| MS-21296 | Definition of Key Executive Amendatory Endorsement |
| --- | --- |
| MS-28994 | Insureds in media and Internet-type Business Exclusion Amendatory Endorsement |

## FOLLOW FORM:

## SUBJECT TO:
- Receipt of signed UM/UIM rejection forms within 30 days.
- The premium in this quotation contemplates the rejection of UM/UIM coverage or the election of minimum statutory limits (where applicable). If UM/UIM coverage is not rejected or minimum statutory limits are not selected, additional premium may apply.
- Receipt of binders for underlying policies
- Receipt of signed TRIA signed acceptance/declination documents at binding
- Receipt and favorable review of underlying policies

## OFAC DISCLAIMER:
OFAC NOTICE: The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy, based on Presidential declarations of "national emergency." OFAC has identified and listed various foreign agents, Front organizations, Terrorists, Terrorist organizations, and Narcotics traffickers as "Specially Designated Nationals and Blocked Persons." This list can be located on the United States Treasury's website: http://www.treasury.gov.

In accordance with OFAC regulations, if it is determined that you or any other insured, or any person or entity claiming the benefits of this insurance, has violated U.S. sanctions law or is a Specially Designated National or Blocked Person, as identified by OFAC, this insurance will be considered a blocked or frozen contract and all provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be such a blocked or frozen contract, no payments nor premium refunds may be made without authorization from OFAC. Other limitations on the premiums and payments also apply.

## CLASS CODE 2-13000
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS.

This binder contemplates ACE USA forms and endorsements.
The binder offered includes a charge for terrorism per the attached disclosure letter; we reserve the right not to bind coverage without coverage for terrorism as provided in the Terrorism Risk Insurance Program Reauthorization Act of 2007.

Please read this binder carefully, as the limits, coverage and other terms and conditions may vary significantly from those requested in your submission and/or from the expiring policy. Terms and conditions that are not specifically mentioned in this binder are not included. The terms and conditions of this binder supersede the submitted insurance specifications and all prior proposals and binders. Actual coverage will be provided by and in accordance with the policy as issued.

The insurer is not bound by any statements made in the submission purporting to bind the insurer unless such statement is reflected in the policy or in an agreement signed by someone authorized to bind the insurer.
This binder has been constructed in reliance on the data provided in the submission. A material change or misrepresentation of that data voids this binder.

Please note that we require copies of underlying policies. Please forward copies of these policies as soon as they have been issued for completion of our underwriting file.
This binder includes an endorsement providing coverage under ACE's Catastrophe Management form. To have a brief discussion regarding your firm's catastrophe response program and to learn more about ESIS' capabilities, you may speak to a representative from ESIS' Catastrophe Management Services. Your ESIS contact is Lori Brassell-Critchon who can be reached by dialing 916.939.6857.

**Anna K. Machalska**
Vice President
212-642-7825 phone
fax
anna.machalska@acegroup.com