# 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 $ 175,980
- **b. TRIPRA Premium:** USD $ 3,520
- **c. Total Premium (with TRIPRA):** USD $ 179,500 (for 100% Flat Annual)
- **d. Minimum Earned Premium:** USD $ 175,980

## 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 AGRL 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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