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09/29/2014 09:53 FAX 9196444701 DRUG TREATMENT COURTS f�007/006 <br /> wittv <br /> I JK V HISCOX INSURANCE COMPANY INC. (A Stock Company) <br /> 104 South Michigan Avenue,Suite 600 Chicago Illinois 60603 <br /> Professional Liability Insurance declarations <br /> This is a"Claims Made and Reported"Policy in which Claim Expenses are included within the Limit of <br /> Liability unless otherwise noted.Those words(other than the words in the captions)which are printed In <br /> Boldface are defined in the Policy. <br /> Policy No.: UDC-1492101-EO-14 <br /> 1. Named Insured: Courtney Kennedy <br /> 2. Address: 704 Sybil Drive <br /> Durham,NC 27703 <br /> 3,A. Limit of Liability: $ 1,000,000 Each Claim <br /> $11000,000 Aggregate for all Claims <br /> 4, Deductible: $S00 Each Claim <br /> 5, Notice: Phone: 866-424.8508 <br /> Email: reportaclairn@hlscox.com <br /> Mail: Hiscox <br /> 520 Madison Avenue-32nd Floor <br /> Attn:Direct Claims <br /> New York, NY, 10022 <br /> 6. Policy period; From: I October 01.2014 To: October 01.2015 <br /> At 12,01 A,M,(Standard Time)at the address shown above. <br /> 7, Retroactive Date: December 01,2003 <br /> 8, Premium: $620.00 —� <br /> - 9. Attachments: <br /> DPL D001 CW(01110)-Professional Liability Errors&Omissions Insurance Declarations <br /> DPL P001 CW(05113)-Professional Liability Coverage Form <br /> DPL E5081 (11111)-E5081.1 Social Worker Services Endorsement <br /> DPL E5118 NC(01110)-E5118.1 North Carolina Amendatory Endorsement <br /> INT N001 CW 0109-Economic And Trade Sanctions Policyholder Notice <br /> DPL D001 CW(01/10) Pagel <br />