**Reliance**

**NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS.**

**IN WITNESS WHEREOF, the Company has caused this policy to be executed and attested, and, if required by state law, this policy shall not be valid unless countersigned by a duly authorized representative of the company.**

**Reliance Insurance Company**
**PHILADELPHIA, PENNSYLVANIA**
**(A STOCK INSURANCE COMPANY)**

**RN 00 A005 00 0593**
**ILBP 83 01 11 88 RE**
**Class Code: 2-13000**

**Secretary**
**President**