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SECTION IV - ADDITIONAL FORMS: Applicable to All Premises and Coverages <br />Coverage <br />Form Number <br />Calculation of Premium <br />BP <br />05 <br />01 <br />07 <br />02 <br />Exclusion - Punitive Damages <br />SB <br />04 <br />03 <br />08 <br />14 <br />Exclusion of Loss Due to By -Products of Production or Processing <br />SB <br />04 <br />17 <br />08 <br />14 <br />Operations <br />Cap on Losses From Certified Acts of Terrorism <br />BP <br />05 <br />23 <br />01 <br />15 <br />Disclosue Pursuant to Terrorism Risk Insurance Act <br />BP <br />05 <br />15 <br />01 <br />15 <br />California Disclosure Notice <br />FNIC <br />DN CA <br />O1 <br />06 <br />Exclusion - Fungi or Bacteria (Liability) <br />BP <br />05 <br />77 <br />01 <br />06 <br />Blanket Additional Insured & Subrogation Waiver <br />SB <br />04 <br />36 <br />01 <br />17 <br />California Changes <br />BP <br />O1 <br />55 <br />OS <br />17 <br />Privacy Policy <br />PRIVACY <br />POLICY <br />O1 <br />20 <br />California Race, National Origin & Gender Form <br />CA <br />RNOGBPF <br />04 <br />21 <br />California Fraud Statement <br />IL <br />N <br />018 <br />01 <br />22 <br />Exclusion - Access or Disclosure of Confidential or Personal <br />BP <br />15 <br />05 <br />05 <br />14 <br />Information and Data -Related Liability <br />Employment -Related Practices Exclusion <br />BP <br />04 <br />17 <br />01 <br />10 <br />Exclusion of Certified Acts of Terror - Nuclear, Biological, <br />BP <br />05 <br />26 <br />01 <br />15 <br />Chemical, or Radiological <br />Equipment Breakdown Schedule <br />SB <br />DS <br />07 <br />12 <br />17 <br />Equipment Breakdown Protection Coverage <br />SB <br />04 <br />53 <br />12 <br />17 <br />Signed: <br />SB DS O1 11 17 <br />004100000000000295223041 0000C <br />7 <br />by. Mark O. Davey, CEO <br />RW�MuugeWWd DMSfan <br />170A�D & APPRovm 8v: <br />A* ju AmA4 <br />® Risk Management SpeciAnt <br />