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DocuSign Envelope ID:F779B82D-01C3-4826-8606-CA75617BC6AA <br /> A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) <br /> 06/26/2017 <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 /> PHONE 02-3007 <br /> Hiscox Inc 888 2 FAX <br /> (A/C,No): <br /> (A/c.No.Extl: ( ) <br /> 520 Madison Avenue EMAIL <br /> ADDRESS: contact @hiscox.com <br /> 32nd Floor <br /> INSURER(S)AFFORDING COVERAGE NAIL# <br /> New York,NY 10022 INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED <br /> INSURER B: <br /> Naw Paw Hser INSURER C <br /> 306 Estes Drive Apt.C-12 <br /> INSURER D <br /> INSURER E: <br /> Carrboro NC 27510 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 /> INSR <br /> ADDL SUBR POLICY EFF POLICY EXP <br /> LTR TYPE OF INSURANCE INSD WYD POLICY NUMBER (MM!D M/DDlYYYY) (MM/DD/YYM LIMITS <br /> COMMERCIAL GENERAL LIABILITY <br /> EACH OCCURRENCE _ $ <br /> CLAIMS-MADE OCCUR DAMAGE TO RENTED <br /> PREMISES(Ea occurrence) $ _ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY _ $ <br /> GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> PRO- _ <br /> POLICY <br /> JECT LOC <br /> PRODUCTS-COMP/OP AGG $ <br /> OTHER: —$ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> (Ea accident) <br /> ANY AUTO BODILY INJURY(Per person) $ <br /> ALL OWNED ^SCHEDULED _ <br /> AUTOS AUTOS BODILY INJURY(Per accident) $ <br /> HIRED AUTOS NON-OWNED PROPERTY DAMAGE <br /> AUTOS $ <br /> (Per accident) <br /> . $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE _ $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE <br /> DEO RETENTION$ $ <br /> WORKERS COMPENSATION H- <br /> AND EMPLOYERS'LIABILITY Y/N STATUTE EERH <br /> ANYPROPRIETOR/PARTNER/EXECUTIVE <br /> OFFICER/MEMBEREXCLUDED? N/A E.L.EACH ACCIDENT $ <br /> (Mandatory in NH) <br /> If yes,describe under E.L.DISEASE-EA EMPLOYEE $ <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> Professional Liability Each Claim: $250,000 <br /> A UDC-1772831-E0-17 07/01/2017 07/01/2018 <br /> Aggregate: $ 250,000 <br /> DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ArrAD11A Mr=UIITLJ TI-Ir Dnl Iry DDr1VICIr,AIC <br />