2025-544-E-AMS-Venus Film-To Video Film at the Drakeford Center in Carrboro

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Page 1 of 2 SCHEDULE OF FORMS DATE (MM/DD/YY) 08/26/2025 APA-CERT-FORMLIST 0914 Certificate Number: 1198109 Insured:Venus Film, LLC This Schedule of Forms is attached to and made part of certificate number 1198109, as of 08/26/2025 at 09:02 AM PT, and lists the forms included in the policy(s) and subsequent endorsement (s) at the time this certificate was issued. Form # Ed. Name Entertainment Production Package Notices U-GU-319-F 0109 Important Notice - In Witness Clause U-GU-874-BCW 0223 Notice of Disclosure for Agent and Broker Compensation UGU873ACW 0611 Disclosure Statement U-GL-1197-A CW 0104 Asbestos Exclusion Endorsement U-GU-1191-ACW 0315 Sanctions Exclusion Endorsement Common UGU727ACW 0806 Commercial Insurance Policy UGU1292ACW 0422 Notice Of Important Provisions UGUD310A 0193 Common Policy Declarations UGU619ACW 1002 Schedule of Forms and Endorsements UGU621ACW 1002 Schedule Of Named Insured(s) UGU618ACW 1002 Schedule Of Locations IL0017 1198 Common Policy Conditions UABI100ACW 0117 Schedule Of Productions UABI105ACW 0117 Non-Insured Production Entity Exclusion UABI101ACW 0117 Definition Of Employee UAB100ACW 0117 Minimum Earned Premium Endorsement IL0003 0908 Calculation of Premium U-GU-630-ECW 0120 Disclosure of Important Information Relating to Terrorism Risk Insurance Act Inland Marine UABMD104ACW 0117 Commercial Inland Marine Declarations Entertainment Program UGU619ACW 1002 Schedule of Forms and Endorsements CM0001 0904 Commercial Inland Marine Conditions UABM133ACW 0117 Common Conditions, Exclusions And Definitions UABM105ACW 0117 Miscellaneous Equipment Coverage Form UABM106ACW 0117 Props, Sets And Wardrobe Coverage Form UABM109ACW 0117 Third Party Property Damage Coverage Form UABM185ACW 0618 Unmanned Aircraft Endorsement UABM165ACW 0117 Vehicle Physical Damage Limit And Rate Schedule (Non-Owned, Hired, Loaned Or Donated Land Vehicles) UABM111ACW 1217 Vehicle Physical Damage Coverage Form UABM102ACW 0117 Schedule Of Productions UABM103ACW 0117 Loss Payable Endorsement UABM128ACW 0117 Excluded Property Endorsement UABM114ACW 0117 Unscheduled Production, Presentation Or Event Exclusion UABM100ACW 0117 Stunt, Animal Exposure And Pyrotechnic Exclusion U-GU-757-B NC 1212 North Carolina - Notice of Certain Causes of Loss Not Covered IL0269 0908 NC Changes - Cancellation and Nonrenewal CM0103 0623 North Carolina Changes U-GU-767-BCW 0115 Cap on Losses From Certified Acts of Terrorism General Liability UABLD100BCW 0119 Commercial General Liability Coverage Part Declarations UGU619ACW 1002 Schedule of Forms and Endorsements CG0001 0413 Commercial General Liability Coverage Form CG2011 1219 Additional Insured - Managers of Lessors of Premises CG2012 1219 Additional Insured - State or Governmental Agency or Subdivision or Political Subdivision - Permits or Authorizations CG2026 1219 Additional Insured - Designated Person or Organization CG2028 1219 Additional Insured - Lessor of leased equipment UABL121ACW 0117 Limited Stationary Aircraft Coverage CG2109 0615 Exclusion - Unmanned Aircraft CG2106 1223 Exclusion - Access or Disclosure of Confidential or Personal Information and Data-Related Liability - With Limited Bodily Injury Exception CG4035 1223 Exclusion - Cyber Incident CG0069 1223 Exclusion - Violation of Law Addressing Data Privacy U-GL-1171-B-CW 0719 Fungi Bacteria Exclusion U-GL-1178-A-CW 0703 Asbestos Exclusion CG2147 1207 Employment Related Practices Exclusion U-GL-1517-BCW 0413 Collection or Distribution of Material or Information in Violation of Law Exclusion UABL131ACW 0117 Non-Performing Animal Exclusion UABL102ACW 0117 Property Damage To Rented Premises Exclusion UABL129ACW 0117 Assault And Battery Exclusion UGL1250ACW 0905 Abusive Act Liability Exclusion UABL122ACW 0117 Newly Acquired Or Formed Entity Exclusion UABL107ACW 0117 Exclusion - Insureds Conducting Media, Entertainment, Or Internet Type Operations UABL130ACW 0117 Informational Content Exclusion UABL135ACW 0117 Media Content Exclusion UABL137ACW 0117 Cross Suits Exclusion UABL138ACW 0117 Personal And Advertising Injury - Exclusion Of False Arrest, Detention, Imprisonment, Libel, Slander, Right Of Privacy, Advertising Idea, And Copyright, Trademark Or Trade Secret UABL106ACW 0117 Unscheduled Production, Presentation Or Event Exclusion UABL103ACW 0117 Stunt, Pyrotechnic And Animal Exposure Exclusion CG2132 0509 Communicable Disease Exclusion Docusign Envelope ID: 257F6E47-2DFB-40BE-98E9-D7FFC13E6CF0