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DocuSign Envelope ID:08F5590C-AFE2-44BA-B873-AC73B2E3Al2B <br /> 441 <br /> l�11 <br /> HISCOX INSURANCE COMPANY INC. (A Stock Company) <br /> I 104 Sdvth Michigan Avenue,Salta 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 /> Ltabillty unless othsrwlse noted.Those words (other than the words In the captions)which ar©printed In <br /> Boldface are defined in the Policy. <br /> Policy No,: UDC-1492101-Pb-14 <br /> 1. Named lnsured: Courtney Kennedy <br /> 2. Address; L7114 ybil Drive <br /> m,NC 27703 <br /> 3,A, Llmlt of Llabllity: $1,000,000 Each Cialm <br /> 3,8, 5 1,000,000 Aggregate for all Claims <br /> 4, Deductlble: S500 Each Claim <br /> 6. Notice: Phone: 866.424.8508 <br /> Email: reportaalalm @hlscox.com <br /> Mail: His= <br /> 520 Madison Avenue-32nd Floor <br /> Attn:DI root Claims <br /> Now York, NY, 14022 <br /> 6. Policy period; From: October 01.201A To-. October 01.2015 <br /> At 12,01 A,M,(Standard Time)at the address shoym above, <br /> 7, Rotroaotive Date; gaonmber t)1,2003 <br /> .8, Premium: 5 624.00 <br /> DPL D001 GW(01110)-Professional Llabllity Errors&Omisnlono Insuranoo Dooloratlont; <br /> DPL P001 CW(05113)-Professional Llabllity Coverage Form <br /> DPL E5081 (11111)-E6081,1 Soclsl Worker Services Endorsement <br /> DPL 06118 NO(01/10)-E5115.1 North Carolina Amendatory Endorsement <br /> INT N001 CW 0109-EwomicAnd Trade Sanctions Poflcyholder Notice <br /> DPL D001 CW(01/10) Page 1 <br />