MEMBER OF

**Great American Insurance Group**

**Great American Professional Risk Insurance Services, Inc.**

**Part of Great American Insurance Group**

**11325 N. Community House Road**
**Suite 200**
**Charlotte, NC 28277**
**(704) 364-5161**

| Policy Premium: | $125,000.00 |
|-----------------|-------------|
| $0.00 Terrorism Included | $125,000.00 |

Term: Annual  
Rate: Flat  
Commission: 0%

**Terms and Conditions**

**Policy Form:** As per coverage form: Excess Liability Insurance Policy (EXU0001.05.16) plus the following:

**Our Policy Terms and Conditions:**

Attachments:
- Amendment of Investigation, Defense And Settlement (EXU4014.04.17)
- In Witness Clause (IL7268.09.09)
- New York Changes - Definition of Underlying Limits of Insurance (EXU1022.05.16)
- New York Changes - Exhaustion of Underlying Limits (EXU1025.05.16)
- New York Policy Holder Notice - FTZ (SDM841.07.14)
- NY Changes - Terms Conform To Statute (EXU1012.05.16)
- Non Following Form (EXU2002.05.16)
- Cap On Losses From Certified Acts of Terrorism (EXU1002.05.16)
- Disclosure Pursuant To TRIA (EXU1004.05.16)

Exclusions: Terrorism

Subjectivities:

To clarify, please note the conditions of this binder may not be in accordance with the conditions requested in your submission. For Complete terms, conditions, exclusions and limitations please refer to the policy language itself.

We will add/delete TRIA forms if there are any changes in the Government requirements.

Regards,

**Ashley Hunley**
Account Exec., CPCU, CRIS  
Great American Professional Risk Ins. Services

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