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C H U B B Policy Conditions <br />Schedule of Forms <br />Policy Period DECEMBER 27, 2018 TO DECEMBER 27. 2019 <br />Effective Date OCfOBER 3, 2019 <br />Policy Number 3589-25-15 WCE <br />Insured NILA.INC. <br />Name of Company FEDERAL INSURANCE COMPANY <br />Date Issued OCTOBER 8. 2019 <br />The following is a schedule of forms issued as of the date shown above: <br />Form Number <br />Edition <br />Date <br />Form Name <br />Effective <br />Date <br />Date <br />Issued <br />80-02.9779 <br />3-11 <br />NOTICE OF CANCEL SCHED PERSONS/ORG EXCPT NP <br />10/03/19 <br />10/08/19 <br />80-02-9001 <br />6.98 <br />HOW TO REPORT A LOSS <br />12/27/18 <br />10/16/18 <br />80-02-9090 <br />6-05 <br />COMMON POLICY CONDITIONS <br />1227/18 <br />10/16/19 <br />80-02-9717 <br />9-15 <br />CAIIFORNIAMANDATORY-CANC/NONRENWAL <br />12/27/18 <br />10/16/18 <br />80-02-9790 <br />3-12 <br />COND - CIVIL UNIONS OR DOMESTIC PARTNERSHIPS <br />12127/18 <br />10/16/18 <br />80-02-9800 <br />12-08 <br />INSURING AGREEMENT <br />1227/18 <br />10/16/18 <br />99-10-0732 <br />1-15 <br />NOTICE TO POLICYHOLDERS-TRIPRA <br />1227/18 <br />10/16/18 <br />99-10.0792 <br />9-04 <br />IMPORTANT NOTICE - OFAC <br />1227118 <br />10/16/18 <br />99-10-0872 <br />6-07 <br />AODPOLICYHOLDER N0ITCE <br />1227/18 <br />10/16/18 <br />REVIEWED & APPROVED <br />By Risk MANAGEMENT DilliSiON <br />2019 E <br />5A 4 <br />FRANCINE R. VILLAREAL <br />leetpW <br />Form 80-02.9999 (ED. 6-95) Schedule of Fame <br />51732735 1 16-19 GL/AL 6 NAB I Lucy PaleOfa 1 10/10/2019 7:42:25 AM (PDT) I Page 6 of 8 <br />Pegs 1 <br />