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16 ' Ud/Ub/ZUZ"1 " I Ut-4UbZ616-UU-UI UNtA I AMEKIUAN INSUKANUt UU <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 />( ) Split Limit <br />Bodily Injury Liability <br />$ each person <br />$ each accident <br />Property Damage Liability <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 />( ) Gar a g e k e e p e r s <br />Liability 1 $ <br />U4 REVIEWED&APPROVED Elp <br />Risk Management Spedalist <br />69GAI, 1620/033Gz/HEvE$!wc/OD6./19Waley P4�0 1 e/z/zozz 10:04:i1f affUF®TI 1 Paoef7 a2. J <br />