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DocuSign Envelope ID:2E150770-7335-4B4E-BDA7-47D76E2FC4C6 <br /> SUMMARY OF ENDORSEMENTS <br /> APPLICABLE TO ALL COVERAGES <br /> 1-U NGL-9512-M U-04, 04104 Commercial General Liability Coverage Part Declarations <br /> IL 09 85(01 08)- Disclosure Pursuant To Terrorism Risk Insurance Act <br /> Premium: $134 <br /> APPLICABLE TO SPECIFIC STATES <br /> STATE: NC <br /> CG 00 01 (12107)Commercial General Liability Coverage <br /> CG 00 99(11185)-Changes in General Liability Forms for CPP <br /> CG 03 00(01196)-Deductible Liability Insurance <br /> The information that follows completes the schedule portion of this endorsement. This endorsement modifies your coverage. <br /> Please refer to the above numbered endorsement(attached)for details. <br /> Deductible: PD Per Occurrence <br /> Deductible Amount: $250 <br /> CG 20 10(07104)-Addl Insured-Owners, Lessees or Contractors <br /> Premium:$49 <br /> CG 20 10(07104)-Addl Insured-Owners. Lessees or Contractors <br /> Premium:$92 <br /> CG 20 28 (07104)-Additional Insured-Lessor of Leased Equipment <br /> Premium:$50 <br /> CG 2149(09/99)-Total Pollution Exclusion <br /> CG 2167(12104)- Fungi Or Bacteria Exclusion <br /> CG 21 70(01 08)- Cap on Losses From Certified Acts of Terrorism <br /> CG 21 76(01 08)- Excl Of Punitive Damages Related To A Cert Act Of Terror <br /> CG 21 B6(12104) -Exclusion- Exterior Insulation and Finish Systems <br /> CG 24 04(10193) -Waiver of Transfer of Rights <br /> The information that follows completes the schedule portion of this endorsement. This endorsement modifies your coverage. <br /> Please refer to the above numbered endorsement(attached)for details. <br /> Premium:$100 <br /> Name of Person or Organization:Skanska USA Building Inc; Skanska USA Inc&Fidelity Investment Inc 4309 Emperor Blvd Ste <br /> 200 Durham, NC 27703-8046 <br /> CGL 025 (11 08)-Addl Insured-PrimarylNon-Contributory Coverage <br /> CGL 036 (11108)- Employee Benefits Liability Coverage <br /> The information that follows completes the schedule portion of this endorsement. This endorsement modifies your coverage. <br /> Please refer to the above numbered endorsement(attached)for details. <br /> Premium:$225 <br /> Limit Of Insurance: $1,000,000 per claiml$1,000,000 aggregate <br /> CGL 064(11108)- Employment Related Practices Exclusion <br /> CGL 072 (11108)- Exclusion-Ops Covered by a Consolidated Ins. Prog. <br /> CGL 084 (10113)-Addl Insured-Owners Lessees or Contractor-Automatic Status <br /> CGL 088 (10113)- First Choice Contractors Liability Endorsement <br /> Premium: $200 <br /> CGL 123(10113)- Employment Practices Liability Insurance Coverage Endo <br /> CGL 137(10113)- North Carolina Changes <br /> IL 00 03(09107)- Calculation of Premium <br /> IL 00 17(11198)-Common Policy Conditions <br /> IL 00 21 (07102)- Nuclear Energy Exclusion(Broad Form) <br /> 1-UNGL-9512-MU-04, 04/04 PREPARED: 10-30-2014 PAGE 4 OF 5 <br /> Includes copyrighted material of Insurance Services Office, Inc.with its permission. <br />