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40 <br />H I SC ®X <br />HISCOX INSURANCE COMPANY INC. (A Stock Company) <br />104 South Michigan Avenue, Suite 600 Chicago Illinois 60603 <br />Certificate of Commercial General Liability Insurance <br />This certificate is issued for informational purposes only. <br />It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to <br />any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not <br />change the terms, exclusions or conditions of such policies. <br />Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of <br />any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits <br />provided at the policy inception. Subsequent paid claims may reduce these limits. <br />Named Insured: <br />Insurer Name: <br />Policy Number: <br />Type of Coverage: <br />Policy Effective Date: <br />Limits of Insurance <br />Each Occurrence: <br />Cit Com <br />Hiscox Insurance Company Inc. <br />UDC - 1377817- CGL -15 <br />Occurrence <br />September 15, 2015 <br />Policy Expiration Date: <br />September 15, 2016 <br />Damage to Premises Rented to You: <br />Medical Expense: <br />Personal & Advertising Injury: <br />General Aggregate: <br />Products /Completed Operations <br />Aggregate: <br />General Aggregate Limit applies per: <br />Description of Endorsements /Special Provisions <br />Not applicable <br />$ 1,000,000 <br />$ 100,000 Any one premises <br />$ 5,000 Any one person <br />$ 1,000,000 <br />$ 2,000,000 <br />Products - completed operations are subject to the General Aggregate <br />Limit <br />Policy <br />Wi uN <br />Additional Insured Status 1 I /' <br />® Certificate holder maintains Additional Insured Status if this boxed checked. <br />This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate <br />holder is an additional insured, the policy(ies) must either be endorsed or contain spe -cific language providing the certificate <br />holder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such <br />policy language or endorsement. <br />Cancellation <br />In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the <br />certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability <br />upon the insurer, its agents or representatives, nor will it delay cancellation. <br />CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., with Page 2 <br />its permission. © ISO Properties, Inc., 2000 <br />