# Allianz

## 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 $ 160,784.00
b. TRIPRA Premium: USD $ 3,216.00
c. Total Premium (with TRIPRA): USD $ 164,000.00 (for 100% Flat Annual)
d. Minimum Earned Premium: USD $ 160,784.00

## 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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