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DocuSign Envelope ID:3104DB10-5BE2-4447-B27F-DB78763E6E88 <br /> � 0 DATE(MMIDDIYYYY) <br /> A <br /> c" CERTIFICATE OF LIABILITY INSURANCE 0612812016 <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 /> HiscoX lnc PHONE $ & 202 3007 FAX <br /> =No.Ext}: ( } __._ _ AfC Na: <br /> 520 Madison Avenue E-MDRESS•AIL <br /> AD contact@hiscox.com <br /> . <br /> 32nd Floor _ INSURER(S}AFFORDING COVERAGE NAIC# <br /> New York,NY 10022 INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED <br /> INSURER B: <br /> Benjamin Beaton INSURER C: <br /> 107 James Helen Ct• INSURERD: <br /> INSURER E: <br /> Wilfow Spring NC 27592 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 ...._ ADDLSUBR -----.. ... <br /> LTR TYPE OF INSURANCE POLICY NUMBER MMID9 EFF MMI ONY POIJP__ LIMITS <br /> COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S <br /> DAMA E <br /> CLAIMS-MADE OCCUR PREMLSES Ea occurcence $ <br /> MED EXP(Any one parson) $ <br /> PERSONAL&ACV INJURY $ <br /> OF AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY 1 JET LOC PRODUCTS-COMPIOPAGO S <br /> ............. <br /> OTHER: S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED BODILY INJURY(Per accidard $ <br /> AUTOS AUTOS } <br /> HIRED AUTOS ANONED PRROP(PerPERR nDAMAGE ... .5.. <br /> $ <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> E HCLAWS-MADEXCESS LIA6 AGGREGATE <br /> OED RETENTION$ $ <br /> WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE I _Eft: <br /> ANYPROPRIETORfPARTNERIEXECUTIVE ❑ NfA E.L.EACH ACCIDENT <br /> E $ <br /> OFFICERIMMBEREXCLUDEDT <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S <br /> If yes,describe under _.-... ....----- <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S <br /> Professional Liability Each Claim: $250,000 <br /> A UDC-1774785-EO-16 07101/2016 07/01/2017 <br /> Aggregate: $250,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I 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 /> ACCORDANCE WITH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> I <br /> ©1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD <br />