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POLICY NUMBER: PHUB793677 <br />Watercraft Liability <br />Company: <br />Policy Number: <br />Policy Period: <br />Retroactive Date: <br />Minimum Applicable Limits <br />PI-CXL-002 (05/19) <br />❑ Occurrence ❑ Claims -Made <br />Other Coverages Not Included in Above ❑ Occurrence ❑ Claims -Made <br />Company: <br />Policy Number: <br />Policy Period: <br />Retroactive Date: <br />Minimum Applicable Limits <br />THESE DECLARATIONS, TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE <br />FORM(S) AND ANY ENDORSEMENT(S), COMPLETE THE ABOVE NUMBERED POLICY. <br />Countersigned: By: <br />(Date) (Authorized Representative) <br />IN WITNESS WHEREOF, we have caused this policy to be executed and attested, and, if <br />required by state law, this policy shall not be valid unless countersigned by our authorized <br />representative. <br />John W. Glomb, Jr. Secretary <br />President & CEO <br />i mie. <br />E' IQIn� G Mvaw'in ft. <br />11 1■J_�t 11 %u r?%ifiWon <br />PI-CXL-002 (05/19) �auxmauyenmoammiaa� .t, <br />Page 5 of 5 <br />Includes copyrighted material of Insurance Services Office, Inc., with permission. <br />