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Philadelphia Indemnity Insurance Company <br />Form Schedule — General Liability <br />Policy Number: PHPK1970371 <br />Forms and Endorsements applying to this Coverage Part and made a part of this <br />policy at time of issue: <br />Form Edition Description <br />Gen Liab Dec <br />1004 <br />Commercial General Liability Coverage Part Declaration <br />Gen Liab Schedule <br />0100 <br />General Liability Schedule <br />CG0001 <br />0413 <br />Commercial General Liability Coverage Form <br />CG2002 <br />1185 <br />Additional Insured - Club Members <br />CG2026 <br />0413 <br />Additional Insured - Designated Person Or Organization <br />CG2147 <br />1207 <br />Employment -Related Practices Exclusion <br />CG2167 <br />1204 <br />Fungi or Bacteria Exclusion <br />CG2170 <br />0115 <br />Cap On Losses From Certified Acts Of Terrorism <br />CG2402 <br />1204 <br />Binding Arbitration <br />CG2404 <br />0509 <br />Waiver of Transfer of Rights of Recovery Against Other <br />CG3234 <br />0105 <br />California Changes <br />PI-GL-001 <br />0917 <br />Exclusion - Lead Liability <br />PI-GL-002 CA <br />0208 <br />Exclusion - Asbestos Liability <br />PI-GLD-HS <br />5011 <br />General Liability Deluxe Endorsement: Human Services <br />PI-SAM-006 <br />0117 <br />Abuse Or Molestation Exclusion <br />PI-SE-001 <br />0718 <br />Special Events Endorsement <br />Page 1 of <br />