Employed Lawyers Questionnaire

CATLIN INDEMNITY COMPANY

EMPLOYED LAWYERS QUESTIONNAIRE

Named Insured:______

1. Please provide the number of lawyers employed in their capacity as such by the Applicant and the number of

independent contractor-attorneys contracted by the Applicantto render legal services on the applicant’s behalf, and average years of legal experience: Employed: ______Subcontracted:______

Average number of years of legal experience:______

2.Please describe the type of work performed by the Employed Lawyers:______

______

3.Does the Applicant or any of its Subsidiaries authorize employed lawyers to issue written legal opinion to outside parties in connection with sales, acquisitions or other transactions? Yes □ No □

4. Does any employed lawyer perform legal services regarding any merger,

acquisition or a consolidation of or by the Applicant or any of its Subsidiaries? Yes □ No □

5.Do the Applicant’s employed lawyers appear in court on behalf of the Applicant or any of its Subsidiaries or any other party? Yes □ No □

6. Are personal legal services offered or provided with respect to criminal, matrimonial or intellectualproperty law or estate/financial planning? Yes □ No □

WARRANTY

The undersigned authorized owner, partner, director, or officer represents and warrants on behalf of the NamedInsured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insureds further agree that in the event of any material misrepresentation or omission in the Application, including materials submitted to or obtained by the underwriter, the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/or this Policy shall be void.

The undersigned authorized owner, partner, director, or officer of the applicant declares that the statements set forth herein are true. The undersigned agrees that if the information supplied on this Application changes between the date of this Application and the effective date of the insurance, that he/she will immediately notify the Insurer of such changes, and the Insurer may withdraw or modify any outstanding quotations or authorizations or agreements to bind the insurance.

Signing this Application does not bind the applicant or the Insurer to complete the insurance, but it is agreed that this Application shall be the basis of the contract should a policy be issued, and it will be attached to and become part of the Policy. Applicant’s acceptance of the Insurer’s quotation is required prior to binding coverage and policy issuance.

The undersigned authorized officer of the applicant declares that the statements set forth herein are true. The undersigned agrees that if the information supplied on this Application changes between the date of this Application and the effective date of the insurance; that he/she will immediately notify the Insurer of such changes, and the Insurer may withdraw or modify any outstanding quotations or authorizations or agreements to bind the insurance.

SIGNED: / DATE:
PRINTED NAME: / TITLE:

If this Application is completed in Florida, please provide the Insurance Agent’s name and license number as designated.

If this Application is completed in Iowa or New Hampshire, please provide the Insurance Agent’s name and signature

only.

Producer:
Producer Signature: / Date:
License No.

Applicable in Delaware:

DELAWARE NOTICE REGARDING THE CIVIL UNION AND EQUALITY ACT

This is to provide notice that, pursuant to the Delaware Insurance Department Domestic/Foreign Insurers Bulletin No. 46, this policy is in compliance with the Delaware Civil Union and Equality Act of 2011, 78 Del. Laws Ch. 22 (2011) (the "Act"). The Act, which becomes effective January 1, 2012, creates a form of legal union between two persons of the same sex who establish a civil union in accordance with the requirements of Delaware law.

The Act provides that parties to a civil union shall have all of the same rights, protections and benefits, and shall be subject to the same responsibilities, obligations and duties, under Delaware law as are granted to, enjoyed by, or imposed upon married spouses. The Act further provides that a party to a civil union shall be included in any definition or use of the terms "dependent", "family", "husband and wife", "immediate family", "next of kin", "spouse", "stepparent", "tenants by the entirety", and other terms, whether or not gender-specific, that denote a spousal relationship or a person in a spousal relationship, as those terms are used throughout Delaware law. For all purposes of Delaware laws that refer to marriage or marital status, other than Chapter 1 of Title 13 of the Delaware Code, parties to a civil union will be included in such reference.

In addition, the Act also automatically recognizes as civil unions, for all purposes of Delaware law, legal unions between two persons of the same sex, such as civil unions, marriages and domestic partnerships that are validly formed in jurisdictions other than Delaware and are substantially similar to Delaware civil unions.

The provisions of the Act apply for all purposes of Delaware law, whether derived from statutes, administrative rules or regulations, court rules, governmental policies, common law, court decisions, or any other provisions or sources of law, which includes the Insurance Code and all regulations and bulletins promulgated thereunder.

Application Addendum

Applicable in AK, FL, KS, KY, ME, MT, NC, OK, OR, SD, WV: As may be used within this application, the word “warrant”/” Warranty” is replaced with the word “represents”/“Representation”.

Applicable in Florida: The following statement is added and supersedes any conflicting statement in the application:

F.Representation

The undersigned authorized owner, partner, director, or officer of the Applicant represents and warrants on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insureds further agree that in the event of any material misrepresentation or omissionin the Application, including materials submitted to or obtained by the underwriter,the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/or this Policy may be void.

Applicable in Georgia: As may be used within this application, the word “warrant” is replaced with the word “certify”. The following statement is added and supersedes any conflicting statement in the application:

F.Representation

The undersigned authorized owner, partner, director, or officer of the Applicant represents and certifies on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after reasonable inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insurer further agrees that in the event of any material misrepresentation or omission in the Application, including materials submitted to or obtained by the underwriter,the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/or this Policy may be cancelled.

Applicable in Illinois: The following statement is added and supersedes any conflicting statement in the application:

F.Representation

The undersigned authorized owner, partner, director, or officer of the Applicant represents and warrants on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. No misrepresentation or false warranty made by the Named Insured or on their behalf in the negotiation for a policy of insurance, or breach of a condition of such policy shall defeat or avoid the policy or prevent its attaching unless such misrepresentation, false warranty or condition shall have been stated in the policy or endorsement attached, or written in the application. No such misrepresentation or false warranty shall defeat or avoid the policy unless it shall have been made with actual intent to deceive or materially affects either the acceptance of the risk or hazard assumed by the Insurer.

Applicable in Kansas, Oklahoma, and South Dakota: The following statement is added and supersedes any conflicting statement in the application:

F.Representation

The undersigned authorized owner, partner, director, or officer of the Applicant represents on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insureds further agree that in the event of any material misrepresentation or omission in the Application, including materials submitted to or obtained by the underwriter, the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/or this Policy may be cancelled.

Applicable in Louisiana and Washington: The following statement is added and supersedes any conflicting statement in the application:

F.Warranty

The undersigned authorized owner, partner, director, or officer represents and warrants on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insureds further agree that in the event of any intentional material misrepresentation or omission in the Application, including materials submitted to or obtained by the underwriter, the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/orthis Policy shall be void.

Applicable in Maine and Maryland: The following statement is added and supersedes any conflicting statement in the application:

F.Representation

The undersigned authorized owner, partner, director, or officer of the Applicant represents on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insureds further agrees that in the event of any material misrepresentation or omission in the Application, including materials submitted to or obtained by the underwriter, the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/or this Policy may be cancelled and/or coverage denied.

Applicable in New Hampshire: The following statement is added and supersedes any conflicting statement in the application:

F.Representation

The undersigned authorized owner, partner, director, or officer represents on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insureds further agree that in the event of any material misrepresentation or omission in the Application, including materials submitted to or obtained by the underwriter,the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/or will cause a claim to be denied.

The undersigned authorized owner, partner, director or officer of the applicant declares that the statements set forth herein are true. The undersigned agrees that if the information supplied on this Application changes between the date of this Application and the effective date of the insurance, that he/she will immediately notify the Insurer of such changes, and the Insurer may withdraw or modify any outstanding quotations or authorizations or agreements to bind the insurance.

It is further understood that the Insured shall reimburse the Insurer for Claim Expenses in connection with any Claim which arises from, in whole or in part, a dishonest, fraudulent, criminal or malicious act or omission, committed by an Insured, or at the direction of an Insured or ratified by an Insured if the commission of such act or omission is admitted by the Insured or otherwise established as a matter of fact in a civil, criminal or alternative dispute resolution proceeding. However, this provision shall not apply to any Insured who did not participate in or have knowledge of such conduct or violation, nor shall this provision apply with respect to the Insurer’s duty to defend, or pay Claims Expenses for any Claim for malicious prosecution or abuses of process.

Applicable in North Carolina: The following statement is added and supersedes any conflicting statement in the application:

F.Representation

The undersigned authorized owner, partner, director, or officer of the Applicant represents on behalf of the Named Insured and all persons/entities for which insurance is being sought that to the best of his/her knowledge and belief after diligent inquiry, the statements set forth herein and attached hereto are true. It is understood that the statements in this Application, including material submitted to or obtained by the underwriter, are material to the acceptance of the risk, and relied upon by the underwriter. The Insureds further agrees that in the event of any material misrepresentation or omission in the Application, including materials submitted to or obtained by the underwriter, the Insurer shall have the right to exclude from coverage any matter based upon, arising out of, or in any way related to the material misrepresentation or omission in the Application and/or this Policy shall be void.

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