**POLICY NO.:** UFP0044276-03  
**RENEWAL OF:** UFP0044276-02

IN WITNESS WHEREOF, the Insurer has caused this Policy to be signed by its duly Authorized Representative.

**Authorized Representative**

- **Date:** July 14, 2014
- **Title:** Senior Vice President  
  Underwriting Manager,  
  Excess Casualty

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BSF-03 (Ed. 3/14)