**POLICY NO.:** UFP0044276-04  
**RENEWAL OF:** UFP0044276-03

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

**Authorized Representative**

* **Date:** July 20, 2015
* **Title:** Senior Vice President Underwriting Manager, Excess Casualty

BSF-03 (Ed. 3/14)

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