Illinois Union Insurance stchester Surplus Lines Insurance Flexible Excess For Individual Public And Scholastic Entities Declarations This is issued by the stock insurance company checked (x) above. Number Named and Principal Address Previous Number Producer Name and Address Premium: Limits of Insurance Schedule of Schedule of Forms and Endorsements Forming a part of this at Inception See attached Schedule of Forms and Endorsements
SCHEDULE OF FORMS AND ENDORSEMENTS The State of Nebraska XPE G19851667 004 July 01, 2014 to July 01, 2015 July 01, 2014 Illinois Union Insurance SCHEDULE OF FORMS Forms Title Endorsement Number Form Number SCHEDULE OF ENDORSEMENTS Title
Schedule of This schedule forms a part of the s Declarations. Number: XPE G19851667 004 Named : The State of Nebraska A No. Insurer Coverage Limits of Insurance General Liability Claims Made Each Occurrence: General Aggregate: Products / Completed Operations Aggregate: Self Retention: Excluded B No. Princeton Excess & Surplus T64-A3-EX-0000006-10 July 1, 2014 July 1, 2015 Automobile Liability Each Accident: Self Retention: 700,000 300,000 Each Accident C No. Law Enforcement Liability Claims Made Each Occurrence: Aggregate: Self Retention: Excluded D No. Errors & Omissions Claims Made Each Claim: Aggregate: Self Retention: Excluded E No. Employment Practices Liability Claims Made Each Claim: Aggregate: Self Retention: Excluded F No. Employee Benefits Liability Claims Made Each Claim: Aggregate: Self Retention: Excluded G No. Claims Made Each Claim: Aggregate: Self Retention: H No. Hot Pursuit Auto Liability Claims Made Each Accident: Aggregate: Self Retention: Each Accident I No. Claims Made Each: Aggregate: Self Retention: PE-21086b (12/06) 2006
Illinois Union Insurance Flexible Excess For Individual Public And Scholastic Entities r Named Our SECTION 1 - INSURING AGREEMENTS Ultimate Net Loss Coverage Underlying Ultimate Net Loss s s Coverage Ultimate Net Loss Ultimate Net Loss Insurers Underlying Ultimate Net Loss SECTION 2 - EXCLUSIONS
Sexual Abuse r Insurer SECTION 3 - DEFINITIONS Insurer Coverage Named Sexual Abuse Underlying Ultimate Net Loss Ultimate Net Loss Ultimate Net Loss SECTION 4 - CONDITIONS Our
Insurers Named s s Named MAIL EMAIL FAX PHONE Damages
Claim Wrongful Act Insurers Our Our Underlying Coverage Our Our Our Ultimate Net Loss Our
Our Insurer s Our Coverage Insurer Underlying Insurer Coverage Coverage Underlying Underlying Insurers Insurer; Insurer Insurer
Named insured Named s Named Named Named Named Named s Named s Named Our Named Ultimate Net Loss Insurer s Ultimate Net Loss Ultimate Net Loss Ultimate Net Loss
COVERAGE PROVIDED BY UNDERLYING COVERAGE BUT EXCLUDED FROM THIS POLICY ENDORSEMENT The State of Nebraska 1 XPE G19851667 004 July 01, 2014 to July 01, 2015 July 01, 2014 Illinois Union Insurance THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This Endorsement modifies insurance provided under the following: FLEXIBLE EXCESS POLICY FOR GROUP PUBLIC AND SCHOLASTIC ENTITIES FLEXIBLE EXCESS POLICY FOR INDIVIDUAL PUBLIC AND SCHOLASTIC ENTITIES Schedule of Coverage(s) Provided and/or Defined in the But Not Covered by this
SERVICE OF SUIT ENDORSEMENT The State of Nebraska 2 XPE G19851667 004 July 01, 2014 to July 01, 2015 July 01, 2014 Illinois Union Insurance THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
TRADE OR ECONOMIC SANCTIONS ENDORSEMENT The State of Nebraska 3 XPE G19851667 004 July 01, 2014 to July 01, 2015 July 01, 2014 Illinois Union Insurance THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SIGNATURES TheStateof Nebraska 4 XPE G19851667 004 July 01, 2014 to July 01, 2015 July 01, 2014 Illinois Union Insurance ILLINOIS UNION INSURANCE COMPANY WESTCHESTER SURPLUS LINES INSURANCE COMPANY
ACE USA Illinois Union Insurance stchester Surplus Lines Insurance The State of Nebraska July 01, 2014 XPE G19851667 004 NEBRASKA SURPLUS LINES NOTIFICATION This policy is issued by anonadmitted insurer, and in the event of the insolvency of such insurer, this policy will not be covered by the Nebraska Property and Liability Insurance Guaranty Association.
ACE Producer Compensation Practices &Policies
IL P001 01 04 U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL ("OFAC") ADVISORY NOTICE TO POLICYHOLDERS Please read this Notice carefully. IL P001 01 04 Page 1of 1
Illinois Union NOTICE POLICY NO. XPE G19851667 004 NAME OF INSURED: The State of Nebraska ADDRESS: 1526 K Street, Suite 220, Lincoln, NE 68509-4974