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DocuSign Envelope ID:91 F43AFA-8CB4-4861-887A-F304C7A6614B <br /> hd1111 P ALLIANCE OF <br /> ❑ NONPROFITS FOR ALLIANCE OF NONPROFITS FOR INSURANCE <br /> 11 INSURANCE RISK RETENTION GROUP(ANI) <br /> 11� www.insurancefornonprofits.org <br /> A Head for Insurance.A Heart for Nonprofits. <br /> INDEX OF FORMS ATTACHED TO THE POLICY <br /> POLICY NUMBER: 2015-37160 <br /> NAME OF INSURED: North Carolina Public Health Foundation Page 1 <br /> LIABILITY FORMS AND ENDORSEMENTS FORM NUMBER/EDITION DATE <br /> Member Criteria ANI-RRG-E03 01 13 <br /> Fireworks Exclusion ANI-RRG-E11 07 92 <br /> Nuclear Energy Liability Exclusion Endorsement ANI-RRG-E12 05 92 <br /> Blood Testing Exclusion ANI-RRG-E15 02 09 <br /> Asbestos Exclusion ANI-RRG-E22 08 95 <br /> Additional Insured- Designated Person or Organization ANI-RRG-E25 01 98 <br /> Property Damage to Personal Property in the Care, Custody or Control of the Insured ANI-RRG-E28 01 99 <br /> Employee Personal Auto Reimbursement ANI-RRG-E29 12 09 <br /> Mold, Fungus Exclusion ANI-RRG-E33 01 02 <br /> Nuclear, Chemical and Biological Hazard Exclusion ANI-RRG-E42 07 06 <br /> Privacy Liability and Cyber Coverage ANI-RRG-E52 07 13 <br /> Volunteer Medical Payments ANI-RRG-E60 07 12 <br /> Additional Insured- Primary and Non-Contributory Endorsement for Public Entities ANI-RRG-E61 02 13 <br /> Exclusion of Coverage for Claims By and Related to Past and Present Employees ANI-RRG-E7 10 04 <br /> Fundraiser Endorsement ANI-RRG-E70 07 13 <br /> Mental Anguish Endorsement ANI-RRG-E74 03 14 <br /> Commercial General Liability Coverage Part Declarations ANI-RRG-GL 04 01 <br /> Commercial Liquor Liability Coverage Part Declarations ANI-RRG-LL 04 01 <br /> Improper Sexual Conduct and Physical Abuse Exclusion-GL ANI-RRG-X1 02 15 <br /> Commercial General Liability Coverage Form CG 00 01 07 98 <br /> Liquor Liability Coverage Form CG 00 33 01 96 <br /> Additional Insured-Owners, Lessees or Contractors CG 20 10 07 04 <br /> Additional Insured- Managers or Lessors of Premises CG 20 11 01 96 <br /> Additional Insured-State or Political Subdivisions-Permits CG 20 12 07 98 <br /> Additional Insured- Mortgagee,Assignee or Receiver CG 20 18 11 85 <br /> Additional Insured-Charitable Institutions CG 20 20 11 85 <br /> Additional Insured-Volunteers CG 20 21 07 98 <br /> Additional Insured- Designated Person or Organization CG 20 26 07 04 <br /> Additional Insured- Lessor of Leased Equipment-Automatic Status-Lease CG 20 34 07 04 <br /> Additional Insured-Owners, Lessees or Contractors-Completed Operations CG 20 37 07 04 <br /> Designated Professional Services Exclusion CG 21 16 07 98 <br /> Cap on Losses from Certified Acts of Terrorism CG 21 70 01 15 <br /> Health or Cosmetic Services Exclusion CG 22 44 11 85 <br /> Products/Completed Operations Hazard Redefined CG 24 07 11 85 <br /> Amendment-Aggregate Limits of Insurance(Per Location) CG 25 04 11 85 <br /> Liability Arising Out of Lead Exclusion CG 77 94 04 93 <br /> Common Policy Conditions IL 00 17 11 98 <br /> North Carolina Changes-Cancellation and Nonrenewal IL 02 69 09 00 <br /> Disclosure Of Premium for Certified Acts of Terrorism Coverage IL 09 99 01 15 <br /> Nonprofits' OWN Enhancement Endorsement NPO-001 04 09 <br /> Commercial General Liability Class Code Schedule SCHEDULE G 01 80 <br /> Commercial General Liability Location Schedule SCHEDULE L 01 80 <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 />