# DECLARATIONS, continued

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

a. All Notices of Occurrence:
   - To: Manager, Claims Department
     - Markel American Insurance Company
     - P. O. Box 2009
     - Glen Allen, VA 23058
     - Fax: 1 (855) 622-7535
     - Email: newclaims@markelcorp.com

b. All other Notices:
   - To: Underwriting Department
     - Evanston Insurance Company
     - 1185 Avenue of the Americas, 8th Floor
     - New York, NY 10036
     - Fax: 1 (212) 898-6601

**Item 7.**
a. Premium without TRIA: USD 138,925.00
b. TRIA Premium: USD
c. Total Premium: USD 138,925.00 (for 100% Flat Annual)
d. Minimum Earned Premium: USD 34,731.00

**Item 8. The Company:** MARKEL AMERICAN INSURANCE COMPANY

**Item 9. Producer:** Aon Risk Services Northeast, Inc.

**Item 10. Policy Form: Endorsements:**
- MGDEC 4011 01 19
- MJ IL 1000 06 10 Policy Jacket
- MPIL 1007 01 20 Privacy Notice
- MPIL 1083 04 15 "U.S. Treasury Department's Office Of Foreign Assets Control (''OFAC'') Advisory Notice To Policyholders"
- MDIL 1001 08 11 Forms Schedule
- MGDEC 4011 01 19 U.S. Short Excess Form Declarations
- MGEC 4008 01 19 U.S. Short Excess Form
- MGEC 4244 04 18 Endorsement No.1 Schedule Of Excess Policies
- MGEC 4247 04 18 Minimum Earned Premium
- MUB TERR-1 01 15 Confirmation Of Certified Acts Of Terrorism Coverage - Terrorism Risk Insurance Act

These Declarations, together with the Coverage Form and any Endorsement(s), complete the above numbered policy.

Countersigned: 05/24/2023 By:

MGDEC 4011 01 19
USXS (Ed. 06/18)

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