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DocuSign Envelope ID:86C86165-F915-4C58-8C57-2284F5D9E950 <br /> 0 DATE IMMIDDIYYYY) <br /> A`aRU CERTIFICATE OF LIABILITY INSURANCE <br /> 02/11/2020 <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 INSURERS), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br /> this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). <br /> PRODUCER CONTACT <br /> NAME: <br /> Hiscox Inc. PHONE (888}202-3007 FAX No Wr <br /> a <br /> 520 Madison Avenue E-MAIL <br /> 32nd Floor ADDRESS: cDntact®hEscax.com <br /> New York,NY 10022 INSURERS AFFORDING COVERAGE NAICk <br /> INSURER A, Hiscox Insurance Company Inc 10200 <br /> INSURED INSURER B: <br /> Daniel Qiao <br /> 1323 Northcreek Dr INSURER C: <br /> ❑urham NC 27707 INSURERD: <br /> INSURER E: <br /> INSURERF: <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 POLICY EFF POLICY EXP <br /> LTR TYPEOF INSURANCE S POLICY NUMBER MIDD (MMODWMI LIMITS <br /> COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ <br /> CLAIMS-MADE OCCUR PREMISES Ea occurrence $ <br /> MED EXP(Any oneperson) 5 <br /> PERSONAL&ADV INJURY $ <br /> GE NL AGGREGATE LIMIT APPLIES PER; GENERALAGGREGATE $ <br /> POLICY JEC'{ LOC PRODUCTS-COMPIOPAGG S <br /> OTHER: S <br /> AUTOMOBILE LIABILITY COMBINED SINGLE€JMIT $ <br /> Ea accident <br /> ANY AUTO BOOILY INJURY[Per person] $ <br /> OWNED SCHEDULED BODILY INJURY(Peracddent) S <br /> AUTOS ONLY AUTOS <br /> HIRED NON-OWNED PROPERTY DAMAGE $ <br /> AUTOS ONLY AUTOS ONLY Per accident <br /> $ <br /> UMBRELLA LIAB OCCUR EACH OCCURRENCE $ <br /> EXCESS LIAB CLAIMS-MADE AGGREGATE $ <br /> DED I RETENTIONS $ <br /> 1 WORKERS COMPENSATION PER OTH- <br /> AND EMPLOYERS'LIABILITY YIN STATUTE ER <br /> ANYPROPRIETORIPARTNEWEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ <br /> OFFICERIMEMB ER EXCLU DED7 <br /> (Mandatory in NH) E,L DISEASE-EA EMPLOYEE $ <br /> Ir yes,describe under E.L.DISEASE-POLICY LIMfi $ <br /> _ DESCRIPTION OF OPERATIONS below <br /> A Professional Liability UDC-4404125-EO-20 02/17/2020 02/1712021 Each Claim: $250.000 <br /> Aggregate: $250.000 <br /> DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101.Additional Remarks Schedule,may be attached if more space is required) <br /> CERTIFICATE HOLDER CANCELLATION <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br /> ACCORDANCE W$TH THE POLICY PROVISIONS. <br /> AUTHORIZED REPRESENTATIVE <br /> 1 <br /> 1988-2015 ACORD CORPORATION. All rights reserved. <br /> ACORD 25(2016103) The ACORD name and logo are registered marks Of ACORD <br />