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DocuSign Envelope ID:29F69F49-AF01-438A-86A0-C2EF1EC6D661 <br /> DATE[MMIDDrm'Y] <br /> CERTIFICATE OF LIABILITY INSURANCE 06128l2019 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANT] 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 Inc. PH°NE (888)202-3007AX <br /> X No): <br /> c <br /> 520 Madison Avenue E-MAIL <br /> 32nd Floor ADoREss: contactahlsc°x,c°m <br /> New York,NY 10022 INSURERS AFFORDING COVERAGE NAIC0 <br /> INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B <br /> Melissa Childers <br /> 112 West Hill Ave N INSURERC- <br /> Hillsborough NO 27278 INSURER D 4 <br /> INSURER E: <br /> INSURER P: <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 INSURANCFEYP <br /> D BR POLICYNUMBER MMIDDIYYYPOLICY MMIDDPOLIOfYYYY LIMITS <br /> LTR <br /> COMMERCIALGENERALLIA13ILITY EACHOCCURRENCE $ <br /> CLAIMS-MADE OCCUR PREMISES f Ea occurrence $ <br /> MED EXP(Any one person) $ <br /> PERSONAL&ADV INJURY $ <br /> GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ <br /> POLICY JE, LOC PRODUCTS-COMPIOP AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COaM8cdd1NEC SINGLE LIMIT $ <br /> E aenf <br /> ANY AUTO <br /> BODILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Per aocldent) $ <br /> AUTOS NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS er accident <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAR CLAIMS-MADE AGGREGATE $ <br /> DEO I I RETENTION$ $ <br /> WORKERS COMPENSATION PFR OTH- <br /> AND EMPLOYERS'LIABILrFY <br /> I ER <br /> ANYPROPRIETORIPARTNERIExECUTIVE YINNIA E.L.EACH ACCIDENT E <br /> OFFICERIM EM6 EF2 ExC LUDEtl7 <br /> (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S <br /> If yes,describe under <br /> DESCRIPTION OF OPERATIONS balow E.L.DISEASE-POLICY LIMIT S <br /> A Professional Liability UDC-4203700-EC-19 07/01/2019 07/01/2020 Each Claim:$1,000.000 <br /> Aggregate:$2,000.000 <br /> DESCRIPTION OF OPE RATION 5 I LOCATIONS I VEHICLES(ACORD 101,Additlonal 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 /> G <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 />