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EXTENSION SCHEDULE OF UNDERLYING <br />INSURANCE (Continued) <br />POLICY NUMBER: 84 SBW BM5WFR <br />*In any jurisdiction where the amount of Employers Liability Coverage afforded by the underlying insurer is by law <br />unlimited, the limit stated does not apply and the policy of which this extension schedule forms a part shall afford no <br />insurance with respect to Employers Liability in such jurisdiction. <br />Form SU 00 03 10 18 Page 4 of 4 <br />Process Date:04/11/2025 © 2018, The Hartford Policy Expiration Date:06/30/2026 <br />(May include copyrighted material of Insurance Services Office, Inc., with its permission) <br />E.( ) Foreign Liability <br />Carrier, Policy Number and Policy Period: <br />Type of Coverage Applicable Limits <br />( )Foreign Commercial General Liability <br />( )Liability and Medical Expenses Per Occurrence <br />( )Personal And Advertising Injury Per Person/Organization <br />( )Products/Completed Operations Aggregate Aggregate <br />( )General Aggregate Aggregate <br />( )Damages To Premises Rented To You Any One Premises <br />( )Foreign Contingent Auto Liability Each Accident <br />( )Foreign Employers Liability Each Accident* <br />Each Employee by Disease* <br />Total Policy by Disease* <br />Docusign Envelope ID: DA5B5AE8-ECA5-4326-9450-28E3F61DAA1B