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PI-POL-FORM-SCH (08/20) <br />Philadelphia Indemnity Insurance Company <br />Form Schedule — Policy <br />Policy Number: PHPK2635616 <br />Forms and Endorsements applying to this Coverage Part and made a part of this <br />policy at time of issue - <br />Form <br />BJP-190-1 <br />IL N 177 <br />PI -FEES -NOTICE 1 <br />PP2020 <br />CPD-PIIC-CW <br />PI-LOC-SCH <br />PI-AI-SCH <br />PI-FEE-SCH <br />PI-BELL-1 <br />PI-CME-1 <br />IL0017 <br />IL0021 <br />IL0270 <br />PI-ACL-001 <br />PI-SAM-018 <br />PI-TER-DN 1 <br />Edition Description <br />1298 Commercial Lines Policy Jacket <br />0912 California Premium Refund Disclosure Notice <br />1119 Notice Late/Non-Sufficient Funds/Reinstatement Fee <br />0220 Privacy Notice For Commercial Lines <br />0221 Common Policy Declarations <br />0820 Location Schedule <br />0820 Additional Insured Schedule <br />0820 Fees and Surcharge Schedule <br />1109 Bell Endorsement <br />1009 Crisis Management Enhancement Endorsement <br />1198 Common Policy Conditions <br />0908 Nuclear Energy Liability Exclusion Endorsement <br />0912 California Changes - Cancellation And Nonrenewal <br />1218 Absolute Cyber Liability And Electronic Exclusion <br />0519 Absolute Abuse or Molestation Exclusion <br />0121 Disclosure Notice Of Terrorism Ins Coverage Rejection <br />PI-POL-FORM-SCH (08/20) <br />Page 1 of 1 <br />F RAMougementDMslcrn <br />%x REVIEWE<7&PaPPROVmBY: <br />— Risk Management Specialist <br />