Declarations - Travelers Insurance

ITEM 5 Only those coverage features marked “ Applicable” are included in this policy.ITEM 6ITEM 7ITEM 8FIDUCIARY LIABILITYLimit of Liability: $ for all ClaimsSettlement Program Limit of Liability $for each Settlement Program Notice,which amount is included within, and notin addition to, any applicable limit of liabilityHIPAA Limit of Liability $ which amount is included within, and notin addition to, any applicable limit ofliabilityAdditional DefenseCoverage: Applicable Not ApplicableAdditional DefenseLimit of Liability: $ for all ClaimsRetention: $ for each Claim under Insuring Agreement APrior and PendingProceeding Date:Continuity Date:$PREMIUM FOR THE POLICY PERIOD:$ Policy Premium$ Annual Installment PremiumTYPE OF LIABILITY COVERAGE:ReimbursementDuty-to-DefendOnly the type of liability coverage marked “for each Settlement Program Notice under InsuringAgreement B” is included in this policy.LIABILITY COVERAGE EXTENDED REPORTING PERIOD:SpecimenAdditional Premium Percentage: %Additional Months:(If exercised in accordance with section III. CONDITIONS, O. EXTENDED REPORTING PERIOD of theLiability Coverage Terms and Conditions)FRI-2001 Ed. 01-09 Printed in U.S.A. Page 2 of 3©2009 The Travelers Companies, Inc. All Rights Reserved