[Letterhead of Fifth Street Finance Corp.]
February 1, 2012
VIA EDGAR
Securities and Exchange Commission
100 F Street, N.E.
Washington, D.C. 20549
Re: | Fifth Street Finance Corp. |
Rule 17g-1(g) Fidelity Bond Filing
Ladies and Gentlemen:
On behalf of Fifth Street Finance Corp. (the Company), enclosed herewith for filing, pursuant to Rule 17g-1(g) under the Investment Company Act of 1940, are the following:
1. | copy of the fidelity bond covering the Company, which includes a statement as to the period for which premiums have been paid; and |
2. | a Certificate of the Secretary of the Company containing the resolutions of the Board of Directors approving the amount, type, form and coverage of the Fidelity Bond and a statement as to the period for which premiums have been paid. |
If you have any questions regarding this submission, please do not hesitate to call me at (914) 286-6804.
Very truly yours, |
Fifth Street Finance Corp. |
/s/ Bernard D. Berman |
Bernard D. Berman |
President, Secretary and Chief Compliance Officer |
Enclosures
CERTIFICATE OF SECRETARY
The undersigned, Bernard D. Berman, President, Secretary and Chief Compliance Officer of Fifth Street Finance Corp., a Delaware corporation (the Company), does hereby certify that:
1. | This certificate is being delivered to the Securities and Exchange Commission (the SEC) in connection with the filing of the Companys fidelity bond (the Bond) pursuant to Rule 17g-1 of the Investment Company Act of 1940, as amended, and the SEC is entitled to rely on this certificate for purposes of the filing. |
2. | The undersigned is the duly elected, qualified and acting Secretary of the Company, and has custody of the corporate records of the Company and is a proper officer to make this certification. |
3. | Attached hereto as Exhibit A is a copy of the resolutions approved by the Board of Directors of the Company, including a majority of the Board of the Directors who are not interested persons of the Company, approving the amount, type, form and coverage of the Bond. |
4. | Premiums have been paid for the period January 17, 2012 to January 17, 2013. |
IN WITNESS WHEREOF, the undersigned has caused this certificate to be executed this 1st day of February, 2012.
/s/ Bernard. D. Berman |
Bernard D. Berman |
President, Secretary and Chief Compliance Officer |
Exhibit A
Excerpt from the minutes of the
meeting of the Board of Directors
of Fifth Street Finance Corp. held
on November 21, 2011
Approval of Fidelity Bond
WHEREAS, Section 17(g) of the Investment Company Act of 1940, as amended (the 1940 Act), and Rule 17g-1(a) thereunder, require a business development company (BDC), such as the Company, to provide and maintain a bond which shall be issued by a reputable fidelity insurance company, authorized to do business in the place where the bond is issued, to protect the Company against larceny and embezzlement, covering each officer and employee of the BDC who may singly, or jointly with others, have access to the securities or funds of the BDC, either directly or through authority to draw upon such funds of, or to direct generally, the disposition of such securities, unless the officer or employee has such access solely through his position as an officer or employee of a bank (each, a covered person); and
WHEREAS, Rule 17g-1 specifies that the bond may be in the form of (i) an individual bond for each covered person, or a schedule or blanket bond covering such persons, (ii) a blanket bond which names the Company as the only insured (a single insured bond), or (iii) a bond which names the Company and one or more other parties as insureds (a joint insured bond), as permitted by Rule 17g-1; and
WHEREAS, Rule 17g-1 requires that a majority of directors who are not interested persons of the BDC, as such term is defined under the 1940 Act (the Non-Interested Directors), approve periodically (but not less than once every 12 months) the reasonableness of the form and amount of the bond, with due consideration to the value of the aggregate assets of the Company to which any covered person may have access, the type and terms of the arrangements made for the custody and safekeeping of such assets, and the nature of securities and other investments to be held by the Company, and pursuant to factors contained in the Rule which are described in the accompanying memorandum attached hereto; and
WHEREAS, under Rule 17g-1, the Company is required to make certain filings with the SEC and give certain notices to each member of the Board of Directors in connection with the bond, and designate an officer who shall make such filings and give such notices;
NOW, THEREFORE, BE IT RESOLVED, that having considered the expected aggregate value of the securities and funds of the Company to which officers or employees of the Company may have access (either directly or through authority to draw upon such funds or to direct generally the disposition of such securities), the type and terms of the arrangements made for the custody of such securities and funds, the nature of securities and other investments to be held by the Company, the accounting procedures and controls of the Company, the nature and method of conducting the operations of the Company, and the requirements of Section 17(g) of the 1940 Act and Rule 17g-1 thereunder, it is determined that the amount, type, form, premium and coverage, covering the officers and employees of the Company and insuring the Company
against loss from fraudulent or dishonest acts, including larceny and embezzlement, issued by National Union Fire Insurance Company of Pittsburgh, PA. having an aggregate coverage of $5 million (the Fidelity Bond) is reasonable, and the Fidelity Bond be, and hereby is, approved by the Board of Directors of the Company; and
FURTHER RESOLVED, that having considered the expected aggregate value of the securities and funds of the Company to which officers or employees of the Company may have access (either directly or through authority to draw upon such funds or to direct generally the disposition of such securities), the type and terms of the arrangements made for the custody of such securities and funds, the nature of securities and other investments to be held by the Company, the accounting procedures and controls of the Company, the nature and method of conducting the operations of the Company, and the requirements of Section 17(g) of the 1940 Act and Rule 17g-1 thereunder, it is determined that the amount, type, form, premium and coverage, covering the officers and employees of the Company and insuring the Company against loss from fraudulent or dishonest acts, including larceny and embezzlement, issued by National Union Fire Insurance Company of Pittsburgh, PA. having an aggregate coverage of $5 million is reasonable, and the Fidelity Bond be, and hereby is, approved by a majority of the Non-Interested Directors; and
FURTHER RESOLVED, that the Authorized Officers of the Company be, and they hereby are, authorized to take all appropriate actions, with the advice of legal counsel to the Company, to provide and maintain the Fidelity Bond on behalf of the Company; and
FURTHER RESOLVED, that the Chief Financial Officer of the Company be, and hereby is, designated as the party responsible for making the necessary filings and giving the notices with respect to such bond required by paragraph (g) of Rule 17g-1 under the 1940 Act.
POLICYHOLDER NOTICE
Thank you for purchasing insurance from the Chartis companies. Chartis insurance companies generally pay compensation to brokers and independent agents, and may have paid compensation in connection with your policy. You can review and obtain information about the nature and range of compensation paid by Chartis insurance companies to brokers and independent agents in the United States by visiting our website at www.chartisinsurance.com/producercompensation or by calling 1-800-706-3102.
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
2-14076
91222 (12/09)
1
National Union Fire Insurance Company of Pittsburgh, Pa.
A capital stock company
POLICY NUMBER: |
01-503-01-67 REPLACEMENT OF POLICY NUMBER 01-492-17-11 |
INVESTMENT COMPANY BLANKET BOND
DECLARATIONS:
ITEM 1. | Name of Insured (herein called Insured): FIFTH STREET FINANCE CORP. |
Principal Address: |
10 BANK STREET, 12TH FL | |
WHITE PLAINS, NY 10606 |
ITEM 2. | Bond Period: from 12:01 a.m. January 17, 2012 to January 17, 2013 the effective date of the termination or cancellation of this bond, standard time at the Principal Address as to each of said dates. |
ITEM 3. | Limit of Liability - Subject to Sections 9, 10 and 12 hereof, |
Single Loss Limit of Liability |
Single Loss Deductible |
|||||||
Insuring Agreement (A)-Fidelity |
$ | 5,000,000/ | $ | Nil | ||||
Insuring Agreement (B)-Audit Expense |
$ | 25,000/ $5,000 | ||||||
Insuring Agreement (C)-On Premises |
$ | 5,000,000/ | $ | 50,000 | ||||
Insuring Agreement (D)-In Transit |
$ | 5,000,000/ | $ | 50,000 | ||||
Insuring Agreement (E)-Forgery & Alteration |
$ | 5,000,000/ | $ | 50,000 | ||||
Insuring Agreement (F)-Securities |
$ | 5,000,000/ | $ | 50,000 | ||||
Insuring Agreement (G)-Counterfeit Currency |
$ | 5,000,000/ | $ | 50,000 | ||||
Insuring Agreement (H)-Stop Payment |
$ | 25,000/ $5,000 | ||||||
Insuring Agreement (I)-Uncollectible Items of Deposit |
$ | 25,000/ $5,000 | ||||||
Insuring Agreement (J)-Computer Systems |
$ | 5,000,000/ | $ | 50,000 | ||||
Insuring Agreement (K)-Unauthorized Signatures |
$ | 25,000/ $5,000 | ||||||
Insuring Agreement (L)-Automated Phone System |
$ | 5,000,000/ | $ | 50,000 | ||||
Insuring Agreement (M)-Telefacsimile Transfer |
$ | 5,000,000/ | $ | 50,000 |
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
2-14076
41205 (04/95)
2
If Not Covered is inserted above opposite any specified Insuring Agreement or Coverage, such Insuring Agreement or Coverage and any other reference thereto in this bond shall be deemed to be deleted therefrom.
ITEM 4. | Offices or Premises Covered-Offices acquired or established subsequent to the effective date of this bond are covered according to the terms of General Agreement A. All the Insureds offices or premises in existence at the time this bond becomes effective are covered under this bond except the offices or premises located as follows: No Exceptions |
ITEM 5. | The liability of the Underwriter is subject to the terms of the following riders attached thereto: Endorsement #1, #2, #3, #4, #5, #6, #7, #8, #9, #10, #11 |
ITEM 6. | The Insured by the acceptance of this bond gives to the Underwriter terminating or canceling prior bond(s) or policy(ies) No.(s) 00-086-08-86 such termination or cancellation to be effective as of the time this bond becomes effective. |
PREMIUM: $12,062
IN WITNESS WHEREOF, the Insurer has caused this policy to be signed on the Declarations Page by its President, a Secretary and a duly authorized representative of the Insurer.
SECRETARY | PRESIDENT |
AUTHORIZED REPRESENTATIVE |
COUNTERSIGNATURE DATE | COUNTERSIGNED AT |
Aon Risk Services Northeast Inc.
199 Water St
New York, NY 10038-3526
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
2-14076
41205 (04/95)
3
INVESTMENT COMPANY BLANKET BOND
The Underwriter, in consideration of an agreed premium, and subject to the Declarations made a part hereof, the General Agreements, Conditions and Limitations and other terms of this bond, agrees with the Insured, in accordance with the Insuring Agreements hereof to which an amount of insurance is applicable as set forth in Item 3 of the Declarations and with respect to loss sustained by the Insured at any time but discovered during the Bond Period, to indemnify and hold harmless the Insured for:
INSURING AGREEMENTS
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
ENDORSEMENT #1
This endorsement, effective 12:01 am |
January 17, 2012 | forms a part of |
Policy number: |
01-503-01-67 | |||||
Issued to: |
FIFTH STREET FINANCE CORP. |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
NEW YORK STATUTORY RIDER/ENDORSEMENT
It is agreed that:
1. | Part (a) of the Section entitled Termination or Cancelation of this bond/policy is deleted. |
2. | Cancel ation of this bond/policy by the Underwriter/Company is subject to the following provisions: |
If the bond/policy has been in effect for 60 days or less, it may be cancelled by the Underwriter/Company for any reason. Such cance lation shall be effective 20 days after the Underwriter/Company mails a notice of cancel ation to the first-named insured at the mailing address shown in the bond/policy. However, if the bond/policy has been in effect for more than 60 days or is a renewal, then cancelation must be based on one of the following grounds:
(A) | non-payment of premium; |
(B) | conviction of a crime arising out of acts increasing the hazard insured against; |
(C) | discovery of fraud or material misrepresentation in the obtaining of the bond/policy or in the presentation of claim thereunder; |
(D) | after issuance of the bond/policy or after the last renewal date, discovery of an act or omission, or a violation of any bond/policy condition that substantially and materially increases the hazard insured against, and which occurred subsequent to inception of the current bond/policy period; |
(E) | material change in the nature or extent of the risk, occurring after issuance or last annual renewal anniversary date of the bond/policy, which causes the risk of loss to be substantially and materially increased beyond that contemplated at the time the bond/policy was issued or last renewed; |
SR 6180b
ENDORSEMENT #1 (continued)
(F) | the cancelation is required pursuant to a determination by the superintendent that continuation of the present premium volume of the insurer would jeopardize that insurers solvency or be hazardous to the interests of the insureds, the insurers creditors or the public; |
(G) | a determination by the superintendent that the continuation of the bond/policy would violate, or would place the insurer in violation of, any provision of the New York State insurance laws. |
(H) | where the insurer has reason to believe, in good faith and with sufficient cause, that there is a possible risk or danger that the insured property will be destroyed by the insured for the purpose of collecting the insurance proceeds, provided, however, that: |
(i) | a notice of cancelation on this ground shall inform the insured in plain language that the insured must act within ten days if review by the Insurance Department of the State of New York of the ground for cancelation is desired, and |
(ii) | notice of cancelation on this ground shall be provided simultaneously by the insurer to the Insurance Department of the State of New York. Cancelation based on one of the above grounds shall be effective 15 days after the notice of cancellation is mailed or delivered to the named insured, at the address shown on the bond/policy, and to its authorized agent or broker. |
3. | If the Underwriter/Company elects not to replace a bond/policy at the termination of the bond/policy period, it shall notify the insured not more than 120 days nor less than 60 days before termination. If such notice is given late, the bond/policy shall continue in effect for 60 days after such notice is given. The Aggregate Limit of Liability shall not be increased or reinstated. The notice not to replace shall be mailed to the insured and its broker or agent. |
4. | If the Underwriter/Company elects to replace the bond/policy, but with a change of limits, reduced coverage, increased deductible, additional exclusion, or upon increased premiums in excess of ten percent (exclusive of any premium increase as a result of experience rating), the Underwriter must mail written notice to the insured and its agent or broker not more than 120 days nor less than 60 days before replacement. If such notice is given late, the replacement bond/policy shall be in effect with the same terms, conditions and rates as the terminated bond/policy for 60 days after such notice is given. |
SR 6180b
ENDORSEMENT #1 (continued)
5. | The Underwriter/Company may elect to simply notify the insured that the bond/policy will either be not renewed or renewed with different terms, conditions or rates. In this event, the Underwriter/Company will inform the insured that a second notice will be sent at a later date specifying the Underwriters/Companys exact intention. The Underwriter shall inform the insured that, in the meantime, coverage shall continue on the same terms, conditions and rates as the expiring bond/policy until the expiration date of the bond/policy or 60 days after the second notice is mailed or delivered, whichever is later. |
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
2-14057
SR 6180b
ENDORSEMENT #2
This endorsement, effective 12:01 am January 17, 2012 forms a part of | ||
Policy number: |
01-503-01-67 | |
Issued to: |
FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
COMPUTER SYSTEMS INSURING AGREEMENT (J)
In consideration of the premium charged the bond is amended as follows:
I.
The bond is hereby amended by adding Insuring Agreement (J) to the bond as follows:
(J) | COMPUTER SYSTEMS |
Loss resulting directly from a fraudulent
(1) | entry of Electronic Data or Computer Program into, or |
(2) | change of Electronic Data or Computer Program within |
any Computer Systems operated by the Insured, whether owned or leased; or any Computer System identified in the application for this bond; or a Computer System first used by the Insured during the Bond Period, as provided by General Agreement A of this bond;
provided that the entry or change causes
(i) | property to be transferred, paid or delivered, |
(ii) | an account of the Insured, or of its customer, to be added, deleted, debited or credited, or |
(iii) | an unauthorized account or a fictitious account to be debited or credited. |
II.
For the purpose of the coverage afforded by this Insuring Agreement, the following definitions shall be added to the policy:
Fraudulent Entry or Fraudulent Change shall include such entry or change made by an Employee of the Insured acting in good faith:
(a) | on an instruction from a software contractor who has a written agreement with the Insured to design, implement or service programs for a Computer System covered by this Insuring Agreement, or |
ENDORSEMENT #2 (continued)
(b) | on an instruction transmitted by Tested telex or similar means of Tested communication (except a Telefacsimile Device) identified in the application for this bond purportedly sent by a customer, financial institution or automated clearinghouse; |
Computer Program means a set of related electronic instructions which direct the operations and functions of a computer or devices connected to it which enable the computer or devices to receive, process, store or send Electronic Data;
Computer Systems means:
1) | computers with related peripheral components, including storage components wherever located, |
2) | systems and applications software, |
3) | terminal devices, and |
4) | related communication networks, including the Internet, |
by which Electronic Data are electronically collected, transmitted, processed, stored and retrieved;
Electronic Data means facts or information converted to a form usable in a Computer System by Computer Programs, and which is stored on magnetic tapes or disks, or optical storage disks or other bulk media;
Telefacsimile Device means a machine capable of sending or receiving a duplicate image of a document by means of electronic impulses transmitted through a telephone line and which reproduces the duplicate image on paper;
Tested means a method of authenticating the contents of a communication by placing a valid test key on it which has been agreed upon between the Insured and a customer, automated clearing house, or another financial institution for the purpose of protecting the integrity of the communication in the ordinary course of business;
ENDORSEMENT #2 (continued)
Internet means worldwide public network of computers, which are commonly referred to as the internet.
III.
For the purpose of the coverage afforded by this Insuring Agreement, the following exclusions shall be added to the policy:
A. | loss resulting directly or indirectly from the assumption of liability by the Insured by contract unless the liability arises from a loss covered by the Computer Systems Insuring Agreement and would be imposed on the Insured regardless of the existence of the contract; |
B. | loss resulting directly or indirectly from negotiable instruments, securities, documents or other written instruments which bear a forged signature, or are counterfeit, altered or otherwise fraudulent and which are used as source documentation in the preparation of Electronic Data or manually keyed into a data terminal; |
C. | loss resulting directly or indirectly from |
1) | mechanical failure, faulty construction, error in design, latent defect, fire, wear or tear, gradual deterioration, electrical disturbance or electrical surge which affects a Computer System, or |
2) | failure or breakdown of electronic data processing media, or |
3) | error or omission in programming or processing; |
D. | loss resulting directly or indirectly from the input of Electronic Data into a Computer System terminal device either on the premises of a customer of the Insured or under the control of such a customer by a person who had authorized access to the customers authentication mechanism; |
E. | loss resulting directly from the theft of confidential information |
ENDORSEMENT #2 (continued)
IV.
Solely with respect to the coverage afforded by this endorsement, all loss or series of losses involving the fraudulent acts of one individual, or involving fraudulent acts in which one individual is implicated, whether or not that individual is specifically identified, shall be deemed to be one loss and shall be limited to the applicable Limit of Liability stated in Item 3 of the Declarations of this bond irrespective of the total amount of such loss or losses and shall not be cumulative in amounts from year to year or from period to period. A series of losses involving unidentified individuals but arising from the same method of operation shall be deemed to involve the same individual and in that event shall be treated as a one loss and shall be limited to the applicable Limit of Liability as described above.
V.
Solely with respect to the coverage afforded by this endorsement, Section 2. EXCLUSIONS (y) is deleted in its entirety.
ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS OF THE BOND REMAIN UNCHANGED
AUTHORIZED REPRESENTATIVE |
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
2-14057
ENDORSEMENT #3
This endorsement, effective 12:01 am January 17, 2012 forms a part of | ||
Policy number: |
01-503-01-67 | |
Issued to: |
FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
UNAUTHORIZED SIGNATURES
It is agreed that:
1. | The attached bond is amended by adding an additional Insuring Agreement as follows: |
UNAUTHORIZED SIGNATURES
2. | Loss resulting directly from the Insured having accepted, paid or cashed any check or withdrawal order, draft, made or drawn on a customers account which bears the signature or endorsement of one other than a person whose name and signature is on the application on file with the Insured as a signatory on such account. |
3. | It shall be a condition precedent to the Insureds right to recovery under this rider that the Insured shall have on file signatures of all persons who are authorized signatories on such account. |
4. | The Limit of Liability for the coverage provided by this rider shall be $25,000. |
5. | The Underwriter shall not be liable under the Unauthorized Signatures Rider for any loss on account of any instrument unless the amount of such instrument shall be in excess of Five Thousand Dollars, ($5,000) (herein called Deductible Amount) and unless such loss on account of such instrument, after deducting all recoveries on account of such instrument made prior to the payment of such loss by the Underwriter, shall be in excess of such Deductible Amount and then for such excess only, but in no event more than the amount of the attached bond, or the amount of coverage under the Unauthorized Signatures Rider, if the amount of such coverage is less than the amount of the attached bond. |
ENDORSEMENT #3 (continued)
6. | Nothing herein contained shall be held to vary, alter, waive, or extend any of the terms, limitations, conditions, or provisions of |
AUTHORIZED REPRESENTATIVE |
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
2-14057
ENDORSEMENT #4
This endorsement, effective 12:01 am January 17, 2012 forms a part of | ||
Policy number: |
01-503-01-67 | |
Issued to: |
FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
AUDIT EXPENSE
It is agreed that:
The attached bond is amended by adding an additional Insuring Agreement as follows:
AUDIT EXPENSE
1. | Expenses incurred by the Insured for that part of the costs of audits or examinations required by any governmental regulatory authority to be conducted either by such authorities or by independent accountants by reason of the discovery of loss sustained by the Insured through dishonest or fraudulent act(s) of an Employee. |
The Limit of Liability for the coverage provided by this Rider by reason of such act(s) of any Employee or in which such Employee is concerned or implicated or with respect to any one audit or examination shall be $25,000, it being understood that such liability shall be in addition to the Limit of Liability state in Item 4 of the declarations of the attached bond.
The underwriter shall only be liable hereunder for the amount by which such expense shall be in excess of $5, 000 (herein called the Deductible Amount) but not in excess of the Limit of Liability stated above.
It is understood that expense covered under this Rider exclude those resulting from an audit or examination required as result of the Insured being taken over by a liquidator or receiver or by state or federal officials.
2. | Coverage under this Rider shall terminate upon termination or cancellation of the b |
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
ENDORSEMENT #5
This endorsement, effective 12:01 am January 17, 2012 forms a part of
Policy number: |
01-503-01-67 | |||
Issued to: |
FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
NEW YORK AMENDATORY ENDORSEMENT - NY STATUTE 3420
Wherever used in this endorsement: 1) we, us, our and Insurer mean the insurance company which issued this policy; 2) you, your, Insured and first Named Insured mean the Named Corporation, Named Entity, Named Organization, Named Sponsor, Named Insured, or Insured stated in the declarations page; 3) other insured(s) means all other persons or ntities afforded coverage under the policy; 4) Discovery Period means Discovery Period or Extended Reporting Period, as defined in the policy; and 5) Claim means Claim or Suit as defined in the policy.
It is hereby understood and agreed that the policy is amended as follows:
A. | The following provisions are hereby added to the policy: |
FAILURE TO GIVE NOTICE WITHIN PRESCRIBED TIME:
Failure to give any notice required to be given by this policy, or any policy of which this is a renewal, within the prescribed time shall not invalidate any Claim made against an Insured if:
(a) | t shall be shown not to have been reasonably possible to give notice within the prescribed time and that notice was given as soon as was reasonably possible thereafter; or |
(b) | the failure to provide timely notice has not prejudiced the Insurer |
Any such Claim shall be deemed to have been first made against the Insured and noticed to the Insurer within the Policy Period or Discovery Period of the policy issued by the Insurer (the Noticed Policy) in which the Insurer received notice of the Claim; provided that the coverage afforded with respect to the Noticed Policy shall be in an amount not greater than the amount of coverage afforded with respect to the Policy Period of the policy issued by the Insurer (the Former Policy) in which the Claim was actually first made against the Insured. The foregoing sentence may result in (but not be limited to): (1) reducing the limit of liability available for such a Claim to the available limit of liability applicable to the Former Policy; (2) increasing the applicable retention amount to that retention amount applicable to the Former Policy; or (3) reducing or eliminating coverage due to exclusions or other restrictions appearing in the Former Policy but eliminated, in part or in whole, in the Noticed Policy. No coverage shall be afforded under this endorsement if there was not in existence a Former Policy at the time the Claim was actually first made against the Insured.
83231 (01/09)
ENDORSEMENT #5 (continued)
With respect to subsection (b) above, any such Claim must be noticed during the Policy Period or Discovery Period of a Noticed Policy which is a renewal or extension of the Former Policy.
Nothing in this endorsement shall be construed to provide coverage for a Claim under more than one Policy Period or Discovery Period.
PREJUDICE:
In the event that the Insurer alleges that it was prejudiced as a result of a failure to give notice within the time required under the policy, the burden of proof shall be on:
(a) | the Insurer to prove that it has been prejudiced, if the notice was provided within two years of the time required under the policy; or |
(b) | the Insured to prove that the Insurer has not been prejudiced, if the notice was provided more than two years after the time required under the policy. |
The Insurers rights shall not be deemed prejudiced unless the failure to timely provide notice materially impairs the ability of the Insurer to investigate or defend the Claim.
Notwithstanding the above, an irrebuttable presumption of prejudice shall apply if, prior to the notice, the Insureds liability has been determined by a court of competent jurisdiction or by a binding arbitration; or if the Insured has resolved the Claim by settlement or other compromise.
NOTICE TO AGENT:
Notice given by or on behalf of the Insured, or written notice by or on behalf of the injured party or any other claimant, to any licensed agent of the Insurer in the state of New York, with particulars sufficient to identify the Insured, shall be deemed notice to the Insurer.
INSOLVENCY/BANKRUPTCY OF INSURED:
The insolvency or bankruptcy of the Insured shall not relieve the Insurer of its obligations under this policy as long as all policy requirements are met by Insured, its trustee or receiver in bankruptcy. Should a covered judgment be rendered against an insolvent or bankrupt Insured, the Insurer shall be liable for the amount of such judgment not to exceed the applicable limit of liability under this policy.
83231 (01/09)
ENDORSEMENT #5 (continued)
The Clause entitled, Action Against Us or Action Against Company is deleted in its entirety and replaced with the following:
No one may bring an action against us unless there has been full compliance with all the terms of this policy and the amount of the Insureds obligation to pay has been finally determined either by:
1. | judgment against the Insured which remains unsatisfied at the expiration of thirty (30) days from the service of notice of entry of the judgment upon the Insured and upon us; or |
2. | written agreement of the Insured, the claimant and us. |
Any person or organization or legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this policy to the extent of the insurance afforded by this policy. We may not be impleaded by the Insured or its legal representative in any legal action brought against the Insured by any person or organization.
OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED.
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
2-14057
83231 (01/09)
ENDORSEMENT #6
This endorsement, effective 12:01 am January 17, 2012 forms a part of
Policy number: | 01-503-01-67 | |||
Issued to: | FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
NOTICE OF CLAIM
(REPORTING BY E-MAIL)
In consideration of the premium charged, it is hereby understood and agreed as follows:
1. | Email Reporting of Claims : In addition to the postal address set forth for any Notice of Claim Reporting under this policy, such notice may also be given in writing pursuant to the policys other terms and conditions to the Insurer by email at the following email address: |
c-claim@chartisinsurance.com
Your email must reference the policy number for this policy. The date of the Insurers receipt of the emailed notice shall constitute the date of notice.
In addition to Notice of Claim Reporting via email, notice may also be given to the Insurer by mailing such notice to: X , X , X or faxing such notice to (866) 227-1750.
2. | Definitions : For this endorsement only, the following definitions shall apply: (a) Insurer means the Insurer, Underwriter or Company or other name specifically ascribed in this policy as the insurance company or underwriter for this policy. |
(b) | Notice of Claim Reporting means notice of claim/circumstance, notice of loss or other reference in the policy designated for reporting of claims, loss or occurrences or situations that may give rise or result in loss under this policy. |
(c) | Policy means the policy, bond or other insurance product to which this endorsement is attached. |
3. | This endorsement does not apply to any Kidnap & ransom/Extortion Coverage Section, if any, provided by this policy. |
ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED.
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
99758 (8/08)
2-14057
ENDORSEMENT #7
This endorsement, effective 12:01 am January 17, 2012 forms a part of
Policy number: | 01-503-01-67 | |||
Issued to: | FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
COVERAGE TERRITORY ENDORSEMENT
Payment of loss under this policy shall only be made in full compliance with all United States of America economic or trade sanction laws or regulations, including, but not limited to, sanctions, laws and regulations administered and enforced by the U.S. Treasury Departments Office of Foreign Assets Control (OFAC).
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
2-14057
89644 (7/05)
ENDORSEMENT #8
This endorsement, effective 12:01 am January 17, 2012 forms a part of
Policy number: | 01-503-01-67 | |||
Issued to: | FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
NEW YORK AMENDATORY ENDORSEMENT
Wherever used in this endorsement: 1) Insurer means the insurance company which issued this policy; and 2) Insured means the Named Corporation, Named Organization, Named Sponsor, Named Insured, Named Entity or Insured stated in the declarations page; The policy is hereby amended as follows:
I. | The cancellation and When We Do Not Renew provisions are deleted and replaced by the following: |
(a) | CANCELLATION BY THE INSURED |
This policy may be cancelled by the Insured by surrender of this policy to the Insurer or by giving written notice to the Insurer stating when thereafter such cancellation shall be effective. The Policy Period terminates at the date and hour specified in such notice, or at the date and time of surrender.
(b) | ANCELLATION, NONRENEWAL AND CONDITIONAL RENEWAL BY THE INSURER |
(i) | f this policy has been in effect for sixty (60) or fewer days when cancellation notice is mailed, and this policy is not a renewal of a policy issued by the Insurer, then this policy may be cancelled by the Insurer by mailing or delivering to the Insured, and to his authorized insurance agent or broker, written notice stating when not less than twenty (20) days thereafter (fifteen (15) days thereafter if cancellation is because of one of the reasons for cancellation set forth in subsection (ii) below) the cancellation shall be effective. Notice of cancellation issued by the Insurer shall specify the grounds for cancellation. |
(ii) | If this policy has been in effect for more than sixty (60) days when notice of cancellation is mailed, or if this policy is a renewal of a policy issued by the Insurer, then this policy may be cancelled by the Insurer by mailing or delivering to the Insured, and to his authorized insurance agent or broker, written notice stating when not less than fifteen (15) days thereafter the cancellation shall be effective; however, such cancellation must be based on one or more of the following: |
(A) | nonpayment of premium, provided, however, that a notice of cancellation on this ground shall inform the first Named Insured of the amount due; |
69898 (9/06)
ENDORSEMENT #8 (continued)
(B) | conviction of a crime arising out of acts increasing the hazard insured against; |
(C) | discovery of fraud or material misrepresentation in the obtaining of the policy or in the presentation of a claim thereunder; |
(D) | after issuance of the policy or after the last renewal date, discovery of an act or omission, or a violation of any policy condition, that substantially and materially increases the hazard insured against, and which occurred subsequent to inception of the current Policy Period; |
(E) | material change in the nature or extent of the risk, occurring after issuance or last annual renewal anniversary date of the policy, which causes the risk of loss to be substantially and materially increased beyond that contemplated at the time the policy was issued or last renewed; |
(F) | required pursuant to a determination by the New York Superintendent of Insurance that continuation of the present premium volume of the Insurer would jeopardize the Insurers solvency or be hazardous to the interests of Insureds of the Insurer, its creditors or the public; |
(G) | a determination by the New York Superintendent of Insurance that the continuation of the policy would violate, or would place the Insurer in violation of, any provision of the New York Insurance Law; |
(H) | revocation or suspension of an Insureds license to practice his profession; or |
(I) | where the Insurer has reason to believe that there is a probable risk or danger that the Insured will destroy or permit the destruction of the insured property for the purpose of collecting the insurance proceeds, provided, however, that: |
(1) | a notice of cancellation on this ground shall inform the Insured in plain language that the Insured must act within ten days if review by the department of the ground for cancellation is desired pursuant to item (3) of this |
(2) | notice of cancellation on this ground shall be provided simultaneously by the Insurer to the department; and |
69898 (9/06)
ENDORSEMENT #8 (continued)
(3) | upon written request of the Insured made to the department within ten days from the Insureds receipt of notice of cancellation on this ground, the department shall undertake a review of the ground for cancellation to determine whether or not the Insurer has satisfied the criteria for cancellation specified in this subparagraph; if after such review the department finds no sufficient cause for cancellation on this ground, the notice of cancellation on this ground shall be deemed null and void. |
(iii) | Notice of cancellation by the Insurer shall specify the grounds for cancellation. |
(A) | The Insurer shall mail to the Insured, and to his authorized insurance agent or broker, written notice indicating the Insurers intention: |
(1) | not to renew this policy; |
(2) | to condition its renewal upon change of limits, change in type of coverage, reduction of coverage, increased deductible or addition of exclusions or upon increased premiums in excess of ten percent; (exclusive of any premium increase generated as a result of increased exposure units or as a result of experience rating, loss rating, or audit); |
(3) | that the policy will not be renewed or will not be renewed upon the same terms, conditions or rates; such alternative enewal notice must be mailed or delivered on a timely basis and advise the Insured that a second notice shall be mailed at a later date indicating the Insurers intention as specified in subparagraph (1) or (2) of this paragraph (A) and that coverage shall continue on the same terms, conditions and rates as expiring, until the later of the expiration date or sixty (60) days after the second notice is mailed or delivered; such alternative renewal notice also shall advise the insured of the availability of loss information and, upon written request, the request, the insurer shall furnish such loss information within ten (10) days to the insured. |
(B) | A nonrenewal notice as specified in subparagraph (1), a conditional renewal notice as specified in subparagraph (2), and the second notice described in subparagraph (3) of paragraph (A) of this subsection |
(iii) shall contain the specific reason or reasons for nonrenewal or conditional renewal, and set forth the amount of any premium increase and nature of any other proposed changes.
69898 (9/06)
ENDORSEMENT#8 (continued)
(C) | The notice required by paragraph (A) of this subsection (iii) shall be mailed at least sixty (60) but not more than one hundred twenty (120) days in advance of the end of the Policy Period. |
(D) |
(1) | If the Insurer employs an alternative renewal notice as authorized by subparagraph (3) of paragraph (A) of this subsection (iii), the Insurer shall provide coverage on the same terms, conditions, and rates as the expiring policy, until the later of the expiration date or sixty (60) days after the mailing of the second notice described in such subparagraph. |
(2) | Prior to the expiration date of the policy, in the event that an incomplete or late conditional renewal notice or a late nonrenewal notice is provided by the Insurer, the Policy Period shall be extended, at the same terms and conditions as the expiring policy, except that the annual aggregate limit of the expiring policy shall be increased in proportion to the policy extension, and at the lower of the current rates or the prior periods rates, until sixty (60) days after such notice is mailed, unless the Insured elects to cancel sooner. |
(3) | In the event that a late conditional renewal notice or a late nonrenewal notice is provided by the insurer on or after the expiration date of the policy, coverage shall remain in effect on the same terms and conditions of the expiring policy for another required policy period, and at the lower of the current rates or the prior periods rates unless the insured during the additional required policy period has replaced the coverage or elects to cancel, in which event such cancellation shall be on a pro rata premium basis. |
(iv) | Nothing herein shall be construed to limit the grounds for which the Insurer may lawfully rescind this policy or decline to pay a claim under this policy. |
(v) | Notice required herein to be mailed to the Insured shall be mailed to the Insured at the address shown in Item 1 of the Declarations. Notice required herein to be mailed by the Insurer shall be sent by registered, certified or other first class mail. Delivery of written notice shall be equivalent to mailing. Proof of mailing of such notice as aforesaid shall be sufficient proof of |
69898 (9/06)
ENDORSEMENT #8 (continued)
notice. The Policy Period shall terminate at the effective date and hour of cancellation or nonrenewal specified in such notice. (vi) If this policy shall be cancelled by the Insured, the Insurer shall retain the customary short rate proportion of the premium hereon. If this policy shall be cancelled by the Insurer, the Insurer shall retain the pro rata proportion of the premium hereon. Payment or tender of any unearned premium by the Insurer shall not be a condition of cancellation, but such payment shall be made as soon as practicable. |
ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
2-14057
69898 (9/06)
ENDORSEMENT #9
This endorsement, effective 12:01 am January 17, 2012 forms a part of
Policy number: |
01-503-01-67 | |||
Issued to: |
FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
VOICE INITIATED TRANSFER FRAUD RIDER
It is agreed that:
1. | The INSURING AGREEMENTS Clause of the attached bond is amended by adding the following additional Insuring Agreement to the end thereof: |
VOICE INITIATED TRANSFER FRAUD
Loss resulting directly from the Insured having, in good faith, transferred Funds from a Customers account through a Computer System covered under the terms of the Computer System Fraud Insuring Agreement in reliance upon a fraudulent voice instruction transmitted by telephone which was purported to be from:
(1) | an officer, director, partner or employee of a Customer of the Insured who was authorized by the Customer to instruct the Insured to make such transfer; |
(2) | an individual person who is a Customer of the Insured; or |
(3) | an Employee of the Insured in another office of the Insured who was authorized by the Insured to instruct other Employees of the Insured to transfer Funds, and was received by an Employee of the Insured specifically designated to receive and act upon such instructions, |
but coverage as is afforded by this Insuring Agreement shall only apply if the voice instruction was not from a person described in (1), (2), or (3) above, provided that:
(i) | such voice instruction was electronically recorded by the Insured and required password(s) or code word(s) given; and |
(ii) | if the transfer was in excess of $50,000, the voice instruction was verified by a call-back according to a prearranged procedure. |
Proof of loss for claim(s) under this Insuring Agreement must include electronic recordings of such voice instructions and the verification call-back, if such call was required.
ENDORSEMENT #9 (continued)
2. | Solely for the purpose of the coverage provided by the VOICE INITIATED TRANSFER FRAUD Insuring Agreement, the following definitions shall apply: |
Customer means an entity or individual which has a written agreement with the Insured authorizing the Insured to rely on voice instructions to make transfers and which has provided the Insured with the names of persons authorized to initiate such transfers and with which the Insured has established an instruction verification mechanism.
Funds means Money on deposit in an account.
3. | Solely for the purpose of the coverage provided by this Insuring Agreement, Section 2. EXCLUSIONS of the CONDITIONS AND LIMITATIONS Clause is amended to include the following exclusion at the end thereof: |
loss alleging, arising out of, based upon or attributable to any actual or alleged contractual liability of any Insured under any express contract or agreement; provided, however, that this exclusion shall not apply to liability which would have attached in the absence of such express contract or agreement.
4. | Nothing contained here shall be held to vary, alter, waive or extend any of the terms, limitations, conditions, or agreements of the attached bond other than as above stated. |
ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED.
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
2-14057
ENDORSEMENT #10
This endorsement, effective 12:01 am January 17, 2012 forms a part of
Policy number: | 01-503-01-67 | |||
Issued to: | FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
LOSS-NOTICE-PROOF-LEGAL PROCEEDINGS AMENDED
In consideration of the premium charged, it is hereby understood and agreed that Section 4. of the attached bond is deleted in its entirety and replaced with the following:
SECTION 4. LOSS -NOTICE -PROOF-LEGAL PROCEEDINGS
This bond is for the use and benefit only of the Insured named in the Declarations and the Underwriter shall not be liable hereunder for loss sustained by anyone other than the Insured unless the Insured, in its sole discretion and at its option, shall include such loss in the Insureds proof of loss. At the earliest practicable moment after discovery of any loss hereunder by the Insureds department of human resources, general counsel or department of risk management, the Insured shall give the Underwriter written notice thereof and shall also within six months after such discovery furnish to the Underwriter affirmative proof of loss with full particulars. If claim is made under this bond for loss of securities or shares, the Underwriter shall not be liable unless each of such securities or shares is identified in such proof of loss by a certificate or bond number or, where such securities or shares are uncertificated, by such identification means as agreed to by the Underwriter. The Underwriter shall have thirty days after notice and proof of loss within which to investigate the claim, but where the loss is clear and undisputed, settlement shall be made within forty-eight hours; and this shall apply notwithstanding the loss is made up wholly or in part of securities of which duplicates may be obtained. Legal proceedings for recovery of any loss hereunder shall not be brought prior to the expiration of sixty days after such proof of loss is filed with the Underwriter nor after the expiration of twenty-four months from the discovery of such loss, except that any action or proceeding to recover hereunder on account of any judgment against the Insured in any suit mentioned in General Agreement C or to recover attorneys fees paid in any such suit, shall be begun within twenty-four months from the date upon which the judgment in such suit shall become final. If any limitation embodied in this bond is prohibited by any law controlling the construction hereof, such limitation shall be deemed to be amended so as to be equal to the minimum period of limitation permitted by such law.
Discovery occurs when the Insureds department of human resources, general counsel or department of risk management.
(a) | becomes aware of facts, or |
ENDORSEMENT #10 (continued)
(b) | receives written notice of an actual or potential claim by a third party which alleges that the Insured is liable under circumstance which would cause a reasonable person to assume that a loss covered by the bond has been or will be incurred even though the exact amount or details of loss may not be then known. |
ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED.
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
2-14057
ENDORSEMENT #11
This endorsement, effective 12:01 am January 17, 2012 forms a part of
Policy number: | 01-503-01-67 | |||
Issued to: | FIFTH STREET FINANCE CORP |
By: | National Union Fire Insurance Company of Pittsburgh, Pa. |
FORMS INDEX ENDORSEMENT
The contents of the Policy is comprised of the following forms:
FORMS INDEX ENDORSEMENT
The contents of the Policy is comprised of the following forms:
FORM NUMBER |
EDITION DATE | FORM TITLE | ||
41205 |
04/95 | INVESTMENT COMPANY BLANKET BOND DEC PAGE | ||
41206 |
09/84 | INVESTMENT COMPANY BLANKET BOND GUTS | ||
SR 6180b |
04/8 | NEW YORK STATUTORY RIDER | ||
MNSCPT |
COMPUTER SYSTEMS INSURING AGREEMENT (J) | |||
MNSCPT |
UNAUTHORIZED SIGNATURES | |||
MNSCPT |
AUDIT EXPENSE | |||
83231 |
01/09 | NEW YORK LAW 3420 AMENDATORY ENDORSEMENT | ||
99758 |
08/08 | NOTICE OF CLAIM (REPORTING BY E-MAIL | ||
89644 |
07/05 | COVERAGE TERRITORY ENDORSEMENT | ||
69898 |
09/06 | NEW YORK AMENDATORY-CANCELLATION/NON RENEWAL | ||
MNSCPT |
VOICE INITIATED TRANSFER FRAUD RIDER | |||
MNSCPT |
LOSS-NOTICE-PROFF-LEGAL PROCEEDINGS AMENDED | |||
78859 |
10/01 | FORMS INDEX ENDORSEMENT |
NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS
AUTHORIZED REPRESENTATIVE |
2-14057
78859 (10/01)