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STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (a New York Stock Life and Health Insurance Company) Home Office: 485 Madison Avenue New York, New York 10022 212-355-4141 POLICY NUMBER: CFE-730-TX POLICYHOLDER: City of LaPorte POLICY PERIOD: April 01, 2002 through March 31, 2003 EFFECTIVE DATE: April 01, 2002 EXPIRATION DATE:March 31,2003 ANNIVERSARY DATE: April 01,2003, and on the same day each year after. PREMIUM DUE DATE: April 01,2002, and on the same day each month. STATE OF DELIVERY: Texas This Policy is a legal contract. We issue it in consideration of: (1) Your Application, (2) Your Disclosure Statement, and (3) Your payment of premiums when due. This Policy, Your Application, Your Disclosure Statement, and a copy of the Plan form the entire agreement between Us. In issuing this Policy, We have relied upon the information (including, without limitation, information in the Disclosure Statement, Your Application, and the Plan) provided to Us by: (1) You, (2) Your Administrator, and (3) Your agent or broker. We have also relied on this information being both complete and accurate. If the information was incomplete or incorrect, We shan have the immediate right: (1) to modify the Policy to reflect the complete or correct information, or (2) to tenmnate the Policy upon written notice. We agree to make payments in accordance with the provisions of this Policy. In this Policy, "You" and ''Your'' refer to the Policyholder, and 'We", "Us", and "Our" refer to Standard Security Life Insurance Company of New York. This Policy is issued and governed by the laws of the state of delivery as indicated above. Signed for Standard Security Life Insurance Company of New York as ofthe Effective Date. ~~. Rachel Lipari President ra-=-r~ David Kettig Secretary EXCESS LOSS INSURANCE POLICY Non-Participating SL-200l 1 (6101)