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ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. <br />PPU 110 04 23 Page 1 of 1 <br />Policy Number: PSE0004755 RLI Insurance Company <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />RLIPack® SCHEDULE OF UNDERLYING INSURANCE <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL EXCESS LIABILITY COVERAGE FORM <br />Item 4. of the declarations is amended to include: <br />Type of Coverage Carrier Eff. Date Exp. Date Limits <br />General Liability <br />Only the Type of <br />Coverage identified in <br />this Schedule of <br />Underlying Insurance <br />by Carrier, policy <br />number and applicable <br />Limits are to be <br />included. <br />RLI Insurance <br />Company <br />09/01/2025 09/01/2026 <br />Occurrence $ 1,000,000 <br />Aggregate $ 2,000,000 <br />Employee Benefits <br />Liability <br />Only the Type of <br />Coverage identified in <br />this Schedule of <br />Underlying Insurance <br />by Carrier, policy <br />number and applicable <br />Limits are to be <br />included. <br />RLI Insurance <br />Company <br />09/01/2025 09/01/2026 <br />Each Employee $1,000,000 <br />Aggregate $1,000,000 <br />Employers’ Liability <br />Only the Type of <br />Coverage identified in <br />this Schedule of <br />Underlying Insurance <br />by Carrier, policy <br />number and applicable <br />Limits are to be <br />included. <br />RLI Insurance <br />Company <br />09/01/2025 09/01/2026 <br />Each Accident: Statutory Limits or $1,000,000 <br />,whichever is greater <br />Disease Each Employee: Statutory Limits or <br />$1,000,000 ,whichever is greater <br />Disease Policy Limit: Statutory Limits or <br />$1,000,000 ,whichever is greater <br />Business Auto Liability <br />Only the Type of <br />Coverage identified in <br />this Schedule of <br />Underlying Insurance <br />by Carrier, policy <br />RLI Insurance <br />Company <br />09/01/2025 09/01/2026 Each Accident $1,000,000 <br />Docusign Envelope ID: C46F6467-48FC-8755-8247-09E863327CA7Docusign Envelope ID: A1F306CD-3D85-8219-8045-1E730ABF3862