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AAn Associates Company <br />NOTICE TO POLICYHOLDER <br />CLAIM REPORTING PROCEDURES <br />All types of claims or potential claims should be reported immediately to our office. All claims that have <br />been made against you; and, any circumstances, acts, or omissions that could result in a claim should be <br />reported. <br />The policy provisions require you to notify the Company, in writing, as soon as practicable. The notice <br />should include the following: <br />How and when and where the act or omission took place. <br />The names and addresses of the person or persons that have made or may make the claim. <br />The nature and approximate value of any damages arising out of the act or omission. <br />You should record the specifics of the claim or suit and the date received. <br />Send copies of any demands, notices, summons or legal papers that you have received. <br />Cooperate and assist the Company in obtaining records, information and investigating and <br />enforcement of rights. <br />You will not, except at your own cost, voluntarily make a payment, assume any obligation, or incur <br />any expense without the Company's consent. <br />Our address and office numbers are: <br />Northland Insurance Companies <br />Claims Department <br />1295 Northland Drive <br />St. Paul, MN 55120-1146 <br />Phone Number: 1-800-328-5972 <br />Fax Number: 1-800-251-7704 <br />Thank you for your cooperation. <br />S 1692-PO (3199) <br />