MEMBER OF
GREATAMERICAN
INSURANCE GROUP

Great American Professional Risk Insurance Services Inc.
Part of Great American Insurance Group
3436 Toringdon Way
Suite 200
Charlotte, NC 28277
(704) 364-5161

| Policy Premium: | $230,000.00 |
| --- | --- |
| $0.00 | Terrorism Included |
| $230,000.00 |

Term: Annual
Rate: Flat
Commission: 0%

**Terms and Conditions**

Policy Form: As per coverage form: U.S. Short Excess Form - Coverage Form (USX8004.02.18) plus the following:

**Our Policy Terms and Conditions:**

Attachments:
- In Witness Clause (IL7268.09.09)
- New York - Global Sanction Endorsement (IL7429.10.21)
- Policyholder Notification - New York (SDM841.07.14)
- U.S. Treasury Departments Office of Foreign Assets Control (OFAC) Advisory Notice To Policyholders (GSD020.01.23)

Follow Forms:
- More Than One Followed Policy Endorsement (USX8030.02.18)
- Non Following Form Endorsement (USX8012.02.18)

Terrorism:
- Disclosure Pursuant To Terrorism Risk Insurance Act (USX8025.06.20)

**Subjectivities:**

To clarify, please note the conditions of this binder may not be in accordance with the conditions requested in your submission. For Complete terms, conditions, exclusions and limitations please refer to the policy language itself.

We will add/delete TRIA forms if there are any changes in the Government requirements.

Regards,

James Callis - Divisional Vice President, CPCU
Great American Professional Risk Ins. Services

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