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DocuSign Envelope ID: 1327919D -9B91- 4603- B056- 5CA1EBBFDF23 <br />ADDITIONAL COVERAGES <br />Ref # <br />Description <br />Improper Sexual Conduct <br />Coverage Code <br />ISC <br />Form No. <br />Edition Date <br />Limit 1 <br />1,000,000 <br />Limit 2 <br />3,000,000 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />$1,148.00 <br />Ref # <br />Description <br />Add'] for policy minimum premium <br />Coverage Code <br />APMP <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />$581.00 <br />Ref # <br />Description <br />Social Service Prof Liab <br />Coverage Code <br />SSP <br />Form No. <br />Edition Date <br />Limit 1 <br />1,000,000 <br />Limit 2 <br />3,000,000 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />$840.00 <br />Ref # <br />Description <br />Liquor Liability <br />Coverage Code <br />LIQUR <br />Form No. <br />Edition Date <br />Limit 1 <br />1,000,000 <br />Limit 2 <br />1,000,000 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />Ref # <br />Description <br />Coverage Code <br />Form No. <br />Edition Date <br />Limit 1 <br />Limit 2 <br />Limit 3 <br />Deductible Amount <br />Deductible Type <br />Premium <br />rOFADTLCV Copyright 2001, AMS Services, Inc. <br />