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POLICY NUMBER: PHUBB00132 <br />PREMIUM SUBTOTAL <br />STATE TAXES, FEES, SURCHARGES (if applicable) <br />® NOT <br />FORM OF BUSINESS: NON PROFIT ORGANIZATION <br />BUSINESS DESCRIPTION: Non -Profit Umbrella <br />PI-CXL-002 (05119) <br />Page 2 of 5 <br />Includes copyrighted material of Insurance Services Office, Inc., with per <br />PI-CXL-002 (05/19) <br />Not <br />00 <br />4,157.00 <br />RlnkMWgM'dDMsIm <br />REVIEWED &APPROVM BY: <br />L■1 '� �I�4�ICWe�4 <br />Risk Management Speoa65t is <br />