HomeMy WebLinkAbout000341.tiff SOMPO Placed by :
- INTERNATIONAL Risk Placement Services , Inc .
Endurance American Specialty Insurance Company
( Wilmington, Delaware )
This Declarations Page together with forms and endorsements, if any, complete the below numbered POLICY .
Policy No. IMU 10012212603 Renewal of: IMU 10012212602
INLAND MARINE DECLARATIONS PAGE
NAMED INSURED AND ADDRESS : PRODUCERS NAME AND ADDRESS:
Colorado Counties Casualty and Property Pool Chelsea Bergen
C/O CTSI Risk Placement Services, Inc
800 Grant St, Suite 400 525 W. Van Buren
Denver, CO 80203 Suite 1325
Chicago, IL 60607
POLICY PERIOD : Inception: 01/01/2021 Expiration: 01/01/2022
12 :01 a.m. Standard Time at the address of the Insured shown above
Notice to Named Insured: It is important that the written portion of all policies covering the same exposure read exactly alike. If
they do not, they should be made uniform at once.
1 . DESCRIPTION OF COVERAGES : Excess Vehicle Physical Damage - Over the Road Only
2. LOCATION(S) OR EXPOSURES COVERED :
3. LIMIT OF LIABILITY : $4,000,000 Per Occurrence Excess of $ 1 ,000,000
Per Occurrence and Annual Aggregate Earthquake $4,000,000 excess $ 1 ,000,000
Per Occurrence and Annual Aggregate Flood $4,000,000 excess $ 1 ,000,000
The Company provides the limits shown above as applying on the basis of $4,000,000 in turn excess of $ 1 ,000,000 in turn excess
of any applicable deductible(s) or self-insured retention contained in the underlying policies with respect to each and every loss or
occurrence caused by or resulting from the perils insured against under this policy and in the annual aggregate(s) as stated above
4. DEDUCTIBLE AMOUNT(s) :
5. TOTAL PREMIUM $54,753 MINIMUM EARNED PREMIUM : 43 %
6. TAXES / FEES APPLICABLE: State Fees : Producer Responsibility
Stamping Fees: Producer Responsibility
Inspection Fee : Not Applicable
Modeling Fee : Not Applicable
7. MORTGAGE OR LOSS PAYABLE CLAUSE : N/A Loss if any should be payable to : All Loss Payees on file
with the company and/or the agent
8. SUBJECT TO FORMS AND ENDORSEMENTS SCHEDULE ECP 0101 ATTACHED.
To Report a Loss
• Dial toll-free #1 (844)777-8323 or visit our
• Website : https ://my. rpsins. com/claimsfnol
• Contact Insurer directly (see policy section)
R P S C H P/S C/2 021 . 05. 04
Endurance American Specialty Insurance Company IM 0001 1014
Lai SOMPO
INTERNATIONAL
Endurance American Specialty Insurance Company
( Wilmington, Delaware )
Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements
or limitations of the above mentioned Policy, other than as above stated.
Any terms used in this Declarations Page that are defined in the attached policy form shall have the same meaning as in
that policy form.
Issuance Date: April 23, 2021 +r f
C .
Authorized Representative
Issuing Office: Chicago, IL
NOTE - SEE ENCLOSED NOTICE FOR SURPLUS LINES NOTIFICATION
Endurance American Specialty Insurance Company IM 0001 1014
SOMPO
INTERNATIONAL
Endurance American Specialty Insurance Company
1221 Avenue of the Americas
New York, NY 10020
IN WITNESS WHEREOF, the Insurer has caused this Policy to be signed by its President and Senior
Vice President and countersigned where required by law on the Declarations page by its duly
authorized representative .
am
Senior Vice President President
Endurance American Specialty Insurance Company IL 1008 0114
FORMS AND ENDORSEMENT SCHEDULE
It is agreed the following forms and endorsements are attached to and are a part of this policy :
# FORM NUMBER FORM NAME
1 SN 9007 0914 CO SN - COLORADO - NON-CLAIMS-MADE
2 PN 0001 0712 U . S . Treasury Department's Office of Foreign Assets Control (OFAC)
3 PN 0007 0115 Claim Notice
4 IM 0001 1014 Inland Marine Declaration Page (Non-admitted only)
5 IL 1008 0114 Signature Page
6 ECP 1001 06 06 General Change Endorsement
7 EIM 3003 0815 Minimum Earned Premium
8 IL 1301 0512 Service of Suit Endorsement
9 ECP 0103 0508 Schedule of Primary Policies Endorsement
10 CL 0700 10 06 Virus Or Bacteria Exclusion
11 IL 1205 O 1 15 Exclusion of Certified Acts of Terrorism
12 IL 1313 O 1 15 TRIA Rejection of Offer
13 ECP 0101 0508 Forms and Endorsements Schedule
14 ECP 0223 05 16 Following Form Excess Policy (Non-admitted only)
Endurance American Specialty Insurance Company ECP 0101 0508
SCHEDULE OF PRIMARY POLICY (IES) ENDORSEMENT
Company Policy Number Policy Period Tyke °f Limits of Insurance
Coverage
Lloyd 's of London PW0330121 01/01/2021-01/01/2022 Property $ 10,000,000
Endurance American Specialty Insurance Company ECP 0103 0508
Endurance American Specialty Insurance Company
EXCESS FOLLOW FORM POLICY
1 . INSURING AGREEMENT
The insurance provided by this policy will follow form and be subject to the same terms and
conditions as the "primary policy" listed in the SCHEDULE OF PRIMARY POLICY(IES)
ENDORSEMENT, except for the premium, the limits of liability, and to the extent that the terms,
conditions, provisions, definitions, endorsements and exclusions of this policy differ from the
"primary policy" . In the event of conflict between this policy and the "primary policy", the terms,
conditions, provisions, definitions, and exclusions of this policy shall control .
2. DROP DOWN PROVISION
It is agreed that liability and any obligation under this policy shall attach to the "Company" only
after the limits of the "underlying policies" (including any deductible(s) or self-insured retention)
have been exhausted or have been held liable to pay in full . The "Company" shall then be liable to
pay only such additional amounts in excess of the limits of liability of the "underlying policies" and
in no event shall such payments exceed the limit of liability or annual aggregate(s) as provided by
this policy, and stated on the Declarations Page under Item 3 .
In the event of exhaustion of the limits of liability provided by the "underlying policies", this policy
shall continue to pay for "loss" or damage as provided by the "underlying policies", subject to the
deductible(s) or self-insured retention contained in the "primary policy", but only to the extent such
"loss" is covered under this policy, and in no event shall such payments exceed the limit of liability
or annual aggregate(s) as provided by this policy .
The limit of liability of this policy does not apply to or include any sub-limited coverages in the
"underlying policies", however, the sub-limits in the "underlying policies" will erode the limits of
liability of the "underlying policies", unless otherwise stated in any endorsements attached to this
policy.
3. UNCOLLECTIBLE INSURANCE
In the event that the limits of liability of any "underlying policies" or other insurance are
uncollectible, this policy will not drop down or replace such uncollectible limits of liability . This
policy shall apply as if the "underlying policies" or other insurance are in force and their limits of
liability are collectible . The risk of uncollectibility (in whole and in part) of any other insurance or
"underlying policies" is expressly retained by the insured and shall not in any way or under any
circumstances become insured or assumed by the "Company" .
Endurance American Specialty Insurance Company ECP 0223 05 16
Page 1 of 3
4. MAINTENANCE OF PRIMARY INSURANCE
The insured must comply with the following conditions precedent to maintain coverage under this
policy:
A. The "underlying policies" that are in effect at the inception date of this policy must be
maintained in full effect during the term of this policy .
B. Immediate notice of any replacement, amendments, or changes to the terms, conditions, limits
of liability and/or premium for the "underlying policies" shall be made to the "Company' s"
authorized representatives by the insured .
Failure to comply with the above conditions precedent, in whole or in part, will negate the following
form nature of this coverage, and this policy will then apply in the same manner as if the original
"primary policy" in effect at the time the policy incepted remained in full effect. This policy will
apply as though the limits of liability and terms and conditions of the "underlying policies" in effect
at the inception of the policy remain in effect and the insured shall bear all liability resulting from
any such decrease in limits of liability or coverage .
The amount of loss from any one "occurrence", for which this policy is excess, shall be determined
by the combined "loss", damage or expense as insured under the "underlying policies" . Any
recovery made under the "underlying policies" shall be treated as applying first in satisfaction of the
"loss" to property and coverages not insured under this policy and thereafter in satisfaction of the
"loss" to property and coverages insured under this policy .
5. MINIMUM EARNED PREMIUM
In the event of cancellation of this policy by the insured or for non-payment of premium, a minimum
earned premium of 25 % of the annual premium shall become payable by the insured .
6. TERRITORY
This policy covers "losses" occurring anywhere within the United States of America, its territories
and possessions, Puerto Rico and the District of Columbia.
7. NOTICE OF LOSS
If the insured or its designated representative(s) becomes aware of any "loss", damage, or
"occurrence" likely to give rise to a claim against this policy, the insured shall as soon as
practicable, promptly report in writing or in any of the following ways, to : Endurance U . S .
Insurance - Claims, 750 Third Avenue, 18th Floor, New York, NY 10017 or Email addressed to :
eclaimsenhinsurance .com every "loss", damage, or "occurrence" which may give rise to a claim
under this policy. Failure by the insured to promptly report the said "loss", damage, or
"occurrence" as soon as practicable shall invalidate any claim under this policy . E-mail is the
preferred method of receiving claim notice information, but any of the above methods of notification
will generate an acknowledgement of receipt of claim with a claim number and all of the claim
adjusters ' contact information .
Endurance American Specialty Insurance Company ECP 0223 05 16
Page 2 of 3
8. SUIT AGAINST COMPANY
No suit, action, or proceeding for the recovery of any claim under this policy shall be sustainable in
any court of law or equity unless there has been full compliance with all of the terms and conditions
of this policy and the suit, action, or proceeding is commenced within twelve ( 12) months after the
date on which the physical "loss" or damage occurred which gives rise to a claim; provided,
however, that if by the laws of the state within which this policy is issued, such limitation of time is
invalid, then any such claims shall be void unless such action, suit, or proceeding be commenced
within the shortest limit of time permitted by the laws of such state .
9. REINSTATMENT OF LIMITS CLAUSE
Any loss hereunder shall not reduce the limits of this policy except for any perils that are written on
an annual aggregate basis .
10. DEFINITIONS
Whenever used in this policy or any endorsement attached to this policy, the following words have
these meanings when they appear in quotation marks :
A. "Company" shall mean Endurance American Specialty Insurance Company .
B. "Loss" or "losses" shall mean all damages sustained by the insured caused by the perils covered
by this policy after making deduction for all salvages, recoveries, and other applicable
insurance .
C. "Occurrence" shall mean any one "loss", disaster, or casualty or series of "losses", disasters, or
casualties arising out of one event.
D. "Primary policy" shall mean that policy which this policy follows form to, as more specifically
described in the SCHEDULE OF PRIMARY POLICY(IES) ENDORSEMENT.
E. "Underlying policy" shall mean all insurance policies, including the "primary policy" that
provide coverage for the same perils insured herein and that attach at a layer below the
attachment point of this policy, including all applicable deductibles and self-insured retentions .
Endurance American Specialty Insurance Company ECP 0223 05 16
Page 3 of 3
ENDORSEMENT
Named Insured : Colorado Counties Casualty Policy Number : IMU 10012212603
and Property Pool
Endorsement Endorsement
Effective Date : January 01 , 2021 Number : N/A
( 12 : 01 AM Standard Time at the address of the Named Insured as shown in the Declarations)
MINIMUM EARNED PREMIUM
It is agreed that :
The policy is amended to add the following :
This policy is subject to a minimum earned premium of $ 23 , 997 . Policy fees are fully earned .
This Minimum Earned Premium is the least amount of premium we shall retain as earned
premium , regardless of the term .
It is agreed that the minimum earned premium for the policy period indicated , or less , is subject
to short rate or pro rate adjustment over and above the minimum earned premium in the event
of cancellation by the insured .
It is further agreed that cancellation request for non - payment of premium shall be deemed a
request by the named insured for cancellation of this policy, and the foregoing minimum earned
premium provision applies .
r'
r^
I
Authorized Representative
This endorsement does not change any other provision of the policy . The title and any headings in this
endorsement are solely for convenience and do not affect its meaning .
Date of Issuance : April 23, 2021 Policy Form : Applicable Forms
Endurance American Specialty Insurance Company Page 1 of 1 Endorsement Form : EIM 3003 0815
GENERAL CHANGE ENDORSEMENT
Named Colorado Counties Casualty and Property Pool
Insured:
Policy No . : IMU10012212603 Endorsement Effective Date : 01 -01 -2021
Issued By : Endurance American Specialty Insurance Company Endorsement No . : NA
THIS ENDORSEMENT CHANGES THIS POLICY. PLEASE READ IT CAREFULLY.
With regards to coverage provided under this policy, the DESCRIPTION OF COVERAGES on
the INLAND MARINE DECLARATION PAGE only applies to Property Insurance, Agreement
C Vehicle Physical Damage of the primary Colorado Counties Casualty and Property Pool
Policy .
This endorsement modifies insurance provided under the FOLLOWING FORM EXCESS
POLICY ECP 0223 05 12 .
The following changes are made to the Coverage form .
A . 5 . EXCLUSIONS A . 4. = Pollution - is deleted .
B . 6. CANCELLATION is deleted and replaced by the following .
6. CANCELLATION
This policy may be cancelled by the insured by mailing to the = Company = written
notice stating when thereafter such cancellation shall be effective . The effective
date of the cancellation will be the date the written notice is received by the
- Company or the date specified in the written notice , whichever is later. This
policy may be cancelled by the _ Company = by mailing to the insured at the
address shown in this policy , or at the last known address , written notice stating
when not less than ninety ( 90) days thereafter such cancellation shall be effective,
subject to the applicable state law governing Notice of Cancellation procedures ;
however, cancellation due to non-payment of premium shall require ten ( 10) days
written notice of cancellation . If this policy is cancelled, the = Company - will send
the first Named Insured any premium refund due . If the iCompanyi cancels, the
refund will be Endurance American Specialty Insurance Company ECP 1001
0606 pro rata . If the insured cancels, the refund may be less than pro rata . The
mailing of notice as aforementioned shall be sufficient proof of notice and the
effective date of cancellation stated in the notice shall become the end of the
policy period. Delivery of such written notice either by the insured or by the
- Company shall be equivalent to mailing .
Endurance American Specialty Insurance Company ECP 1001 0606
C . 9 . NOTICE OF LOSS and 11 . PROOF OF LOSS are deleted and replaced by the
following .
9. NOTICE OF LOSS
The insured through County Technical Services , Inc. Claims Management
Department shall as soon as practicable report to this Company or its agent every
loss or damage which may become a claim under this Policy and shall also file
with the Company or its agents within ninety ( 90 ) days from date of loss a
detailed sworn proof of loss . Failure by the insured or County Technical Services ,
Inc. to report the said loss or damage and to file such proof of loss as herei nbef ore
provided shall not invalidate any claim under this policy for such loss .
D . 30 . DEFI NITI ONS C . - Occurrence = is deleted and replaced with the following .
C . " Occurrence " means all covered loss , damage , or a sequence of
losses or damage , casualties or disasters , arising from a single
event or catastrophe . So far as loss involving in whole or in part, the
perils of wind , ( including hurricanes , tornadoes , cyclones ) , snow,
rain , or hail is concerned a single event shall mean one single
atmospheric disturbance during a continuous period of seventy two
( 72 ) hours ( not limited by the date on which coverage under this
policy ceases ) .
Nothing herein contained shall vary , alter, waive , or extend any of the terms , representations ,
conditions or agreements of the policy other than as above stated.
______„7-4
( ___-- .-------- ,;
_j_u7k
Authorized Representative
Endurance American Specialty Insurance Company ECP 1001 0606
SERVICE OF SUIT ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
In the event of failure of the Company to pay any amount claimed to be due under the terms of this policy,
the Company, at the request of the Insured, will submit to the jurisdiction of a court of competent
jurisdiction within the United States . Nothing in this condition constitutes or should be understood to
constitute a waiver of the Company ' s rights to commence an action in any court of competent jurisdiction
in the United States to remove an action to a United States District Court or to seek a transfer of a case to
another court as permitted by the laws of the United States or of any state in the United States . In any suit
instituted against the Company upon this policy, the Company will abide by the final decision of such court
or of any appellate court in the event of appeal .
It is further agreed that service of process in such suit may be made upon the Senior Vice President -
Claims, 1221 Avenue of the Americas New York, NY 10020 .
Further, pursuant to any statute of any state , territory, or district of the United States which makes
provision therefore, the Company hereby designates the Superintendent, Commissioner or Director of
Insurance , or other officer specified for that purpose in the statute, as its true and lawful attorney upon
whom service may be made of any lawful process in any action, suit, or proceeding instituted by or on
behalf of the Insured or any beneficiary hereunder arising out of this policy of insurance and hereby
designates the above named Senior Vice President - Claims as the person to whom the said officer is
authorized to mail such process or a true copy thereof.
This endorsement does not change any other provision of the policy .
Endurance American Specialty Insurance Company IL 1301 0512
AAIS This endorsement changes
CL 0700 10 06 the policy
Page 1 of 1 -- PLEASE READ THIS CAREFULLY --
VIRUS OR BACTERIA EXCLUSION
This exclusion applies to , but is not limited to ,
DEFINITIONS any loss , cost , or expense as a result of:
a . any contamination by any virus ,
Definitions Amended -- bacterium , or other microorganism ; or
When "fungus " is a defined "term" , the definition of b . any denial of access to property because
"f
ungus " is amended to delete reference to a of any virus , bacterium , or other
bacterium . microorganism .
When "fungus or related perils " is a defined "term " , 2 . Superseded Exclusions -- The Virus or
the definition of "fungus or related perils " is Bacteria exclusion set forth by this
amended to delete reference to a bacterium endorsement supersedes the "terms " of any
other exclusions referring to " pollutants " or to
PERILS EXCLUDED contamination with respect to any loss , cost, or
expense caused by , resulting from , or relating
to any virus , bacterium , or other
The additional exclusion set forth below applies to all microorganism that causes disease , illness , or
coverages , coverage extensions , supplemental physical distress or that is capable of causing
coverages , optional coverages , and endorsements disease , illness , or physical distress .
that are provided by the policy to which this
endorsement is attached , including , but not limited
to , those that provide coverage for property , OTHER CONDITIONS
earnings , extra expense , or interruption by civil
authority .
Other Terms Remain in Effect --
1 . The following exclusion is added under Perils The "terms " of this endorsement , whether or not
Excluded , item 1 . . applicable to any loss , cost , or expense , cannot be
construed to provide coverage for a loss , cost , or
Virus or Bacteria -- expense that would otherwise be excluded under
"We" do notpay for loss , cost , or expense
the policy to which this endorsement is attached .
p
caused by , resulting from , or relating to any
virus , bacterium , or other microorganism that CL 0700 10 06
causes disease , illness , or physical distress or
that is capable of causing disease , illness , or
physical distress .
Copyright , American Association of Insurance Services, Inc. , 2006
ENDORSEMENT
Named Insured : Colorado Counties Casualty and Property Policy Number : IMU10012212603
Pool
Endorsement Endorsement
Effective Date : January 01, 2021 Number : N/A
( 12 :01 AM Standard Time at the address of the Named
Insured as shown in the Declarations)
EXCLUSION OF CERTIFIED ACTS OF TERRORISM
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
It is agreed that :
A. The following exclusion is added :
This insurance does not apply to :
TERRORISM
'Any injury or damage " arising, directly or indirectly, out of a "certified act of terrorism " .
B . The following definitions are added :
1 . For the purposes of this endorsement, " any injury or damage " means any injury or damage
covered under any Policy or "underlying insurance" to which this endorsement is applicable,
and includes but is not limited to " bodily injury" , " property damage " , " personal and
advertising injury" , " injury " or " environmental damage " as may be defined in any applicable
Policy or " underlying insurance" .
2 . " Certified act of terrorism " means an act that is certified by the Secretary of the Treasury, in
accordance with the provisions of the federal Terrorism Risk Insurance Act, to be an act of
terrorism pursuant to such Act . The criteria contained in the Terrorism Risk Insurance Act for a
" certified act of terrorism " include the following :
a . The act resulted in insured losses in excess of $ 5 million in the aggregate , attributable to
all types of insurance subject to the Terrorism Risk Insurance Act; and
b . The act is a violent act or an act that is dangerous to human life , property or infrastructure
and is committed by an individual or individuals as part of an effort to coerce the civilian
population of the United States or to influence the policy or affect the conduct of the
United States Government by coercion .
Date of Issuance : April 23, 2021 Policy Form :
Endurance American Specialty Insurance Company Page 1 of 2 Endorsement Form : IL 1205 01 15
ENDORSEMENT
r _
Authorized Representative
This endorsement does not change any other provision of the Policy . The title and any headings in this
endorsement are solely for convenience and do not affect its meaning .
Includes copyrighted material of Insurance Services Office, Inc . with its permission .
Date of Issuance : April 23, 2021 Policy Form :
Endurance American Specialty Insurance Company Page 2 of 2 Endorsement Form : IL 1205 01 15
ENDORSEMENT
Named Insured : Colorado Counties Casualty and Property Policy Number : IMU10012212603
Pool
Endorsement Endorsement
Effective Date : January 01, 2021 Number : N/A
12 :01 AM Standard Time at the address of the
Named Insured as shown in the Declarations .
DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT -
REJECTION OF OFFER
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
It is agreed that :
THIS ENDORSEMENT IS ATTACHED TO AND MADE PART OF YOUR POLICY IN RESPONSE TO THE
DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES
NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER
THE POLICY.
A. Rejection of Offer
You have rejected the offer of terrorism coverage for Acts of Terrorism that are certified under
the Terrorism Risk Insurance Act as reauthorized and amended , as an Act of Terrorism . An
exclusion of terrorism losses has been made a part of this policy .
B . Disclosure of Federal Participation in Payment of Terrorism Losses
The United States government, Department of the Treasury, will pay a share of terrorism
losses insured under the federal program . The federal share equals 85% in 2015 and decreases
its share 1% each calendar year to a total of 80% in 2020 of that portion of the amount of such
insured losses that exceeds the applicable insurer retention .
You have rejected this offer of coverage .
1
j
Authorized Representative
This endorsement does not change any other provision of the Policy . The title and any headings in
this endorsement are solely for convenience and do not affect its meaning .
Includes copyrighted material of Insurance Services Office , Inc. with its permission .
Date of Issuance : April 23, 2021 Policy Form :
Endurance American Specialty Insurance Company Page 1 of 1 Endorsement Form : IL 1313 01 15
SURPLUS LINES NOTICE
COLORADO
THIS CONTRACT IS DELIVERED AS SURPLUS LINE COVERAGE UNDER THE NONADMITTED INSURANCE
ACT. THE INSURER ISSUING THIS CONTRACT IS NOT LICENSED IN COLORADO BUT IS AN APPROVED
NONADMITTED INSURER . THERE IS NO PROTECTION UNDER THE PROVISIONS OF THE COLORADO
GUARANTY ASSOCIATION ACT.
Endurance American Specialty Insurance Company 1 of 1 SN 9007 0914 CO
U . S . TREASURY DEPARTMENT ' S OFFICE OF FOREIGN
ASSETS CONTROL ( " OFAC " )
NOTICE TO POLICYHOLDERS
No coverage is provided by this Policyholder Notice nor can it be construed to replace any provisions of your
policy . You should read your policy and review your Declarations page for complete information on the
coverages you are provided .
This Notice provides information concerning possible impact on your insurance coverage due to directives
issued by OFAC . Please read this Notice carefully.
The Office of Foreign Assets Control (OFAC) administers and enforces sanctions policy , based on
Presidential declarations of " national emergency" . OFAC has identified and listed numerous :
• Foreign agents ;
• Front organizations ;
• Terrorists ;
• Terrorist organizations ; and
• Narcotics traffickers ;
as " Specially Designated Nationals and Blocked Persons " . This list can be located on the United States
Treasury 's website - http//www .treas . gov/ofac.
In accordance with OFAC regulations , if it is determined that you or any other insured , or any person or entity
claiming the benefits of this insurance has violated U . S . sanctions law or is a Specially Designated National
and Blocked Person , as identified by OFAC , this insurance will be considered a blocked or frozen contract
and all provisions of this insurance are immediately subject to OFAC . When an insurance policy is
considered to be such a blocked or frozen contract , no payments nor premium refunds may be made without
authorization from OFAC . Other limitations on the premiums and payments also apply .
Endurance American Specialty Insurance Company 1 of 1 PN 0001 0712
POLICYHOLDER NOTICE
CLAIM NOTICE
In the event of claim to which this policy may apply, please give immediate notice in either of the
following ways, to :
Endurance U . S . Insurance - Claims
750 Third Avenue, 18th Floor
New York, NY 10017
E- Mail addressed to : eclaims@enhinsurance . com
Toll Free Reporting : 877 -676-7575
E- mail is the preferred method of receiving claim notice information , but any of the above methods of
notification will generate an acknowledgement of receipt of claim with a claim number and all of the
claim adjusters' contact information .
Endurance American Specialty Insurance Company Page 1 of 1 PN 0007 0115
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