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DocuSign Envelope ID: 7F8DFDB2-D81A-4AOF-AF96-9B69F601FC96 <br /> .A.11xance,,f <br /> Ar Mw <br /> Nonprofits INDEX OF FORMS ATTACHED TO THE POLICY <br /> f-Insurance POLICY NUMBER:2013-37180-D0 <br /> Risk Retention Group <br /> NAME OF INSURED: North Carolina Public Health Foundation Page 1 <br /> DIRECTORS AND OFFICERS FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE <br /> Punitive and Exemplary Damages AN[-RRG ED013 0211 <br /> Directors&Officers Liability Policy Declarations ANI-RRG-DODEC 04 01 <br /> Nonprofit Organization Directors and Officers Liability Policy ANI-RRG-DOET 02 11 <br /> Prior Wrongful Acts Coverage Endorsement ANI-RRG-DOPWA 07 09 <br /> Member Criteria ANI-RRG-E3DO 0199 <br /> Nuclear, Chemical and Biological Hazard Exclusion ANI-RRG-E42 07 06 <br /> Nuclear Energy Liability Exclusion Endorsement(Broad Form) ANI-RRG-EDO1 08 91 <br /> Amended Definition of Deductible-Applies to Defense Costs and Damages ANI-RRG-ED011 0713 <br /> Revision of Exclusion L AN]-RRG-EDO18 04 13 <br /> Mold, Fungus Exclusion ANI-RRG-ED 034 0102 <br /> Blood Testing Exclusion ANI-RRG-ED04 03 94 <br /> Non-Imputation ANI-RRG-ED07 0211 <br /> Cap on Losses from Certified Acts of Terrorism CG 2170 01 08 <br /> Disclosure Pursuant to Terrorism Risk Insurance Act IL 09 85 01 08 <br /> This list of forms is not part of the actual policy, but is for your information only. <br /> Please refer to the policy(s)for actual limits, coverages and exclusions. <br />