15. Provide the following information on all primary and excess insurance over which the proposed Umbrella Liability coverage is to apply:

| Limit | Carrier | Earned or Estimated Earned Annual Premium |
|-------|---------|------------------------------------|
| a)    | General B.I. P.D. | -                                  |
| b)    | Products B.I. P.D. | -                                  |
| c)    | Auto B.I. P.D. | -                                  |
| d)    | E.L., E.L.O.D. Jones Act F.E.L.A. F.L. & H.W.A. | -                                  |
| e)    | Advertisers. | See Attachment #5                  |
| f)    | Aircraft. | -                                  |
| g)    | Watercraft. | -                                  |
| h)    | Malpractice. | -                                  |
| i)    | Any other Liability Policies. | -                                  |
| j)    | Employee Benefit Liability Policy. | -                                  |

16. (a) Do the general liability policies specified under Item No. 15 provide:

(1) Blanket Contractual coverage?

(2) Occurrence B.I.? Occurrence P.D.? Broad Form P.D.?

(3) Standard Personal Injury coverage? Including:

a) Group A:  
b) Group B:  
c) Group C:  
See Attachment #5

(4) Modified care, custody or control coverage of any kind? If so, explain:

(5) Coverage for special hazards referred to in the liability manuals as "x", "c", or "u" for mining, logging or lumbering operations?

(b) Describe any other significant extensions, exclusions or limitations of coverage in the primary policies, other than the coverage afforded in a standard policy.

(c) State deductibles, if any, involved in the above policies.

17. What self-insured retention should apply - $10,000 or $25,000? $10,000