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OD6 A005679 1902820 <br />SCHEDULE A -SCHEDULE OF UNDERLYING POLICIES <br />Insured: <br />Effective on and after:,12:01 AM Standard Time <br />This schedule is part of Policy Number: <br />CARRIER,POLICY NUMBER &PERIOD TYPE OF POLICY APPLICABLE LIMITS OR <br />AMOUNT OF INSURANCE <br />(a)Carrier: <br />Policy Number: <br />Policy Period: <br />Commercial <br />General Liability <br />Non-owned & <br />Hired Autos <br />$Each Occurrence <br />$General Aggregate <br />$Product/Compl eted <br />Operations <br />Aggregate <br />(b)Carrier: <br />Policy Number: <br />Policy Period: <br />Comprehensive <br />Automobile Liability <br />Bodily Injury and Property <br />Damage Liability Combined <br />$Each Accident <br />Bodily Injury <br />$Each Person <br />$Each Accident <br />Property Damage <br />$Each Accident <br />(c)Carrier: <br />Policy Number: <br />Policy Period: <br />Standard Workers <br />Compensation & <br />Employers Liability <br />Please Note:The <br />Umbrella Coverage <br />for Workers <br />Compensation and <br />Employers Liability <br />is not applicable in <br />situations where an <br />employee is subject <br />to the New York <br />Workers <br />Compensation Law. <br />Coverage B -Employers Liability <br />Bodily Injury by Accident <br />$Each Accident <br />Bodily Injury by Disease <br />$Aggregate <br />$Each Employee <br />(d)Carrier: <br />Policy Number: <br />Policy Period: <br />Liquor Liability $Limit of Liability <br />(e)Carrier: <br />Policy Number: <br />Policy Period: <br />Professional <br />Liability <br />$Limit of Liability <br />An "X"marked in the box provided indicates these broadening or optional coverages are provided in the <br />Underlying Insurance <br />(f)Carrier: <br />Policy Number: <br />Policy Period: <br />Directors &Officers <br />Liability <br />$Limit of Liability <br />(g)Carrier: <br />Policy Number: <br />Policy Period: <br />Employee Benefits <br />Liability <br />$Limit of Liability <br />Countersigned By: <br />Date: <br />Authorized Representative of the Company <br />473-1103 (11/08) <br />TRIANGLE UROLOGY ASSOCIATES, <br />06/25/2020 <br />OD6-A005679-07 <br />MASSACHUSETTS BAY INSURANCE COMPANY <br />OD6-A005679-07 <br />X <br />06/25/2020 TO 06/25/2021 <br />CITIZENS INSURANCE COMPANY OF AMERICA <br />WB6A00428807 <br />06/25/2020 TO 06/25/2021 <br />1,000,000 <br />2,000,000 <br />2,000,000 <br />500,000 <br />500,000 <br />500,000 <br />DocuSign Envelope ID: F746D5BF-EF42-497A-9B83-D263FC4E623D