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DocuSign Envelope ID:AFDEA346-5B2C-4141-81 00-A2E551 BE280D <br /> Total Policy Premium: <br /> Item E. COVERAGE FORMS <br /> Form Number Edition Title <br /> BOP43591 b 0117 BUSINESSOWNERS POLICY DECLARATIONS <br /> CC1K11H 0314 SIGNATURES <br /> BOP43603 0814 EXCLUSION-GENETICALLY MODIFIED ORGANISMS <br /> BOP43830 0614 LEAD EXCLUSION <br /> BP0003 0713 BUSINESSOWNERS COVERAGE FORM <br /> BP0501 0702 CALCULATION OF PREMIUM <br /> BP0515 0115 DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT <br /> BP0517 0106 EXCLUSION -SILICA OR SILICA-RELATED DUST <br /> BP0595 0514 ELECTRONIC DATA LIABILITY-LIMITED COVERAGE <br /> BP0598 0713 AMENDMENT OF INSURED CONTRACT DEFINITION <br /> BP0805 0110 VETERINARIANS PROFESSIONAL LIABILITY <br /> BP1407 0110 BUSINESS INCOME AND EXTRA EXPENSE- REVISED PERIOD OF INDEMNITY <br /> BOP47736 0416 AMENDMENT OF BODILY INJURY DEFINITION - INCLUDING RESULTING MENTAL ANGUISH <br /> BOP47738 0416 EXCLUSION-HEALTHCARE INFORMATION TECHNOLOGY PRODUCTS AND SERVICES <br /> BP0523 0115 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM <br /> BOP48932a 0618 ANIMAL BAILEE COVERAGE <br /> BOP47643 0316 EMPLOYMENT-RELATED PRACTICES EXCLUSION <br /> BOP48527 0117 ASBESTOS EXCLUSION <br /> ALL20887 1006 ACE PRODUCER COMPENSATION PRACTICES AND POLICIES <br /> ILP001 0104 U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY <br /> NOTICE TO POLICYHOLDERS <br /> ALL42490B 0716 U.S. FOREIGN ACCOUNT TAX COMPLIANCE ACT("FATCA") <br /> ALL21101 1106 TRADE OR ECONOMIC SANCTIONS ENDORSEMENT <br /> BOP49269 0517 PERIOD OF RESTORATION DEFINITION—WAITING PERIOD AMENDED <br /> TRIA11c 0115 DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT <br /> BPO116 0315 NORTH CAROLINA CHANGES <br /> Item F. Notice under this Policy shall be given to: <br /> Chubb North America Claims <br /> P.O. Box 5122 <br /> Scranton, PA 18505-0554 <br /> Toll Free: 844-539-3801 <br /> BOP-43591 b(01/17) ©2015 Page 3 of 4 <br />