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�ptco4- <br /> P MIDI <br /> +SE R.4♦ <br /> Additional information must be received within (30) thirty days of the date of this binder at which time, <br /> the company, in reliance upon such information will make a determination as to policy issuance. <br /> Failure to remit all requested information within (30) thirty days of the date of this binder may result <br /> in the termination of this binder. <br /> This binder is strictly conditioned upon any subjectivities listed above and upon there being no <br /> material change in the risk occurring between the date of this binder letter and the inception date of <br /> the proposed policy(including any claim or notice of circumstances which may be reasonably expected <br /> to give rise to a claim under any policy of which the policy being proposed is a renewal, replacement or <br /> excess of). <br /> Office of Foreign Assets Control(OFAC)Disclosure Notice: <br /> This quote,binder,the continuation of any bound insurance,and any benefit or payments to you,to a <br /> claimant or to another third party,may be affected by the administration and enforcement of U.S. <br /> economic embargoes and trade sanctions by the Office of Foreign Assets Control (OFAC),if we <br /> determine that any such party is on the"Specially Designated Nationals or Blocked Persons"list as <br /> maintained by OFAC. <br /> Michael Sacco <br /> Authorized Representative <br /> National Producer License# 16862567 <br /> Falcon Risk Services <br /> National Producer License#19972129 <br /> AE BDE 91998 MU 07 24 Page 6 of 6 <br />