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Underwritten by: Scottsdale Insurance Company <br /> Home Office: One Nationwide Plaza •Columbus, Ohio 43215 <br /> Administrative Office: 18700 North Hayden Road •Scottsdale,Arizona 85255 <br /> 1-800-423-7675•A Stock Company <br /> COMMERCIAL EXCESS LIABILITY <br /> SCHEDULE OF CONTROLLING UNDERLYING INSURANCE(continued) <br /> Policy No.: CXS4007716 Effective Date: 08/21/2023 <br /> 12:01 A.M. Standard Time <br /> J K MIKLIN INC. DBA YAMADA <br /> Named Insured:ENTERPRISES Agent No.: 040BB <br /> INSURER, POLICY NUMBER TYPE OF COVERAGE APPLICABLE LIMITS <br /> AND POLICY PERIOD <br /> Employer's Liability Bodily Injury Limit <br /> Insurer's Name $ 1,000,000 Each Accident <br /> Hartford Casualty Insurance Company (by accident)** <br /> Policy Number $ 1,000,000 Policy Limit <br /> TBD (by disease)** <br /> Policy Period $ 1,000,000 Each Employee <br /> 08/21/2023 to 08/21/2024 (by disease)** <br /> ** or unlimited in states where benefits are <br /> unlimited. <br /> \ 1 <br /> niCEmarED&PoTeavEDBY: <br /> RiskManagemettDivision <br /> P. <br /> --firsooxi. Rick Management Specialist <br /> XLS-SP-1-0319(01-21) Page 2 of 2 ✓ F` Nationwide` <br />