Lloyd’s Certificate This Insurance is effected with certain Underwriters at Lloyd’s, London. This Certificate is issued in accordance with the limited authorization granted to the Correspondent by certain Underwriters at Lloyd’s, London whose syndicate numbers and the proportions underwritten by them can be ascertained from the office of the said Correspondent (such Underwriters being hereinafter called “Underwriters”) and in consideration of the premium specified herein, Underwriters hereby bind themselves severally and not jointly, each for his own part and not one for another, their Executors and Administrators. The Assured is requested to read this Certificate, and if it is not correct, return it immediately to the Correspondent for appropriate alteration. All inquires regarding this Certificate should be addressed to the following Correspondent: 303 Congressional Boulevard Carmel, IN 46032 1-800-335-0611 317-575-2652 317-575-2659 FAX www.sevencorners.com SLC-3 (USA) NMA 2868 (24/08/2000 From approved by Lloyd’s Underwriters’ Non-Marine Association Limited EASON PRINTING CO., CHICAGO LON07-070418-01G 1 Reside Worldwide 08/14/09 CERTIFICATE PROVISIONS 1. Signature Required. This Certificate shall not be valid unless signed by the Correspondent on the attached Declaration Page. 2. ...
This Insurancewith certain Underwriters at Lloyd’s, London.is effected This Certificate issued in accordance with the limited authorization granted to the Correspondent by is certain Underwriters at Lloyd’s, London whose syndicate numbers and the proportions underwritten by them can be ascertained from the office of the said Correspondent (such Underwriters being hereinafter called “Underwriters) and in consideration of the premium specified herein, Underwriters hereby bind themselves severally and not jointly, each for his own part and not one for another, their Executors and Administrators. The Assured isthis Certificate, and if it is not correct, return it immediately to the requested to read Correspondent for appropriate alteration. All inquires regarding this Certificate should be addressed to the following Correspondent:
SLC-3 (USA) NMA 2868 (24/08/2000 From approved by Lloyd’s Underwriters’ Non-Marine Association Limited EASON PRINTING CO., CHICAGO
LON07-070418-01G 1 Reside Worldwide 08/14/09
CERTIFICATE PROVISIONS 1. Signature RequireTdh.is Certificate shall not be valid unless signed by the Correspondent on the attached Declaration Page. 2. Correspondent Not InsuTrheer.Correspondent is not an Insurer hereunder and nesithallresosrocroaynlliablefbensiroIneThreahwmial.reveostssehrudnrereuetohaer Underwriters at Lloyd’s, Londhonsewsyndicate numbers can bertatofstcre.hisnAeudeasshereinbeforesetaciU“eredntirwindhitCesifrttomededuenilcshaersedellb incorporatedaswellasunincatoerpdoprersonsorentitiestheatUanrderwritersatLloyd’s,London.3. CancellatioInf.isCthlelcrfosdeivorpetacifitreanincontindahitCesfitrtacisienaccelledaftertheicnpeitnodta,ednearemiuemprebtsumrofdiaptimtheeinethcneusarebneahs force. 4. Service of SuiItt.erdetahisgaeventotinthefoeruliafehtftoseritwrerndUnutaomaynpyaetobmedclaiderussAslliw,esqureehetofttirererwtht,sareuneheUndder,ubmdiuttothejurisdictionofaCourtofcompetentjurisdictionUwnititheind in this Clause constitutes oertShteates. Nothingtoshts’erigrernditwrrevUfoaetiawconstitutoodtonuedsrhsuodlbcommenceanactioninanyCourtofcompetentjurisdictionintheUnitedStates,toremoveanactiontoaCUonuirtte,dorSteotcsafoaefrrtaCoutheranotcirtsnsrataekseoaetsiD permittedbythelawsoftheUnitedStatesorofanthyeStUatnieteinduftrehrtIisStates.niecifotharvsereagtedecorchpsusthe firm or person name in iteusit may be made upon 6oftheattachedDeclarationPage,andthatinaintuytesuditaignasitnstanyoneofthemuponthiscontract,UndllerawbriidtesrwifielnabthyfohcusicednoisrofanyCourtotAppleal Court in the event of an appeal. Theabove-namedareauthorizedanddirectedtoacceptprsoecreviscseoonfbehalfofUnderwirnitaernsysuchsuitand/orurpeqounestoftheAssuregdivtoea written undertaking to theAssuredthattheywiellreantgeneralappearanceupnodnerUwriters’behalfhienet vent such astiulahisnlebet.ditut Further,pursuanttoanystatuteofanystate,terrirtiocrtyoforthdeistUnitedStateswhichmakesprovisiontherewfroitr,erUsnhdeerrebydesignateStuhpeerintendent,CommissionerorDirectorofInsuranceorotherofpfiecceifriesdforthatpurposeinthestatute,orhissuccessorsinoffice,adsltahwefirultrautteoraney upon whom may be served any lawful process anyaction,suitorproceedinginstitutedbyoronbeAhaslsfuorfetdheoranybeneficiaryhereaurnisdienrgoutofthiscaocnttrofinsurance,andherdenaigttebysnem-noitaehevobedas the person to whom the said officeriszeadutoel.ifamorohtracueyoperthhcusorpssecro5. AssignmentT.hisCertifrtwnpauttithonhwreiroiloeigssabetheidnehsetacitonllahreoe.nendorsedpondentoCeserrotnhtfcenseonwhettri 6. Attached Conditions IncorporTahtiesd.Certificate is made and accepted subject totheallisioprvdnoc,snasnoitiraarwndsentiefosrth herein, attacheednodrorsed, all of which are to be consideredinacsorporated herein. 7. Short Rate CancellatiIfonth.ullccaoetheatblliwwtdesuearhsrochedproeattarpvodieivisnoslaelontirfonccaelbolebht,atetnofrtiopretheoropepleabnduermuimehwpancilp the terms of cancellation. 1.Short Rate Cancellation Table for Term of One Year. Days Insurance Per Cent of Days Insurance Per Cent of Days Insurance Per Cent of Days Insurance Per Cent of In Force One Year Premium In Force One Year Premium In Force One Year Premium In Force One Year Premium 1.......................................5%66-69...................................291%54-............................1..5..6.53256-..........................2..6...0..77 2....................................... 6 70 - 73 ................................... 30 % % 3-4.......................................774-76...................................31157-...........................1..6..0..54261-...........................2..6..4..785-6.......................................877-80...................................32161-............................1..6..4.55265-...........................2..6..9..797-8.......................................981-83...................................33165-...........................1..6..7..56270-...............2..7..3(9mos.)809-10.....................................1084-87...................................34168-............................1.7...1.57274-...........................2..7..8..8111-12.....................................1188-91(3mos.).......................35172-...........................1..7..5..58279-..........................2..8...2..8213-14.....................................1292-94...................................36176-...........................1..7..8..59283-..........................2..8...7..8315-16.....................................1395-98...................................37179-...............1..8..2(6mos.)60288-...........................2..9..1..8417-18.....................................1499-10.2..................................38183-............................1..8..7.61292-..........................2..9...6..8519-20.....................................15103-..........................1...0..5..39188-............................1.9..1..62297-..........................3..0...1..8621-22.....................................16106-...........................1..0..9..40192-............................1..9..6.63302-.............3...0.5(10mos.)8723-25.....................................17110-..........................1..1...3..41197-...........................2..0..0..64306-..........................3..1...0..882629.....................................18114-...........................1..1..6..42201-...........................2..0..5..65311-..........................3..1...4..89-30-32(1mos.).......................19117-...........................1..2..0..43206-...........................2...0..9.66315-..........................3..1...9..9033-36.....................................20121-...............1..2..4(4mos.)44210-...............2...1.4(7mos.)67320-..........................3..2...3..9137-40.....................................21125-..........................1..2...7..45215-............................2..1..8.68324-..........................3..2...8..9241-43.....................................22128-..........................1..3...1..46219-............................2..2..3.69329-...........................3..3..2..9344-47.....................................23132-..........................1..3...5..47224-............................2..2..8.70333-..............3..3.7(11mos.)9448-51.....................................24136-..........................1..3...8..48229-............................2..3..2.71338-...........................3..4..2..9552-54.....................................25139-..........................1..4...2..49233-............................2..3.7..72343-..........................3...4..6..9655-58.....................................26143-..........................1..4...6..50238-...........................2..4..1..73347-..........................3..5...1..9759-62(2mos.).......................27147-..........................1..4...9..51242-................2.4..6(8mos.)74352-..........................3..5...5..9863-65.....................................28150-...............1..5..3(5mos.)52247-............................2..5..0.75356-...........................3..6..0..99251-............................2..5..5.76361-..............3..6.5(12mos.)100Rules applicable to insurance with terms less than or more than one year: A.insIfeensabechrunashortrpplytheeofrnataeatlborfneofinceorsela,saeyrorlrptedsnilauntecnarufuethouannallermuimasinedinsuforcnarrweettiofnarrmtefoeon year. B.in force for more than one year:If insurance has been 1.muimerplaunnalulfnemieretD.eonaryermtenonofraerwtietinsurancasfor2.emraimuimerpodna,lliefuancensurimmupermhtfortcuhcusdeDnhetcerdrtaelaucalettehporaeomfisthetatroiomtuhifmlneoethehngtfisaobrnedpre beyondoneyeartheinsurancehasbeeninforcetothtiemlefohtnoyebngtehihhcciyploeyedonorwarfeisawgiron.ally writt 3.eintaobot2)(dna)1(smetihtiodlfulringmudmeuidrpraenApdddancewiinaccororudecderimmupinsurancehasbeennifroec.rpe LON07-070418-01G 2 Reside Worldwide 08/14/09