# Excess Insurance Policy

## Item 5: SCHEDULE OF UNDERLYING INSURANCE
See Schedule of Underlying Policies – Excess

## Item 6: FORMS AND ENDORSEMENTS ATTACHED attached hereto:
See Forms and Endorsements Schedule – 104-XS (Ed. 03 00)

IN CONSIDERATION OF THE PAYMENT OF THE PREMIUM, IN RELIANCE UPON THE STATEMENTS IN THE DECLARATIONS, AND SUBJECT TO ALL TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE COVERAGE AS STATED IN THIS POLICY.

**President**
David A. Cohen

**Secretary**
Dexter R. Legg

July 1, 2013
Issuance Date

100-XS (Ed. 03 00)
2 - 13000