# CLAIMS MADE STAND ALONE/RETAINED AMOUNT FORM

This is a Claims Made Form. Read your policy CAREFULLY.

Certain provisions in this policy restrict coverage. Read the entire policy carefully to determine your rights and duties, and what is and is not covered.

The words "we", "us" and "our" refer to the Lexington Insurance Company. The word "insured" means any person or organization qualifying as such under the section entitled, "DEFINITIONS - PERSONS INSURED".

In consideration of the payment of the premium, and in reliance upon the statements in the Declarations made a part hereof and subject to the limits of liability, exclusions, conditions and other terms of this policy, we agree with the first Named Insured named in the Declarations as follows:

## INSURING AGREEMENTS

### I. COVERAGE

A. We will pay on behalf of the "insured" that portion of the "ultimate net loss" in excess of the Retained Amounts as determined in Section III B of this policy, which the "insured" shall become legally obligated to pay as compensatory damages (excluding all fines, penalties, punitive or exemplary damages) because of "Personal Injury", "Property Damage" or "Advertising Injury", caused by an "occurrence" to which this insurance applies, due to:
1. liability imposed upon the "insured" by law, or
2. liability of others assumed by the "insured" under written contract.

B. This insurance applies to "Personal Injury", "Property Damage" or "Advertising Injury" only if a "claim" for such damages:
1. is first made in writing against the "insured" during the policy period, and written notice of such "claim" is received by the "insured", the underlying insurer or us, whichever comes first; AND

LEX-CM-STA-2
(Ed. 4/86)