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KINSALE INSURANCE COMPANY <br />2035 Maywill Street, Suite 100 <br />Richmond, VA 23230 <br />COMMERCIAL EXCESS LIABILITY DECLARATIONS <br />Policy Number: 0100169118-0 <br />Producer Number: 10401 <br />Name and Address: RSG Specialty, LLC - Irvine, CA <br />2601 Main Street, Suite 450 <br />Irvine, CA 92614 <br />NAMED INSURED: %icon Enterprises Incorporated <br />MAILING ADDRESS: 5433 E Spyglass Way <br />Anaheim, CA 92807 <br />POLICY PERIOD: FROM 11/03/2021 TO 08/13/2022 at 12:01 AM at the address of the named insured as shown <br />above. <br />1. LIMITS OF INSURANCE <br />=ach Occurrence: $2,000,00C <br />4nnualAggregate: $2,000,OOC <br />2. SCHEDULE OF UNDERLYING INSURANCE <br />Schedule of Underlying Insurance: Refer to CAX1001, SCHEDULE OF UNDERLYING INSURANCE <br />3. PREMIUM <br />Total Premium (Deposit Premium): <br />$3,500 <br />Company Fee: <br />CA - Surplus Lines Tax- $112.50 $250 <br />Total Payable at Inception: <br />CA- Stamping Office Fee- $9.38 $3,750 <br />It. DESCRIPTION OF BUSINESS <br />DESCRIPTION OF OPERATIONS: Fabrication and Installation Services <br />3usiness Type: Corporation <br />S. FORMS AND ENDORSEMENTS <br />iefer to ADF4001, SCHEDULE OF FORMS <br />S. AUDIT <br />3olicy Subject To Audit: Y Audit Period: Annual <br />rwe RNI Management DWim <br />REviewm &APPRovim BBy.,f <br />MNYrf1 R. vj&4 Ri <br />Rtsk Management Analyst <br />CAX10000521 <br />