# NAVIGATORS INSURANCE COMPANY
POLICY NO.: NY22AXSZ056H1IV
RENEWAL OF: NY21AXSZ056H1IV

Which in turn is excess of various insurances and/or retentions as more fully set forth in the Followed Policy

**Item 6. Notice to:**
(Conditions 3 and 4)
a) All Notices of Occurrence:
Navigators Management Co., Inc.
Claims Division
One Hartford Plaza
Hartford, CT 06155
PHONE: 24 Hours a day /7 Days a week (855) 444-4796
FAX: (847) 285-9003
newloss@thehartford.com

b) All other notices:
To Insured: Per Item 1. listed above.
To Company: One Penn Plaza 50th Floor
New York, NY 10119
navpacendorsement@thehartford.com

**Item 7. Premium:**
a) Premium without TRIA: $161,386
b) TRIA Premium: $1,614
c) Total Premium: $163,000
d) Minimum Earned Premium: $40,750

**Item 8. The Company:**
One Penn Plaza, 32nd Floor
New York, NY 10119
212-244-2333

**Item 9. The Producer:**
AON RISK SERVICES NORTHEAST INC
165 BROADWAY SUITE 3201
NEW YORK, NY 10006

Producer Number: AONO0003

**Item 10. Policy Form:**
True Excess Liability Policy
NAV-AXS-POL

1. TRUE EXCESS LIABILITY POLICY DECLARATIONS NAV-AXS-DEC (06/18)
2. TRUE EXCESS LIABILITY POLICY NAV-AXS-POL (06/18)

**Class 2-13000 Risk**

**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.

NAV-AXS-DEC (06/18)
Page 2 of 3