# Berkshire Hathaway Specialty Insurance

## Item 5. Premium:
- Total Advance: $87,500
- Total Minimum Annual: $87,500
- Minimum Earned: 35%
- Terrorism Premium Included in the Advanced: $867
- Estimated Total Annual Exposure: $92,792,861,329 Total Revenue
- Auditable / Not Auditable: Not Auditable
- Rate: Flat

## Item 6. In the event of a claim, please notify the following:
- By 24-hour toll free number: 855-453-9675
- By Email: claimsnotice@bhspecialty.com
- By Fax: 617-507-8259
- By Mail: Log on to www.bhspecialty.com/claims-reporting.html for mailing address.

## Item 7. Retroactive Date:
- Not Applicable

## Item 8. "Company":
- National Liability & Fire Insurance Company

This policy is comprised of this Declarations page, the policy form and the schedules and endorsements, if any, attached at inception or during the Policy Period.

Service of Suit may be made upon: Counsel, Legal Department, National Liability & Fire Insurance Company

## Signatures:
- Mike Gottschalk, Secretary
- Donald Wurster, President

**Dated:** 5/14/2015

## 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.

Class Code: 2-13000

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