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DocuSign Envelope ID: o240er38-3r84-4*4e'e0e8-C4r5eAC37487 <br /> C °81 ^D2/22/1O~MAC5O25182'O0^511354745 ^ O/8 ~ ORIG IMAGE COPY <br /> 0410446 GREAT AMERICAN E&S INS CO <br /> Administrative Offices <br /> 3o�Ewxmm° CG �� �2 <br /> �»u����&�yERYC/�� om,/nneuooe2ox (Ed. 12/09) <br /> INSURANCE GROUP 513 369 5000 ph <br /> Policy No. MAC 502-51 -82 - 00 <br /> ABUSE OR MOLESTATION COVERAGE FORM <br /> DECLARATIONS PAGE <br /> NAMED INSURED: KAH CARE, LLC POLICY PERIOD: <br /> O2/ 1G/ 18 to 02/ 10/ 17 <br /> LIMITS OF INSURANCE: <br /> Aggregate Limit $ 1 , 0 0 0, 0 0 0 Each Abuse Limit $ 1 , 0 0 0 , 0 0 0 <br /> DESCRIPTION OF BUSINESS: <br /> Form of Business ( ) Individual ( ) Joint Venture ( ) Partnership <br /> ( X ) Organization (Other Than Partnership or Joint Venture) <br /> READ YOUR POLICY CAREFULLY, OPTIONAL COVERAGES ARE PROVIDED BY PREMIUM INSERTION. <br /> Premium <br /> Abuse or Molestation Coverage $ I N C L <br /> TOTAL ADVANCE PREMIUM $ 3 8 1 <br /> Premium shown is payable: $ }NCL at inception; <br /> FORMS AND ENDORSEMENTS Applicable to this Coverage Part and made part of this Policy at time of issue are <br /> listed on the attached Forms and Endorsements Schedule CG 88 01 (11/85). <br /> CG 82 82 (Ed. 12/03) (Page 1 of 1) <br />