**Liberty Agency Underwriters**

**Coverage Is Provided In:**
The Ohio Casualty Insurance Company

**Policy Number:**
ECO (14) 54 08 82 46

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**POLICY FORMS AND ENDORSEMENTS**

This section lists all the Forms and Endorsements for your policy. Refer to these documents as needed for detailed information concerning your coverage.

| FORM NUMBER | TITLE |
|-------------|-------|
| CE 65 04 03 98 | New York State Amendatory Endorsement for Excess Liability |
| CE 65 15 06 97 | Limits of Liability Amendment - Quota Share Endorsement |
| CE 65 24 06 97 | Excess Liability Coverage Form |
| *CE 65 27 04 99 | Following Form Endorsement |
| CE 65 30 01 08 | Caps on Losses from Certified Acts of Terrorism |
| CE 66 10 06 05 | New York Excess Changes Amendatory Endorsement |
| CE 66 54 05 09 | Exclusion - Recording and Distribution of Material or Information in Violation of the Law |
| CU 60 05 06 97 | Named Insured |
| CU 60 53 06 97 | Cancellation Amendment |
| CU 62 05 08 04 | New York Changes Cancellation and Nonrenewal |

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In witness whereof, we have caused this policy to be signed by our authorized officers.

**Dexter R. Legg**  
**Secretary**

**Paul Condrin**  
**President**

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To report a claim, call your Agent or send info to Fax: 1-(800)293-4269 or email: 'umbrellaexcessclaims@libertyau.com'

DS 70 23 01 08

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