# Excess Insurance Policy

$25,000,000 – Aggregate Limit (where applicable)

**Item 5:** SCHEDULE OF UNDERLYING INSURANCE  
See Schedule of Underlying Policies – Excess

**Item 6:** FORMS AND ENDORSEMENTS ATTACHED attached hereto:  
See Forms and Endorsements Schedule – 104-XS (Ed. 03 00)

IN CONSIDERATION OF THE PREMIUM, IN RELIANCE UPON THE STATEMENTS IN THE DECLARATIONS, AND SUBJECT TO ALL TERMS OF THIS POLICY, WE AGREE WITH YOU TO PROVIDE COVERAGE AS STATED IN THIS POLICY.

**President:** Christopher L. Peirce  
**Secretary:** Dexter R. Legg  

June 2, 2015  
Issuance Date

100-XS (Ed. 03 00)  
2 - 13000