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DocuSign Envelope ID:5ED77415-392C-4A8D-9E51-CB251ABA325A <br /> Insurea Name: Havancea uentai /Associates Inc. <br /> Policy Number: Q971310636 <br /> Policy Period: 06/02/2020 to 06/02/2021 Page 3 of 10 <br /> Supplemental Declarations <br /> Location 1 /Building 1 <br /> Address: Occupancy/Operations: <br /> 2 CROSSWINDS ESTATES DR Employment Agency <br /> PITTSBORO NC 27312-8450 <br /> County: Chatham <br /> Interest of Named Insured In Such Premises: Homeowner <br /> Coverage Deductible Amount of Insurance <br /> Property Protection <br /> 1. Buildings NIL <br /> 2. Business Personal Property and Personal Property of Others Property Deductible $10,900 <br /> Replacement Cost <br /> Theft Exclusion Applies: No <br /> 3. Income Protection&Extra Expense Actual Loss Sustained 12 Months <br /> Automatic Adjustment of Business Personal Property and Personal Property of Others Coverage —2% <br /> Property and Inland Marine-Optional Coverages: <br /> Sewer and Drain Backup $500 $5,000 <br /> Utility Properties-Direct Damage $5,000 <br /> Schedule of Static Forms <br /> Form Number Edition Date Description <br /> UPP 01/10 ULTRAPACK PLUS POLICY <br /> PK0001 05/20 ULTRAPACK PLUS COMMERCIAL PROPERTY COVERAGE PART <br /> PKAX 01/10 PRODUCTION OR PROCESS MACHINERY- DEDUCTIBLE <br /> PKAY 12/14 SEWER AND DRAIN BACK-UP COVERAGE <br /> PKBB 07/16 UTILITY PROPERTIES - DIRECT DAMAGE <br /> CL0209 11/10 IMPORTANT NOTICE - LEAD LIABILITY EXCLUSION <br /> CL0214 11/10 IMPORTANT NOTICE - POLICY SERVICE FEES <br /> CL0492 04/19 IMP NOTICE TO PROP INS POLHLDR-NO FLOOD, EARTHQUAKE, MUDSLIDE, <br /> MUDFLOW, OR LANDSLDE COV <br /> PKGP 01/10 AMENDMENT OF MOBILE EQUIPMENT DEFINITION <br /> PKRE 01/10 NORTH CAROLINA AMENDATORY ENDORSEMENT <br /> CL0495 05/20 * IMPORTANT NOTICE TO POLICYHOLDERS - ULTRAPACK PLUS PROGRAM <br /> PK0003 05/20 * ULTRAPACK PLUS EXTRA LIABILITY COVERAGES <br /> CG0001 04/13 COMMERCIAL GENERAL LIABILITY COVERAGE FORM <br /> CGO099 11/85 CHANGES IN GENERAL LIABILITY FORMS FOR COMMERCIAL PACKAGE <br /> POLICIES <br /> CG2138 11/85 EXCLUSION - PERSONAL AND ADVERTISING INJURY <br /> CG2147 12/07 EMPLOYMENT-RELATED PRACTICES EXCLUSION <br /> CG2167 12/04 FUNGI OR BACTERIA EXCLUSION <br /> UFB213 11/12 * SUBSCRIBER'S AGREEMENT <br /> CG2170 01/15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM <br /> CG2196 03/05 SILICA OR SILICA-RELATED DUST EXCLUSION <br /> PKGN 12/14 PUNITIVE DAMAGES COVERAGE <br /> Processed On: 03/19/2020 (See Reverse Side) <br />