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BERKLEY INSURANCE COMPANY <br />item 9, <br />Item 10. <br />Forms and Endorsements attached at inception: LPL 39400 (rev. 12-14) <br />1 701-CR- 0419 <br />2 LPL 205201 (05-14) <br />3 LPL 306901 (05-14) <br />4 LPL 306902-CW (02-15) <br />5 LPL 400907 (09-14) <br />6 LPL 504901 (07-14) <br />7 LPL 604101 (05-14) <br />8 LPL-M N-PAE (05-14) <br />9 LPL-MN-PHN (05-14) <br />:�'r �. �ts}a ~� <br />3a% "T f :SaT.3T Fi.1 1 <br />CLAIM REPORTING PROCEDURES <br />Disciplinary Proceeding Supplemental Coverage for Privacy Breach Claims <br />Prior Acts Date for Listed Insured <br />Addition of Insured <br />Specific Entity Exclusion <br />Addition to Section V. D. Other Insurance <br />Mercer Consumer Modification to Non -Practicing Extended Reporting Period <br />Minnesota Policy Amendatory Endorsement <br />Minnesota Policyholder Notice <br />Notice to the Insurer as provided in section V. A, shall be sent <br />to: <br />Berkley Select Claims Department on behalf of <br />Berkley Insurance Company <br />550 W. Jackson Blvd, Suite 500, Chicago, IL 60661 <br />Toll Free: (844) 465-6256 Fax: (312} 207-1933 <br />Email: newclaim@berkleyselect.com <br />All other notices to be given to the Insurer shall be sent to: <br />Berkley Select on behalf of <br />Berkley Insurance Company <br />550 W. Jackson Blvd, Suite 500, Chicago, IL 60661 <br />Toll Free: (800) 446-2100 <br />These Declarations along with the completed and signed Application and the Lawyers Professional Liability Insurance Policy shall constitute <br />the contract between the Named Insured and the Insurer. <br />Authorized Representative: <br />Date Issued: June 15, 2020 <br />LPL 39401 (rev. 07-16) <br />Producer: Kathy S. Van Weelden Page 2 of 2 <br />