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DocuSign Envelope ID:5ED77415-392C-4A8D-9E51-CB251ABA325A <br /> Insured Name: Havanceo uentai Hssouates Inc. <br /> Policy Number: Q971310636 <br /> Policy Period: 06/02/2020 to 06/02/2021 Page 4 of 10 <br /> Schedule of Static Forms - (continued) <br /> Form Number Edition Date Description <br /> CL0396 01/17 IMPORTANT NOTICE - DATA BREACH RESPONSE EXPENSES COVERAGE <br /> CG2106 05/14 EXCL-ACCESS OR DISCLOSURE OF CONFIDENT OR PERS.INFO AND <br /> DATA-RELATED LIAB - WITH LIMIT BOD INJ EXCEP <br /> CG2109 06/15 EXCLUSION - UNMANNED AIRCRAFT <br /> IL0017 11/98 COMMON POLICY CONDITIONS <br /> IL0021 09/08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) <br /> IL0269 09/08 NORTH CAROLINA CHANGES - CANCELLATION AND NONRENEWAL <br /> IL0952 01/15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM <br /> IL985F 01/15 DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT <br /> PKMJ 01/10 EXCLUSION - LEAD LIABILITY <br /> PKMN 01/10 EXCLUSION - PERSONAL ACTIVITY LIABILITY <br /> PKMD 01/10 EXCLUSION -ASBESTOS <br /> PKMQ 12/14 EXCLUSION - PROFESSIONAL LIABILITY <br /> PKRO 01/10 AMENDMENT OF POLICY -TWO OR MORE COVERAGE PARTS <br /> Processed On:03/19/2020 <br />