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Empl Practices Liab Ins EPL-1 <br />25,000 25,000 <br />Hired Non Owned Auto HDNON <br />1,000,000 <br />WC & Employer's liability WCEL <br />1,000,000 1,000,000 1,000,000 <br />Experience Mod Factor 1 EXP01 <br />ADDITIONAL COVERAGES <br />Ref #Description Edition DateForm No.Coverage Code <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Ref #Description Coverage Code Form No.Edition Date <br />Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium <br />Copyright 2001, AMS Services, Inc.OFADTLCV <br />Docusign Envelope ID: 350039A9-AFEB-4970-8520-D138EE89708B