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DocuSign Envelope ID:AE9D9297-6804-4094-8035-98E5531C978A <br /> EXTENSION OF DECLARATIONS <br /> Policy No. SP 1557590 Effective Date_ 10/02/2014 <br /> 12:01 AM STANDARD TIME <br /> FORMS AND ENDORSEMENTS <br /> The following forms apply to the Specified Professions Professional Liability Errors And Omissions coverage <br /> part <br /> Endt# Revised Description of Endorsements <br /> CONSA (01/08) Specified Professions Professional Liability Application <br /> PROF-001 06/01 Absolute Pollution Exclusion-Professional <br /> PROF-002 06/01 Mold, Fungus, Bacteria,Virus And Organic Pathogen Exclusion- <br /> Professional <br /> SP 07109 Specified Professions Professional Liability Coverage Form <br /> SP 210 07109 Retroactive Date Endorsement <br /> SP 211 07/09 Professional Services Exclusion Endorsement <br /> SP NC 07/09 North Carolina State Amendatory Endorsement <br /> SP Jacket 09/10 Specified Professions Professional Liability Policy Jacket <br /> EOD(01195) All other terms and conditions remain unchanged. Page 1 of 1 <br />