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DocuSign Envelope ID: 37EO5944- 6119 - 4717- A9E3- 4C519DD0322C <br />'I a <br />ACORD CERTIFICATE OF LIABILITY INSURANCE <br />DATE (MMIDDNYYY) <br />05117/2018 <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 pollcy(les) 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 <br />CONTACT <br />NAME: <br />_ <br />PHONE (888) 202-3007 &C No l: <br />HISCOX inc <br />ADRIESS! COnlact@iQ hi5cox,com <br />520 Madison Avenue <br />INSURER JS) AFFORDING COVERAGE <br />NAIC N <br />32nd Floor <br />INSURER A: Hiscox Insurance Company Inc <br />10200 <br />New York, NY 10022 <br />INSURED <br />INSURER B <br />CLAIP.IS- l.4ADE � OCCUR <br />INSURER C: <br />Margaret Toe <br />INSURER D: <br />611 <br />INSURER E : <br />5 <br />Dupree St. <br />INSURER F: <br />S <br />Durham NC 27701 <br />r OVFRAr,FS rFRTIFICATF 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 />LTR <br />TYPE OF INSURANCE <br />IHS12 <br />wBR <br />POLtCYNUMBER <br />MfA@p EFF <br />POLICY <br />LIMITS <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />5 <br />CLAIP.IS- l.4ADE � OCCUR <br />PREMISES EaEoccur ence <br />5 <br />MED EXP (Any one person) <br />S <br />PERSONALBAUV)NJURY <br />S <br />LIMITAPPLI ESPER: <br />GENERAL AGGREGATE <br />$ <br />7AG3REM <br />PRO- LOC <br />JECT <br />PRODUCTS - C054PIOP AGG <br />$ <br />$ <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />S <br />BODILY INJURY (Par person) <br />S <br />ANY AUTO <br />BODILY INJURY (Per accident) <br />S <br />ALL OWNED SCHEDULED <br />AUTOS <br />or POPERTYDAMAGE <br />5 <br />NO - OViNED <br />HIRED AUTOS AUTOS <br />$ <br />UMBRELLA LIAS <br />OCCUR <br />EACH OCCURRENCE <br />S <br />AGGREGATE <br />S �^ <br />EXCESS LIAB <br />CLAI64S -MAIDE <br />DED RETIIT10N S <br />S <br />� <br />WORKERS COMPENSATION <br />AND EMPLOYERS'LIABILITY <br />ANYPROPRIETORIPARTNERIEXECUTIVE Y� <br />STATUTE OTRH- <br />--- <br />5 <br />E.L_ EACH ACCIDENT <br />OFFICERIMEMBEREXCLUDED? <br />NIA <br />(Mandatory In NH) <br />E.L. DISEASE - EA EMPLOYEE <br />S <br />E.L. DISEASE - POLICY LIMIT <br />S <br />If yes, descnbe under <br />DESCRIPTION OF OPERATIONS belax <br />Professional Liability <br />Each Claire: $ 250,000 <br />A <br />UDC - 2009323 Efl 18 <br />0710112018 <br />07/01/2019 <br />Aggregate: $ 250,000 <br />DESCRIPTION OF OPERATIONS f LOCATIONS [VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE �% <br />t^ <br />O 1988 -2014 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />