KOHLB&CO
XXXXX(TM) INSURANCE BINDER DATE
11/22/06
THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE
SIDE OF THIS FORM.
PRODUCER PHONE
(A/C, No, Ext): 000-000-0000 COMPANY BINDER #
FAX
(A/C. No); 9147476399 Federal Insurance Co 112206
EFFECTIVE EXPIRATION
------------------------------ --------------------------
USI Northeast, Inc. - C/L DATE TIME DATE TIME
Suite 301, North -------- ------------------ -------- ---------------
000 Xxxxxxxxxxxxx Xx. 11/22/06 12:01 X AM 11/22/07 X 12:01 AM
Xxxxxxxxxx Xxxxx, XX 00000 PM NOON
THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE
CODE: SUB CODE: NAMED COMPANY PER EXPIRING POLICY #:
AGENCY DESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY (Including
CUSTOMER ID: 962 Location)
INSURED Kohlberg Capital LLC
Kohlberg Capital Corporation
000 Xxxxxxx Xxxxxx
0xx Xxxxx
Xxx Xxxx, XX 00000
COVERAGES LIMITS
------------------------------------------------------------------------------ ----------------------------------
TYPE OF INSURANCE COVERAGE/FORMS DEDUCTIBLE COINS % AMOUNT
----------------------------------- ------------------------------------------ ------------------- ------- ------
PROPERTY CAUSES OF LOSS
[ ] BASIC [ ] BROAD [ ] SPEC
[ ]
[ ]
GENERAL LIABILITY EACH OCCURRENCE $
[ ] COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES $
[ ][ ] CLAIMS MADE [ ] OCCUR MED EXP (Any one person) $
[ ] PERSONAL & ADV INJURY $
[ ] GENERAL AGGREGATE $
[ ] RETRO DATE FOR CLAIMS MADE: PRODUCTS - COMP/OP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
[ ] ANY AUTO BODILY INJURY (Per person) $
[ ] ALL OWNED AUTOS BODILY INJURY (Per accident) $
[ ] SCHEDULED AUTOS PROPERTY DAMAGE $
[ ] HIRED AUTOS MEDICAL PAYMENTS $
[ ] NON-OWNED AUTOS PERSONAL INJURY PROT $
[ ] UNINSURED MOTORIST $
[ ] $
AUTO PHYSICAL DAMAGE DEDUCTIBLE [ ] ALL VEHICLES [ ] SCHEDULED VEHICLES [ ] ACTUAL CASH VALUE
[ ] COLLISION: ___________ [ ] STATED AMOUNT $
[ ] OTHER THAN COL: ___________ [ ] OTHER
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
[ ] ANY AUTO OTHER THAN AUTO ONLY:
[ ] EACH ACCIDENT $
[ ] AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
[ ] UMBRELLA FORM AGGREGATE $
[ ] OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE: SELF-INSURED RETENTION $
WORKER'S COMPENSATION [ ] WC STATUTORY LIMITS
AND E.L. EACH ACCIDENT $
EMPLOYER'S LIABILITY E.L. DISEASE - EA EMPLOYEE $
E.L. DISEASE -POLICY LIMIT $
SPECIAL Miscellaneous Coverage - Fidelity FEES $
CONDITIONS/ Limit $1,000,000 Ded.: $50,000 TAXES $
OTHER ESTIMATED TOTAL PREMIUM $
COVERAGES
NAME & ADDRESS
--------------
[ ] MORTGAGEE [ ] ADDITIONAL INSURED
[ ] LOSS PAYEE
LOAN#
AUTHORIZED REPRESENTATIVE
/s/ Xxxxxxx X. Xxxxxxxx
XXXXX 75 (2001/01)1 of 2 #28403
NOTE: IMPORTANT STATE INFORMATION ON REVERSE SIDE JAP
(C) XXXXX CORPORATION 1993
CONDITIONS
This Company binds the kind(s) of insurance stipulated on the reverse side. The
Insurance is subject to the terms, conditions and limitations of the
policy(ies) in current use by the Company.
This binder may be cancelled by the Insured by surrender of this binder or by
written notice to the Company stating when cancellation will be effective. This
binder may be cancelled by the Company by notice to the Insured in accordance
with the policy conditions. This binder is cancelled when replaced by a policy.
If this binder is not replaced by a policy, the Company is entitled to charge a
premium for the binder according to the Rules and Rates in use by the Company.
Applicable in California
When this form is used to provide insurance in the amount of one million
dollars ($1,000,000) or more, the title of the form is changed from "Insurance
Binder" to "Cover Note".
Applicable in Delaware
The mortgagee or Obligee of any mortgage or other instrument given for the
purpose of creating a lien on real property shall accept as evidence of
insurance a written binder issued by an authorized insurer or its agent if the
binder includes or is accompanied by: the name and address of the borrower; the
name and address of the lender as loss payee; a description of the insured real
property; a provision that the binder may not be canceled within the term of
the binder unless the lender and the insured borrower receive written notice of
the cancellation at least ten (10) days prior to the cancellation; except in
the case of a renewal of a policy subsequent to the closing of the loan, a paid
receipt of the full amount of the applicable premium, and the amount of
insurance coverage.
Chapter 21 Title 25 Paragraph 2119
Applicable in Florida
Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of
a binder is required unless the duration of the binder exceeds 60 days. For
auto insurance, the insurer must give 5 days prior notice, unless the binder is
replaced by a policy or another binder in the same company.
Applicable in Nevada
Any person who refuses to accept a binder which provides coverage of less than
$1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00,
and (B) is liable to the party presenting the binder as proof of insurance for
actual damages sustained therefrom.
XXXXX 75 (2001/01) 2 of 2 # 28403
