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THESE DECLARATIONS, TOGETHER WITH THE COMPLETED AND SIGNED APPLICATION, FOR THIS POLICY AND THE <br />FOLLOWED POLICY, INCLUDING INFORMATION FURNISHED IN CONNECTION THEREWITH WHETHER DIRECTLY OR <br />THROUGH PUBLIC FILING, AND THE POLICY FORM ATTACHED HERETO, CONSTITUTE THE INSURANCE POLICY. <br />1 <br />Date: June 15 2021 <br />MO/DAY/YR. Authorized Representative <br />WMnugtmentDivision <br />REVIEWED S APPROVED BY: <br />LPL.DEC.002 (05/09) <br />� Risk Management Analyst <br />