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DocuSign Envelope ID: 53EDA064- 8713 -4EAA- 8288- 4C2296C110F6 <br />Ac a CERTIFICATE OF LIABILITY INSURANCE 7DATE, (M MIOOlYlvY} <br />/2512018 <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(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 CONTACT <br />NAME: <br />Hiscox Inc WC PHONE t , (88$ 202 -3007 FCC No : <br />520 Madison Avenue ADDREss: contact @hiscox,ccm <br />32nd Floor INSURERS AFFORDING COVERAGE NAIC p <br />New York, NY 10022 INSURER A ; Hiscox Insurance Company Inc 10200 <br />INSURED <br />Naw Paw HSer <br />2088 SOftwinds Or <br />I Graham NC 27253 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 />INSIR <br />LTR <br />TYPE OF INSURANCE <br />ADD <br />SUER <br />POLICY NUMBER <br />POLICY EFF <br />MMDDIYYYY <br />POLICY EXP <br />MMIDDIYYYY <br />LIMITS <br />GENERAL LIABILITY <br />EACH OCCURRENCE <br />_ <br />$ <br />CLAIMS -MADE F OOGUR <br />47MERCIAL <br />MA <br />PREMISES Ea occurrence <br />$ <br />MED EXP (Any One person) <br />$ <br />PERSONAL & ADV INJURY <br />$ <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />POLICY F—] PRO- F—] JECT LOC <br />PRODUCTS - GOMPIOPAGG <br />$ <br />$ <br />OTHER: <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />AUTOS AUTOS <br />BODILY INJURY (Per accident) <br />$ <br />PROPERTY DAMAGE <br />Per accident <br />$ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />UMBRELLA LIAB <br />HC1_AIMS-MADE <br />OCCUR <br />EACH OCCURRENCE <br />$ <br />AGGREGATE <br />$ <br />EXCESS LIAB <br />DED RETENTION $ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />PER OTH- <br />STATUTE I I ER <br />E.L. EACH ACCIDENT <br />$ <br />ANYPROPRIETORIPARTNE PIE XECUTIVE <br />OFFICER/MEMBER EXCLUDED7 <br />NIA <br />E.L. DISEASE - EA EMPLOYEE <br />$ <br />(Mandatory In NH) <br />If yas, describe under <br />DESCRIPTION OF OPERATIONS below <br />E.L. DISEASE - POLICY LIMIT <br />` <br />$ <br />A <br />Professional Liability <br />UDC - 1772831 -E0.18 <br />0710112018 <br />0710112019 <br />Each Claim: $ 254,000 <br />Aggregate: $ 254,000 <br />DESCRIPTION of OPERATIONS f LOCATIONS 1 VEHICLES (ACORD 161, Additllonal Remarks Schedule, may be attached If more space is required) <br />CERTIFICATE HOLDER I AAIf_FI I ATInM <br />V 19BU -2U14 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <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 f <br />V 19BU -2U14 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />