# Midwestern Risk Specialists
**AVRECO**
200 W. Monroe Street, Suite 1407, Chicago, IL 60606
COMM: 15.0%

## Xington Insurance Company
Wilmington, Delaware (A Stock Insurance Company)
Administrative Offices: 100 Summer Street, Boston, Massachusetts

**Policy No.:** 5512881
**Renewal of No.:** 550-18-52

## Declarations - Following Form Excess Liability Policy

### Section I - Excess Insurance
**(a) Policy Period:**
From: MAY 21, 1978 To: MAY 21, 1979
12:01 a.m. Standard Time at the Address of the Insured stated herein.

**(b) Coverage:** QUOTA SHARE EXCESS UMBRELLA

**(c) Limits of Liability:** $2,000,000. COMBINED SINGLE LIMIT BODILY INJURY & PROPERTY DAMAGE AND IN THE AGGREGATE WHERE APPLICABLE PART OF $21,000,000. COMBINED SINGLE LIMIT

**(d) Premium:** $6,000.
Minimum Premium:
Rating Base: PLAT
Rate:

**(e) Audit Period:**

### Section II - Underlying Insurance
**(a) Underlying Policy:** NORTHBROOK
Coverage: EXCESS UMBRELLA
Policy No.: 63 004 593
Policy Limit: $9,000,000.
Policy Period: MAY 21, 1978 TO MAY 21, 1979

**(b) Total limits of all underlying insurance including the underlying policy in excess of which this policy applies:** $19,000,000. COMBINED SINGLE LIMIT AND IN THE AGGREGATE WHERE APPLICABLE

**Endorsements Made Part of this Policy:** SERVICE OF SUIT, ERISA, D&O, POLLUTION-EXCEPT SUDDEN AND ACCIDENTAL, FOLLOWING FORM PUNITIVE DAMAGES, AIRCRAFT PRODUCTS, PROFESSIONAL LIABILITY EXCL., AIRPORT EXCLUSION, FOLLOWING FORM PERSONAL INJURY, CONTRACTORS LIMITATION

Countersigned On: 8-30-78
At Boston, Massachusetts 02110

**By:** [Authorized Representative]

Branch: 39
Div.: 1
Maj. Prod.: 371
Sub. Prod.: AVRECO
Comm.: 15%
Co/No.: 89
Reinsurance % Comm.: 0%