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DocuSign Envelope ID: B78A3FOE-AA4A-4AA8-BO30-351CO676A960 <br /> l <br /> Medical Mutual ��,n 4,.:;.:::.�:.-:,. ; �3 �: v::., :. :::a, �, � _:a«•, ..M�._.�; .:. :::, .: e. :.: ar;, <br /> ►RUT ECTI W[ OUR PRO FES SmN <br /> CERTIFICATE OF INSURANCE <br /> This certificate is issued as a matter of information only and confers no rights upon the certificate holder. <br /> This certificate does not amend extend or alter the coverage afforded by the policies listed below. <br /> INSURED: <br /> Triangle Urology Associates PA <br /> 205 Frasier St <br /> Durham,NC 27704 <br /> COMPANY AFFORDING COVERAGE: <br /> Medical Mutual Insurance Company of North Carolina <br /> 700 Spring Forest Road 4th Floor <br /> Raleigh,NC 27609 <br /> TYPE OF INSURANCE: Medical Professional Liability-Claims Made <br /> POLICY NUMBER: PGI 13371 RETROACTIVE DATE:March 1, 1978 <br /> POLICY PERIOD: <br /> �. FROM: January 1,2019;12:01 A.M. TO: January 1,2020;12:01 A.M. <br /> LIMITS OF LIABILITY: <br /> EACH CLAIM ANNUAL AGGREGATE <br /> 3,000,000 5,000,000 <br /> Date: October 29,2018 <br /> Authorized resentative <br /> Certificate Holder: <br /> MEDICAL MUTUAL INSURANCE COMPANY <br /> PM09(01/16) OF NORTH CAROLINA SPRATLT <br />