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DocuSign Envelope ID:26CB3394-9EF5-42C1-8EAB-432A9B415AA4 <br /> WINNOMMO <br /> LOA Aeiministrators 8a Insurance Services S,P E N <br /> APPRAISAL AND VALUATION <br /> PROFESSIONAL LIABILITY INSURANCE POLICY <br /> DECLARATIONS <br /> ASPEN SPECIALTY INSURANCE COMPANY <br /> (A stock insurance company herein called the"Company") <br /> 175 Capitol Blvd. Suite 100 <br /> Rock Hill,CT 06067 <br /> Date Issued Policy Number Previous Policy Number <br /> 08/11/2015 ASI001985-01 <br /> THIS IS A CLAIMS MADE AND REPORTED POLICY.COVERAGE IS LIMITED TO LIABILITY FOR ONLY THOSE <br /> CLAIMS THAT ARE FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD AND THEN REPORT- <br /> ED TO THE COMPANY IN WRITING NO LATER THAN SIXTY(60)DAYS AFTER EXPIRATION OR TERMINATION <br /> OF THIS POLICY,OR DURING THE EXTENDED REPORTING PERIOD,IF APPLICABLE,FOR A WRONGFUL <br /> ACT COMMITTED ON OR AFTER THE RETROACTIVE DATE AND BEFORE THE END OF THE POLICY <br /> PERIOD.PLEASE READ THE POLICY CAREFULLY. <br /> Item <br /> 1.Customer ID: 113569 <br /> Named Insured: The insurance company with which this <br /> ANALYTICAL CONSULTANTS,INC. coverage has been placed is not licensed <br /> 125 Kingston Drive by the State of North Carolina and is not <br /> Chapel Hill,NC 27514 subject to its supervision. In the event of <br /> the insolvency of the insurance company, <br /> losses under this policy will not be paid by <br /> any State insurance guaranty fund. <br /> 2.Policy Period: From:09/09/2015 To: 09/09/2016 <br /> 12:01 A.M.Standard Time at the address stated in 1 above. <br /> 3.Deductible: $2,500 Each Claim <br /> 4.Retroactive Date: 09/09/2004 <br /> 5.Inception Date: 09/09/2015 <br /> 6.Limits of Liability: A. $1,000,000 Each Claim <br /> B. $1,000,000 Aggregate <br /> 7.Mail all notices,including notice of Claim,to: <br /> LIA Administrators&Insurance Services <br /> 1600 Anacapa Street <br /> Santa Barbara,California 93101 <br /> (800)334-0652; Fax: (805)962-0652 <br /> 8.Annual Premium: 41.10.0110 <br /> + 01111111116urplus Lines Tax <br /> 9. Forms attached at issue: LIA002S(12/14) ASPC0002 0715 LIA012(12/14) LIA013(10/14) <br /> LIA025A(11/14) <br /> • <br /> This Declarations Page,together with the completed and signed Policy Application including all attachments and exhibits thereto,and <br /> the Policy shall constitute the contract between the Named Insured and the any. <br /> 08/11/2015 By r <br /> Date Authorized Sigatire <br /> LIA-001S(12/14) Aspen Specialty Insurance Company • <br />