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DocuSign Envelope ID: 3AD36C66- 5658 - 4281- 93DF- B77A9B2D44C6 <br />"a' <br />AC`CW?L CERTIFICATE OF LIABILITY INSURANCE DATE (MMdDDdYYYY) <br />�� 0710912018 <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 />- . <br />Hiscox Inc 888 202 -3007 -- FAX <br />fC No. <br />520 Madison Avenue A DRESS: contact@hiscox.com <br />32nd Floor INSURER (S) AFFORDING COVERAGE NAIC # <br />New York, NY 10022 INSURER A: Hiscox Insurance Company Inc 10200 <br />INSURED INSUx1 =R e : <br />SHELTON HAYNES INSURER C: <br />. . . .. .... ....... . <br />555 E 78TH ST INSURERo <br />6B INSURER E <br />NEW YORK NY 10075 INSURER F: <br />PnVIFRAnPR f`FI7TIF1r`AT1- RIIIMRFR• RFvl -ql m fJIIMRPR. <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 RESPE=CT 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMiDDI EFF (MMIDDNYYYI EI(P LIMITS <br />IT. Rim Wyo <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />COMMERCIAL GENERAL LIABILITY <br />EACH OCCURRENCE <br />$ <br />_ CLAIMS,MADE OCCUR <br />$ <br />DA AG O R h <br />E ISES_ Eac urrence <br />$ ....... <br />MED EXP (Any one person) <br />_ ............._.. _.. ..........._. — <br />PERSONAL a ADV INJURY <br />$ <br />GEWL AGGREGATE LIMIT APPLIES PER: <br />GENERAL AGGREGATE <br />$ <br />PRO' <br />..__ POLICY n JECT [A LOC <br />- -- ......... <br />$ <br />PRODUCTS <br />$ <br />OTHER: <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accldent <br />$ <br />BODILY INJURY (Per person) <br />$ <br />ANY AUTO <br />ALL OWNED SCHEDULED <br />BODILY INJURY (Per acctdant) <br />I <br />$ <br />AUTOS AUTOS <br />- - --- <br />PROPERTY DAMAGE <br />Per awldent <br />$ <br />- -... ......_. <br />_ <br />NON -OWNED <br />HIRED AUTOS AUTOS <br />$ <br />UMBRELLA LIAR OCCUR <br />EACH OCCURRENCE. _ <br />$ <br />$ <br />EXCESS LIAR CLAIMS -MADE <br />AGGREGATE <br />DED RETENTION$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY YIN <br />ANYPROPRIEfOWPARTNERIEKECUTIVE <br />OTH <br />STATUTE ER <br />.- ....... <br />3 <br />E.L. EACH ACCIDENT <br />- <br />$ <br />OFFICEWMEMBEREXCLUDED? ❑ <br />(Mandatory In NH) <br />NIA <br />NIA <br />-- <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. DISEASE - POLICY LIMIT <br />If es, desMbe under <br />DESCRIPTION OF OPERATIONS below <br />$ <br />Professional Liability <br />Each Claim: $ 1 ,000,000 <br />A <br />UDC- 2303886 -EO -18 <br />07/0912018 <br />0710912019 <br />Aggregate: $ 1,000,000 <br />DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) <br />nra rrrrr me unr M=M I Alkirt =1 1 ATInM <br />(511VUtf -ZU14 AS.:UKU L;UKVUKAI IUN. All rlgnis reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />AUTHORIZED REPRESENTATIVE <br />(511VUtf -ZU14 AS.:UKU L;UKVUKAI IUN. All rlgnis reserved. <br />ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD <br />