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Form SS 00 02 12 06 Page <br />Process Date: Policy Expiration Date: <br />This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any <br />other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock <br />insurance company of The Hartford Insurance Group shown below. <br />INSURER: <br />COMPANY CODE: <br />Policy Number: <br />SPECTRUM POLICY DECLARATIONS <br />Named Insured and Mailing Address: <br />(No., Street, Town, State, Zip Code) <br />Policy Period: From To <br />12:01 a.m., Standard time at your mailing address shown above.Exception:12 noon in New Hampshire. <br />Name of Agent/Broker: <br />Code: <br />Previous Policy Number: <br />Named Insured is: <br />Audit Period: <br />Type of Property Coverage: <br />Insurance Provided:In return for the payment of the premium and subject to all of the terms of this policy, we <br />agree with you to provide insurance as stated in this policy. <br />____________________________________________________________________________________________________________________ <br />TOTAL ANNUAL PREMIUM IS: <br />______________________________________________________________________________________________ <br />Countersigned by <br />Authorized Representative Date <br />DocuSign Envelope ID: 17579A7B-89F6-45AA-B34D-9D6BDE022562