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/EMC <br />INSURANCE <br />PAGE NO: 2 <br />: 3D6 -49-04--- <br />S AND B HOLDINGS, LLC EFF DATE: 09/01/16 EXP DATE: 09/01/17 <br />G E N E R A L L I A B I L I T Y P O L I C Y <br />D E C L A R A T I O N S <br />ENDORSEMENT SCHEDULE <br />DATE OF ISSUE: 07/14/16 <br />FORM: IL7131A (ED. 04-0 <br />EDITION <br />FORM <br />DATE <br />DESCRIPTION/ADDITIONAL INFORMATION PREMIUM <br />------------------------------------------------------------------------------ <br />*IL7338 <br />05-15 <br />NOTICE OF CANC PROV BY US DESIGNATED <br />NAME OF ENTITY: <br />E: STATE OF COLORADO <br />DIVISION OF RECLAMATION MINING AND <br />SAFETY <br />MAILING ADDRESS: <br />1313 SHERMAN ST., RM 215 <br />NUMBER OF DAYS NOTICE: 30 <br />IL7602 <br />01-99 <br />COLORADO COMPANY ELIMINATION <br />*IL8021 <br />04-88 <br />ASBESTOS NOTICE <br />IL8383.2A <br />01-15 <br />DISCL PURSUANT TERRSM RISK INS. ACT $ 9 <br />IL8384A <br />01-08 <br />TERRORISM NOTICE <br />*IL8576 <br />09-09 <br />MEDICARE IMPT NOTICE TO POLICYHOLDER <br />DATE OF ISSUE: 07/14/16 <br />FORM: IL7131A (ED. 04-0 <br />