Formatting Template:

<tr><td><b>Additional Charges/Information:</b></td></tr>

<tr><td>Fee: ${fees}</td></tr>

<tr><td>Taxes: ${taxes}</td></tr>

<tr><td>LARRY'S NAME, ADDRESS, LICENSE, ETC.</td></tr>

</table></td></tr></table>

<div class="slwording"><div class="center">SL WORDING TITLES</div></div>

<div class="slwording">SL WORDING</div>

<tr><td><b> FPL Data Breach Data Breach/Infection Sublimit: $ Per Claim/$ Aggregate

</b></td></tr>

<tr><td><b> MML Data Breach Data Breach/Infection Sublimit: $ Per Claim/$ Aggregate

</b></td></tr>

<tr><td><b> FPL GL General Liability Coverage Endorsement: $ Each Occurrence/$ Aggregate

</b></td></tr>

<tr><td><b> MML GL General Liability Coverage Endorsement: $ Each Occurrence/$ Aggregate

</b></td></tr>

<tr><td><b> PAL/PLL GL General Liability Coverage Endorsement: $ Each Occurrence/$ Aggregate

</b></td></tr>

<tr><td><b> FPL/MML Crime Crime Endorsement: $ Per Claim/$ Aggregate

</b></td></tr>

<tr><td><b> MML Surety Bond Business Surety Bond Endorsement: $10,000

</b></td></tr>

<tr><td><b> PAL/PLL Hired/Non-Owned Auto Hired Auto and Non-Owned Auto Liability Endorsement: $ Each Occurrence/$ Aggregate

</b></td></tr>

<tr><td><b> Notary Public Notary Public Endorsement

</b></td></tr>

<tr><td><b> Payroll Processor 5 Payroll Processor Endorsement

</b></td></tr>

<tr><td><b> Payroll Processor 10 Payroll Processor Endorsement

</b></td></tr>

<tr><td><b> Payroll Processor 25 Payroll Processor Endorsement

</b></td></tr>

<tr><td><b> Professional Organizer Professional Organizer Endorsement

</b></td></tr>

<tr><td><b> Tax Preparer Tax Preparer Endorsement

</b></td></tr>

<tr><td><b> Medication Coordinator Medication Coordinator Endorsement

</b></td></tr>

Larry's Initials:

<img src="https://dominioninsurance.com/img/Larry-initial.gif" width="60" align="top"/>

Larry's Signature:

<span class="underline">&nbsp;&nbsp;<img valign="bottom" src="https://in.dominioninsurance.com/images/Larry.gif" height="60" align="bottom">&nbsp;&nbsp;</span>

both dates at 12:01 am standard time at the location identified in item1, above.

Endorsement Printing Header:

Named Insured: Authority Number:

Policy Number: Endorsement Number: