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DocuSign Envelope ID: D3A34EE2-C6BF-4507-98CF-C34B773F48D6 <br /> / ® DATE(MM/DD/YYYY) <br /> A�o CERTIFICATE OF LIABILITY INSURANCE <br /> 03/31/2015 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to <br /> the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br /> certificate holder in lieu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> HISCOX Inc. PHCN o E . (888)202-3007 ac No: <br /> 520 Madison Avenue a ooRlEss: contact @hiscox.com <br /> 32nd Floor INSURER(S)AFFORDING COVERAGE NAIC# <br /> New York,NY 10022 INSURERA: Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B: <br /> Tomatillo Design LLC INSURERC: <br /> PO Box 51852 INSURER D: <br /> INSURER E: <br /> Durham NC 27717 1 INSURER F: <br /> COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br /> THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> ILTR ADD SUBR POLICY EFF POLICY EXP LIMITS <br /> TYPE OF INSURANCE POLICYNUMBER MWDD MM/DD <br /> X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 <br /> CLAIMS-MADE I OCCUR PREM SES(Ea RENTED <br /> occurrence) $ 100,000 <br /> MED EXP Any one person) $ 5,000 <br /> A Y UDC-1561781-CGL-15 03/30/2015 03/30/2016 PERSONAL B ACV INJURY $ 1,000,000 <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 <br /> X <br /> JECT <br /> POLICY❑PRO-- LOC PRODUCTS-COMP/OPAGG $ S/T Gen.Ag . <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY Ee aacelNdentSINGLE LIMIT $ <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ <br /> AUTOS AUTOS _ <br /> NON-OWNED PPReOPPER DAMAGE $ <br /> HIREDAUTOS AUTOS <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ $ <br /> WORKERS COMPENSATION <br /> ER <br /> AND EMPLOYERS'LIABILITY STATUTE <br /> ANYPROPRIETOR/PARTNERIEXECUTIVE Y]NIA E.L.EACH ACCIDENT $ <br /> OFFICER/MEMBEREXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-FA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Professional Liability Y UDC-1561781-EO-15 03/30/2015 03/30/2016 Each Claim: $1,000,000 <br /> Aggregate: $1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> Orange County NC <br /> P.O.Box 8181 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> Hillsborough,NC 27278 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> @ 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />