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PAYMENT TERMS: PREMIUM PAYMENT IS DUE WITHIN TWENTY(20) DAYS FROM EFFECTIVE DATE UNLESS <br /> OTHERWISE STIPULATED. <br /> The coverage outlined above may not conform to the terms and conditions you requested. Please check carefully. This document Is <br /> intended for use as evidence that the insurance, as described herein, has been effected and shall be subject to all terms and <br /> conditions of pollcy(les)which will be Issued and that,In the event of any Inconsistency herewith,the terms and provisions of such <br /> poitcy(les)shall prevail. <br /> if this policy Is Issued on a Non-Admitted basis, all applicable taxes 8 fees must be added to the bound premium. Your office Is <br /> responsible for collecting Surplus Lines taxes 8 fees(If applicable)from the Insured In addition to completing any required Surplus <br /> Lines forms. RPS will remit the applicable taxes and forms to the State. This Policy Is subject to the Surplus Linea Laws in your <br /> State,therefore you should make every effort to comply with any special provisions and regulations of your State. <br /> Bill Wilkinson,Area Senior Vice President/SE Casualty M <br /> AUTHORIZED REPRESENTATIVE <br /> • <br /> INSURED: Hellas Construction Inc <br /> DATE ISSUED:January 18,2012 <br /> Reference a:579685A <br /> RFP#12-10-03 P.126 <br /> Hellas Construction,Inc. <br />