National Union Fire Insurance Company of Pittsburgh, Pa

AIG Executive Liability®

Insurance provided by the following member of American International Group, Inc.

National Union Fire Insurance Company of Pittsburgh, Pa.®

Illinois National Insurance Co.

A capital stock company

NOTICE: THIS POLICY CONTAINS ONE OR MORE COVERAGE MODULES. CERTAIN LIABILITY COVERAGE PARTS OF THIS POLICY ARE LIMITED TO LIABILITY FOR CLAIMS THAT ARE FIRST MADE AGAINST THE INSUREDS DURING THE POLICY PERIOD AND REPORTED IN WRITING TO THE INSURER AS REQUIRED. CLAIM EXPENSES SHALL REDUCE THE APPLICABLE LIMITS OF LIABILITY AND ARE SUBJECT TO APPLICABLE RETENTIONS. PLEASE READ THIS POLICY CAREFULLY AND REVIEW IT WITH YOUR INSURANCE AGENT OR BROKER.

Terms appearing in bold type have special meanings. See the Definitions for more information.

PRIOR POLICY NUMBER: POLICY NUMBER:

DECLARATIONS

ITEMS
1 / NAMED INSURED:
1(a) / MAILING ADDRESS:
1(b) / STATE OF INCORPORATION/FORMATION:
1(c) / Subsidiary Coverage: / ¨ none / ¨ blanket; or / ¨ only those listed by endorsement
2 / POLICY PERIOD: / From: / To: / 12:01 A.M. at the address in Item 1(a)
LIMITS OF LIABILITY:
3 / POLICY AGGREGATE: Aggregate for all coverages combined (including claim expenses): / $______
4 / COVERAGE MODULE (OR SECTIONS) / SUBLIMIT OF LIABILITY /

RETENTION

/ RETROACTIVE DATE / FIRST
INCEPTION DATE
TECH / NIL / Policy Inception / Policy Inception
TELECOM / NIL / Policy Inception / Policy Inception
INTERNET PRO / NIL / Policy Inception / Policy Inception
MPL / NIL / Policy Inception / Policy Inception
MEDIA / NIL / Not Applicable / Policy Inception
SEC LIAB / NIL / Policy Inception / Policy Inception
SEC/PRV LIAB
A.1. Security Liability
A.2. Privacy Liability / NIL / A.1. Policy Inception
A.2. Policy Inception / Policy Inception
CCP / NIL / (a) Non-indemnifiable loss:
$______
(b) All other Loss: $______/ Policy Inception / Policy Inception
INFO ASSET / NIL / Not Applicable / Policy Inception
BUS INT / NIL* / The greater of: $______; or the business interruption loss during the ______hour waiting hours period / Not Applicable / Policy Inception
CYBER EXT / NIL / Not Applicable / Policy Inception
CM / NIL / Not Applicable / Policy Inception
Sublimit of Liability of “Nil” for any Coverage Module reflects that such module was not purchased.
5 /

PREMIUM:

$

/
6 / NAME AND ADDRESS OF INSURER
NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA.
175 Water Street
New York, NY 10038

This policy is issued only by the insurance company indicated in this Item 6.

7 / Coinsurance Percentage for CM Module: %

PRODUCER:

PRODUCER LICENSE NO.:

ADDRESS:

IN WITNESS WHEREOF, the insurer has caused this policy to be signed on the Declarations by its President, a Secretary and its duly authorized representative or countersigned in states where applicable.

PRESIDENT SECRETARY

______

AUTHORIZED REPRESENTATIVE

OR COUNTERSIGNATURE

(IN STATES WHERE REQUIRED)

______

COUNTERSIGNATURE DATE COUNTERSIGNED AT

Subject to an hourly sublimit of 10% and other sublimits as set forth in Clause 5. of the BASE Section, as amended by the Business Interruption Module