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CNA <br />CNA Paramount Excess and Umbrella Liability <br />Policy Declarations <br />Underlying Insurer <br />Policy Number <br />Policy Period <br />Note: Underlying Insurance I Coverages Limits of Insurance <br />IN ANY JURISDICTION, STATE, OR PROVINCE WHERE THE AMOUNT OF EMPLOYERS LIABILITY <br />INSURANCE PROVIDED BY THE UNDERLYING INSURER(S) IS BY LAW "UNLIMITED", THE UNDERLYING <br />EMPLOYERS LIABILITY LIMIT(S) SHOWN IN THE ABOVE SCHEDULE DO NOT APPLY AND NO COVERAGE <br />SHALL BE PROVIDED FOR EMPLOYERS LIABILITY UNDER THIS POLICY. <br />Continental Insurance <br />Company <br />6079204724 <br />09/01 /2021 to <br />09/01/2022 <br />Employee Benefits <br />Liability <br />Forms and Endorsements Attached to this Policy <br />FORMSSee SCHEDULE OF DO• <br />Each Employee Limit <br />Aggregate Limit <br />Minimum Earned Premium <br />0% of the Total Premium <br />Total Premium <br />$28,998.00 <br />Premium includes the following amount for Certified Acts of <br />$0 <br />Terrorism Coverage <br />r <br />Notice to insurer <br />Address: <br />CNA Claims Reporting <br />P.O. Box 8317 <br />Chicago, IL 60680-8317 <br />Fax #: <br />800-446-8632 <br />Email Address: <br />HPReports@CNA.com <br />Form No: CNA75501XX (03-20151 <br />Policy Declarations Page: 3 of 3 <br />Underwriting Company: The Continental Insurance Company, 151 N Franklin St, Chicago, IL 60606 <br />Copyright CNA All Rights Reserved. <br />Pc <br />PC <br />Rkk MngWdDkMlan <br />Rtvitwm6Ar off: <br />PC <br />