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State of Arizona

Department of Insurance

Financial Affairs Division

Trust Deposit Unit

2910 North 44th Street, Suite 210

Phoenix, Arizona 85018-7256

Phone: (602) 912-8427

Telecopier: (602) 912-8421

BNY WESTERN TRUST COMPANY

AS CUSTODIAN FOR ARIZONA STATE TREASURER

AND ARIZONA DEPARTMENT OF INSURANCE

INSURANCE COMPANY CUSTODY AGREEMENT

COMPANY NAME

(complete company name)

NAIC NUMBER

ACCOUNT NUMBER

(To be assigned by Institution)

hereinafter called "Insurance Company", hereby contracts with BNY Western Trust Company, in its capacity as

custodian, hereinafter called "Institution", to perform safekeeping duties and provide services hereafter set forth

with respect to Eligible Securities as described in Section 17 herein as are from time to time held hereunder.

Pursuant to Arizona Revised Statutes, as they may be amended from time to time, that require deposits by insurance

companies, the Insurance Company agrees to deliver and maintain Eligible Securities with a par or market value

that shall be determined from time to time by the Arizona Department of Insurance (“ADOI”).

Custodial Services. Institution shall not accept any securities from Insurance Company without prior written

approval from the ADOI. Institution shall safekeep all property delivered to it, shall identify such property

on its books and records as held in trust for the State Treasurer, shall receive the income attributable thereto,

and shall hold, invest, disburse or otherwise dispose of such income and principal, or its proceeds, pursuant to

the provisions of this Agreement.

1.1 All physical securities held hereunder shall be identified in the Institution’s automated and paper records

as such and shall be locked in a safe or vault with access restricted to Institution personnel authorized to

inspect, inventory or handle the securities.

1.2 All book-entry securities shall be identified in the Institution’s automated and paper records as such.

Access to perform safekeeping duties and provide services under this Agreement shall be restricted to

authorized Institution personnel only.

1.3 All securities identified or classified by the Insurance Company for the purpose of its Workers’

Compensation deposit shall be so identified and classified in the Institution’s automated and paper records in

a manner which readily distinguishes such securities from all other securities deposited by the Insurance

Company.

1.4 Institution shall identify full Insurance Company name, or an abbreviation of the Insurance Company

name that is acceptable to the ADOI, in its automated and paper records for the Insurance Company’s account

information and shall not change or modify the Insurance Company name without prior written approval

from the ADOI. The Institution shall refer any written or verbal instruction that it receives from the

Insurance Company to change or modify the Insurance Company’s name to the ADOI for response.

Responsibility for Assets. Institution shall be responsible for losses of or damage to the securities under its

care, custody and control or under the care, custody and control of its nominee, its agents or a depository

selected by it. In the event of loss of or damage to the securities under the care, custody and control of

Institution or its nominee, a depository or other agent of Institution, Institution shall, upon demand by

Insurance Company, promptly replace such securities with like kind and quality, together with all rights and

privileges pertaining to such securities, or, if acceptable to Insurance Company, deliver cash to the trust

account equal to the then fair market value of the securities. Under no circumstances, however, shall

Institution be liable for consequential damages under this Agreement for causes beyond its control, which

causes shall be war, insurrection, nuclear fission or fusion, radioactivity, seismic activity, earth movement,

volcanism, flood, windstorm hurricane, tornado or lightning.

Form E003BNY (Rev. 11/00)

Page 1 of 6

Form E003bny - Insurance Company Custody Agreement - Department Of Insurance, State Of Arizona

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