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DocuSign Envelope ID:A551A38E-3703-439F-B000-AB96C3150AB4 <br /> Attachment D-Lex Loci General Liability insurance policy <br /> BPO523 0i15 GAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM <br /> BOP47643 0316 EMPLOYMENT-RELATED PRACTICES EXCLUSION <br /> BOP45068 1214 PROPERTY COVERAGE PART EXCLUSION <br /> BOP48527 0117 ASBESTOS EXCLUSION <br /> ALL202$7 1006 ACE PRODUCER COMPENSATION PRACTICES AND POLICIES <br /> ILP001 0104 U.S. TREASURY DEPARTMENTS OFFICE OF FOREIGN ASSETS CDNTROL ("OFAG") ADVISORY <br /> NOTICE TO POLICYHOLDERS <br /> ALL42490B 0716 U-S_FOREIGN ACCOUNT TAX COMPLIANCE ACT("FATCA") <br /> ALL21101 1106 TRADE OR ECONOMIC SANCMN5 ENDORSEMENT <br /> TRIA11c 0115 DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT <br /> BPO116 0315 NORTH CAROLINA CHANGES <br /> Item F. Notice under this Policy shall be given to: <br /> Chubb North America Claims <br /> P.O. Box 5122 <br /> Scranton,PA 18E05-0654 <br /> Tall Free: 844-539-3801 <br /> ACECRS-CLAIMS@chubb.com <br /> Item G. Producer Name and Mailing Address <br /> COVERHOUND INC❑SA:COVERHOUND INSURANCE SOLUTIONS <br /> 5655 LINDERO CANYONRD42G <br /> WESTLAKE VILLAGE,CA 91362-4046 <br /> Item H_ Producer Cade:Z08497 <br /> IN WITNESS WHEREOF,the Insurer has caused this Policy to be signed by its President and Secretary,and countersigned by <br /> duly authorized representative of the Insurer. <br /> DATE: 01-04-2019 <br /> Authorized Representative <br /> BOP-43591b(01117) 02015 Page 3 of 3 <br />