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etv <br /> HISCOX HISCOX INSURANCE COMPANY INC. (A Stock Company) <br /> encourage courage` 104 South Michigan Avenue,Suite 600, Chicago, Illinois 60603 <br /> (914)273-7400 <br /> INT N001 CW(01/09)-Economic And Trade Sanctions Policyholder Notice <br /> IN WITNESS WHEREOF,the Insurer indicated above has caused this Policy to be signed by its President and Secretary,but this Policy shall not be effective unless also <br /> signed by the Insurer's duly authorized representative. <br /> President <br /> ,i),. . ..____12\e,..4—"._E--- <br /> Secretary <br /> Authorized Representative <br /> Date:January 12,2024 <br /> / <br /> Risk Management Division _ <br /> g(t REVIEW @&APPROVED BY: <br /> 'E rrcw4ta A :a <br /> - Risk Management Specialist <br /> DPL D001 CW(11/19) / i ayG L. <br />