# Signature Page

**Policy Number:** CCU3967489  
**Interline:** QBIL-0170 (09-10)

## Signature Page

In witness whereof, we, as officers of the stock Company designated on the Declarations Page, have caused this policy to be executed and attested. If required by state law, this policy shall not be valid unless countersigned by our authorized representative.

**Peter T. Maloney**  
Secretary

**Robert Byler**  
President

QBIL-0170 (09-10)  
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