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2 <br />BASIC PROVISIONS <br />Maximum <br />Compensation <br />Amount <br />Enter dollar amount <br />Exhibits <br />Exhibit A: Enter name of Exhibit <br />Exhibit B: Enter name of Exhibit <br />Exhibit C: Enter name of Exhibit or N/A <br />Exhibit D: Enter name of Exhibit or N/A <br />Service Provider <br />Insurance Contact <br />Information <br />Enter insurance contact name <br />Enter insurance contact phone number <br />Enter insurance contract email address <br />Additional <br />Provision(s) Enter other provision(s) or N/A. <br />EXHIBIT D