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| Company: | Zurich |
| Policy Number: | To be determined |
| Coverage: | Umbrella Liability Occurrence Form |
| Term: | One Year |
| Available Limits: | $25,000,000 Per Occurrence $25,000,000 Products and Completed Operations Hazard Aggregate $25,000,000 General Aggregate, where applicable, follow form of Primary Policies $10,000,000 Per Occurrence $10,000,000 Products and Completed Operations Hazard Aggregate $10,000,000 General Aggregate, where applicable, follow form of Primary Policies $5,000,000 Per Occurrence $5,000,000 Products and Completed Operations Hazard Aggregate $5,000,000 General Aggregate, where applicable, follow form of Primary Policies |
| SIR | $0 Each Occurrence Except New York - $10,000 SIR |
| Coverage Terms: | As per American Guarantee Form U-UMB-103-B CW (7/03) Coverages provided only to the extent that the primary carrier is providing coverage as stated in the Underlying Requirements. |
| Excess Uninsured Motorist/ Underinsured Motorist: | If you have vehicles registered in, or employees located in, the following states there will be an additional premium charge for this exposure, unless you reject such insurance in writing. Affected states: Florida; Georgia; Louisiana; New Hampshire; Vermont; West Virginia. |
| Certified Terrorism: | There will be an additional premium charged for Certified Terrorism coverage. |
| General Liability: | $1,000,000 Per Occurrence $1,000,000 Personal & Advertising Injury $2,000,000 General Aggregate per Location $1,000,000 Products Completed Operations Aggregate |
| Employee Benefits | $1,000,000 (if applicable) |
| Automobile Liability | $1,000,000 Combined Single Limit BI and PD |
| Employers Liability | $500,000 Each Accident $500,000 Disease Policy Limit $500,000 Disease Each Employee |
| Liquor Law Liability | $1,000,000 Each Occurrence/Aggregate per Location (Applicable to Hospitality and Restaurant Programs and specific Retail, Service and Wholesale risks) |
| D&O — Condo & Co-Op’s | $1,000,000 Each Occurrence and Aggregate |
| Professional Liability** (Only for designated classifications) | $1,000,000 Each Occurrence and Aggregate |
| Pesticide or Herbicide Applicator Liability* | $1,000,000 Each Occurrence and Aggregate |
Underlying Carriers must be rated A-VII or better, Employer liability carriers rated B+V or better are acceptable.