TRI-VALLEY HAVEN - THRID AMENDMENT (#2023439)

PI-GLD-HS (10/11) Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. © 2011 Philadelphia Indemnity Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non-Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage to Premises Rented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supplementary Payments Bail Bonds $5,000 5 Supplementary Payment Loss of Earnings $1,000 per day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement Janitorial Services Client Coverage $10,000 limit 6 Additional Insured Newly Acquired Time Period Amended 6 Additional Insured Medical Directors and Administrators Included 7 Additional Insured Managers and Supervisors (with Fellow Employee Coverage) Included 7 Additional Insured Broadened Named Insured Included 7 Additional Insured Funding Source Included 7 Additional Insured Home Care Providers Included 7 Additional Insured Managers, Landlords, or Lessors of Premises Included 7 Additional Insured Lessor of Leased Equipment Included 7 Additional Insured Grantor of Permits Included 8 Additional Insured Vendor Included 8 Additional Insured Franchisor Included 9 Additional Insured When Required by Contract Included 9 Additional Insured Owners, Lessees, or Contractors Included 9 Additional Insured State or Political Subdivisions Included 10 Policy No: PHPK2723715-000 Policy Term: 10/1/2025 -7/1/2026 Docusign Envelope ID: 5F03BFB0-7BA9-4891-8961-458838FA3D65