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Policy Number: PHPK2618575 PI-GLD-HS (10/11) <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> GENERAL LIABILITY DELUXE ENDORSEMENT: <br /> HUMAN SERVICES <br /> This endorsement modifies insurance provided under the following: <br /> COMMERCIAL GENERAL LIABILITY COVERAGE <br /> It is understood and agreed that the following extensions only apply in the event that no other specific coverage for <br /> the indicated loss exposure is provided under this policy. If such specific coverage applies,the terms, conditions and <br /> limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on <br /> this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this <br /> endorsement. For complete details on specific coverages, consult the policy contract wording. <br /> Coverage Applicable Limit of Insurance Page# <br /> Extended Property Damage Included 2 <br /> Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 <br /> Non-Owned Watercraft Less than 58 feet 2 <br /> Damage to Property You Own, Rent, or Occupy $30,000 limit 2 <br /> Damage to Premises Rented to You $1,000,000 3 <br /> HIPAA Clarification 4 <br /> Medical Payments $20,000 5 <br /> Medical Payments—Extended Reporting Period 3 years 5 <br /> Athletic Activities Amended 5 <br /> Supplementary Payments—Bail Bonds $5,000 5 <br /> Supplementary Payment—Loss of Earnings $1,000 per day 5 <br /> Employee Indemnification Defense Coverage $25,000 5 <br /> Key and Lock Replacement—Janitorial Services Client Coverage $10,000 limit 6 <br /> Additional Insured—Newly Acquired Time Period Amended 6 <br /> Additional Insured—Medical Directors and Administrators Included 7 <br /> Additional Insured—Managers and Supervisors(with Fellow Included 7 <br /> Employee Coverage) <br /> Additional Insured—Broadened Named Insured Included 7 <br /> Additional Insured—Funding Source Included 7 <br /> Additional Insured—Home Care Providers Included 7 <br /> Additional Insured—Managers, Landlords, or Lessors of Premises Included 7 <br /> Additional Insured—Lessor of Leased Equipment Included 7 <br /> Additional Insured—Grantor of Permits Included 8 <br /> Additional Insured—Vendor Included 8 <br /> Additional Insured—Franchisor Included 9 <br /> Additional Insured—When Required by Contract Included 9 <br /> Additional Insured—Owners, Lessees, or Contractors Included 9 <br /> Additional Insured—State or Political Subdivisions Included 111de, / <br /> ort,�c. Risk ManagementD[viston <br /> Page 1 of 12 REVIEWED&APPROVED By: <br /> °' ,►3 �, A�ev4 <br /> Includes copyrighted material of Insurance Services Office, Inc., with its p ,, ''�ie <br /> ©2011 Philadelphia Indemnity Insurance Company — Risk Management Specialist <br />