**BLANKET EXCESS LIABILITY POLICY FOLLOWING FORM**

**POLICY NUMBER:** XLX-120-29-01

**PRODUCER & COMPANY:**
- **Producer:** [Producer's Name and Location]
- **Company:** [Company's Name]

**DECLARATIONS:**
- **Insured:** [Insured's Name and Address]
- **Effective Date:** [Effective Date]
- **Expiration Date:** [Expiration Date]

**POLICY INFORMATION:**
- **Policy Type:** Blanket Excess Liability Policy
- **Form:** Following Form
- **Limit of Liability:** $10,000,000
  - Each Occurrence
  - Aggregate
- **Underlying Insurance Limit of Liability:** $40,000,000
  - Each Occurrence
  - Aggregate
- **Premium Basis:** Flat Charge
- **Advance Premium:** $11,580
- **Annual Minimum Premium:** $11,580

**SCHEDULE OF UNDERLYING INSURANCE:**
- [Schedule details]

**FOLLOWING FORM BLANKET EXCESS LIABILITY POLICY**

The Company designated above, a stock insurance company (herein called the Company), agrees with the Insured, named in the declarations made a part hereof, in consideration of the payment of premium and in reliance upon the statements in the declarations and subject to the limits of liability, exclusions, conditions and other terms of this policy.

**INSURING AGREEMENTS:**
1. **Coverage:** To indemnify the Insured for the Insured's ultimate net loss in excess of the amounts specified in the Blanket Excess Liability or "Umbrella" policies specified in Item 3 of the Declarations, hereinafter called underlying insurance, in full force and effect at the expiration of this policy, provided that the insurance for injury to or destruction of property under this policy and underlying policies shall not apply except as respects damage to or destruction of property itself, including loss of use thereof.
2. **Limit of Liability:** The Company shall be liable only for the limit of liability specified in Item 3 of the Declarations in excess of the limit or limits of liability of the policies of underlying insurance, policy or policies all as stated in the Declarations of this policy. The limit of the liability stated in the Declarations as applicable to "each occurrence" shall be the total limit of the Company's liability for all damages sustained during each annual period of this policy, provided, however, in the event of reduction of any one occurrence, provided, however, in the event of reduction of the applicable aggregate limit or limits of liability under said underlying policies, this policy shall apply as excess of the reduced limit of liability thereunder. Subject to the applicable limit of liability as respects each occurrence, the limit of liability in the aggregate shall be the total limit of the Company's liability for all damages sustained during each annual period of this policy.
3. **Policy Period:** This policy applies only to occurrences which take place during the policy period.

**DEFINITIONS:**
- "Ultimate net loss" means all sums actually paid, or which the Insured is legally obligated to pay, as damages in settlement or satisfaction of claims or suits in which insurance is afforded by this policy, after proper deduction of all recoveries or salvage.

**CONDITIONS:**
1. **Maintenance of Primary Insurance:** The Insured warrants and it is a condition of this policy, that at the inception of this policy, insurance afforded by the underlying policies of insurance (apply)

**COUNTERSIGNATURE DATE:** 5/13/76
**COUNTERSIGNATURE OF AUTHORIZED AGENT:** [Signature]