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DocuSign Envelope ID:87213ABF-3732-4E88-B475-AD615EF503C2 <br /> DATE(MMIDDIYYYY) <br /> '4 �o CERTIFICATE OF LIABILITY INSURANCE <br /> a5r17=19 <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 /> H€SCox Inc, PHONE (888)202-3007 FAX <br /> No): <br /> 520 Madison Avenue nnoal <br /> 32nd Floor ss, contact@hiscox.com <br /> New York,NY 10022 INSUWHIG)AFFORDING COVERAGE NAIC# <br /> _ INSURER : Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B: <br /> Naw Paw Hser <br /> INSURER C <br /> 2088 Softwinds Dr <br /> Graham NC 27253 INSURER D: <br /> INSURER E; <br /> 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 ADD L MM POLICY EFF POLICY EXP LIMITS <br /> LTR TYPE OF INSURANCE POLICY NUMB IY ER MWDDYYY MMIDDIYY'/Y <br /> COMMERCIALGENERAL LIABILITY EACH OCCURRENCE 5 <br /> —DAMAGET <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence 5 <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN1.AGGREGATE LIMITAPPLiES PER: GENERAL AGGREGATE $ <br /> POLICY❑JERCOT- ❑LOC. PRODUCTS-COMPIOPAGG $ <br /> OTHER, 5 <br /> AUTDMOBiLELlABILITY CDMBINED SINGLE LIMIT S <br /> Ea accident <br /> ANY AUTO <br /> BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED BODILY INJURY(Par aocldent) S <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE S <br /> HIRED AUTOS AUTOS Per accident <br /> S <br /> I <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE S <br /> EXCESS LIAB HCLAIMS-MADE AGGREGATE S <br /> DED I I RETENTION 5 $ <br /> WORKERS COMPENSATION <br /> TH- <br /> AN EMPLOYERS'LIABILITY YIN STATUTE I I OR <br /> ANYPROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT S <br /> OFFIC MM EMS ER EXCLUDED? <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yyes,describe under <br /> DESCRIPTION OF OPERATIONS halow E.L.DISEASE-POLICY LIMIT $ <br /> A Professional Liability UDC-1772831-EO-19 07/01/2019 07/01/2020 Each Clafm:$250,000 <br /> Aggregate:$250,000 <br /> DESCRIPTION OF OPERATIONS ILOCATI0NS 1 VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached 11 mare 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 /> �7 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014)01) The ACORD name and logo are registered marks of ACORD <br />