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* T8 * 08/05/2021 * TUE-4052373-00-01 GREAT AMERICAN INSURANCE CO <br />410783 <br />GAI 6003 <br />(Ed. 06 97) <br />SCHEDULE A - SCHEDULE OF UNDERLYING INSURANCE <br />Carrier, Policy Number <br />and Period Type of Coverage Limits of Insurance <br />a) CALIFORNIA STATE Employers Liability Bodily Injury By Accident <br />FUND <br />POLICY: T.B.D. $ 1,000,000. each accident <br />8/1/21 TO 8/1/22 <br />Bodily Injury By Disease <br />$ 1,000,000. policy limit <br />$ 1 ,000,000. each employee <br />b) MIDDLESEX INSURANCE <br />COMPANY <br />POLICY: A0152818004 <br />8/1/21 TO 8/1/22 <br />Automobile/Garage <br />( X ) Any Automobile <br />( ) Owned Automobile <br />Only <br />( ) Specifically <br />Designated <br />Automobile <br />( ) Hired Automobile <br />( ) Non - owned <br />Automobile <br />( ) Garage Liability <br />( X ) DEFENSE OUTSIDE <br />THE LIMIT <br />( ) Garagekeepers <br />L i a b i l i t y <br />( ) Split Limit <br />Bo d i I y I n j u r y L i a b i l i t y <br />$ each person <br />$ each accident <br />Property Damage Li a b i l i t y <br />$ each accident <br />( X ) Combined Single Limit <br />$ 1 ,000,000. each accident <br />( ) Garage Operations <br />$ Auto only <br />each accident <br />$ Other than <br />auto each <br />accident <br />$ Other than <br />auto <br />aggregate <br />$ a N_oaa Risk ManagementDMsian <br />REVIEWED & APPROVED BY.- <br />3 t <br />f R. W&Wd <br />Risk Management Analyst <br />640A111 1620/023;L/tiE�/Wc/0c6L,/19r7nJ KeFN;�p 1 9/20/2021 1: 59:5% Pla ((PDe)Page f of28) <br />This certificate ancels and super edes ALL previously issiled c rtificates. <br />