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DocuSign Envelope ID: E0823671-DC32-4568-94FB-2BF1139E36EAD <br /> AC <br /> DATE(MMIDDIYYYY)o►20� CERTIFICATE OF LIABILITY INSURANCE <br /> 0 612 91201 9 <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 CONTACTNAME: <br /> Hiscox Inc. PHONEN. EAL (888}202-3007 we No: _ <br /> 520 Madison Avenue %[MAIL contactChiscox,cam <br /> 32nd Floor _ADDxess; <br /> New York,NY 10022 IN SU RER(S)AFFORDING COVERAGE NAIC6 <br /> _ INSURERA; Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B: <br /> Patricia Nadabar <br /> 203 Swordgate Dr. INSURER C: <br /> Cary NC 27513 INSURER➢: <br /> INSURERS <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 /> INBR TYPE OF INSURANCE ADD SUER POLICY NUMBER MMIa CY EFF POLICY EXP <br /> LTR ➢IYYYY MMIDDIYYYY LIMITS <br /> COMMERCIAL GEN ERAL UABILITY EACH OCCURRENCE $ <br /> DAMAGE TO Rr.NTEU- <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one parson) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY jE T LOC PRODUCTS-COMPIOP AGG S <br /> OTHER: S <br /> COMB <br /> AUTOM081LE LIABILITY Ea accINED SINGLE LIMITident $ <br /> ANY AUTO aOOILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED ➢ODILY INJURY(Par accident) S <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE S <br /> HIRED AUTOS AUTOS Per accident <br /> a <br /> UMBRELLALIAB OCCUR EACH OCCURRENCE S <br /> EXCESS LIAR HCLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTION$ S <br /> WORKERS COMPENSATION <br /> AND EMPLOYERS'LIAHILITY YIN STATUTE OR <br /> ANYPROPRIETORIPAR'NERIEXECUTIVE ❑ E.L.EACH ACC ID ENT $ <br /> ED7 OFF ICERIMEMBER EXCLU D NIA <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ <br /> A Professional Liability UDC-4204872-EC-19 07/01/2019 07/01/2020 Each Claim:$1.000.000 <br /> Aggregate:$1.000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AC 0RD 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 REPRESENTATWE <br /> v� <br /> 1 r� <br /> Q 1988-2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />