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Policy Number: PHPK2220125 <br />Policy Effective Date: 01/15/21 - 01/15/22 <br />PI-GLD-HS (10/11) <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />GENERAL LIABILITY DELUXE ENDORSEMENT: <br />HUMAN SERVICES <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE <br />It is understood and agreed that the following extensions only apply in the event that no other specific coverage for <br />the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and <br />limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on <br />this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this <br />endorsement. For complete details on specific coverages, consult the policy contract wording. <br />Coverage Applicable <br />Limit of Insurance <br />Page # <br />Extended Property Damage <br />Included <br />2 <br />Limited Rental Lease Agreement Contractual Liability <br />$50,000 limit <br />2 <br />Non -Owned Watercraft <br />Less than 58feet <br />2 <br />Damage to Property You Own, Rent, or Occupy <br />$30,000 limit <br />2 <br />Damage to Premises Rented to You <br />$1,000,000 <br />3 <br />HIPAA <br />Clarification <br />4 <br />Medical Payments <br />$20,000 <br />5 <br />Medical Payments — Extended Reporting Period <br />3 years <br />5 <br />Athletic Activities <br />Amended <br />5 <br />Supplementary Payments — Bail Bonds <br />$5,000 <br />5 <br />Supplementary Payment — Loss of Earnings <br />$1,000 per day <br />5 <br />Employee Indemnification Defense Coverage <br />$25,000 <br />5 <br />Key and Lock Replacement — Janitorial Services Client Coverage <br />$10,000 limit <br />6 <br />Additional Insured — Newly Acquired Time Period <br />Amended <br />6 <br />Additional Insured — Medical Directors and Administrators <br />Included <br />7 <br />Additional Insured — Managers and Supervisors (with Fellow <br />Employee Coverage) <br />Included <br />7 <br />Additional Insured — Broadened Named Insured <br />Included <br />7 <br />Additional Insured — Funding Source <br />Included <br />7 <br />Additional Insured — Home Care Providers <br />Included <br />7 <br />Additional Insured — Managers, Landlords, or Lessors of Premises <br />Included <br />7 <br />Additional Insured — Lessor of Leased Equipment <br />Included <br />7 <br />Additional Insured — Grantor of Permits <br />Included <br />8 <br />Additional Insured — Vendor <br />Included <br />8 <br />Additional Insured — Franchisor <br />Included <br />9 <br />Additional Insured —When Required by Contract <br />Included <br />9 <br />Additional Insured — Owners, Lessees, or Contractors <br />Included <br />9 <br />Additional Insured — State or Political Subdivisions <br />Included <br />10 <br />Page 1 of 12 <br />Includes copyrighted material of Insurance Services Office, Inc., with its pe tee, kla mamipmentDiVisbn <br />© 2011 Philadelphia Indemnity Insurance Company REIAE&Eo&APPRovED By. <br />P, V:" <br />[tuRAM12nnemenC AFlatyst <br />