**(4) Limit of Liability:** Subject to all of the terms of this policy having reference thereto, the company's liability hereunder shall not exceed Two Million Dollars ($2,000,000) with respect to any one occurrence; provided, however, that such limits shall be the annual aggregate limit with respect to all losses which are subject to an annual aggregate limit under the Excess Umbrella Policy issued by American Home Assurance Company.

**(5) Premium Computation:**

* Flat Charge $2,352.94

This policy is nonassessable. The policyholder is a member of the company and shall participate to the extent and upon the conditions fixed and determined by the Board of Directors in accordance with the provisions of law, in the distribution of dividends so fixed and determined.

In witness whereof, the LIBERTY MUTUAL INSURANCE COMPANY has caused this policy to be signed by its President and its Secretary at Boston, Massachusetts, and countersigned by a duly authorized agent of the Company.

**Sales Office H. O. - 001**
**Salesman - 9999**
**N/R Code - 1**
**First Yr. - 69**
**Audit Basis - 0**
**Work Unit - 6-1**
**Home State - N. Y.**
**Renewal of - New**

**Countersigned by:**

**Authorized Representative**

**Used - G 27**
```

This document appears to be a section of an insurance policy, detailing the limit of liability, premium computation, and other relevant information about the policyholder's participation in the company's dividends. It also includes signatures from the company's President and Secretary, along with some administrative details like sales office and renewal information.