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Policy Form No. PF-31181 ( 10/10) TankSafe® Storage Tank Liability Insurance Policy <br /> Endorsements and Notices Attached at Policy Issuance : <br /> Endorsement Form Number: Form Name . <br /> Number . <br /> 001 PF-34075 (07/11 ) Closure , Removal Or Replacement Amendatory <br /> 002 PF-31172 (09/10) Financial Responsibility Condition <br /> 003 PF-31174 (09/10) Loading And Unloading Coverage (Time Element) <br /> 004 PF-31164 (09/10) Schedule of Covered Storage Tanks <br /> 005 SL-34255a (01 /16 ) Service of Suit Endorsement <br /> 006 ALL-21101 ( 11 /06 ) Trade Or Economic Sanctions Endorsement <br /> 007 LD-5S23j (03/14) Signatures <br /> SL- 17888 ( 01 /17) California Surplus Lines Notification <br /> TRIA24 (01 /15) Policyholder Disclosure Notice of Terrorism Insurance Coverage <br /> ALL-20887a (03/16 ) Chubb Producer Compensation Practices & Policies <br /> ILP 001 01 04 U . S . Treasury Department's Office of Foreign Assets Control <br /> ("OFAC") Advisory Notice to Policyholders <br /> IN WITNESS WHEREOF, the Insurer has caused this Policy to be countersigned by a duly authorized <br /> representative of the Insurer. <br /> WWI I NJ <br /> DATE : 12/28/2019 ;JO8 IV J. LUPICA. President <br /> MO/DAY/YR, AUTHORIZED REPRESENTATIVE <br /> PF-31180 (09/10) Page 3 of 3 <br />