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<br />DNE 21 10 01 19 <br />COMMERCIAL EXCESS LIABILITY DECLARATIONS <br />Policy Number: <br /> <br /> <br />Renewal/Rewrite of: <br /> <br />Named Insured and Mailing Address <br /> <br /> <br /> <br /> <br /> <br />Producer’s Name and Mailing Address <br /> <br /> <br /> <br /> <br /> <br />POLICY PERIOD: From to At 12:01 A.M. Standard Time at your mailing address shown above <br />IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, <br />WE AGREE TO PROVIDE YOU WITH THE INSURANCE AS STATED IN THIS POLICY. <br />THE NAMED INSURED IS:  Individual  Partnership  Corporation  Joint Venture  Other <br />  Trust  Limited Liability Company <br /> <br />Item I: Limits of Insurance: <br />Each Occurrence Limit $ <br />Aggregate Limit $ <br /> <br />Item II: Premium: <br /> Deposit Premium $ <br /> Terrorism Premium $ <br /> Total Premium $ <br /> <br /> <br /> <br />Item III: Minimum Retained Premium: <br /> <br /> <br />Item IV: Forms attached at inception: <br />See Schedule of Forms EU 00 05 <br /> <br /> <br /> <br /> <br /> <br />Authorized Representative <br />AN1294383 <br />09/27/2023 <br />0.00 <br />645.00 <br />645.00 <br />03/28/2024 <br />1,000,000 <br />1,000,000 <br />Wilson General Contracting, Inc. <br />427 Betlell Ave <br />Mountain House, CA 95391 <br />BASS UNDERWRITERS, INC. <br />455 University Ave <br />Suite 330 <br />Sacramento, CA 95825 <br />X <br />If the insured cancels this policy, we will retain no less than $250 or 25% of the Total Premium, whichever <br />is greater. <br />DocuSign Envelope ID: C872947D-41CE-4639-8F1A-296D6CD20936