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DocuSign Envelope ID:OFE288A9-2EE6-4332-87FC-71 131331362CE2 <br /> �® CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDIYYYYI <br /> 07/03/2019 <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 /> Hlscox Inc. PRONE FAX <br /> E . (888)202-3007 we No); <br /> 520 Madison Avenue I <br /> 32nd Floor ADDRESS: contact@hisoox.cam <br /> New York,NY 10022 INSURERS AFFORDING COVERAGE NAIC9 <br /> INSURERA: Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER 5 <br /> Celia PaUng <br /> 1309 Silver Dr INSURER C <br /> Mebane NC 27302 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 TYPE OF INSURANCE DD SUBR POLICY EFF POLICY EXP LIMITS <br /> V POLICY NUMBER MMIDD/YYYY MMIDD <br /> COMMERCIAL GENERALLIAOILITY EACH OCCURRENCE $ <br /> DA A <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S <br /> POLICY D JERo- F LOC PRODUCTS-COMPIOPAGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Es acckdent <br /> ANY AUTO BODILY INJURY(Per person) S <br /> ALL OWNED SCHEDULED' BODILY INJURY(Per accldent) $ <br /> AUTOS NON-OWNED <br /> PROPERTY DAMAGE S <br /> HIRED AUTOS AUTOS Peraccldent <br /> S <br /> UMBRELLA LIAR OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I I RETENTIONS $ <br /> WORKERS COMPENSATION sER ORH- <br /> AND EMPLOYERS'LIABILITY <br /> ANYPROPRIE ETGRIPARTNERfXECUTIVE YINNIA E.L.EACH ACCIDENT $ <br /> OFFICERIMEMB E R EXC LUGED7 <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 /> A Professfonal Liability UDC-4207383-EO-19 07/02/2019 07/02/2020 Each Claim:$250,000 <br /> Aggregate:$250,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(ACORD 101,AddltlonaI Remarks Schedute,may he attached irmore space Is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E 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(2014101) The ACORD name and logo are registered marks of ACORD <br />