| MS-21881 (05/13) | Knowledge of Occurrence |
| --- | --- |
| MS-21924 (05/13) | Joint Venture Limitation Endorsement |
| MS-28994 (03/14) | Insureds In Media and Internet-Type Business Exclusion Amendatory Endorsement |
| MS-29623 (04/14) | Preamble Amendatory Endorsement |
| MS-49267 (05/16) | Access, Collection and Disclosure of Information and Electronic Data Exclusion – Limited Bodily Injury and Redefined Property Damage Exceptions with Aggregate Retained Limit (including $15M aggregate over the SIR) |
| MS-9606 (05/12) | Technology Services Errors and Omissions Exclusion Endorsement |
| MS-9612 (05/12) | Electronic Chat Rooms or Bulletin Boards Exclusion Endorsement |
| MS-9613 (05/12) | Employee Benefit Plan Follow Form Endorsement [Claims Made] |
| MS-9614 (05/12) | Incidental Medical Malpractice and Good Samaritan Endorsement |
| MS-9617 (05/12) | Joint Venture Limitation Endorsement-Infoprint Solutions Company LLC And Its Subsidiaries |
| MS-9620 (05/12) | Named Peril and Time Element Pollution Exclusion With Limited Exceptions Including Auto, Mobile Equipment and Products-Completed Operations And Self-Insured Retention |
| MS-9623 (05/12) | Nuclear Liability Exclusion Endorsement |
| MS-9624 (05/12) | Retained Limit Amendatory Endorsement-No Underlying Insurance |
| MS-9625 (05/12) | Who is an Insured Amendatory Endorsement |
| MS-9626 (05/12) | Watercraft Exclusion Amendatory Endorsement |
| MS-9627 (05/12) | Trade or Economic Sanctions Amendatory Endorsement |
| MS-9628 (05/12) | Professional and Financial Service Exclusion - Limited Exception For Resulting Bodily Injury And Property Damage |
| MS-9629 (05/12) | Aircraft Exclusion with Exception and Self-Insured Retention For Industrial Aid Aircraft |

**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 within sixty (60) days

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 2015.

The policy to which this form is attached has been issued using Rates, Rules, and/or Contract Provisions and Forms that are exempt from the filing and approval requirements of the Department of Insurance in your state of domicile.

Please read this carefully, as the limits, coverage and other terms and conditions may vary significantly from those requested in your submission or tailor from the existing 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.

Electronic Delivery: Acceptance of this binder indicates the insured's consent to accept delivery of the policy by electronic means, including delivery of the policy to the email address shown above. If the insured would like to withdraw their consent to electronic delivery and exclusively receive a printed paper copy of the policy, please contact the undersigned.

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.

**Signature:**

**Anna Machalska**
Vice President
212-642-7825
Anna.Machalska@chubb.com
Edition Date: 05/06/2016

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