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<br /> First NoUce Fax: (800) 951-411 9 <br /> First Notice Email: <br /> Q..asualtvRiskEnvi ronmentaIFirsJNotice@aceQroup_com <br /> b. All Other Notices: <br /> Environmental Risk Underwriting Officer <br /> ACE Environmental Risk <br /> P.O. Box 1000 <br /> 436 Walnut Street- WA 07A <br /> Philadelphia, PA 19106 <br />Item 8. Schedule of Covered Underground Storage Tank(s): <br /> Not Applicable <br />Item 9. Schedule of Covered Aboveground Storage Tank(s): <br /> Per Schedule of Covered Storage Tank Endorsement <br />Item 10. Producer Name and Address: Public Risk Underwriters of Florida <br /> P. 0_ Box 956455 <br /> lake Mary,FL,32795 <br /> -... ---- <br /> <br />Forms and Endorsements Attached at Policy Issuance: <br /> <br />Endorsement Form Number: Form Name: <br />Number: <br />001 PF-14104 Schedule of Covered Storage Tanks <br />002 PF-14624 Regulatory Compliance Exclusion Endorsement <br />003 LD-5S23g Signature Form <br />004 PF-23728 Terrorism Risk Insurance Act Endorsement <br />005 TRIA11b Disclosure Pursuant To Terrorism Risk Insurance Act <br /> ALL-20887 Producer Compensation Practices-Policies Policyholder Notice <br /> ALL-5X45 Questions about your Insurance - FL, MO. TN <br /> SL-24680 Florida Surplus Lines Notification <br />006 ALL-21101 Trade or Economic Sanctions Endorsement <br /> ILPOD10104 OFAC Advisory Notice to Policyholders <br />007 XS-3U96f Service of Suit Endorsement <br /> <br />IN WITNESS WHEREOF, the Insurer has caused this Policy to be countersigned by a duly authorizod <br />representative of the Insurer. <br /> <br />DATE: <br /> <br />12/30/2010 <br />MOIDAYNR. <br /> <br />Dj,cA..~':' f J~'1'('-h,-- <br /> <br />--- <br />AUTHORIZED REPRESENTATIVE <br /> <br />ACE TankSafesm.Dec 4/04 <br /> <br />ACE USA Copyright, 2004 <br /> <br />Page 2 of 2 <br />