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DocuSign Envelope ID:4DOA7074-E28B-4FEA-A9EE-3856ABFCD1DB <br /> _ 7 ® DATE(MMIODIYYYY) <br /> CERTIFICATE OF LIABILITY INSURANCE <br /> 07/12/2019 <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 endorsements). <br /> PRODUCER CONTACT <br /> NAME: _ <br /> Hiscox Inc. PHONE (888)202-3007 FAX <br /> No): <br /> 520 Madison Avenue E-MAIL <br /> ADDREss: confact@hisc0x.cam <br /> 32nd Floor <br /> New York,NY 10022 IN SURER(S)AFFORDING COVERAGE NAIL# <br /> INSURER A: Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B: <br /> Cindy Chen <br /> 111 Tealight Ln €NSllRERt <br /> Cary NG 27513 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 ADDLTYPE OF}NSURANCE JUM SU n POLPOLICY NUMBER MMI Io�YY M <br /> LTR MID LIMITS <br /> GOMMERCIALGENERAL LIABILITY EACH OCCURRENCE S <br /> DAMAGE? _11 NT O <br /> CLAIMS-MADE - OCCUR PREMISES Ea occurrence $ <br /> ME EXP(Arty one person) $ <br /> PERSONAL&AOV INJURY $ <br /> GEN'L AGO REGATE LI M IT APPLI ES PE R: GENERAL AGGREGATE $ <br /> POLICY PRO LOC PRODUCTS-COM Plop AGG $ <br /> OTHER: $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> Ea accident <br /> ANY AUTO 0DOILY INJURY(Per person) $ <br /> ALL OWNED SCHEDULED BODILY INJURY(Peraccldent) $ <br /> AUTOS AUTOS <br /> NON-OWNED PROPERTY DAMAGE $ <br /> HIRED AUTOS AUTOS Per a.iden! <br /> I <br /> MBRELLALIAB HOCCUR EAGHOCCURRENCE S <br /> XCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> ED RETENTIMiJS <br /> WORKERS COMPENSATION PER STATUTE EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRIETORIPARTNEPJEXECUTIVE ❑ NIA E.L.EACH ACCIDENT S <br /> OFFICERIM EMBER EXCLUDED? <br /> (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ <br /> If yes,describe under <br /> DESCRIPTION of OPERATIONS below E.L.DISEASE-POLICY LIMIT I S <br /> A Professional Liability UDC-4212840-EO-19 07/10/2019 07110/2020 Each Claim:$250,00 <br /> Aggregate:$250,000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD let,Additional Remarks Schedule,may be attached it 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 /> __, <br /> 01988.2014 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD <br />