 HOURS ^^_ <br /> SECTION II -LIABILITY LIMITS OF INSURANCE _--_—_ <br /> Liability and Medical Expenses Limits of Insurance: <br /> Except for Damage to Premises Rented to You, each paid claim for the following coverages reduce the Amount of Insurance we <br /> provide during the applicable annual period. Please refer to SECTION If - LIABILITY, D. LIABILITY AND MEDICAL EXPENSES <br /> LIMITS OF INSURANCE, paragraph-4. of the Businessowners Coverage Form. <br /> Liability and Medical Expenses Li1nit $ 1,000,000 Per Occurrence $2,000,000 A re ate <br /> Medical Expenses $ 10,000 Each Person <br /> Fama a to Premises Rented to You 1 $ 500,000 All Perils <br /> M 'ate Issued: 06/13/2018 ORIGINALIINSURED Payment Type: CUST SERV CTR-DIRECT BILL <br /> 003404 <br /> 391-1002 08 16 Page 1 of 2 <br />