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PI-CXL-002 (05/19) <br />POLICYNUMBER: PRUB793677 <br />Watercraft Liability C) Occurrence O Clalms-Made <br />Company: <br />Poficy Number: <br />Policy Period: <br />Retroactive Date: <br />Minimum Applicable Limits <br />Other Coverages Not Included In Above 0 Occurrence ❑ Claims -Made <br />Company: T <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: <br />(Date) <br />am <br />(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 />V4 <br />John W. Gfomb, Jr. <br />President & CEO <br />PI-CXL-002 (05/19) <br />Secretary <br />�na�ntmkwaa <br />eVcxov[u�9v: <br />%azt �tcnarc. <br />RkklYLino9epx„,(����/J�� <br />Page 5 of 5 — <br />Includes copyrighted material of Insurance Services Office, Inc., With permissfon. <br />