**Item 6. Notice to: (Conditions 3 and 4)**

a. All Notices of Occurrence:
   - Allianz Global Risks US Insurance Company
     225 West Washington Street, Suite 1800
     Chicago, Illinois 60606-3483
     Attention: Claims Department

b. All Other Notices:
   - Allianz Global Risks US Insurance Company
     225 West Washington Street, Suite 1800
     Chicago, Illinois 60606-3483
     Attention: Liability Underwriting

**Item 7.**
a. Premium without TRIPRA: USD $
b. TRIPRA Premium: USD $
c. Total Premium (with TRIPRA): USD $ (for 100% Flat Annual)
d. Minimum Earned Premium: USD $

**Item 8. The Company:**
   - Allianz Global Risks US Insurance Company
     225 West Washington Street, Suite 1800
     Chicago, IL 60606-3484

**Item 9. Producer:**
   - Aon Risk Services Northeast Inc.
     One Liberty Plaza 165 Broadway
     New York, NY 10006

**Item 10. Policy Form:**
   - Excess Liability Following Form Short Excess Form
     Form Number AG RL XS ASF 2000 10 20

**Endorsements:**
   - As per Forms and Endorsement List attached to this Policy.

AGRL XS ASF 1000 10 20
Copyright © 2020 Allianz Global Risks US Insurance Company. All rights reserved.
Contains copyrighted material of AON Risk Services, AON Risk Solutions and AON, plc used with their permission.
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