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DocuSign Envelope ID:92CA6B6A-5CBD-40AE-8FF1-B6100066874C <br /> _ 7 ® DATE(MMIDDrMY) <br /> ACC?o CERTIFICATE OF LIABILITY INSURANCE <br /> 05JI712019 <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 endorsements). <br /> PRODUCER NAME CONTACT <br /> : <br /> Hiscox Inc. PHONE {888}202-3007 FA No <br /> 520 Madison Avenue ADDRESS:32nd Floor contact®hiscox.com <br /> New York,NY 10022 INSURERS AFFORDING COVERAGE NAIC# <br /> INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B <br /> Silvia Ussette Saca <br /> 103 N.Crabtree}mall INSURER C <br /> Chapel Hill NC 27514 INSURERD: <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 /> IN8R TYPE OF IN DDL SUER POLICYHUMBER MMM DDPOLICYIYYYY EFF MWDD Y LIMITS <br /> LTR10k MT- <br /> COMMERCIALGEN ERA LLIABIL17Y EACHOCCURRENCE $ <br /> DAMAGE TO RENTr.157- <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ _ <br /> ME EXP(Wry one emon) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ <br /> POLICY❑jECT LOC PRODUCTS-COMPIOPAGG $ <br /> OTHER: <br /> AUTOMOBILE LIABILITY COMBiNEDSINGLEUMIT $ <br /> Ea acc[den! <br /> ANY AUTO BODILY INJURY(Per parson) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Foraccldent) $ <br /> AUTOS AUTOS <br /> NON-OWNED FIR-OPERTY <br /> accident)DAMAGE $ <br /> HIRED AUTOS AUTOS <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE S <br /> .DE❑ I I RETENTION$ $ <br /> WORKERS COMPENSATION PER <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRIETORIPARTNERIEXECUTIVE ❑ N f A E.L.EACH ACCIDENT $ <br /> OFFICERIMEMBEREXCLUDED7 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ <br /> Ii yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Professional Liability UDC-1763911-EO-19 07101/2019 07/01/2020 Each Claim:$250,000 <br /> Aggregate:$250,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS r VEHICLES (ACORD 101,Additional Remarks Schedule,may be attachod 1r 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 /> AUTHOR2EDREPRESENTATIVE Y <br /> 1 <br /> a 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />