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Extended Declarations Page <br />ISSUED BY:. Westchester Surplus Lines Insurance Company <br />NAMED INSURED: Ecotierra Consulting Inc <br />POLICY NUMBER: G24305296 013 <br />POLICY PERIOD: 09/04/2424 - 09 f 04/2025 <br />STATE SURPLUS LINES REQUIRED WORDING: <br />the NAIC's International Insurers Department (IID) listing of <br />approved nonadmitted non -United States insurers. Ask your agent, <br />broker, or "surplus line" broker to obtain more information about <br />that insurer. <br />7. California maintains a "List of Approved Surplus Line Insurers <br />(LASLI)." Ask your agent or broker if the insurer is on that list, or <br />view that list at the internet website of the California Department of <br />Insurance: www.insurance.ca.gov/01-consumers/120-company/07- <br />lasli/lasli.cfm. <br />8. If you, as the applicant, required that the insurance policy you <br />have purchased be effective immediately, either because existing <br />coverage was going to lapse within two business days or because you <br />were required to have coverage within two business days, and you did <br />not receive this disclosure form and a request for your signature until <br />after coverage became effective, you have the right to cancel this <br />policy within five days of receiving this disclosure. If you cancel <br />coverage, the premium will be prorated and any broker's fee charged <br />for this insurance will be returned to you. <br />Ri& MmaganadDMsiaâ–ºt <br />E <br />REVIEWED & APPROVED BY: <br />Risk Management Specialist <br />D-2 (Effective January 1, 2020) <br />