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DocuSign Envelope ID:9F8945D7-E616-45A2-816D-12F64FB659FF <br /> DESCRIPTIONS (Continued from Page 1) <br /> Form Information <br /> Form Description: Sexual Acts Liability Endorsement Limit#1: 1,000,000 <br /> Limit#2: 2,000,000 <br /> *"Workers Comp Information** <br /> Other States Coverage <br /> Proprietors/Partners/Executive Officers/Members Excluded: <br /> Nancy Espersen,Officer <br /> Ann Burton, Officer <br /> Dave Wilkerson,Officer <br /> Residual Market Limited Other States Insurance Endorsement <br /> **Supplemental Name** <br /> First Supplemental Name applies to all policies-Name Printed on DEC Page:Senior Care of Orange County <br /> Inc <br /> Policy includes endorsement that provides Additional Insured status for any Landlord, Owner,or Property <br /> Manager of the Designated Premises or any Tradeshow or Convention Sponsor or operator or any lessor of <br /> equipment. <br /> SAGITTA 25.3(2016/03) 2 of 2 <br /> #S28393862/M28393830 <br />