Orange County NC Website
Browse       Search
MEMORANDUM OF INSURANCE Date Issued <br />Producer <br />coverages afforded by the Certificate listed below. <br />Company Affording Coverage <br />Insured <br />This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated, not <br />withstanding any requirement, term or condition of any contract or other document with respect to which this memorandum may be <br />issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the terms, exclusions and conditions of <br />such Certificate. The limits shown may have been reduced by paid claims. <br />The Memorandum of Insurance and verification of payment are your evidence of coverage. No coverage is afforded unless the premium <br />is successfully paid in full. <br />Type of Insurance Certificate Number Effective Date Expiration Date Limits <br />Professional Liability Per Incident/ <br />Occurrence <br />Annual Aggregate <br />PROOF OF INSURANCE <br />Memorandum Holder:Should the above describe <br />of any kind up <br />representatives. <br />Authorized Representative <br />Joan O’Sullivan <br />North Carolina Assoc of Ins Agents Inc <br />101 Weston Oaks Court <br />Cary NC 27513 <br />Client # 484672 <br />11/09/2021 <br />Robert E. Dupuis <br />c/o NCAIA <br />PO Box 1165 <br />Cary, NC 27512 <br />Pharmacist E <br />Pharmacist <br />AHY-768247008 12/22/2021 12/22/2022 $2,000,000 <br />$4,000,000 <br />Mercer Consumer, a service of Mercer Health & Benefits Administration LLC. In CA d/b/a Mercer Health & Benefits Insurance Services LLC. CA License #0G39709 <br />PROOF OF COVERAGE ONLY <br />Mercer Consumer, a service of <br />Mercer Health & Benefits Administration LLC <br />P.O. Box 14576 <br />Des Moines, IA 50306-3576 <br />1-800-375-2764 <br />Liberty Insurance Underwriters Inc. <br />Mark Brostowitz <br />DocuSign Envelope ID: 9626C6F3-65DD-4E0D-A501-6A3A939E2BA1