Executive Protection Policy Declarations between Federal Insurance Company and Roundy's Acquisition Corp.
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Summary
This document is the declarations page for an Executive Protection Policy issued by Federal Insurance Company to Roundy's Acquisition Corp. The policy provides executive liability, indemnification, fiduciary liability, outside directorship liability, and employment practices liability coverage for claims made between November 1, 2002, and November 1, 2003. The policy replaces a prior policy and covers only claims first made during the policy period, unless otherwise stated. Both parties have signed the document to confirm its validity.
EX-10.16 3 c75739exv10w16.txt DECLARATIONS PAGE FOR RENEWAL OF LIABILITY POLICY EXHIBIT 10.16 EXECUTIVE PROTECTION POLICY DECLARATIONS EXECUTIVE PROTECTION POLICY Policy Number 8132-0532 Federal Insurance Company, A stock insurance company, incorporated under the laws of Indiana, herein called the Company. Item 1. Parent Organization ROUNDY'S ACQUISITION CORP. 23050 ROUNDY DRIVE PEWAUKEE, WI 53072 Item 2. Policy Period: From 12:01 A.M. on November 1, 2002 To 12:01 A.M. November 1, 2003 Local time at the address shown in Item 1. Item 3. Coverage Summary Description GENERAL TERMS AND CONDITIONS EXECUTIVE LIABILITY AND INDEMNIFICATION Item 4. Termination of Prior Policies: 8132-0532 (November 1, 2001 - November 1, 2002) THE EXECUTIVE LIABILITY AND INDEMNIFICATION, FIDUCIARY LIABILITY, OUTSIDE DIRECTORSHIP LIABILITY AND EMPLOYMENT PRACTICES LIABILITY COVERAGE SECTIONS (WHICHEVER ARE APPLICABLE) ARE ALL WRITTEN ON A CLAIMS MADE BASIS. EXCEPT AS OTHERWISE PROVIDED, THESE COVERAGE SECTIONS COVER ONLY CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD. PLEASE READ CAREFULLY. In Witness Whereof, the Company issuing this policy has caused this policy to be signed by its authorized officers, but it shall not be valid unless also signed by a duly authorized representative of the Company. FEDERAL INSURANCE COMPANY /s/HENRY G. GULICK /s/DEAN R. O'HARE - ------------------ ----------------------- Secretary President 11/01/02 /s/ROBERT HAMBURGER - ------------------ ----------------------- Date Authorized Employee
