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NONPROFITS <br />INSURANCE <br />ALLIANCE OF CALIFORNIA <br />A Head for Insurance. A Heartfor Nonprofits. <br />NONPROFITS INSURANCE ALLIANCE <br />OF CALIFORNIA (NIAC) <br />INDEX OF FORMS ATTACHED TO THE POLICY <br />POLICY NUMBER: 2022-09201-UMB-NPO <br />NAME OF INSURED: Orange County Children's Therapeutic Arts Center <br />www.insurancefornonprofits.org <br />Page 1 <br />UMBRELLA FORMS AND ENDORSEMENTS FORM NUMBERIEDITION DATE <br />Cap on Losses for Certified Acts - Terrorism Coverage CU 2130 01 15 <br />Exclusion of Certified Acts of Terrorism - Automobile Liability Underlying Insurance Only CU 2133 a 01 15 <br />Disclosure Of Premium For Certified Acts of Terrorism <br />IL 09 99 12 20 <br />Member Criteria <br />NIAC-EO03 UMB 08 2 <br />Communicable Disease - Exclusion <br />NIAC-E180 UMB 012 <br />Workers' Compensation - Exclusion <br />NIAC-E253 UMB 08 2 <br />Nuclear, Chemical and Biological Hazard Exclusion <br />NIAC-E42 UMB 09 19 <br />Schedule A - Schedule of Underlying Insurance <br />SCHEDULE A 0180 <br />Privacy Liability and Cyber Coverage Exclusion <br />UMB 23106 16 <br />Medical Payments Exclusion <br />UMB 232 06 16 <br />Commercial Umbrella Policy <br />UMB-100 05 21 <br />Unimpaired Aggregate Limits Endorsement (Non-Concurrency) <br />UMB166 12 88 <br />Employers' Liability Exclusion <br />UMB61 05 13 <br />e�kAbgenmtonarm <br />g�6Aweo+®Br: <br />8 .Ijr'•au % Z%ic:Je,r <br />�Ruk Mn,agmm [ tlmral Ai tle <br />This list of forms is not part of the actual policy, but is for your information only. <br />Please refer to the policy(s) for actual limits, coverages and exclusions. <br />