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CNA <br />151 N. Franklin St. <br />Chicago, IL 60606 <br />Policy Number From Policy Period To Coverage Is Provided By Agency <br />C6017210152 �04/16/21 04/16/22 Valley Forge Insurance Company �028489380 <br />Named Insured And Address Agent <br />LYRASIS INC ARTHUR J GALLAGHER RISK MGMT SRV INC <br />1438 W PEACHTREE ST NW STE 150 1050 CROWN POINTE PKWY STE 600 <br />ATLANTA, GA 30309-2955 ATLANTA, GA 30338 <br />** PAYMENT PLAN SCHEDULE ** <br />IT IS AGREED THAT THE TOTAL ESTIMATED PREMIUM SHOWN IN <br />THE DECLARATIONS OF THIS POLICY IS PAYABLE AS FOLLOWS: <br />EFFECTIVE DATE <br />04/16/2021 <br />TOTAL PREMIUM <br />PREMIUM <br />$5,142.00 <br />$5,142.00 <br />COMMISSION <br />ISSUE DATE 05/03/21 <br />ortaN <br />o - `':ccREVIEWED <br />o� x <br />RiskMmWmentDMsian <br />& APPROVED BY: <br />T <br />Risk Management Analyst <br />