# NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS

## Premiums and Commission

| Layer Premium: | $217,000 |
| --- | --- |
| Ascot Premium: | $108,500 |
| Terrorism Premium: | Accepted, included in premium above |
| Minimum Earned Premium | 35% at inception |
| Commission: | 0.00% |
| Auditable: | no |

## Schedule of Controlling Underlying Insurance

### Excess 1

| Company: | ACE Property and Casualty Insurance Company |
| --- | --- |
| Policy Number: | XEU G27983212 009 |
| Policy Period: | 5/21/2024 - 5/21/2025 |
| Each Occurrence Limit: | $15,000,000 |
| Aggregate Limit: | $15,000,000 |
| Premium: | $812,396 |
| Brokerage: | 0.00% |
| Policy Form: | XSE-50762 (05/18) |

### Excess 2

| Company: | Berkshire Hathaway Specialty Insurance |
| --- | --- |
| Policy Number: | 47-XSF-100238-11 |
| Policy Period: | 5/21/2024 - 5/21/2025 |
| Each Occurrence Limit: | $15,000,000 |
| Aggregate Limit: | $15,000,000 |
| Premium: | $405,900 |
| Brokerage: | 0.00% |
| Policy Form: | FF-XS-USF-POL-05/2018 |

### Excess 3

| Company: | Allianz Global Risks US Insurance Company |
| --- | --- |
| Policy Number: | USL00197724 |
| Policy Period: | 5/21/2024 - 5/21/2025 |
| Each Occurrence Limit: | $15,000,000 |
| Aggregate Limit: | $15,000,000 |
| Premium: | $295,800 |
| Brokerage: | 0.00% |
| Policy Form: | AGRL XS ASF 2000 10 20 |