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DocuSign Envelope ID:088E9D73-6D60-4316-99EB-19302C74139C <br /> Healthcare Professional Liability Libe-rty <br /> lnterrudonA <br /> lb�'Uudcrwrltcm <br /> LIBERTY INSURANCE UNDERWRITERS INC. <br /> (A Stock Insa=ce C:nmp my,hereini ter the"Comp=3e) <br /> 55 Water Street,18d,Floor <br /> New York,NY 10041 <br /> CERTIFICATE OF INSURANCE <br /> HEALTHCARE PROFESSIONAL LIABILITY <br /> CLAIMS-MADE INSURANCE POLICY FOR MEMBERS OF THE FEDERATION <br /> Item CERTIFICATE NUMBER: AHX-102357008 RENEWAL OF: AHX-102357007 <br /> 1. NAIYIED INSURED Lorraine Lewis <br /> 2. ZYLULING ADDRESS 107 Morningside Drive <br /> Carrboro,NC 27510-1254 <br /> 3 Policy Period 12:01 A.M,Standard Time From: 06/01/2019 To: 06/01/2020 <br /> At Location of Designated Premises <br /> 4, Prior Acts Date: 06/13/1993 <br /> 5. COVERAGE LIMITS OF LIABILITY PREMIUM <br /> Professional Liability $1,000,000 each Incident 1$3,000,000 Aggregate $93.00 <br /> Terrorism Risk Insurance Act 0 00 <br /> $0.00 <br /> 6. Deductible(if applicable) $0 each Incident Total: $95.00 <br /> 7. The Named Insured is: X Sole Proprietor(including Independent Contractors) ❑Partnership ❑Corporation <br /> ❑Other. Affiliation: 3410-Trager Approach Prof.Liability <br /> $ Business or Occupation of the Named Insured:AS STATED IN THE MASTER POLICY DECLARATIONS OR,IF <br /> APPLICABLE,AS ENDORSED HEREON <br /> 9. This policy is made and accepted subject to the printed conditions of tl-ds policy together with the provisions,stipulations and <br /> agreements contained in the following form(s)or endorsement(s): <br /> HCPL-2026(11/09),HCPL-2038(11/09),HCPL-8002 (11/09),HCPL-8004(11/09) <br /> HCPL-8005 (11/09),HCPL-8086(12110),HCPL-8001 (11/09), <br /> OFAC (08/09),HCPL-2026-9000-NC(4110) <br /> REPRESENTATINT: <br /> Mercer Consumer,a service of <br /> Agent. Mercer Health&Benefits Administration LLC <br /> Office Address: P,O•Box 14576 <br /> Des Moines,IA 50306-3576 <br /> IRE <br /> I ICPL-2026D(11/09) <br />