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NONPROFITS <br />INSURANCE: <br />�W.L�f¢Cr Ur ��l. e.IPa iL %ll, <br />A "Je7rf;nr Wxvrap.cc-. A 14e4rt for Nonprofits. <br />NONPROFITS INSURANCE ALLIANCE <br />OF CALIFORNIA (NIAC) <br />www.insurancefortionprofits.org <br />POLICY CHANGE <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />COMPANY: Nonprofits Insurance Alliance of California <br />POLICY NUMBER: 2021-52013-UMB <br />NAMED INSURED: Training and Research Foundation <br />POLICY CHANGE EFFECTIVE: 07/01/2021 <br />COVERAGE PART AFFECTED: COMMERCIAL UMBRELLA <br />POLICY CHANGE #: 1 <br />This policy is hereby amended as follows: <br />Schedule A- Schedule of Underlying Insurance <br />(D) Standard Workers Compensation and Employers Liability: <br />Insurer: State Compensation Insurance F <br />Policy: 9300505-21 <br />Applicable Period: 7/1/2021 to 7/1/2022 <br />Applicable Limits: <br />Bodily Injury by Accident 1,000,000 Each Accident <br />Bodily Injury by Disease 1,000,000 Each Employee <br />Bodily Injury by Disease 1,000,000 Policy Limit <br />UMB62/05-13. Employers' Liability Follow Form is hereby added to the policy. <br />UMB61/05-13. Employers' Liability Exclusion is hereby deleted From the policy. <br />All other terms, limits and conditions remain the same. <br />ADDITIONAL PREMIUM: $0 <br />RETURN PREMIUM: $0 <br />TOTAL PREMIUM: $0 <br />w.trlaaw <br />��. flENEwFD6MPPRWtDBY: <br />09/13/2021 'fd.�, ^Ins iakuor <br />AUTHORIZED <br />SIGNATURE <br />--=Wp eknt ge, )ta.i�fAde <br />