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C H U B Bm Liability Insurance Endorsement Policy Period Effective Date Policy Number Insured Name of Company Data Issued This Endorsement applies to the following forms: GENERAL LIABILITY Who Is An Insured Additional Insured - Scheduled Person Or Organization MAY 17, 2021 TO MAY 17, 2022 MAY 17, 2021 3602-53.12 TPA CMCPLUS,LLC GREAT NORTHERN INSURANCE COMPANY NNE 4, 2021 Under Who Is An Insured, the following provision is added Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are obligatedpursuant to a contract or agreement to provide them with such insurance as is afforded by this policy. However, the person or organization is an insured only: if and then only to the extent the person or organization is described in the Schedule; to the extent such contract or agreement requires the person or organization to be afforded status as an insured; for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). with respect to any assumption of liability (of another person or organization) by them in a contract or agreement This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement Liability Insurance Addidonalineured- Scheduled Person OrOrganizatlon Fonn 80-02.2367(Rev. 5-07) Endorsement Wh Mo.gmwtniWi ` rRHElgID6�fMPRbJ®arr: Ru1,M1MwgermrtClmUlAitle