# Extension Schedule of Underlying Insurance Policies

**Policy Number:** 16 HU SG6756

**Named Insured and Address:**

This extension schedule forms a part of the policy designated herein.

| Insurer, Policy Number & Period | Type of Coverage | Applicable Limits |
|---------------------------------|------------------|-------------------|
| (a) Zurich T.B.A. 5-21-87/88     | Employers Liability | Bodily Injury: $500,000 each accident by accident* $500,000 policy limit by disease* $500,000 each employee by disease* |
| (b) Zurich T.B.A. 5-21-87/88     | Comprehensive Automobile Liability including: owned automobiles non-owned automobiles hired automobiles | Bodily Injury Liability: $ each person $ each occurrence Property Damage Liability: $ each occurrence Bodily Injury and Property Damage Liability Combined $1,000,000 each occurrence |
| (c) Zurich T.B.A. 5-21-87/88     | General Liability including: products-completed operations Liability contractual Liability personal injury Liability employees as additional insureds liquor law liability | Bodily Injury Liability: $ each occurrence aggregate Property Damage Liability: $ each occurrence aggregate Bodily Injury and Property Damage Liability Combined $2,000,000 each occurrence aggregate $2,000,000 aggregate |
| (d)                               | Watercraft Liability including: owned watercraft non-owned watercraft | Bodily Injury Liability: $ each person $ each occurrence Property Damage Liability: $ each occurrence Bodily Injury and Property Damage Liability Combined $ each occurrence |
| (e)                               | Other (Specify) | |

An "X" marked in the box indicates the coverage is provided in the Underlying Policies.

**Note Maintenance of Underlying Insurance Condition:**
*Except that in any jurisdiction where the amount of Employers Liability Coverage afforded by the underlying insurer is by law unlimited, the limit stated does not apply and the policy of which this extension schedule forms a part shall afford no insurance with respect to Employers Liability in such jurisdiction.*

Form XL-11-3 (Ed. 5-85) Printed in U.S.A. (NS)