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2025-482-E-Health Dept-Robert Dupuis-Pharmacy Services
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2025-482-E-Health Dept-Robert Dupuis-Pharmacy Services
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Last modified
8/6/2025 1:24:49 PM
Creation date
8/6/2025 1:24:38 PM
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Template:
Contract
Date
8/4/2025
Contract Starting Date
8/4/2025
Contract Ending Date
8/5/2025
Contract Document Type
Contract
Amount
$15,174.00
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MEMORANDUM OF INSURANCE Date Issued <br />Prod ucer <br />coverages afforded by the Certificate listed below. <br />Company Afford ing 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 Insuran ce Certificat e Number Effective Date Expirati on Date Limits <br />Pro fessional 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 />11/08/2024 <br />Robert E. Dupuis <br />c/o NCAIA <br />PO Box 1165 <br />Cary, NC 27512 <br />Pharmacist E <br />Pharmacist <br />AHY-768247011 12/22/2024 12/22/2025 $2,000,000 <br />$4,000,000 <br />AMBA In CA dba Assn. Member Benefits & Insurance Agency. CA License #0I96562 <br />PROOF OF COVERAGE ONLY <br />AMBA <br />P.O. Box 14554 <br />Des Moines, IA 50306 <br />1-800-375-2764 <br />Liberty Insurance Underwriters Inc. <br />Stephen Miller <br />Docusign Envelope ID: F1B6D46E-B6F4-46B7-A7DE-F4008698951A
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