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ADDITIONAL COVERAGES Ref# I Description Coverage Code Form No. Edition Date Employee Benefits EBLIA Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 1,000,000 $538.00 Ref# Description, Coverage Code Form No. Edition Date Additional Insured ADDIN Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $2000 Ref# Description Coverage Code Form No. Edition Date Medical payments MEDPM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 2,000 Ref# Description Coverage Code Form No. Edition Date Umbrella(C) CUMBR Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $16,681.00 Ref# Description Coverage Code Form No. Edition Date Products/Completed Ops Aggregate PRDCO Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium 5,000,000 Ref# Date Description Coverage Code Form No. Edition General Aggregate GENAG Limit 1 I Limit 2 Limit 3 Deductible Amount Deductible Type Premium 5,000,000 Ref# Description Coverage Code Form No. Edition Date Personal&Advertising Injury PIADV Limit 1Limit 2 Limit 3 Deductible Amount Deductible Type Premium 5,000,000 Ref# Description Coverage Code Form No. Edition Date Adjst.to reconcile-exp mod. premium AREM Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref# Description Coverage Code Form No. Edition Date Schedule rate adjustment SRA Limit 1 Limit 2 limit 3 Deductible Amount Deductible Type Premium -$3,099.00 Ref# Description Coverage Code Form No. Edition Date Premium discount PDIS Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium -$39 00 on Date Ref# I Description Coverage Code Form No. Editi Adjst to reconcile-exp mod. premium AREM Limit 1 Limit 2Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001,AMS Services,Inc.