# Berkshire Hathaway Specialty Insurance

## Item 5. Premium:
- Total Advance: $74,773
- Total Minimum Annual: $74,773
- Minimum Earned: 35%
- Terrorism Premium Included in Advanced: $740
- Estimated Total Annual Exposure: $81,741,225,850 Total Sales
- Auditable / Not Auditable: Not Auditable
- Rate: $0.0915 per $100,000 of Total Sales

## Item 6. In the event of a claim, please notify the following:
- By 24-hour toll free number: 855-453-9675
- By Email: claimnotice@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
1314 Douglas Street, Suite 1400, Omaha, NE 68102-1944

## Signatures:

**Mike Gottschalk, Secretary**
**Donald Wurster, President**

**06/01/2016**
**Dated**

Page 2 | FF-XS-DSF-10/2014