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DocuSign Envelope ID: A07C4620 -D9F0- 4228- 9B2F -1 D499E5F8796 <br />AGENCY CUSTOMER ID: 4884 <br />LOG #: All <br />► �' ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br />AGENCY <br />INSURED <br />HANOVER EXCESS & SURPLUS, INC. <br />Dorothea Farrington <br />COVERAGE PART — - <br />Personalized Patients Home Assistance <br />Commercial Liability <br />POLICY NUMBER <br />108 Concord Dr <br />AH 1555797A <br />Chapel Hill, NO 27516 <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: 711712018 <br />United States Liability Insurance Company <br />25$95 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: <br />CERTIFICATE OF LIABILITY INSURANCE <br />COVERAGE PART — - <br />LIMITS — <br />Commercial Liability <br />Each Occurrence Limit <br />$1,000,000 <br />Personal & Advertising Injury Limit (Any One Person /Organ Ization) <br />$1,000,000 <br />Medical Expense (Any One Person) <br />$5,000 <br />Damages To Premises Rented To You (Any One Premises) <br />$100,000 <br />Products/Completed Operatlons Aggregate Llmit <br />Included <br />General Aggregate Limit <br />$3,000,000 <br />Allied Health Abuse Molestation Each Claim Limit <br />$1,000,000 <br />Allied Health Abuse Molestation Aggregate <br />$2,000,000 <br />Professional Liability <br />Each Clalm LImit <br />$1,007,000 <br />Annual Aggregate Limit <br />$3,000,000 <br />Deductible <br />$0 <br />Retroactive Date <br />07/17/2017 <br />ACORD 101 (2008101) Copyright 2008 ACORD CORPORATION, All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />