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af27858 0 6 44887 3t 3 8tn 388 3 -c 389 frx6o6o3 h 312 quotation confirmation date mar 11,2008 fax 505 888-6334 agency insurance one attn allison wylie pleased confirm following quotation received carrier shown please note quotation based coverage terms conditions listed may different requested original submission representative insured incumbent upon review terms quotation carefully insured reconcile differences terms requested original submission crc insurance services inc. disclaims responsibility failure reconcile insured differences terms quoted terms originally requested coverage may bound without fully executed brokerage agreement insured name accustat medical transcription inc insurance company evanston insurance company coverage e 0 miscellaneous policy form mg-843 ed 2/99-service technical professional liability insurance policy claims made reported policy professional services medical transcription services others fee retroactive date policy inception limit liability deductible premium plus taxes fees 1,000,000/51,000,000 s2,500 s2,107 1,000,000/51,000,000 s5,000 s2,026 add contingent biipd 500 additional premium terms conditions ~minimum earned premium 25 ~deductible applies indemnity lor claim expenses ~defense costs included within limits -punitive damages exemplary damages covered policy ~no coverage express warranties guaranties cost estimates ~bodily injurylproperty damage exclusion ~claims notification immediately claim made insured later sixty 60 days expiration policy period endorsements ~minimum earned premium endorsement 25 ~service suit ~amendment optional extension period bilateral 12 months 150 full annual premium subjectivities needed binding -completed signed dated markel shand specified professions application ~please indicate criteria used selecting subcontractors tax filing responsibility crc insurance services inc non-admitted carrier policy provides surplus lines insurance insurer otherwise authorized transact business new mexico policy subject supervision review approval superintendent insurance insurance s0 provided within protection guaranty fund law mexico designed protect public event insurer 's insolvency quotation continues onto next page new term premium 52,107.00 agency fee s350.00 state tax 513.78 total 52,530.78 commission 10 h. quotation confirmed renee engman fax 312-899-1480 mar 11 2008 submission 2773266 accustat medical transcription inc. agency response 1 yes please bind a8 per quote effective complete fax back signed date confidential

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: professional liability||Date : Mar 18 ,2008

q uo ta tion marke finders inc. pobox 90280 mananine 14b8041 jla3uny albuquerque nm 87199-0280 toll free 800 530-8711 505 822-8711 fax 505 822-1165 19445 coverage effected dxcument may rendered autkorized representative insurer named insured artistic homes inc 4420 tower road sw suite albuquerque nm 87121 allison wylie insurance one inc name insurer 6101 moon ne_ suite 1000 scottsdale insurance co 1008 albuquerque nm 87111 fax 505 888-6334 proposed 'term annual property location 1 1570 rustica los lunas nm 87031 4 2 1574 rustica los lunas nm 87031 property acv x rc 808 co-insurance s1,000 deductible building 1 8179,000 building 2 8172,900 coverage basic fire ec vmm x special theft excluded x included sublimtt sublimit flood/ quake excluded wind hail excluded policy conditions 258 minimum earned premtum endorsements war exclusion nuclear exclusion mold/ fungi exclusion continued page 2 premium 82 633 00 policy fee 200 00 surplus lines tax 885 08 commission 10 00 total 2,918 08 conditions proposal expires 30 days issue date listed reconfirmed time proposal 1s based underwriting rating information application provided coverage terms offered may broad requested application_ please review carefully advise us immediately questions thank opportuni help service clients needs look forward receiving order date august 19_ 2008 omni dcogsoq-041007/0808211346 contact patty blaylock ty 19445 page coverage desired need a_ completed signed acord appliction brokers affidavit terrorism elect reject form terrorism coverage wanted additional premium s132.00 plus tax signed terrorism form required bind coverage quote subject satisfactory inspection omni dcog5ox-020808/0808211346

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: professional liability||Date : 19-Aug-08

01/10/2008 12:40 fax 5058899353 hull co abq insurance one 001 abu sktzs hull company albuquerque qffice p 0. box 90385 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 quqte confirmation date 12/20/07 agent insurance one incichrs insured wemer gilchrest llc tem six months 01/13/08 07/13/08 coverage ggl occurrence fom limits 5 2,000,000 gen agg 5 excluded prodicomp ops agg 5 000,000 personal adv injury 00,00o occ 00,000 fire damage legal 5,000 med pay coverage property limits loc bldg s200,000 loc 2 bldg 90,000 bldg 2 41,000 bldg 3 41,000 loc 3 bldg 1 5108,000 equipment breakdown included covers basic form excluding sprinkler leakage acv bo coinsurance deductible 51,000 deductible locations 202 cornell se abq nm 87106 208 comell se abq nm 87106 208 cornell se abq nm 87108 premium 6 3,091.00 minimum deposit premium 10 comm 5 250.00 fee fully eamed 5 100.33 state sl tax 3,441.33 total shori termpolicy fully earned g months company mt vemon fire ins co non-admitted carrier please sure check carriers best rating satisfy clients interests terms conditions include limited following terms conditions exclusions service suit product-completed ops excl cgl coverage form excl new entities contractual liabllity limitation nuclear energy liab excl additional exclusions conditions includes employment related punitive exemplaryasbestos lead absolute pollution mold fungi bacteria organic pathogens exclusions classification limitation endt premises limitation endt assault battery excl absolute liquor liab excl independent contractors excl minimum earned premium endt exclusion badily injury employees volunteer workers terporary workers casual laborers contractors subcontractors excl violation statutes govem emails faxes etc excl construction operations excl exterior work four stories absolute war terorsm excl disclosure notice terorism insurance coverage see 2nd page details premiums signed terrqrism nqiice requiredat bindingl heat warranty excl loss loss use 0f data computer hardware lunsc wio/on n hull co abq insurance one 002 01/10/2008 12:40 fai 5058899353 systems vacancy permit sprinkler leakage excl asbestos material excl lead contamination excl absalute pollution excl mold fungus bactera virus organic pathogen excl quote subject 100 fully eamed short-term 3 month policy satisfactory inspection original signed completed acord app subject t0 audit class 68806 vacant vacant buildings must fully secured locked class code 68608 vacant bldg-not factories- otnfp 5,551 quotation offered basls indicated incumbent upon t0 ascertain accuracy quote nd review applicant terms quote carefully coverage tems conditions may different irom requested please remember dealing specialty markets tespectiva forms coverage forms used may include additional exclusions andlor coverage enhancements listed specimen policy formg available review upon request 25 deposit required prior binding coverage 10 fully eamed premium minimum deposit applies balance paid within 20 days eftective date unless otherwise indicated quote ofiered requested renewal date 1/13/08 ters valid untl 1/13/08 coverage backdated presumed ta bound without confirmation authorized reprasentative hull inc_ requests bind coverage must received offce writing advised hull co inc hae recelved response expiration date af quote consider quotation closed agency binding authority therefore binders certifcates issued hull co- inc acceptance quote 0n behalf applicant confirms fully explained terms conditions foms applicant said terms conditions ard forms fully understaod applicant hull co inc representative building ftom co hullrco abq insurrance one 003 01/10/2008 12 41 fai 5058899353 disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance act 2002 amended terrorism risk insurance extension act 2005 effective december 22,2005 right purchasc insurance coverage losses oul acts terrorism defined section 102 1 acl term `` act terrorism meang act certified secretary treasury concurrence secretary state attorney general united states ~to act terrorism 9 violent act act dangerous human life property infrastructure resulted damage within unitcd states outside united states case air carrier vessel premises united states mission committed individual individuals acting behalf foreign person foreign interest part effort coerce civilian population united states influence policy affect conduct united states government coercion know coverage losses caused certtfied acts terrorism partially remmbursed unkted states formula established federal law formula united states pays 90 losses occurring 2006 85 losses occurring 2007 covered terrorism losses exceedig statutorily established deductible paid ansurance company providing coverage fremium charged coverage provided include charges portion loss covered federal government act coverage `` insured losses '' defined terrorism risk insurance act qf 2002 terrorism risk insurance extensionact 2005 amended subject tq coverage terms conditions amounts limits policy applicable losses arising events acts terrorism know federal law required purchase coverage losses caused certiied acts terrorism rejection qr selection qe terrorism insurance cqverace please `` x '' one boxes return notice company decline purchabe terrorism coverage underatand coverage losses arislng_trom acts teroriem elect purchase coverage certified acts terrorism premium note respond offer return notice company terrorism coverage thia policy applicant name authorized signature print name date triadn 1/2006 unitcd stalds insurancc company u underwriters inyurance campany mt vernon firc insurancc company arising liability

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: professional liability||Date : 1/10/2008

insurance commercial premium finance agreement first disclosure statement ifunding corp quote number 000000505068 insurediborrower name address shown policy total premium 85,966.75 artistic homes inc b cash payment required 5 24,609.251 4420 tower rd sw suite albuquerque nm 87121 unpaid premium balance 61,357.50 telephone number 505 247-8400 pocuppeictoie sraoriga ax 5 0.00 direct correspondence tom wade amount financed amount credit provided behalf 61,357.50 agent broker name business address 08578-0025 insurance one finance charge 'dollar amount credit cost 2,203.92 5728 osuna ne total payments amount paid making scheduled payments 63,561.42 albuquerque nm 87109 annual percentage rate cost credit figured yearly rate 8.540 telephone number 505 888-6333 fid 015 payment schedule see schedule attached lender first insurance funding corp 450 skokie blvd suite 1000 number payments due amount p.o_ box 3306 payments monthly payment first northbrook il 60065-3306 telephone 8003 837-370 fax 837-3709 beginning 12/07/2007 7,062.38 prepayment insured may prepay full amount due late late charge_will imposed payment receive refund unearned interest provided payment received first within five 5 days due date unless page 2 agreement whone horgecageace 'lazericrage speriiee `` e impeed aprlicatye law security made insured received first within grace periody late assigns igecuriyrsof insi bayxect funding corp herein charge overdue amount maximum referred `` first security interest return fre maaigem petecleargeys 3286ab18 de lawt anachgver less premiums dividend payments_ certain loss baxdeente reference polgies= listed contract reference made terms certain conditions first right reference stated injosmagoeemenb cancel financed policies provided page 2 canzedation right demand agreement mayate paymeetantull prepayment prn 110707 cfg 08578-0001 rt 085 8opt2-15 crd n/a bp bill p/ f 390 sub 003103 schedule policies policy number full name insurance company name type policy term effective date policy prefix address general agent insurance months mo_ yr. premiums company office premium paid tbd 75530-002 probuilders spec ins co rrg gl 14 11-07-2007 81,810.00 003103 western pacific insurance network 25.000 cx 10 fin txsifees 0.00 au ern txsifees 4,156.75 notice see page 2 important information total premiums 85,966.751 provisions page 2 incorporated reference constitute part agreement record `` '' agent broker representations warranties insured 's agreement undersigned agent broker read agentibroker consideration premium `` amount financed '' representations warranties page completed made captioned pa8exerts brokerby first named zabeve nsoree copies seqleiceced makes herein referred insured '' promisedi order first_ total regeesentations warranties herein payments subject rpsovisiongayset forth pages undersigned agent broker agrees pay_all reasonable agreement attorney fees courts costs collection costs incurred first recovering_ amounts due the_agent notice insured broker connection breach agentibroker representations warranties rredemniof first 1 not_sign agreement losses first incurs result error read pages committed oa9gto_ completing sailingr eottaeas+ blank spaces_ zled-i8l name insured print type complete portion agreement copy agreement rigl advance full hmonpay due signature signature agent broker certain conditions obtain refund service charge partiaeerefatd copthef sevicgreeanget title date protect legal rights_ title date fif st 0206 faxrenn bsle- day conppietel yuunder fawin additional provisions premium finance agreement warranty accuracy_ insured represents warrants first interest due cancellation_ extent permitted applicable law insurance policies listed schedule policies full force cancellation occurs insured agrees pay first interest balance due effect insured assigned any_interest policies except contract rate maximum rate allowed applicable law whichever less_ interest mortgagees loss payees insured represents balance paid full date provided applicable iaw warrants first none insurance policies listed schedule policies personal family household purposes right demand immediate payment full time default first insured indebtedness insurers issuing listed policies none demand right receive immediate payment total unpaid insurers asserted claims payment insured amount due agreement even first received refund unearned premium_ representation solvency_ insured represents insured cancellation charge default insured results cancellation ofany insolvent presently subject insolvency proceeding_ insurance policy listed schedule policies insured pay first charge equal maximum charge permitted law collateral_ secure payment amounts due underthis agreement insured grants first security interest policies including return assignments_ insured may assign policy without first 's written consent premiums dividend payments_ loss payments reduce unearned however first 's consent_ needed add mortgagees persons loss premiums subject mortgagee loss payee interest payees_ first may transfer rights agreement anyone without consent insured right cancel insured make payment due insured otherwise default agreement first may cancel collections attorney fees_ first may enforce rights collect policies act insured 's place regard policies including amounts due without using security interest granted agreement endorsing check draft_issued insured 's name funds assigned first uses attorney salaried emtpisvag first incurs first security herein right given insured first constitutes collection costs collect money owed agreement insured agrees `` power attorney '' first cancels policies first provide reasonable attorney fees court costs collection costs incurred notice insured required law insured right paxsteaconabeceecozoegercens tneramoostsdue payable agreement cancel insured granted bi first ageesevaed first's.right cancel terminate insured 's indebtedness prepayment time insured reay pad entire amount still unpaid agreement paid full insured pafinance f chargeaico amount due insured receive refund unearned computed actuarial method rule 78's_ default_ insured default agreement payment permitted fon gendobiancervicakee law_ refund subject maximum received first due b insured insurance companies service fee permitted applicable iaw refund made insolvent involved bankruptcy similar proceeding debtor c amount refunded less 1.00 insured fails comply terms agreement insurance audit reporting form policies regard policy schedule companies cancel coverages e premiums increase policy listed policies auditable reporting form type insured agrees promptly agreement insured fails pay increased premium within thirty pay insurance company difference actual earned premium 30 days notification f insured default agreement generated policy premiums financed agreement first wherever word default '' used this_agreement means one above_ insured default first finance charge finance charge earliest effective date obligation afraerente premiums insured 's behalf policies listed schedule policies sbetgons finance charge includes interest firs may pursue remedies provided agreement may include non-refundable service fee equal maximum fee permitted applicable iaw finance charge computed 365 day year late charges late charge imposed payment received first within five 5 days due date unless longer agent broker agent broker_handling agreement agent period specified applicable iaw case late charge rwirace broker first legally bind first way imposed payment received first within grace period permissible law portion finance charge may paid first late charge 5 overdue amount maximum iate charge agent broker executingthis agreement payment forghe servicesain rendering tne permitted applicable law whichever less maximum late charge bezdiceczeai insurance premiums_ questions payment s5.00 de mt nd_ agent broker dishonored check fee insured 's check dishonored corrections first may insert names insurance companies relicys reason permitted law insured pay first dishonored check numbers known time insured signs agreement first authorized correct patent errors omissions agreement fee equal maximum fee permitted law effective date agreement become effective accepted payments received notice cancellation_ notice writing first_ cancellation sent insurance company first duty rescind ask policy reinstated even first later receives governing law agreement governed interpreted laws insured 's payment payments first receives sending notice state first accepts court finds part cancellation may applied insured 's account without changing agreement invalid tiindhg agaemenaffecf an8 remainder anys pagreemenis first 's rights agreement singular words agreement shall mean plural vice versa may required give agreement meaning_ north carolina department insurance permit first 's rights policies cancelled_ policy b-482_ cancelled whether insured first anyone else first right receive unearned premiums funds assigned first security signature acknowledgment insured signed agreement herein apply insured 's unpaid balance agreement received copy ofit insured corporation the_person signing officer agreement insured first amount '' received corporation authorized sign agreement insured corporation_ amount owed insured excess amount refunded insureds listed policy signed insured amount received less amount owed insured insured pay first balance due first may act insured 's place liability_ insured understands agrees first liability insured whatever necessary collect refunds insurance com person upon exercise f first 's right cancellation except rely whatever first tells regarding policies 'pavees igey event willful intentional misconduct first_ proof insured anyone else_ agent broker representations warranties signatures genuine best knowledge insured 's signature depositiprovisional premiums_ audit reporting form policies policies genuine_ subject retrospective included noted section authorizationirecognition_ insured authorized transaction deposit provisional premiums aqeeemeoti less insured agentibroker recognize security interest granted anticipated premiums earned full term `` polcicies herein pursuant insured assigns first unearned premium dividends certain loss payments_ upon cancellation policies loss payees named policies provide premium may earned listed schedule policies agentibroker agrees videnediated/ pay earlier event loss noted section b andlor first unearned commissions unearned premiums dividends loss agentibroker notified relevant insurance companies insured first payments received funds notremitted first within 10 days named loss payee policies_ receipt agentibroker agentibroker agrees pay first interest funds maximum rate allowed law authorized issuing agent scheduled policies agentibroker either policies effectiveipremiums `` correerlicabe policies listed schedule insurance companys authorized policy issuing agent broker placing policies full force effect premiums correct listed coverage directly insurance company except name address insured document insured given copy issuing agent general agent listed schedule policies_ agreement insolvency best knowledge neither insured amounts due insured cash payment installments due insurance companies insolvent involved bankruptcy similar insured collected insured_ proceeding debtor except clearly indicated page 1 agreement scheduled policies agent broker warrants policies auditable reporting form policies policies subject policy number retrospective rating except policies listed right indicated exceptions comments schedule policies b policies subject minimum earned premium except policies listed indicated schedule policies minimum earned 9emoums listed policies b c ail policies provide unearned premiums computed standard short rate pro rata 'poacies except policies listed right indicated c schedule policies contain provisions prohibit cancellation either insured insurance iarcaze col within scheala ia p8licegt policies listed right fif st 0206 pay using 'entity rating ten

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: general liability||Date : 12/07/2007

hull company albuquerque office po box 90365 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 quqte confirmation date 7/5/08 agent insurance one inc allison wylie insured werner gilchrest llc coverage c.gl occurrence form limits 2,000,000 general aggregate excluded prodicomp ops aggregate 1,000,000 personal advertising injury 1,000,000 occurrence 100,000 fire damage legal 5,000 medical payments coverage property vacant building limits tiv s480,000 building value basic form excluding sprinkler leakage actual cash value 80 coinsurance 1,000 deductible premium 3,091.00 minimum deposit premium 10 comm 250.00 fee fully earned 100.33 state sl tax 3,441.33 total_ shqrt term policy fully earned6 months company mt vernon fire ins co. non-admitted carrier please sure check carrier 's best rating satisfy clients interests terms conditions include limited following terms conditions exclusions service suit product-completed ops excl cgl coverage form excl new entities contractual liability limitation nuclear energy liab excl additional exclusions conditions includes employment related punitive exemplary asbestos lead absolute pollution mold fungi bacteria organic pathogens exclusions classification limitation endt premises limitation endt assault battery excl absolute liquor liab excl independent contractors_excl minimum earned premium endt exclusion bodily injury al employees volunteer workers temporary workers casual laborers contractors subcontractors excl violation statutes govern emails faxes_ etc excl construction operations excl exterior work four stories absolute war terrorism excl disclosure notice terrorism insurance coverage see 2nd page details premiums signed terrorismnqtice requiredat binding heat warranty excl loss loss use data computer hardware systems vacancy permit sprinkler lleakage excl asbestos material excl lead contamination excl absolute pollution excl mold fungus bacteria virus organic pathogen excl quote subject 100 fully earned short-term 6 month satisfactory inspection original signed completed acord subject audit class 68606 vacant building aii vacant buildings must fully secured locked continued page 2 policy app hull company albuquerque qffice po box 90365 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 quotation offered basis indicated incumbent upon ascertain accuracy quoter review applicant terms quote carefully coverage terms conditions may different vou requested please remember dealing specialty markets respective forms_ coverage forms used may include additional exclusions andlor coverage enhancements listed specimen policy forms available review upon request 25 deposit required prior binding coverage 100 fully earned premium minimum deposit applies balance paid within 20 effective date unless otherwise indicated quote offered requested renewal date 07/21/2008 terms valid 07/21/2008 coverage backdated presumed bound without confirmation authorized representative hull co. inc_ requests bind coverage must received office advised hull co. inc received response expiration date quote consider quotation closed agency binding authority therefore binders certificates issued hull co. inc_ acceptance quote behalf applicant confirms fully explained terms conditions forms applieanr ane said terms conditions forms fully understood applicant hull co. inc. representative days writing disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance program reauthorization act 2007 `` act '' effective december 26th 2007 right purchase insurance coverage losses arising acts terrorism defined section 102 1 0f act term `` act terrorism '' means act certified secretary treasury concurrence secretary state attorney general united states act terrorism beea violent act act dangerous human life property infrastructure resulted damage within united states outside united states case air carrier vessel premises united states mission committed individual individuals a8eartof effort coerce civilian population f united states influence policy affect conduct united states government coercion know coverage losses caused certified acts terrorism partially reimbursed united-states formula established federal law formula united states pays 85 covered terrorism losses exceeding statutorily established deductible paid insurance company providing coverage program year january december 31 premium charged coverage provided include charges portion loss covered federal government act coverage `` insured losses defined act subject coverage terms conditions amounts limits policy applicable losses arising events acts terrorism know act amended contains 100 billion cap limits u.s. govemment reimbursement well insurers liability losses resulting certified acts terrorism amount losses insurers exceeds 100 billion coverage may reduced also know federal law required purchase coverage losses caused certified acts terrorism rejection selectionqe terrorisminsurance cqverage please x one boxes return notice company decline purchase terrorism coverage understand coverage losses arising_from acts 0f terrorism elect purchase coverage certified acts 0f terrorism premium note ifyou respond offer return notice company terrorism coverage policy applicant name print named insured authorized signature date united states liability insurance company u.s. underwriters insurance company mt vernon fire insurance company triadn 01-08

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Property Policy||Date : 7/5/2008

quotation american e 5299 dtc blvd suite 900 greenwood village co 80111 telephone 303-751-7974 facsimile 303-745-8278 june 23,2008 insurance one inc telephone 505-888-6333 attn allison wylie facsimile 505-888-6334 6101 moon ne suite 1000 number pages 5 albuquerque nm 87111 pleased provide following quotation response submission carrier colony insurance company company non-admitted carrier new mexico policy provides surplus lines insurance insurer otherwise authorized transact business new mexico policy subject supervision review approval superintendent insurance insurance provided within protection guaranty fund law new mexico designed protect public event insurer 's insolvency insured sos managed waste inc address p.o box 659 portales nm 88130 proposed term 07/25/2008 07/25/2009 coverages commercial general liability/occurrence form limits s2,000,000 general aggregate slncluded productsicompleted operations general aggregate s1,000,000 personal advertising injury s1,000,000 occurrence 100,000 fire damage 5000 medical expense deductible s500 biipd per claim exclusions total pollution asbestos silica dust toxic substance punitive exemplary damages lead- contamination employment related practices employers iiability warlterrorism moldlfungilbacteria rotlwet-rot nuclear energy land subsidence professional liability others per iso company forms mandatory exclusion may apply forms iist attached terrorism coverage additional 5100. plus surplus lines tax desired cqverage cannoi bqundwihqulthe signedrejection fqrm _unless cqverageis 7 desired american e nsurance brokers dry- quotation american e subject completed signed terrorism form completed signed affidavit attached quote based expiring exposures operations binding please confirm changes exposures operations last year new application required changes bound amendments coverage must specifically requested approved insurance company underwriters effective issuance certificates insurance gross minimum premium s1,161.00 note additional insured 's must policy fee s150.00 submitted prior approval charged surplus lines tax 839.37 accordingly total 1,350.37 commission 10 gross premium excluding taxes fees quote offered using carrier licensed state colorado requires maintain documentation file compliance sdue dilignce '' set forth regulation 90-14. minimum deposit premium event annual premium less minimum premium shown premium adjustable upwards rate reflected quote payment terms 20 days effective date subject minimum retained 25 flat cancellations ail fees 100 retained inception return premiums financed policies remitted directly finance company retailer responsible return unearned commission quotation based upon fax mail /or telephone advices insurer issued american e insurance brokers inc. without liability whatsoever insurer insurance subject terms conditions policy cover note may issued terms conditions quotation may broad requested submission_ carefully read terms conditions contained quotation shall effective 30 days 12.01 a.m standard time date quote requested effective date whichever occurs first look forward receiving written instructions appreciate interest facility thank opportunity quote renewal behalf leigh ann richmond underwriteribroker ext 229 leighann_richmond aesbrokerscom american e insurance brokers policyholder disclosure notice terrorism insurance coverage hereby notified fthat terrorism risk insurance act amended right purchase insurance coverage losses resulting acts terrorism defined section 102 1 act tem `` act terrorism '' means act certified secretary treasury concurrence secretary state attorney general united states act terrorism violent act act dangerous human life property infrastructure resulted damage within united states outside united states case certain air carriers vessels premises united stales mission committed individual individuals part effort coerce civilian population united states t0 infiuence policy affect conduct united states government coercion know coverage provided policy losses resulting certified acts terrorism losses may partially reimbursed united states government formula established federal law however policy may contain exclusions might affect coverage exclusion nuclear events formula united states government generally reimburses 85 covered terrorism losses exceeding statutorily established deductible paid insurance company providing coverage premium charged coverage provided include charces portion loss covered federal government act shquld also know terrorism risk insurance act amended contains 100 billion cap limits u.s government reimbursement well insurer 's liability losses resulting certified acts terrorism amount losses one calendar year exceeds 100 billion aggregate insured losses insurers exceed 100 billion coverage may reduced please also aware policy nqi provide coverage acts terrorism certified secretary treasury acceptance rejegtion terrorism insurance coverage must accept reject insurance coverage losses arising acts terrorism a8 defined section 102 1 act effective date policy coverage be_bound unless representative_has received fommsignedby yol behalf allinsureds allpremiums coverage acceptance hereby elect purchase coverage certified acts terrorism defined section 102 1 act prospective annual premium understand coverage losses resulting non-certified acts terrorism coverage rejection hereby decline purchase coverage certifed acts terrorism defined section 102 1 act understand coverage losses arising either certified non-certified acts terrorism colony insurance company palicyholderiapplicant signature- insurance company must person authorized sign insureds print name number bs/anagld laste lne submission number named insured producer number date producer name street address state zip producer shown wholesale insurance broker insurance agent used place insurance coverage wlth us please discuss disclosure agent signing triazooznotice-0108 page 1 1 duer policy city producing braker affdavit required hy nmsa 1978 sectivn 594-14-1ib name ofpraducing broker address producing broker peing duly i0rz iafirm irts engaged cbtaln fqlloring olicy jtttrer policy number_ type cuverage_ eflective dates_ cherk eithcr orb beloiv 4s ppropriate baking diligent sarch efodud dhat fl amornt type insurance requested conld potbe obtained frm authorized insurcrs nef merdca within te last year thave trled place thistype coverage least four insuters authorized new merico induding insurers bot sppointed therefoxe know jubstantial recent experience tbat cuverugc obtained frum atty suthorized instrer ner mexica ierpressly advised insured prior placing insurance insurance policy states bbe insurer fith ihon insurlhce placed fs hot un aathorized insurer new merico _nd ks hot subject jupervision gf superintendent iuronce itbe event fbe insurer becomes insolrebt claims pot pald sny new mexdco guaranty sociation ihave sked fe insured tv fbebet ofmylnorledg4 coverage replacing eristing coperagc n andhorized insurer ras continue pruviding qoveiage fhat iam icensed new merico department insurance tetype € coverrge pruvided end tnat information ttis frn tue correct mn complience spplicable prorisions ner merico insurance code tbis rule signature date rilling certify

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: commercial General liability||Date : June 23 ,2008

originated lake forest bank trust company physical address 727 north bank lane commercial premium finance agreement lake forest il 60045 disclosure statement serviced first insurance funding corp quote number 000000529899 insurediborrower name address shown policy total premium 30',211.00 sos managed waste inc cash payment required 8,224.861 po box 659 portales nm 87111 unpaid premium balance 21,986.14 telephone number 505 356-8720 docuppeotor istao8a tax 0.00 direct correspondence lisa victor amount financed amount credit provided behalf 21,986.14 agent broker name business address 08677-0001 insurance one finance charge dollar amount credit cast 891.30 6101 moon street ne total payments amount suite 1000 paid making scheduled payments 22,877.44 albuquerque nm 87111 annual percentage rate cost credit figured yearly rate 10.700 telephone number 505 822-8114 fid o0o payment schedule see schedule attached lender number payments due amount lake forest bank trust company monlhly clo first insurance corp. payments payment 450 skokie blvd suite gitedio8o northbrook il 60062 8 beginning 02/04/2008 2,859.68 prepayment insured may prepay full amount due late late charge imposed a8y receivve refund unearned interest provided payment eneeyed aheegges lender period fie 3 8e uodeit ddufcdae date page 2 oethiscagreemenur iaw cageace late charge security security payments made insured rigeae `` qargcerad sfnper rhevitovier 026 assigns lake forest bank trust company maximum iate permitted herein referred `` lender security interest less_ mahiaga late cargy 35.00 iare mt return premiums dividend payments certain loss nd_ eadeente reference 8 endexidies listed contract reference made terms certain conditions_ right reference stated 'iniccmagoremenb cancel financed policies provided deaadt `` canzaqetior f ne right denboyd page 2 agreement_ frreaaer paymeelantfuli ndfpretioyment prn 010308 cfc stdio1d rt 086770pt2 f crd n/a bp bill p/f 100 88 sub 08677-0001 schedule policies policy number full name insurance company name type policy term effectivve date policy prefix address general agent insurance months mo day yr. premiums 0r company office premium paid tbd 03078-001 argonaut-midwest ins co truk 12 01-04-2008 29,711.0q 25.000 30 fin txsifees 0.0q ern txsifees 500.00 notice see page 2 important information total premiums 30,211.0q provisions page 2 incorporated reference constitute part agreement record '' agent broker representations warranties insured 's agreement undersigned broker read agentbroker consideration premium baynent8 amount financed '' representations '2808 arranties page 2 agetbrete made captioned age broker lender named insured 2 anc jeez euner hezeira referred a5 ecsureal tq pay '' lender yeaeacdeteec recited payments subjectto provsions 'set forth pages 'this ezze agent broker an3 rees callecdoaicoetsonable agreement costs eee23e1 `` recovering amounts 58863 '' notice insured jon breach 6.e7332 lemnify iianar8 aear jaean ende icurs youdoezot bigf figegrgement ic4ar result error comitted eo genugrope e8t2a3 blank rledv8u nae insured printbr jsgreglaen failing complete portion g8nriglunded copy o4 uhiaegretneentigf 8ffawn hal advance full 'sb8ainn signature certain eo jav tp8 signature agent wr broker partiaeepefiod copyor ghivice ggreearent copy protect legal rights title daa title date fif st 0206 8p845838 ordefboin opromised ub jmt sonddoounfayu warranty accuracy additional provisions premium finance agreement ihe insurance coliciecyistedthre thesuscredeneesenpolicics warrants lender interest due cancellation extent permitted applicable effect_tand insured assigned interest sharpoiicied force iaw_ cancellation occurs_ insured agrees pay lender interest interest mortgagees loss payees ayin tesesredn ueneolicepresenept ar balance due contract rate r maximum rate allowed applicable law warrants lender none insurancerpolreies ursted irepreseche whichever balance paid full date provded policies personal household schedule applicable law purposes ii insured indebtedness insurers issuing listed policies_ none thase rightjo demand immediate payment full time insurers asserted claims payment insured_ lender demand 'the right t0 receiveu mmedtateny default representation unpaid amount due agreement ven lender haaynent received ton solvency_ insured represents insured refund unearned premium insolvent presently subject 0f insolvency proceeding cancellation charge default insured results cancellation collateral to_secure payment amounts due agreement insurance listed schedule sy poeiciesu insured pay lender insured grants lender security interest policies_ including return charge equal maximum charge permitted iaw premiums divdend payments loss payments reduce unearned premiums subject mortgagee payee interest assignments insured may assign policy without lender 's written consent_ however lender 's consent needed add mortgagees right cancel insured make payment due persons loss payees_ lender may transfer rights agreerent insured otherwise default lender anyone without consent insured policies act insured '' place hegargreemenp policies_ ercluoang cancorsing check draft issued insured '' name funds lender collections attorney fees lender may enforce its.rights collect security herein this_right given insured lender cons- corsigqeest `` '' power 3s 2 q8t8 due without security interest granted inthis agreament attorney '' lender canceis policies lender provide notice uses attorney salaried employee lender incurs insured required insured agrees collection costs collect money owed agreement insured insured granted lexder revokad highilerdercerighhice agrees ranferonobleo excocey court costs_ collection costs cancel terminate insured 's indebtedness right incuagre exceed 20 percent amount payable paid full_ agraement agreement default insured default agreement payment dsured yqaentr fhe fll anpaicemourureeforayt '' payaube entire amount stil 4exaia received lender due b insured insurance companies unearned qafinaneef computed actuarial inetrod illheceule r'e853 insolvent involved bankruptcy similar proceeding debtor c insured porcrefendable applical law_ refund subject aeximuns fails comply terms agreement insurance companies service fee permitted applicable law na refund made cancel coverages_ e premiums increase policy dsted agreement amount refunded less 1 tbo insured fails pay increased premium within 30 notification_ insured default agreement lnbex audit reporting form policies regard policy wherever ihe word `` default '' used eement means one schedule policies auditable reporting form txpe nsured agrees above_ insured default lender age obligation promptly pay insurance company difference actual '' earned agreement pay premiums insured 's behalf lender may pursue premium generated policy premiuris financed ithis agreement remedies provided agreement_ finance charge finance chargecieegigec the_earliest effective date late charges late charge imposed payment poecess listed schedule section_ finance charge includes received lender within filve days due date unless longer peereidtedy z appakcabcl include non-refundable service fee equal maximum ee period specified `` applicalie iaw case late chioggerwirace law finance charge computed using 385 day year imposed ax paement ot tneceoverdbe lenonr orthine grace period agent broker_ agent broker agreement late charge 5 overdue amount maximum late broker lender legally bind le tavsling way_ agent pednittedf andrplicable law whichever less_ maximum late charge sch388 s5_ permissible law portian finance may paid lender de_ nd agent broker executing agreement payment servces dishonored check fee insured 's check dishonored reason beediceccedi 8 t08h6 sgencor brokeums questions payment endenocaat permitted iaw insured pay lender dishonored fee agent broker equal io maximum fee permitted iaw corrections_ lender may insert names insurance companies pelcyeru numbers notknown time insured signs agreement payments received notice cancellation notice authorized i0 correci patent errors omissionssu eis ageement cancellation sent insurance company lender duty rescind ia ask policy bereinstated even lender later receives effective date_ agroement become effective accepted insured 5 payment payments lender receives sending notice writing lender cancellation may applied insured 's account without changing governing law lender 's rights agreement lehbegrecces governed ad interpreted ihe iaws state accepts agreement court finds part lender 's rights policies cancelled_ policy agreement invalid finding shall affect ihe remainder cancelled whether insured lender anyone else lender agreement singular words agreement shall mean plural vce versa receive eneerned premiums funds assigned t0 lender thectgly may required glive agreement meaning north carolina department herein t0 apply ihem insured 's unpaid balance agreement insurance permit b-482 agreement insured lender amount received signature acknowledgment_ insured signed agreement amount owed insured excess amount refunded insured received copy insured person signing officer amount received less amount owed insured insured corporation authorized sign icorporatiogreeheene insured lender balance due lender may act insured place 1o whatever pay corporation insureds iisted policy signed zer83erv collect refunds insurance companies may rely whatever tells regarding policies get proor liability_ insured understands agrees lender insured insured anyone else_ person upon theexercise lender '' right 0f oariebilaior except event willful intentional misconduct lender agent broker representations warranties signatures genuine best knowledge insured 's signature depositiprovisional premiums audit reporting form policies jcmhipbrizationirecognition policies subject retrospective provisioir ipclrderns forishegceeolciesararenorod leeowan insured authorized transaction section anticipated preteross premiums ihese less herein insured agentbroker5ecg99 le8decral/ itescnieg preed premiums earned tho full term porcieies pursuant insured assigns lender premium dividends certain loss `` polcieenne upon cancellation policies loss payees named policies provide premium may_ listed schedule andealtgrearn agrees 10 immediately pay earned earlier event '' loss noted section andlor lender unearned commissions unearned dividends loss lgererokerc notified relevant companies rand thendrosurea payments eceived '4nd a3ent8roee remitted aesle62 10 df named loss payee rinsnyanch policies teceipt agentbroker agrees t0 pay interest funds maximum rate alllowed `` eorkepeica ble law_ authorized issuing agent scheduled policies theagentbroker policies effectiveipremiums policies listed schedule either tha insurance companys authorized policy issuing broker placing ot policies full force effect premiums correct listed coverage directly insurance company except name insured document insured given copy address ssuing agent general agent listed schedule 0f policies_ agee1e8lvency best kmvoledge neither insured amounts due insured cash payment installments insurance companies insolvent bankruptcy similar due insured collected rom insured proceeding debtor except clearly indicated page 1 agreement scheduled policies agent broker warrants policies auditable reporting forr policies policies subject to_retrospective rating except policies listed right indicated schedule policies_ policy number exceptions comments b policies sgtted_ minimum earned premium 'eared poeiciemiscedated right indicated iule policies minimum policies c policies provide unearned premiums computed standard short rate b rata table except policies listed right indicated schadule poicaea c policies contain provisions prohibit cancellation either insured insurance company within ten 10 days except policies listed right indicated schedule policies fif st 0206 less 'the family policyhe toss using pany eese due cicae thirty tho charge achecea entity any_ days agent 0 ioeq uo siena0 `` s0inx8a 6 1 00 1 7 v 3 n ne 3 2 1 1 n j 4 1 8 4 n 3 4 8 n 5 j8 n 1 3 4 8 1 3 23 8 2/ 3 r 03 8 1 ij 1 h ps 2 1 1 8 ih 1 1 3 2 28 6 2 9 v 1 hunaes 1 3 8 l 3 v 3 2 ra

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: commercial General liability||Date : 2/4/2008

01/10/2008 12:40 fax 5058899353 hull co abq insurance one 001 abu sktzs hull company albuquerque qffice p 0. box 90385 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 quqte confirmation date 12/20/07 agent insurance one incichrs insured wemer gilchrest llc tem six months 01/13/08 07/13/08 coverage ggl occurrence fom limits 5 2,000,000 gen agg 5 excluded prodicomp ops agg 5 000,000 personal adv injury 00,00o occ 00,000 fire damage legal 5,000 med pay coverage property limits loc bldg s200,000 loc 2 bldg 90,000 bldg 2 41,000 bldg 3 41,000 loc 3 bldg 1 5108,000 equipment breakdown included covers basic form excluding sprinkler leakage acv bo coinsurance deductible 51,000 deductible locations 202 cornell se abq nm 87106 208 comell se abq nm 87106 208 cornell se abq nm 87108 premium 6 3,091.00 minimum deposit premium 10 comm 5 250.00 fee fully eamed 5 100.33 state sl tax 3,441.33 total shori termpolicy fully earned g months company mt vemon fire ins co non-admitted carrier please sure check carriers best rating satisfy clients interests terms conditions include limited following terms conditions exclusions service suit product-completed ops excl cgl coverage form excl new entities contractual liabllity limitation nuclear energy liab excl additional exclusions conditions includes employment related punitive exemplaryasbestos lead absolute pollution mold fungi bacteria organic pathogens exclusions classification limitation endt premises limitation endt assault battery excl absolute liquor liab excl independent contractors excl minimum earned premium endt exclusion badily injury employees volunteer workers terporary workers casual laborers contractors subcontractors excl violation statutes govem emails faxes etc excl construction operations excl exterior work four stories absolute war terorsm excl disclosure notice terorism insurance coverage see 2nd page details premiums signed terrqrism nqiice requiredat bindingl heat warranty excl loss loss use 0f data computer hardware lunsc wio/on n hull co abq insurance one 002 01/10/2008 12:40 fai 5058899353 systems vacancy permit sprinkler leakage excl asbestos material excl lead contamination excl absalute pollution excl mold fungus bactera virus organic pathogen excl quote subject 100 fully eamed short-term 3 month policy satisfactory inspection original signed completed acord app subject t0 audit class 68806 vacant vacant buildings must fully secured locked class code 68608 vacant bldg-not factories- otnfp 5,551 quotation offered basls indicated incumbent upon t0 ascertain accuracy quote nd review applicant terms quote carefully coverage tems conditions may different irom requested please remember dealing specialty markets tespectiva forms coverage forms used may include additional exclusions andlor coverage enhancements listed specimen policy formg available review upon request 25 deposit required prior binding coverage 10 fully eamed premium minimum deposit applies balance paid within 20 days eftective date unless otherwise indicated quote ofiered requested renewal date 1/13/08 ters valid untl 1/13/08 coverage backdated presumed ta bound without confirmation authorized reprasentative hull inc_ requests bind coverage must received offce writing advised hull co inc hae recelved response expiration date af quote consider quotation closed agency binding authority therefore binders certifcates issued hull co- inc acceptance quote 0n behalf applicant confirms fully explained terms conditions foms applicant said terms conditions ard forms fully understaod applicant hull co inc representative building ftom co hullrco abq insurrance one 003 01/10/2008 12 41 fai 5058899353 disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance act 2002 amended terrorism risk insurance extension act 2005 effective december 22,2005 right purchasc insurance coverage losses oul acts terrorism defined section 102 1 acl term `` act terrorism meang act certified secretary treasury concurrence secretary state attorney general united states ~to act terrorism 9 violent act act dangerous human life property infrastructure resulted damage within unitcd states outside united states case air carrier vessel premises united states mission committed individual individuals acting behalf foreign person foreign interest part effort coerce civilian population united states influence policy affect conduct united states government coercion know coverage losses caused certtfied acts terrorism partially remmbursed unkted states formula established federal law formula united states pays 90 losses occurring 2006 85 losses occurring 2007 covered terrorism losses exceedig statutorily established deductible paid ansurance company providing coverage fremium charged coverage provided include charges portion loss covered federal government act coverage `` insured losses '' defined terrorism risk insurance act qf 2002 terrorism risk insurance extensionact 2005 amended subject tq coverage terms conditions amounts limits policy applicable losses arising events acts terrorism know federal law required purchase coverage losses caused certiied acts terrorism rejection qr selection qe terrorism insurance cqverace please `` x '' one boxes return notice company decline purchabe terrorism coverage underatand coverage losses arislng_trom acts teroriem elect purchase coverage certified acts terrorism premium note respond offer return notice company terrorism coverage thia policy applicant name authorized signature print name date triadn 1/2006 unitcd stalds insurancc company u underwriters inyurance campany mt vernon firc insurancc company arising liability

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Equipment Floter Policy||Date : 1/14/2008

hull company albuquerque qffice po box 90365 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 revised quqie confirmation date 7/22/08 agent insurance one inc chris koester insured werner gilchrest llc coverage c.g.l occurrence form limits 2,000,000 general aggregate excluded prodicomp ops aggregate 1 000,000 personal advertising injury ,000,000 occurrence 100,000 fire damage legal 5,000 medical payments coverage property vacant building limits tiv s250,000 building value basic form excluding sprinkler leakage actual cash value 80 coinsurance 1,000 deductible premium 1,145.00 minimum deposit premium 10 comm 200.00 fee fully earned 40.39 state sl tax 1,385.39 total shqrt termpolicy_fully earned 6 months company mt vernon fire ins co. non-admitted carrier please sure check carriers best rating satisfy clients interests terms conditions include limited following terms conditions exclusions service suit product-completed ops excl cgl coverage form excl new entities contractual leabieity limitation nuclear energy liab excl additional exclusions conditions includes empioymaent relatedepunitive exemplary asbestos lead absolute pollution moid fungi bacteria organic aasogens exclusions classification limitation endt premises limitation endt assault battery excl absolute liquor liab excl independent contractors excl minimum earned premium endt exclusion bodity injuryto employees volunteer workers temporary workers casual laborers contractors subcontractors excl violation statutes govern emails faxes etc excl construction operations excl exterior work four stories absolute war terrorism excl disclosure notice terrorism insurance coverage see 2nd page details premiums signed terrorismnqtice requiredat binding heat warranty excl loss loss use 0f data computer hardware systezs vacancy permit _sprinkler leakage excl asbestos material excl lead contamination excl absolute pollution excl mold fungus bacteria virus organic pathogen excl quote subject 4oo fully earned short-term 6 month policy satisfactory inspection original signed completed acord app subject audit class 68606 vacant building ail vacant buildings must fully secured locked continued page 2 hull company albuquerque qffice po box 90365 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 quotation offered basis indicated incumbent upon ascertain accuracy quote review applicant terms quote carefully coverage terms conditions different requested please remember dealing specialty markets may forms_ coverage forms used may include additional exclusions andior respective above_ specimen_policy forms available review coverage enhancements listed coverage_ 100 fully earned premium minimum upon request 25 deposit required prior binding effective date unless otherwise indicated deposit applies balance paid within 20 days quote offered requested renewal date 07/21/2008 termstareivalid 07/21/2008_ coverage backdated presumed bound without confirmaeioe authorized representative hull co inc. ail requests bind coverage must received office bresidevrised thatif hull co inc received response expiration date ifis quote consider quotation closed agency authority therefore certificates issued hull co. inc acceptance quote behalf binders fully explained terms conditions forms applicant said applicant confirms fully understood theapplicant terms conditions forms hull co. inc. representative writing- binding

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Business Policy||Date : 6/15/2009

american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 businessowners policy worksheet quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 beginning ending 12:01 a.m. locations described control date 06/15/2009 location 1 building address 1919 main street sw los lunas nm 87031 building type motel bldg cooking personal property motel bpp cooking class const code frame predominantly walls wood territory protection deductible s1,000 deductible credit 95 irpm 1 000 pro-rata fctr 1 000 liab type liab exposure liab type liab exposure gasoline sales gallons n/a motel sales s580,000 convenience store sales n/a restaurant sales n/a limit base rate sprk ftr disc acv liab prem w h ded cred irpm annual prem term premium building 1,500,000 22 70 1.00 1.00 s835 1.00 95 1.000 52,988 83,555 per s100 replacement cost value 100 sprinkler w h exclusion nj incr bldg 3145.00 150 471.750 1.000 95 1.000 s448 included liability swim pool s125 1.000 95 1.000 s119 included pers prop s250,000 31 x 70 54 n/a x 1.00 95 1.000 s278 s320 per s100 replacement cost value 100 sprinkler w h exclusion nj incr p.p 292.950 150 43.940 1.000 95 1.000 s42 included liability damage 100,000- 100,000 1.00 10 1.000 95 1.000 charge charge prem increase per 100 home office copy 06-08-09 06 dsutl page american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 businessowners policy worksheet quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 beginning ending 12:01 a.m. locations described location building l optional coverages base sprkl deduct claims annual term limit rate fctr disc acv credit free irpm premium premium employee dishonesty 10,000 employees 1.0 95 1.000 1.000 total exterior signs s5,000 5,000 95 1.000 1.000 charge charge per 100 accounts recev s25,000 -25 o0 x 95 1.000 1.000 charge charge per s100 valuable papers s25,000 25,000 95 1.000 1.000 charge charge per 100 p.p prem s25,000 95 x 1.000 1.000 charge charge hired auto coverage 1,000,000 s101 95 x 1.000 1.000 s96 s96 water back-up sump ovr s25,000 010 95 x 1.000 1.000 charge charge total building-1 premium s3 971 terrorism coverage accepted non-sfp state prod prem s3,971 rating ftr 0300 119 119 form cap735 y/n terrorism optional form total annual premium s4,090 home office copy 06-08-09 06 dsutl page 2 american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 common policy declaration quote summary quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 shown applicable policy dec larations named insured limited liab company business desc motel pool return payment premium subject terms policy agree provide insurance stated policy policy consists following coverage parts premium indicated_ premium may subject adjustment premium commercial advantage policy 4 090 comercial auto covered comercial umbrella covered estimated total premium s4 090 forms endorsements applicable coverage parts ahoo2z 03 05 declarations common policy declarations applicable together common policy conditions coverage form forms endorsements issued form part thereof complete numbered policy_ home office copy 06-08-09 06 dsutl page signature authorized representative american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 businessowners policy quote summary quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 beginning ending 12:01 a.m. locations described business description motel pool named insured limited liab company return payment premium subject al1 terms policy_ agree named insured provide insurance stated policy_ location described premises location 1 building 1919 main street sw los lunas nm 8 7031 section building bus iness personal property described premises limits liability coverage bui lding 1,500,000 coverage business personal property s250,000 optional coverages coverage limits liability employee dishonesty occurrence s10,000 exterior signs 5,000 home office copy 06-08-09 06 dsutl page 2

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Business Policy||Date : 6/15/2009

american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 businessowners policy worksheet quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 beginning ending 12:01 a.m. locations described control date 06/15/2009 location 1 building address 1919 main street sw los lunas nm 87031 building type motel bldg cooking personal property motel bpp cooking class const code frame predominantly walls wood territory protection deductible s1,000 deductible credit 95 irpm 1 000 pro-rata fctr 1 000 liab type liab exposure liab type liab exposure gasoline sales gallons n/a motel sales s580,000 convenience store sales n/a restaurant sales n/a limit base rate sprk ftr disc acv liab prem w h ded cred irpm annual prem term premium building 1,500,000 22 70 1.00 1.00 s835 1.00 95 1.000 52,988 83,555 per s100 replacement cost value 100 sprinkler w h exclusion nj incr bldg 3145.00 150 471.750 1.000 95 1.000 s448 included liability swim pool s125 1.000 95 1.000 s119 included pers prop s250,000 31 x 70 54 n/a x 1.00 95 1.000 s278 s320 per s100 replacement cost value 100 sprinkler w h exclusion nj incr p.p 292.950 150 43.940 1.000 95 1.000 s42 included liability damage 100,000- 100,000 1.00 10 1.000 95 1.000 charge charge prem increase per 100 home office copy 06-08-09 06 dsutl page american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 businessowners policy worksheet quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 beginning ending 12:01 a.m. locations described location building l optional coverages base sprkl deduct claims annual term limit rate fctr disc acv credit free irpm premium premium employee dishonesty 10,000 employees 1.0 95 1.000 1.000 total exterior signs s5,000 5,000 95 1.000 1.000 charge charge per 100 accounts recev s25,000 -25 o0 x 95 1.000 1.000 charge charge per s100 valuable papers s25,000 25,000 95 1.000 1.000 charge charge per 100 p.p prem s25,000 95 x 1.000 1.000 charge charge hired auto coverage 1,000,000 s101 95 x 1.000 1.000 s96 s96 water back-up sump ovr s25,000 010 95 x 1.000 1.000 charge charge total building-1 premium s3 971 terrorism coverage accepted non-sfp state prod prem s3,971 rating ftr 0300 119 119 form cap735 y/n terrorism optional form total annual premium s4,090 home office copy 06-08-09 06 dsutl page 2 american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 common policy declaration quote summary quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 shown applicable policy dec larations named insured limited liab company business desc motel pool return payment premium subject terms policy agree provide insurance stated policy policy consists following coverage parts premium indicated_ premium may subject adjustment premium commercial advantage policy 4 090 comercial auto covered comercial umbrella covered estimated total premium s4 090 forms endorsements applicable coverage parts ahoo2z 03 05 declarations common policy declarations applicable together common policy conditions coverage form forms endorsements issued form part thereof complete numbered policy_ home office copy 06-08-09 06 dsutl page signature authorized representative american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 businessowners policy quote summary quote 44-pb-058544-00/000 renewal new named insured mailing address agency mailing address 5345 days inn los lunas sm hospitality llc dba mark muth insurance inc 5600 glencrest lane po box 5080 orangevale ca 95662 santa fe nm 87502-5080 policy period 06/15/2009 06/15/2010 beginning ending 12:01 a.m. locations described business description motel pool named insured limited liab company return payment premium subject al1 terms policy_ agree named insured provide insurance stated policy_ location described premises location 1 building 1919 main street sw los lunas nm 8 7031 section building bus iness personal property described premises limits liability coverage bui lding 1,500,000 coverage business personal property s250,000 optional coverages coverage limits liability employee dishonesty occurrence s10,000 exterior signs 5,000 home office copy 06-08-09 06 dsutl page 2

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: commercial General liability||Date : 7/25/2009

quotation 1 americane 5600 quebec street suite 30sb greenwood village co 80111 telephone 303-751-7974 facsimile 303-745-8278 june 30,2009 insurance one inc telephone 505-888-6333 attn julia aguirre facsimile 505-888-6334 5501 eagle rock road n.e suite a3 number pages 5 albuquerque nm 87113 pleased provide following quotation response submission carrier colony insurance co company non-admitted surplus line carrier new mexico `` contract delivered surplus line coverage 'nonadmitted insurance act insurer issuing contract licensed new mexico approved nonadmitted insurer protection provisions 'new mexico insurance guaranty association act '' insured sos managed waste inc. address p.o.box 659 portales nm 88130 proposed term 07/25/2009 07/25/2010 coverages commercial general liability/occurrence form limits 2,000,000 general aggregate 2,000,000 products/ completed operations general aggregate 1,000,000 personal advertising injury 1,000,000 occurrence 100,000 fire damage 5000 medical expense deductible 500 bl/pd per claim exclusions total pollution asbestos silica dust toxic substance punitive exemplary damages lead-contamination employment related practices emplyers liability war/terrorism mold/fungi/bacteria dry-rot/wet-rot nuclear energy land subsidence professional liability others per iso company forms mandatory exclusion may apply forms list attached terrorism coverage additional 10o plus surplus lines tax desired cqverage cannoi bebqund withoul signedrejectionform_unless cqverage desired '' bind completed signed terrorism form bind order quote based expiring exposures operations binding please advise changes operations and/or exposures subject completed signed terrorism form completed signed affidavit attached american e insurance brokers page quotation page 2 american e bound amendments coverage must specifically requested approved insurance company underwriters effective issuance certificates insurance gross minimum premium 1,100.00 policy fee 150.00 note additional insured 's must submitted surplus lines tax 37.54 approval charged accordingly total 51287.54 commission 1o gross premium excluding taxes fees quote offered using carrier licensed state colorado requires maintain documentation file compliance `` due dilignce '' set forth regulation 90-14. minimum deposit premium event annual premium less minimum premium shown premium adjustable upwards rate reflected quote payment terms 20 days effective date subject minimum retained 25 flat cancellations fees 10o retained inception return premiums financed policies remitted directly finance company retailer responsible return unearned commission quotation based upon fax mail /or telephone advices insurer issued american e 5 insurance brokers inc without liability whatsoever insurer insurance subject terms conditions policy cover note may issued terms conditions quotation may broad requested submission carefully read terms conditions contained above_ quotation shall effective 30 12:01am standard time date quote requested effective date whichever occurs first look forward receiving written instructions appreciate interest facility thank opportunity quote renewal behalf elena kingsland renewal underwriter melissa bernard cic ctsr underwriting manager/broker ext.228 mbernard aesbrokerscom elena_kingsland aesbrokerscom ek american e insurance brokers prior days policyholder disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance act amended right purchase insurance coverage losses resulting acts terrorism defined section 102 1 act term `` act terrorism '' means act certified secretary treasury concurrence secretary state attorney general united states act terrorism violent act act dangerous human life property infrastructure resulted damage within united states outside united states case certain air carriers vessels premises united states mission committed individual individuals part effort coerce civilian population united states influence policy affect conduct united states govemment coercion shquld know coverage provided policy losses resulting certified acts terrorism losses may partially reimbursed united states government formula established federal law however policy may contain exclusions might affect coverage exclusion nuclear events formula united states government generally reimburses 85 covered terrorism losses exceeding statutorily established deductible paid insurance company providing coverage premium charged coverace provided include charges portion loss covered federal government act alsq know terrorism risk insurance act amended contains 100 billion cap limits u.s. government reimbursement well insurer 's liability losses resulting certified acts qf terrorism amount losses one calendar year exceeds 100 billion aggregate insured losses insurers exceed 100 billion coverage may reduced please also aware policy nqi provide coverage acts terrorism certified secretary treasury acceptance reiection terrorism insurance coverage must accept reject insurance coverage losses arising acts terrorism defined section 102 1 act effective date policy your_coverage be_bound unless representative_has received form signed yol behalf alllinsureds allpremiums due coverage acceptance hereby elect purchase coverage certified acts terrorism defined section 102 1 act prospective annual premium iq understand coverage losses resulting non-certified acts terrorism coverage rejection hereby decline purchase coverage certified acts terrorism defined section 102 1 act understand coverage losses arising either certified non-certified acts terrorism_ colony_insurance company_ policyholderiapplicants signature- insurance company must person authorized sign insureds print name policy number s8 mamcle woske submission number namel insured producer number date producer name street address state zip producer shown wholesale insurance broker insurance agent used place insurance coverage us_ please discuss disclosure agent signing triazooznotice-0108 page 1 1 city producing broker affidavit required hy nmba 1978 section 594-14-1ib name ofproducing broker_ address ofproducing braker duly iwdrn iaftrm irs engaged obtatn following policy instet pallcy number type coverege_ eftlective dates checkeither b beloj ppropriate 1 diligept cerch ifound fl amoutor typeof insurance requested could notbe obtained tron authorized insurers j nel merco within lest year ihave tried placethis- coverage witt jeast fobr esurersauthorized ia new mexico including insurers bot `` ppointed therefote tnon trom substential tecent experience thas coveruge oblalned frum iny juthorizcd insurcr newv merica 3 ietrtisly `` dvised lnsuredprtor placing iesurance insurance policy statcs te insurer rith thon insurahce placed fs hot ar anthorized insuter new merico js subject t0 jupervision af superintendent f inurance intbe cvent fbe insurer becomes insolyent cains new mexdco guatenty tssociaton ibave ked insured ta best horledge coverage replacing eristing coveragc fron jnfhorized insuret ras rilling continve providing cupeiage ian jicensed nerr merico department insurance thetye covernge pruvided information n forn true correct end h cmpliance fith spplicable puvisiatis ner merico insurance code rule signature date mating= type peid 1 certify

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: General liability||Date : 1/31/2009

`` insurance commercial premium finance agreement eirstl disclosure statement ifunding corp quote number 000000722875 insurediborrower name address shown policy total premium 57,587.07 artistic homes inc b cash payment required 5 17,075.82 4420 tower rd sw albuquerque nm 87121 unpaid premium balance 40,511.25 telephone number 505 247-8400 focuppeictoie sraonigafax 0.00 direct correspondence amount financed amount credit provided behalf 40,511.25 agent broker name business address 08578-0025 insurance one finance charge dollar amount credit cost 1,171.89 5728 osuna ne total payments amount paid making scheduled payments 683.14 albuquerque nm 87109 annual percentage rate cost credit figured yearly rate 6.890 telephone number 505 888-6333 fid 015 payment schedule see schedule attached lender first insurance funding corp 450 skokie blvd suite 1000 number payments due amount p.o_ box 3306 payments monthly payment first northbrook il 60065-3306 telephone 8003 837-3703 fax 837-3709 beginning 01/31/2009 4,631.46 prepayment insured may prepay full amount due late late charge imposed payment receive refund unearned interest provided payment received first within five 5 days due date unless page 2 agreement longer grace laericqe specified applicanbye law case charge imposed security security made insured received first within grace periady late assigns first insi bayxect funding corp herein charge overdue amount orthe maximum referred `` first security interest return fre maaigem petectearges 32863b181 de lavt anachgver less premiums dividend payments_ certain loss baxdeente reference pogies listed contract reference made terms certain conditions first right reference stated fintosmagoeemenb cancel financed policies provided page 2 canzedetion right demand agreement omayate paymeelanitull prepayment prn 123108 cfg 08578-0001 rt 085 8opt2-15 crd n/a bp bill p/f:171.18 sub 003103 schedule policies policy number full name insurance company name type policy term effective date policy prefix address general agent insurance months mo_ yr. premiums company office premium paid tbd 75530-002 probuilders spec ins co rrg gl 12 12-31-2008 54,015.00 003103 western pacific insurance network 25.000 cx 10 fin txsifees 0.00 au ern txsifees 3,572.07 notice see page 2 important information total premiums 57,587.07 provisions page 2 incorporated reference constitute part agreement record `` '' insured 's agreement agent broker representations warranties consideration premium `` amount financed '' undersigned agent broker read agentibroker made captioned a8exerts broker first named insured representations warranties completed herein referred 'insured '' promised payseto bye order first total copies makes payments subject provisions forth pages regeesentations warranties sequeiceced herein agreement undersigned agent broker agrees pay reasonable notice insured attorney fees courts costs collection costs 1 sign agreement incurred first recovering amounts due the_agent read pages broker connection breach agentibroker blank spaces_ representations warranties iredemniof first eottaeas zled-8l copy losses first incurs result error agreement committed rthon oqeigt/r0k completing sailingr rig 2 pay name insured print type complete portion agreement advance full amount due certain conditions obtain refund service charge signature agent broker b rer copy agreement signature legal rights title date title date fif st 0206 41 e paxtienn bsl day page korhiet el under_ fawin keep additional provisions premium finance agreement warranty accuracy_ insured represents warrants first interest due cancellation_ extent permitted applicable law insurance policies listed schedule policies full force cancellation occurs insured agrees pay first interest balance due effect insured assigned any_interest policies except contract rate maximum rate allowed applicable law whichever less_ interest mortgagees loss payees insured represents balance paid full date provided applicable iaw warrants first none insurance policies listed schedule policies personal family household purposes ii right demand immediate payment full time default first insured indebtedness insurers issuing listed policies none demand right receive immediate payment total unpaid insurers asserted claims payment insured amount due agreement even first received refund unearned premium_ representation solvency_ insured represents insured cancellation charge default insured results cancellation ofany insolvent presently subject insolvency proceeding_ insurance policy listed schedule policies insured pay first charge equal maximum charge permitted law collateral_ secure payment amounts due agreement insured grants first security interest policies including return assignments_ insured may assign policy without first 's written consent premiums_ dividend payments_ loss payments reduce unearned however first 's consent needed add mortgagees persons loss premiums subject mortgagee loss payee interest payees_ first may transfer rights agreement anyone without consent insured right cancel insured make payment due insured otherwise default agreement first may cancel collections attorney fees_ first may enforce rights collect policies act insured 's place regard policies including amounts due without using security interest granted agreement endorsing check draft_issued insured 's name funds assigned first uses attorney salaried empisvag first incurs first security herein right given insured first constitutes collection costs collect money owed agreement insured agrees `` power attorney '' first cancels policies first provide reasonable attorney fees court costs collection costs incurred notice insured required law insured right paxsteaconabeceecozoegercensof tneramoostedue payable agreement cancel insured granted bto first ageesevaed first's.right cancel terminate insured 's indebtedness prepayment time insured reay pad entire amount still ueraid agreement paid full insured pafinance f chargeaico amount due insured receive unearned computed actuarial method rule 78's_ default_ insured default agreement payment permitted fon gendobiancervicalee law_ refund subject maximum received first due b insured insurance companies service fee permitted applicable iaw refund made amount refunded less s1.00 insolvent involved bankruptcy similar proceeding debtor c insured fails comply terms agreement insurance audit reporting form policies regard policy schedule companies cancel coverages e premiums increase policy listed policies auditable form type_ insured agrees agreement insured fails pay increased premium within thirty pay insurance company ceperenge actua earned premrum 30 days notification_ f insured default agreement generated policy premiums financed agreement first wherever word `` default '' used this_agreement means one above_ insured default first finance charge finance charge earliest effective date ebrigatioa afraerente premiums insured 's behalf policies listed schedule policies sbetgons finance charge includes interest may pursue remedies provided agreement may include non-refundable service fee equal maximum fee permitted applicable law finance charge computed using 365 day year late charges late charge imposed payment received first within five 5 days due date unless longer agent broker agent broker_handling agreement agent period specified applicable aw case late charge rwrace broker first legally bind first way imposed payment received first within grace period permissible law portion finance charge may paid first late charge 5 overdue amount maximum iate charge agent broker executingthis agreement payment forghe servicesain rendering tne permitted applicable law whichever less maximum late charge beadireczedf insurance premiums_ questions payment s5.00 de mt nd_ agent broker dishonored check fee insured 's check dishonored corrections first may insert names insurance companies pelicys reason permitted law insured pay first dishonored check numbers known time insured signs agreement first authorized correct patent errors omissions agreement fee equal maximum fee permitted law effective date agreement become effective accepted payments received notice cancellation_ notice writing first_ cancellation sent insurance company first duty rescind ask policy reinstated even first later receives governing law agreement governed interpreted laws insured 's payment payments first receives sending notice state first accepts court finds part cancellation applied insured 's account without changing invalid tiindhig aqaemenaffecf remainder ans pagreemenis first 's rights agreement 3rgelaent words agreement shall mean plural vice versa may required give agreement meaning_ north carolina department insurance permit first 's rights policies cancelled_ policy b-482_ cancelled whether insured first anyone else first right receive unearned premiums funds assigned first security signature acknowledgment insured signed_ agreement herein apply insured 's unpaid balance agreement received copy ofit insured corporation the_person signing officer agreement insured first amount '' received corporation authorized sign agreement insured corporation amount owed insured excess amount refunded insureds listed policy signed insured amount received less amount owed insured insured pay first balance due first may act insured 's place liability insured understands agrees first liability insured whatever necessary collect refunds insurance comm person entity upon exercise first 's right cancellation except whatever first tells regarding policies 'pavies igey event willful intentional misconduct first proof insured anyone else_ agent broker representations warranties signatures genuine best knowledge insured 's signature depositiprovisional premiums_ audit reporting form policies policies iaehrezationirecognition subject retrospective included noted section insured authorized transaction deposit provisional premiums agesempoli_ less insured agentibroker recognize security interest granted anticipated premiums earned €he fullfterm oftinee `` polcicies herein pursuant insured assigns first unearned premium dividends certain loss payments upon cancellation policies loss payees named policies provide premium may earned listed schedule policies agentibroker agrees videnediated/ pay earlier event loss noted section b andlor first unearned commissions unearned premiums dividends loss agentibroker notified relevant insurance companies insured first payments received funds remitted first within 10 days named loss payee policies_ receipt agentibroker agentibroker agrees pay first interest funds maximum rate allowed law authorized issuing agent scheduled policies agentibroker either policies effectiveipremiums `` correerlicabe policies listed schedule insurance companys authorized policy issuing agent broker placing policies full force effect premiums correct listed coverage directly insurance company except name address insured document_ insured given copy issuing agent general agent listed schedule policies_ agreement insolvency best knowledge neither insured amounts due insured cash payment installments due insurance companies insolvent involved bankruptcy similar insured collected insured_ proceeding debtor except clearly indicated page 1 agreement scheduled policies agent broker warrants policies auditable reporting form policies policies subject policy number retrospective rating except policies listed right indicated exceptions comments schedule policies b policies subject minimum earned premium except policies listed indicated schedule policies minimum earned 9emoums listed policies b c ail policies provide unearned premiums computed standard short rate pro rata poabiesexcept policies listed right indicated c schedule policies contain provisions prohibit cancellation either insured insurance indicgeed col within scheala ia p8lcept policies listed right fif st 0206 pay may rely rating ten

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: General liability||Date : 15-Sep-19

westernpacific insurance proposal illustration date september 15,2009 producer insurance one kelly jenkins name insured accurate roofing operations roofing residential coverage quoted commercial general liability insurance company first mercury insurance company best 's rating a- vi policy term 12 months proposed eff date 9/16/09 quote terms pleased offer following consideration general liability coverages general aggregate 2,000,000 products-completed opera tions aggregate 2,000,000 personal advertising injury 1,000,000 occurrence 1,000,000 fire damage one fire 50,000 medical expense one person 5,000 deductible _bipd per claim including lae 5,000 premium basis estimated gross receipts 300,000 minimum earned premium 25 1 minimum audited premium estimated annual premium minimum deposit premium credit audit audit rate 31.66668 est annual premium 9,500.00 co processing policy fee fully earned binding 300.00 premium tax 3.003 307.81 broker fee fully eamed binding 350.00 surplus lines tax filing fee 100.00 total premium 10,557,81 estimated deposit 25 +100 fees 3,432.81 audit adjustment upward premium minimum deposit policy term quotation quo01519oo effective 09/15/09 mainpolicy classification 2 98678-roofing-residential rate exposure basis minimum premium class premium audit 531.86670 300,000 per 1,000 receipts 89,500.00 s9,500.00 annual audit exposure base deemed less shown quote needs resubmitted rate used quoted lower exposure base except prior approval coverx pqlicy forms cg 00 01 07/98 commercial general liability coverage form cg 00 57 09/99 -amendment insuring agreement-known injury damage cg 00 67 0315 exclusion-volation statutes govern emails fax cg 21 4901/96 total pollution exclusion endorsement cg 21 54 01/96 exclusion designated ops covered consolid wrap-up cg 22 79 01/96 exclusion contractors-professional liability cg 24 26 07/04 amendment insured contract definition cl 701 10/93 employment-related practices exclusion cvx-gl-0301 04/91 oeductible liability insurance cvx-gl-o8o0 02/06 amendment premium endorsement cvx-gl-iooia 09002 exclusion mold fungi bacteria cvx-gl-1002 09/02 terrorism exclusion cvx-gl-5000 o7rzo00 designated work excl ext insul finish systems cvx-gl-5002 07/2000 aircraft products grounding exclusion cvx-gl-5018 07/2000 lead exclusion endorsement cvx-gl-5033 022004 exclusion leased workers temp workers injury cvx-gl-5052 09104 roofing operations endorsement cvx-gl-5054 08004 exclusion asbestos silica dust toxic substances cvx-gl-5086 05/04 continuous progressive injury damage exclusion cvx-gl-5087 09/04 basis premium endorsement cvx-gl-5068 12104 excl-independent contractors employeesleased workers fmic claim notification 1216 fmic-legal '198 service suit gu 267 11/85 common policy conditions gu 481 11/94 nuclear energy liability exclusion endorsement broad form cg 20 33 07004 additional insrd-auto status req const agree cg 24 04 10/93 waiver trans rights recovery others additional requirements 'no deposit required agency bill important notice page 3 4 accurate roofing conditions completed signed application acord 125 2. signed terrorism electionirejection statement see following 3 s300 company processing fee fully earned binding 4 currently valued loss runs 04/05 05/06 06/07 07/08 years special notes 25 minimum earned premium inception 100 minimum earned premium policy period deductible includes indemnity lae coverage bound requested documenta tion provided quotation expires october 15,2009 agent commission 10.00 page 4 4 accurate roofing section iv terrorism cqverage terrorism coverage premium charge 380.00 note lo agenl required federal law provide document 0 dhe insured applicant policyholder disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance act of2002 tria extended december 22,200s right purchase insurance coverage losses arising ofacts terrorism defined seclion 102 1 act term `` certified act terrorism '' means act certified secretary treasury concurrence secretary state attorney general united states act terrorism violent act act dangerous human life property infrastructure resulted datage united stafes outside united states case air carrier vessel premises ofa united states mission committed individual individuals behalf foreign person foreign interest part effort coerce civilian population untied states influence policy affect conduct united states govemment coercion_ notice government reinsurance participation know coverage losses caused `` certified acts terrorism '' partially reimbursed united states formula established federal law tria formula united states pays 90 gradually reduced 85 2007 covered terrorism losses exceeding statutorily established deductible insurance company providing coverage premium coverage shown elsewhere information disclosure include charged portion loss covered federal government act accordance act right choose accept reject coverage scertified acts terrorism '' hereby elect purchase certified terrorism coverage act prospective premium hereby reject purchase certified terrorism coverage policyholder applicant signaturc named insured fim print name dale acting paid

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Workers' Compensation||Date : 28-Aug-09

new mexico mutual august 28 2009 insurance one inc. 5501 eagle rock ne ste a-3 albuquerque new mexico 87113 severiano hernandez policy 44742.105ar attached renewal proposal policy adjusted payrolls based factors inflation audits inspections changes operations wish nmmcc renew policy must receive following prior effective date shown attached quote check money order bank draft made nmmcc amount total estimated annual premium cash required renewal deposit shown attached quote receive appropriate premium prior expiration date may suffer lapse coverage please contact agent questions thank new mexico mutual enclosure cc severiano hernandez 5805 1/2 tunnel sw albuquerque new mexico 87105 po box 27825 albuquerque nm 87125 main office 505-345-7260 toll free 800-788-8851 www newmexicomutual.com wcip new mexico mutual quote insurance one inc. 5501 eagle rock ne ste a-3 albuquerque new mexico 87113 phone 505-888-6333 fax 505-888-6334 renewal 44742.104ar date 08/28/2009 address severiano 5805 1/2 tunnel sw hernandez dbaaccurate roofing city state zip code albuquerque new mexico 87105 policy period new mexico mutual casualty company 08/30/2009 08/30/2010 insured insurance company severiano hernandez dbaaccurate new mexico mutual casualty company roofing quote valid insured fein 850413985 10/29/2009 quote 08/28/2009 based information provided subject annual audit quote 60 days beyond effective date however coverage backdated employers liability limit 100,000/500,000/s100,000 deductible premium information new mexico classification code description rate annual payroll manual premium 5551 roofing kinds s39.03 045 s1,188 drivers manual premium new mexico s1,188 increased limits deductible account experience modifier arap cpap credit aircraft surcharge assigned risk surcharge s119 premium discount s-6 waiver subrogation fee expense constant s230 terrorism risk act s1 total estimated premium new mexico s1,532 total estimated premium s1,532 new mexico mutual group nmmg pleased offer workers compensation quote new mexico mutual nmmg rated a- excellent a.m. best company good s3 group payment plan 65 semi-annual report cash required renew policy 996 please send amount new mexico mutual p.o 27805 albuquerque nm 87125-7805 box

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Business owners Policy||Date : 7/12/2010

american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 quote summary quote 44-pb-460786-01/003 renewal 44-pb-460786-0 named insured mailing address agency mailing address 3110 days inn los lunas sm hospitality llc dba insurance one inc 5600 glencrest lane 6751 academy rd ne ste orangevale ca 95662 albuquerque nm 8 7109 policy period 07/30/2010 07/30/2011 shown applicable policy dec larations named insured limited liab company business desc motel return payment premium subject terms policy agree provide insurance stated policy policy consists following coverage parts premium indicated_ premium may subject adjustment premium commercial advantage policy 3 765 comercial auto covered comercial umbrella covered estimated total premium s3 765 forms endorsements applicable coverage parts ahoo2z 03 05 declarations common policy declarations applicable together common policy conditions coverage form forms endorsements issued form part thereof complete numbered policy_ agent copy 07-12-10 06 rbela page signature authorized representative american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 quote summary quote 44-pb-460786-01/003 renewal 44-pb-460786-0 named insured mailing address agency mailing address 3110 days inn los lunas sm hospitality llc dba insurance one inc 5600 glencrest lane 6751 academy rd ne ste orangevale ca 95662 albuquerque nm 8 7109 policy period 07/30/2010 07/30/2011 beginning ending 12:01 a.m. locations described business description motel named insured limited liab company return payment premium subject al1 terms policy_ agree named insured provide insurance stated policy_ location described premises location 1 building 1919 main st nw los lunas nm 8 7031 section building bus iness personal property described premises limits liability coverage bui lding 1,976,000 coverage business personal property s250,000 optional coverages coverage limits liability employee dishonesty occurrence s10,000 exterior signs 15,000 agent copy 07-12-10 06 rbela page 2 american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 quote summary quote 44-pb-460786-01/003 renewal 44-pb-460786-0 named insured mailing address agency mailing address 3110 days inn los lunas sm hospitality llc dba insurance one inc 5600 glencrest lane 6751 academy rd ne ste orangevale ca 95662 albuquerque nm 8 7109 policy period 07/30/2010 07/30/2011 beginning ending 12:01 a.m. locations described optional coverages coverage limits liability accounts recejvable coverage occurrence s25,000 valuable papers coverage s25,000 personal property premises coverage s25,000 hired auto coverage included water back-up sump overflow s25,000 deductible location covered causes loss unless otherwise indicated s2,500 total building-1 premium s3 529 section ii bus iness liability medical payments limits liability business liability s1,000,000 occurrence medical payments s5,000 person damage premises rented 100,000 occurrence agent copy 07-12-10 06 rbela page 3 american hallmark insurance company texas 777 main st ste 1000 fort worth tx 76102 quote summary quote 44-pb-460786-01/003 renewal 44-pb-460786-0 named insured mailing address agency mailing address 3110 days inn los lunas sm hospitality llc dba insurance one inc 5600 glencrest lane 6751 academy rd ne ste orangevale ca 95662 albuquerque nm 8 7109 policy period 07/30/2010 07/30/2011 beginning ending 12:01 a.m. locations described additional insured blanket additional insured cbp041 agent copy 07-12-10 06 rbela page 4

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Commerical Property Policy||Date : 12/16/2011

quote number 2127372 uca general insurance services `` service strength '' 6363 katella ave. cypress ca tel 714-228-7888 fax 714-228-7855 license 0670192 attention cindy millikan date 09/08/2010 agency insurance one inc_ commission 10.00 named insured address asn llc quality inn econoldge 25 hotel circle ne albuquerque nm 87112 quote number 2127372 company xl specialty insurance company umbrella policy period 09/25/2010 09/25/2011 umbrella quote based solely information submitted commercial umbrella acord application umbrella limits insurance 5,000,000 occurrence limit liability coverage personal advertising injury limit one person organization 5,000,000 aggregate limit liability coverage except respect `` covered autos '' self-insured retention 10,000.00 occurrence umbrella premium 2,500.00 fee 0.00 total 2,500.00 underlying insurance commercial general liability 1 occ iaggregate limits commercial auto liability combined single limit employer 's liability accident/each employeelaggregate liquor liability common cause aggregate business owners liability liability medical expense limit umbrella quote valid 30 days date letter subject following exclusions exclusions_under coveragea b asbestos fungi bacteria silica silica related lead medical expense payments nuclear energy pollution um coverage property damage exclusions_under_coverage bonly advertising injury alcoholic beverages punitive damages contractual liability property damage productlwork employee injury expected intended impaired property personal injury remarks coverage certified acts terrorism added quote premium 25.00 subject terrorism coverage must purchased underlying policy sincerely carole ashton quote number 2127372 uca general insurance services `` service strength '' 6363 katella ave. cypress ca tel 714-228-7888 fax 714-228-7855 license 0670192 uca ez-pay direct bill worksheet please find information broker need set account uca 's new ez-pay system required collect full payment amount well fees allowed retain full annual commission send remaining amount uca indicated net payment due mandatory payment collected broker sent uca effective date policy bill payment please send copy worksheet along binding request net payment summary qf pqlicy quote 2127372 expiring policy pup2000798-01 named insured asn llc dba quality inn econoldge billing address 25 hotel circle ne albuquerque nm 87112 please note billing address incorrect please write correct address area provided address invoices notices sent correct billing address accounting break premium 2,500.00 fees 0.00 total premium 2,500.00 gross payment amount collected time binding 625.00 annual commission earned broker 250.00 net payment due upon binding gross payment less annual commission 375.00 quote number 2127372 uca general insurance services `` service strength '' 6363 katella ave. cypress ca tel 714-228-7888 fax 714-228-7855 license 0670192 policyholder disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance act amended right purchase insurance coverage losses resulting acts terrorism defined section 102 1 act term `` act terrorism means act certified secretary treasury_in concurrence secretary state attorney general united states-to act terrorism violent act act dangerous human life property infrastructure resulted damage within united states outside united states case certain air carriers vessels premises united states mission committed individual individuals part effort coerce civilian population united states influence policy affect conduct united states government coercion_ know coverage provided policy losses resulting certified acts terrorism losses may partially reimbursed united states government formula established federal law however policy may contain exclusions might affect coverage exclusion nuclear events formula united states government generally reimburses 85 covered terrorism losses exceeding statutorily established deductible paid insurance company providing coverage premium charged coverage provided include charges portion loss may covered federal government act also know terrorism risk insurance act amended contains 100 billion cap limits u.s. government reimbursement well insurers liability losses resulting certified acts terrorism amount losses one calendar year exceeds 100 billion aggregate insured losses insurers exceed 100 billion coverage may reduced acceptance rejection terrorism insurance coverage hereby elect purchase terrorism coverage prospective premium s25.00 hereby decline purchase terrorism coverage certified acts terrorism understand coverage losses resulting certified acts terrorism policyholderiapplicant 's signature insurance company 2127372 print name quote number date includes copyrighted material national association insurance commissioners permission_ pn160 12 07

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Commerical Property Policy||Date : 7/11/2011

pacific excess insurance underwriters az inc 8777 evia de ventura suite 135 scottsdale az 85228 joanne malin fhone 602 942-0292 ext kelly mancha fax 480 922-1347 email jmalin pacificexcesscom date 12/16/2011 agency insurance one inc company century surety company loma verde motel hafiz investments best rating a-excellent quote reference 781748 col reference number 764370 quoteforinsurance rroposed policy efective dates 12-16-2011 12-16-2012 pleased offer following quote coverage detailed information line coverage isattached fease review thisquotation detail ensure fully understood needs general liability 500.00 rroperty 860.00 inspection fee 150.00 sa taxes 45.35 total amount 1,555.35 commission 10.00 quotation subject thefollowing favorable inspection updated lossletter april 1,2011to date coverage bound explanation asto gone without coverage since april 2011 sgned acord application thisquote valid 3/15/2012 quote isbased information provided timeof quote renewal offersare valid expiration current policy term thisisaquote isonly coverageslisted may conform application specifications submitted flat cancellations thispolicy premium is25 earned inception thank opportunity quote business janne malin underwriter/ broker produced century insurance group turn www centurysurety.com 465 cleveland avenue westerville oh 43082 page 1 6 pacific excess insurance underwriters f az inc 8777 evia de ventura suite 135 scottsdale az 85228 loma verde motel hafiz investments date 12/16/2011 col reference number 764370 commercial property quote location7 iocation description cnstruction protection haswindthail bldg cass exclusion 1/1 7503 central avenue ne albuquerque nm 87108 building bisted masonry 1/2 7503 central avenue ne albuquerque nm 87108 building 2 bisted masonry deductible applies per premises ocationt cde coverage u0 vaaluation aop ded_ theft ded cause loss limit rate premium bldg type insurance basis special form excluding 1/1 0746 building 1,000| cov 90 acv 120,0001 000.3101 5 372| theft business income extra secial form excluding 1/1 0746 cov 1/6 monthly 26,0001 000.327 851 expense including rental theft business personal secial form excluding 1/1 0746 1,000 cov 90 acv 9,0001 000.3101 28 froperty theft secial form excluding 1/2 0745 1,000 cov 90 acv 100,0001 000.310 s310 theft business income extra secial form excluding 1/2 0745 cov 1/6 monthly 14,000| 000.327 46 expense including rental theft business personal secial form excluding 1/2 0745 1,000 cov 90 acv 6,0001 000.3101 19 froperty theft subtotal coverage premium 860 tria premium total coverage premium 860 required protective safeguards loc/bldg symbol requirements il 0415- rotective safeguard endorsement fully functional actively engaged smoke detectors 1/1,1/2 pg complying local building code unitsand hallways page 2 6 building pacific excess insurance underwriters az inc 8777 evia de ventura suite 135 scottsdale az 85228 loma verde motel hafiz investments date 12/16/2011 col reference number 764370 general liability quote coverage type per ocurrence limits general aggregatelimit foducts completed operations s2,000,000 foducts completed operationsaggregate limit included general aggregate personal advertising injury limit 1,000,000 ocurrencelimit 1,000,000 damageto femisesrented limit 100,000 medical expenselimit 5,000 defense defense addition policy limits deductible 500 combined biifd per aim defense included deductible yes deductible shall reducepolicy limits rate advanced premium st/terr gl code classification prem basis prem ops_ prico prico aii nm/oo1 45192 hotelsand motels-without poolsor beaches-less 80,000 6.168 ind ind 5493 four stories subtotal general liability premium 500 mp notes premium line business subtotal premium 5 50 tria premium= total coverage premium 5001 subtotal coverage premium shown may include coverage type minimum femium legend area c cost admissions 0 total operating expenses p payroll sales u units produced century insurance group turn www centurysurety.com 465 cleveland avenue westerville oh 43082 page 3 6 pacific excess insurance underwriters az inc 8777 evia de ventura suite 135 scottsdale az 85228 loma verde motel hafiz investments date 12/16/2011 col reference number 764370 policy forms interline forms required ccp2010 05 08 service suit cause cil 1500b02 02 schedule formsand endorsements cscp 1000 02 04 century surety company policy jacket cscp 1001 05 09 century urety company common policy declarations il 0003 09 08 calculation femium il 0017 11 98 common policy conditions prv 0001 11 09 frivacy satement tria 0001 10 08 pblicyholder disclosure notice terrorism general liability policy forms required cgooo1 12 07 commercial general liability coverage form cg0068 05 09 recording distribution material information violation law exclusion cg0300 01 96 deductible liability insurance cg2146 07 98 abuse molestation exclusion cg2147 12 07 employment-related factices exclusion cg2165 12 04 total follution exclusion wth building heating cooling dehumidifying equipment exception hostile fire exception cg2175 06 08 exclusion certified actsof terrorism exclusion actsof terrorism committed outside united states cg2176 01 08 exclusion punitive damages related certified act terrorism cg2184 01 08 exclusion certified nuclear biological chemical radiological actsof terrorism cap lossesfrom certified actsof terrorism cg2196 03 05 slica sllica-related dust exclusion cg2245 07 98 exclusion-secified therapeutic cosmetic services ccl 1500 04 07 century insurance goup commercial general liability declarations ccl 1701 05 10 secial exclusionsand limitations endorsement ccl 1704 02 06 exclusion-assault battery ccl 1709 03 01 exclusion-swimming pool ccl 1711a09 11 cassification location limitation endorsement ccl 1714 09 04 exclusion firearms ccl 1723 08 08 exclusion-dogs ccl 1736 10 11 exclusion bed bugs ccl 1812 05 01 exclusion past liabilities ccl 1852 03 11 past fojects foperty damage exclusion il 0021 09 08 nuclear energy liability exclusion endorsement broad form produced century insurance group turn www centurysurety.com 465 cleveland avenue westerville oh 43082 page 4 6

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: General liability||Date : 9/7/2011

pacific excess insurance underwriters az inc 8777 e via de ventura suite 135 scottsdale az 85228 joanne malin phone 602 942-0292 ext chris koester fax 480 922-1347 email jmalin pacificexcess.com date 07/11/2011 agency insurance one inc company century surety company loma verde motel hafiz investments a.m best rating a- excellent quote reference indication col reference number 681178 finalize letter quote insurance proposed policy effective dates 07-18-2011 07-18-2012 pleased offer following quote coverage detailed information line coverage attached please review quotation detail ensure fully understood needs remove general liability 500.00 property 61200 inspection fee 150.00 sla tax 37.90 total amount 1,299.90 commission 10.00 quotation subject following indication only- need following additional information order offer firm quote ~supplemental app need bottom half page 2 completed occupied type wiring etc ~prior carrier info 3 year loss info filled acord app ~need verify insured financially sound foreclosure bankruptcy pending willneed current favorable financial information single page profit/loss statement balance sheet fine within 30 days binding building values need verified explained based information provided acord app current valuation per square foot isas follows building 1 3951 sq ft building 2 55.83 sq ft business income need verification als offered carrier quoted 40,000 limit 1/6 mo llimitation based est ann sales applied s26,000 loc 65 14,000 loc 2 35 currently insured ifnot need signed known loss letter period date previous policy expired date coverage requested bound remarks non bindable indication need addl u/w info quote quote valid 10/9/2011 quote based information provided time quote renewal offers valid expiration current policy term quote coverages listed may conform application specifications submitted flat cancellations policy premium 25 earned inception thank opportunity quote business produced century insurance group turn www centurysurety.com 465 cleveland avenue westerville oh 43082 page 1 7 pacific excess insurance underwriters az inc 8777 e via de ventura suite 135 scottsdale az 85228 joanne malin phone 602 942-0292 ext chris koester fax 480 922-1347 email jmalin pacificexcess.com date 07/11/2011 agency insurance one inc company century surety company loma verde motel hafiz investments a.m best rating a- excellent quote reference indication col reference number 681178 joanne malin underwriter/broker produced century insurance group turn www centurysurety.com 465 cleveland avenue westerville oh 43082 page 2 7 pacific excess insurance underwriters az inc 8777 evia de ventura suite 135 scottsdale az 85228 loma verde motel hafiz investments date 07/11/2011 col reference number 681178 commercial property quote locationp location description construction protection windmhail bldg class exclusion 1/1 7503 central avenue ne albuquerque nm 87108 building joisted masonry 1 /2 7503 central avenue ne albuquerque nm 87108 ibuilding 2 joisted masonry deductible applies per premises location code coverage co valuation aop ded theft ded_ cause loss limit rate premium bldg type insurance basis special form excluding 1/1 0746 building 1,0001 cov 90 f acv 80,0001 000.310 248 theft business income extra special form excluding 1/1 0746 cov 1/6 monthly 26,000 000.327 585 expense including rental theft business personal special form excluding 1/1 0746 ,0001 cov 90 acv 9,0001 000.310 28 property theft special form excluding 1/2 0745 building 1,0001 cov 90 acv 60,000 000.310 186 theft business income extra special form excluding 1/2 0745 cov 1/6 monthly 14,000 000.327 46 expense including rental theft business personal special form excluding 1/2 0745 1,0001 cov 90 acv 6,000 000,310 19 property theft subtotal coverage premium 612 tria premium total coverage premium 612 ke loc /bldg symbol rrequirements 0415 protective safeguuardlendorsement 1/1 1/2 p-9 fully functional actively engaged smoke detectors complying local building code units hallways_ pu12im burglary andirobbery endorsement page 3 7 pacific excess insurance underwriters az inc 8777 e via de ventura suite 135 scottsdale az 85228 loma verde motel hafiz investments date 07/11/2011 col reference number 681178 general liability quote coverage type per occurrence limits general aggregate limit products completed operations 2,000,000 products/completed operations aggregate limit included general aggregate personal advertising injury limit 1,000,000 occurrence limit 1,000,000 damage premises rented limit 100,000 medical expense limit 5,000 defense defense addition policy limits deductible 500 combined bi/pd per claim defense included deductible yes deductible shall reduce policy limits rate advanced premium stfterr gl code classification prem basis prem ops prico prico nmoo1 45192 hotels motels-without pools beaches-less 5 80,000 6.168 incl 493 four stories subtotal coverage premium 5 500 mp notes premium line business subtotal premium 50 '' tria premium total coverage premium 5 500 subtotal coverage premium shown may include coverage type minimum premium legend area cost admissions total operating expenses p payroll sales u units produced century insurance group turn www centurysurety.com 465 cleveland avenue westerville oh 43082 page 4 7

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Package Policy||Date : 22-Dec-11

neff risk services inc. po box 90365 po 26142 po box 10367 albuquerque nm 87199 scottsdale az 85255 kalispell mt 59901 quqte date 09/07/11 agency insurance one kelly mancha john roberta stack policy term annual commercial general liability coverage occurrence form 2,000,000 general aggregate sincluded products-completed operations aggregate 1,000,000 occurrence 1,000,000 personal advertising injury 100,000 fire damage 5,000 medical payments 500 deductible gl class code 49451 vacant land otnfp exposure 1.75 acres 2 acres used rating premium 500.00 gl premium 25 minimum earned 10 commission 150.00 policy fee fully earned 19.52 nm surplus lines tax 669.52 grand total montpelier us insurance company non-admitted carrier ensure interests clients met please check carrier 's m_ best rating binding conditions required bind 1 faxed emailed bind request backdating flat cancellations 2 requested paperwork signed acord application full net payment due within 20 days binding 3 tria offered 150.00 completed tria form must received prior policy issuance 4 written confirmation course policy term plans type real estate development 5 written statement applicant there_have_been claims past 3_years terms conditions include limited following terms conditions exclusions mus 01 01 10001 0110 policy jacket mus 01 01 10002 0910 commercial policy declarations mus 01 01 10003 1207 schedule forms endorsements mus 01 01 10004 1207 notices policy holder mus 01 01 10005 0211 service suit mus 01 01 10007 1207 minimum earned premium endorsement mus 01 01 10009 1207 non-stacking limits endorsement il 00 17 11 98 common policy conditions il 00 21 05 02 nuclear energy liability exclusion endorsement mus 01 01 20001 0608 general liability coverage part declarations mus 01 01 20003 1207 additional exclusions provisions liability ins mus 01 01 20004 1207 liability deductible mus 01 01 20007 1207 limit coverage contractors employees gl box cg 00 01 12 04 commercial general liability coverage form cg 00 62 12 02 war liability exclusion cg 21 47 12 07 employment related practices exclusion cg 21 49 09 99 total pollution exclusion endorsement cg 21 67 12 04 fungi bacteria exclusion cg 21 75 06 08 tria reject coverage cg 21 39 10 93 contractual liability limitation cg 21 44 07 98 limitation designated premises project mus 01 01 20023 1207 special conditions sub-contractors quotation offered based upon terms conditions listed retail agent confirm accuracy quote review terms quote carefully applicant coverage terms conditions may different listed submission please remember dealing specialty markets respective forms coverage forms used may include additional exclusions and/or coverage enhancements listed above_ specimen policy forms available review upon request 25 deposit required prior binding coverage_ 25 minimum earned premium_ minimum deposit applies balance paid within 20 days effective date unless otherwise indicated quote offered requested effective date asap terms valid 10/07/11 coverage backdated considered bound without confirmation authorized representative neff risk services inc ali binding requests coverage must received office writing quotation closed response received quotation expiration date listed above_ agency binding authority therefore binders issued neff risk services inc acceptance quote behalf applicant confirms fully explained terms conditions forms applicant said terms conditions forms fully understood applicant patty mccafferty underwriter/broker neff risk services inc. 877 920-6333 montpelier us insurance company important information policyholder disclosure notice insurance coverage acts terrorism hereby notified terrorism risk insurance act 2002 effective november 26 2002 right purchase insurance coverage losses arising acts terrorism defined section 102 1 act subject applicable policy provisions_ term `` act terrorism means act certified secretary treasury concurrence secretary state attorney general united states-to act terrorism violent act act dangerous human life property infrastructure resulted damage within united states outside united states case air carrier vessel premises united states mission committed individual individuals acting behalf foreign person foreign interest part effort coerce civilian population united states influence policy affect conduct united states government coercion_ know coverage provided policy losses caused certified acts terrorism partially reimbursed united states formula established federal law formula united states pays 90 covered terrorism losses exceeding statutorily established deductible paid insurance company providing coverage premium charged coverage provided include charges portion loss covered federal government act please select one following either accept reject terrorism insurance coverage hereby elect purchase coverage losses arising certified acts terrorism defined act subject applicable policy provisions premium 150.00 plus applicable tax may apply period know policy provide coverage acts terrorism certified secretary treasury hereby reject coverage losses arising certified acts terrorism defined act understand losses arising terrorism excluded type print policyholder/applicant name policyholderiapplicant signature policyholderlapplicant 's title policy number date please return original form us agent recommend copy notice records mus 01 01 tria 1207 keep

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Commerical Property Policy||Date : 06/28/2011

8777 e via de_venturaste-135 scottsdale az 85258 phone 480-922-1344 fax 480-922-1347 wsurance quqte terms conditions quotation may comply specifications submitted consideration please read quote carefully compare specifications_ accordance instructions mentioned insurer acted reliance upon statements made retail brokers submission insured insurer offered following quotation_ date issued december 22 2011 producer insurance one inc kelly mancha wsurer century surety company- non admitted non-admitted coverage commercial package policy insured loma verde motel hafiz investments inc 7503 central ave ne albuquerque nm 87108 effective date 12/29/2011 limits coverage per century surety quote attached deductible without terrorism terrorism premium s1,360.00 taxes s45.35 fees s150.00 total 51,555.35 51,555.35 commission 10 terms conditions per century surety quote attached col reference 764370 notable endorsements exclusions per century surety quote attached col reference 764370 indication strictly conditional upon material change risk date quote inception date proposed policy event change risk insurer may sole discretion whether indication already accepted insured modify andior withdraw indication_ thank opportunity provide indication account please note indication contains general description coverages provided detailed description terms policy must refer policy endorsements_ questions indication please hesitate call sincerely joanne malin 480 922-1344 jmalin pacificexcess com quote reference id:0614098

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: EMPLOYEMENT PRACTICES LIABILITY POLICY||Date : 28-Nov-12

hull company inc_ hull 8400 ej prentice ave suite 535 greenwood village co 80111 303 217-4855 fax 866 610-8043 company managing general agents wholesale insurance brokers date 06/28/2011 kelly mancha agency code 92633 insurance one inc 6751 academy road ne ste albuquerque nm 87109 agency fax 505 888-6334 kelly urling loma verde motel policy tba quotation quotation premium quote eff date 06/28/2011 quote exp date 07/28/2011 12.01 excluding tria including tria `` premium s975.00 premium 5975.00 inspection fee s100.00 inspection fee s100.00 policy fee s200.00 policy fee s200.00 tria s150.00 sl tax 3.003 s38.29 sl tax 3.003 s42.79 total s1,313.29 total s1,467.79 commission 10 minimum earned percent 25.00 minimum earned premium 243.75 carrier lloyd 's london non-admitted hull company inc responsible collecting filing surplus lines taxes_ locations 7503 central ave ne albuquerque nm 87108 commercial property coverage scheduled limit bl wiee s40,000 building s80,000 bpp business personal property s9,000 building s60,000 bpp business personal property s6,000 endorsementsiexclusions include limited following terms conditions exclusions xx abo7575a11 sch security details line slip xx mep minimum earned premium 06/28/11 page 2 3 xx st11 policy jacket xx nma 362 co-insurance clause xx ilo017 11/98 common policy conditions xx nma 356 claim notification clause usa xx lma5019 asbestos endorsement xx nma2962 06/02/03 biological chemical materials exclusion xx cpoo1o 06/07 building personal property xx cpoo9o 07/88 commercial property conditions xx il 09 35 007/02 exclusion certain computer-related losses xx bcm-3a microorganism excl map absolute xx nma 1257 nuclear incident exclusion clause-liability-direct limited u.s.a xx nma 1999b authorities exclusion xx 07/01 mold fungi exclusion clause 3 xx lsw1135b lloyd 's privacy policy statement xx nma 1991 radioactive contamination exclusion clause- physical damage direct u.s.a xx seepage andlor pollution andlor contamination exclusion debris removal cost clean extension authorities exclusion xx nma 1998 service suite clause u.s.a xx lsw 1001 insurance several liability notice xx nma 464 war civil war exclusion clause xx lma 5092 21/12/2007 u.s. terrorism risk insurance act 2002 amended purchased clause xx cp 1030 04/07 causes loss special form xx cp 10 33 06/95 theft exclusion xx cp 0030 04/02 business income w/extra expense coverage form xx ilo298 09/08 nm changes-cancellation nonrenewal 06/28/11 page 3 3 conditions include limited following terms conditions exclusions 100 minimum deposit applies including ail fees 25 minimum earned premium completed/signed affidavit binding full net payment within 20 days along copy signed finance agreement applicable subject audit policy fees 100 earned receipt currently valued favorable loss runs binding quote based losses receipt favorable inspection compliance recommendations retail agent binding authority coverage backdated presumed bound without confirmation authorized representative hull company subject completed acord company specific applications signed insured producer coverage exposures matching quote bound binding terrorism form completedlsignedldated applicant binding written bind request backdating flat cancellations special provisions quotation offered basis indicated incumbent upon ascertain accuracy quote review insured terms quote carefully coverage terms conditions may different original application ali requests bind coverage must received office writing coverage backdated presumed bound without confirmation authorized representative hull company inc advised hull company inc. received response expiration date quote consider quotation closed specimen policy forms available review upon request please sure check carrier 's m. best rating satisfy client 's interests please review advise questions look forward hearing concerning placement coverage hull company inc. 8400 e prentice ave suite 535 hull greenwood village co 80111 303 217-4855 fax 866 610-8043 company managing general agents wholesale insurance brokers rating worksheet insured loma verde motel insured address 7503 central ave ne albuquerque nm 87108 insurer lloyd 's london underwriter kelly urling commercial property location building 1 7503 central ave ne cause loss special form occupancy motel construction masonry wind deductible excluded coverage limit coins deductible valuation final rate premium bl wiee 40,000 1/6 200 cause loss special form excluding flood quake occupancy motel construction masonry wind deductible excluded coverage limit coins deductible valuation final rate premium building 80,000 90 1,000 replacementcost 400 cause loss special excluding theft flood earthquake occupancy motel construction masonry wind deductible excluded coverage limit coins deductible valuation final rate premium bpp business personal property 9,000 90 1,000 replacementcost 45 location building 2 7503 central ave ne cause loss special form excluding flood quake occupancy motel construction masonry wind deductible excluded coverage limit coins deductible valuation final rate premium building 60,000 90 1,000 replacementcost 300 cause loss special excluding theft flood earthquake occupancy motel construction masonry wind deductible excluded coverage limit coins deductible valuation final rate premium bpp business personal property 6,000 90 1,000 replacementcost 30

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Package Policy||Date : 8/30/2018

2850 west golf road suite 800 rolling meadows il 60008-4039 20 monitor 847 806-6590 liability managers llc fax 847 806-6282 arrktey compana years 6 quotation employment practices liability insurance november 28,2012 kelly m. mancha abeyta engineering insurance one inc po box 1499 suite ranchos de taos nm 87557 6751 academy rd ne albuquerque nm 87109 quotation number 1181626 505 888-6333 kelly mancha ins-one.com dear kelly thank considering monitor liability managers llc client 's insurance needs pleased provide quotation employment practices liability insurance_ monitor member company w.r. berkley corporation operates underwriting manager carolina casualty insurance company carolina casualty insurance company wholly owned w.r berkley corporation a.m. best company rated a+ superior financial size category xiii quotation expires december 28,2012. event change condition abeyta engineering occur could materially alter underwriting evaluation quotation may withdrawn written notice proposed insured coverage risks underwritten monitor behalf carolina casualty insurance company bound authorized employees monitor event conflict ambiguity proposed policy statements made concerning coverage proposed policy shall control proposed coverage purchased commission payable firm disclosed attached document premium due must remitted monitor invoice due date questions concerning proposed coverage please call thank considering monitor liability managers llc client 's professional liability insurance needs regards cguthyiolc courtney olsen underwriter colsen monitorliability.com 303 221-4751 ext 216 2850 west golf road suite 800 rolling meadows il 60008-4039 20 monitor 847 806-6590 liability managers llc fax 847 806-6282 arrktey compana years 6 quotation employment practices liability insurance quotation expires december 28 2012. date quotation effective date policy significant adverse change condition applicant occurrence event could substantially change underwriting evaluation applicant carolina casualty insurance company 's option quotation may withdrawn written notice proposed insured event conflict ambiguity proposed policy statements made concerning coverage proposed policy shall control subject terms conditions contained herein monitor liability managers llc behalf carolina casualty insurance company provides quotation employment practices liability insurance follows insured abeyta engineering policy period determined determined policy type primary carrier carolina casualty rated a+ superior financial size category xiii quotation number 1181626 policy form ct 22360 10-05 epl 24360 10-05 quotation expires december 28 2012 option limit liability limit liability 81,000,000 per claim 1,000,000 aggregate deductible s5,000 total premium s864 commission percent 16.00 includes promotional commission rate option 2 limit liability limit liability s1,000,000 per claim 1,000,000 aggregate deductible s10,000 total premium s824 commission percent 16.00 includes promotional commission rate option 3 limit liability limit liability s500,000 per claim 500,000 aggregate deductible s5,000 total premium s648 commission percent 16.00 includes promotional commission rate abeyta engineering 1181626 11/28/2012 po box 1499 page 3 ranchos de taos nm 87557 quotation employment practices liability insurance monitor liability managers llc option 4 limit liability limit liability 5500,000 per claim s500,000 aggregate deductible s10,000 total premium s618 commission percent 16.00 includes promotional commission rate additional terms prior pending litigation dates employment practices liability insurance determined conditions quotation subject following conditions new mexico policyholder acknowledgment must signed dated authorized representative insured indicated endorsement prior binding receipt review underwriting acceptance properly completed signed currently dated carolina casualty insurance company proposal form employment practices liability insurance epl 24507 10-05 copy proposal forms specimen copy policy form downloaded website www .monitorliability.com monitor reserves right modify final policy terms conditions upon review information received endorsements form id number form name form description 265 01-08 policyholder disclosure notice terrorism insurance coverage ct 220155 10-05 new mexico amendatory modifies policy include state amendatory endorsement provisions ct 220158 09-06 new mexico policyholder costs defense subject deductible acknowledgement amounts may reduce limit liability signature required ct 220159 rev 09-06 new mexico policyholder new mexico notice policyholders_ notice epl 243026 09-06 addition section iii a. illegal adds section iii a_ employment alien investigative proceeding practices liability insurance coverage section coverage sub-limit policy provide specific sub-limit illegal alien investigative proceeding claim epl 243114 09-06 addition section iii j. third adds section iii j. employment party liability coverage practices liability insurance coverage section sub-limit policy provide specific sub-limit third party liability coverage_ abeyta engineering 1181626 11/28/2012 po box 1499 page 2 3 ranchos de taos nm 87557 quotation employment practices liability insurance monitor liability managers llc endorsements form id number form name form description epl 244101 09-06 modification section iv amends section iv i. employment wage hour laws exclusion practices liability insurance coverage section costs defense sub-limit policy exclude coverage loss arising wage laws specific sub-limit liability costs defense please note title brief description endorsement listed quotation describe scope intent endorsement please read endorsement carefully abeyta engineering 1181626 11/28/2012 po box 1499 page 3 3 ranchos de taos nm 87557 hour

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Package Policy||Date : 9/15/2020

food industry self insurance fund new mexico p.o box 14710 fla albuquerque nm 87191-4710 505 298-9095 1-800-288-0893 new mexico fax 505 298-9094 wc26 2015 fund year premium computation quote date 8/5/2015 member wing stop tesstab enterprises inc. dba address 5241 ouray road nw city/stizip albuquerque nm 87120 phonelfax contact agency insurance one inc. producer larry koester phonelfax 505-888-6333 classification operations code number annual payroll rate per s100 estimated premium restaurant fast food 09083 s90,800.00 s1.42 81,289.36 outside sales 08742 so.00 s0.83 s0.00 clerical 08810 so.00 s0.26 s0.00 so.00 so.00 s0.00 sub-total s90,800.00 s1,289.36 experience modification 0.92 s1,186.21 annualized s1,186.21 pro-rated 8/18/2015 1/1/2016 s700.00 s700 minimum premium applies pro-rated deposit required 50.00 s350.00 increased limits simmm s100.00 one time admin fee s100.00 total due s550.00 balance s350.00 due equal payments s350,00 interesti finance chargei membership new mexico grocers association new mexico restaurant association required

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Property Policy||Date : 1/10/2008

united states liadbility insurance group committed 054 derkshiire hatiuvity cowrany making adifference eplo1sn3978 emailed 11/30/2015 1:14 pm 11/30/2015 please bind effective quote valid 1/29/2016 confirm optional coverages include optional coverages_ shoes shoestring include following optional coverages section iii taxes fees may apply optional premium purchased option add 10 apply premium shown limit selected section third party insurance one inc. policy eligible direct billed please select one following judy heffel direct bill new business future renewals commission 17.5 checked select payment plan single payment melyssa uribe two payments premium must s400 three payments premium must 675 muribe usli.com 888 523-5545 ext 7507 four payments premium must 1,000 bind coverage please complete bind request box six payments premium must 2,500 selections send request ten payments premium must 5,000 matias ledesma mledesma usli.com fax 610-688- 4391 along applicable 'prior bind '' information see last page quote payment plan descriptions direct bill new business direct bill future renewals direct bill policy note direct bill option selected company invoice insured bill collect payment fees state surcharges billed full first installment signature premium underwriting notesirequirements employment practices liability policy information carrier united states liability insurance company status admitted best rating at+ superior ix limit options s1,000 s2,500 s5,000 s10,000 retention retention retention retention s500,000 s1,791 s1,665 51,541 s1,416 s1,000,000 s2,170 s2,019 51,868 s1,716 s2,000,000 s3,270 s3,119 s2,968 s2,816 53,000,000 s4,370 s4,219 s4,068 53,916 s4,000,000 s5,470 s5,319 s5,168 s5,016 s5,000,000 s6,570 s6,419 s6,268 s6,116 additional quote information retroactive date inception date policy punitive damages coverage included premium_ please contact us questions regarding terminology used coverages provided product 040052 read quote carefully may match coverages requested request underwriting services page 2 attn eplo1sn3978 please note able bind coverage satisfy prior binding requirements prior_to_binding_this account subject to_the_following underwriter receipt review acceptance fully completed usli employment practices liability application dated 45 prior effective date coverage signed one following applicable officer member board directors managing member executive director owner partner principal authority bind applicant representations therein may modify terms andlor premiums quoted rescind quote information provided completed application different original submission significant change risk date quoted underwriting notes epl-133 defense costs within limits liability endorsement added s250,000 limit bound applicant 200 full time equivalent employees part time/seasonal 1/2 full prior acts coverage may available additional premium_ providing 100,000 sub-limit violations fair labor standards act flsa additional premium please see endorsement epl-162 addition included materials assist evaluation offer coverage thank opportunity quote risk required forms endorsements employment practices endorsements epl app 7 12/12 employment practices liability application epl-167 05/09 amended definition loss endorsement epl jacket 09/10 employment practices liability policy epl-169 11/13 amended notice/claim circumstance reporting provisions epl-148 09/07 retroactive date endorsement epl-j 09/07 employment practices liability insurance policy epl-162 05/10 fair labor standards act sub-limit endorsement iil offer optional coverage based information provided following additional coverages available applicant currently included quotation additional premium may subject taxes fees firm final amount please contact us revise quote_ coverage additional premium option 1 third party 10 apply premium shown limit selected section important information third party coverage purchased epl-144 third party coverage endorsement added covers discrimination harassment person insured interacts performing duties related conduct organization business iv direct bill payment plan descriptions one year payment plan descriptions single payment entire premium invoiced immediately due 20 days invoiced two payments 50 premium invoiced immediately due 20 days invoiced balance invoiced 60 days inception_ three payments 40 premium invoiced immediately due 20 days invoiced 30 invoiced 60 days inception balance invoiced 120 inception four payments 40 premium invoiced immediately due 20 days invoiced three equal installments 20 invoiced 60 days 120 days 180 inception six payments 40 premium invoiced immediately due 20 days invoiced five equal installments 12 invoiced 45 105 days 165 days 225 255 inception ten payments 25 premium invoiced first installment due expiration date remaining amount divided 9 equal installments invoiced 30 day intervals 30 days 60 days 90 120 days 150 days 180 days 210 days 240 270 days inception please contact us questions regarding terminology used coverages provided product 040052 read quote carefully may match coverages requested page 2 2 days days days days days days days days

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Package Policy||Date : 7/22/2008

quote insurance one inc. 6751 academy rd ne ste albuquerque new mexico 87109 phone 505-888-6333 fax 505-888-6334 date 01/04/2016 address soas inc dba shoes 7200 montgomery blvdjne shoestring city state zip code albuquerque new mexico 87109 policy period new mexico premier insurance company 01/04/2016 01/04/2017 insured insurance company soas inc dba shoes shoestring new mexico premier insurance company quote valid insured fein 870704413 02/03/2016 quote 01/04/2016 based information provided subject annual audit quote 30 beyond effective date however coverage backdated employers liability limit s500,000/s500,000s500,000 deductible 0 premium information new mexico classification code description rate annual payroll manual premium 8008 store shoe-retail s1.58 s458,315 s7,241 8810 clerical office s0.35 s176,509 s618 employees noc manual premium new mexico s7,859 increased limits s63 balance coverage b minimum premium s12 deductible account experience modifier s-952 cpap credit scheduled debits scheduled credits aircraft surcharge large deductible premium discount s-328 waiver subrogation fee alternate employer surcharge expense constant s230 terrorism risk act s63 total estimated premium new mexico s6,947 total estimated premium s6,947 new mexico mutual group nmmg pleased offer workers compensation quote mexico mutual nmmg rated a- excellent a.m. best company_ good days new group payment plan 25 9 installments

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: UMBRELLA Policy||Date : 9/8/2010

united states liadbility insurance group committed 0f derkshiire hatiuvity cowrany making adifference mseo16f3346 emailed 2/18/2016 11.56 2/18/2016 please bind effective quote valid 7/23/2016 confirm optional coverages include optional coverages_ cinfranky llc dba new mexico pinon include following optional coverages section iv coffee please see prior bind taxes fees may apply optional premium purchased notes option 1 set-up andlor take-down coverage option 2 add 50 rain date coverage insurance one inc. option 3 add s100 banner coverage option 4 add s100.00 terrorism coverage judy heffel see terrorism section exact pricing terms commission 12.5 bound paid online additional 2.5 commission applies tammy ross signature tross usli.com 888 523-5545 ext 7422 bind coverage please complete bind request box selections send request daniel gilronan jr. dgilronan usli com fax 610-688- 4391 along applicable 'prior bind '' information may also bind quote online usli.com premium underwriting notesirequirements general liabilityiliquor liability special event policy information carrier united states liability insurance company status admitted best rating att superior ix general liability general liability liquor liability common liquor liability occurrenceiaggregate premium causeiaggregate premium s100,000/5200,000 5325 s100,000/5200,000 s490 s300,000/5300,00 s416 5300,000/5300_ s627 s300,000/5600,000 s429 5300,000/5600_ s647 s500,000/5500,000 s487 5500,000/5500 s735 s500,000/51,000,000 s499 s500,000/51,000,000 s752 s1,000,000/51,000,000 s568 s1,000,000/s1,000,000 s858 s1,000,000/52,000,000 s580 s1,000,000/52,000,000 s875 additional quote information policy minimum premium s220 personal advertising injury occurrence limit products aggregate see l-535 damages premises rented 100,000 medical payments 51,000 please contact us questions regarding terminology used coverages provided product 050157 read quote carefully may match coverages requested request underwriting services page attn mseo16f3346 refer covered events section event dates covered policy period 7123/2016 7/25/2016 pricing contingent upon gl liquor coverage chosen please note able bind coverage satisfy prior binding requirements prior_to_bindingthis account subject to_the_following multiple liquor vendors participating liquor vendors required carry liquor liability insurance equal greater limits applicant binding order must received start event coverage provided already provided mailing address location address additional insured information need information order bind coverage underwriting notes quote contemplates spectator liability include injury athletic participants performers thank opportunity quote risk ii covered events event 1 9401 balloon museum dr albuquerque nm 87113 entity type applicant host event event coverages general liability liquor liability event exposure start date end date sporting event tournament volleyball applicant host event 2000 attendees 7/23/2016 7/23/2016 liability sporting event tournament volleyball applicant host event 1000 consumers 7/23/2016 7/23/2016 liquor event coverages exposure limit premium additional insured managers lessors premises liability per additional insured included additional insured managers lessors premises liquor per additional insured included iii required forms endorsements common endorsements ilo017 11/98 common policy conditions llq1oo 07/06 amendatory endorsement il0o21 709708 nuclear energy liability exclusion '' llq101 08/06 expanded definition employee endorsement il0298 09/08 new mexico changes cancellation llq102 02/15 event vendor exhibitor contractor nonrenewal exclusion l-206 02/11 fully earned premium endorsement llq-368 08/10 separation insureds clarification endorsement l-224 10/10 punitive exemplary damages jacket 09/10 main event special event exclusion commercial liability policy jacket l-610 11/04 expanded definition bodily injury spe-312 03/15 insured l-656 02/06 extension coverage committee members please contact us questions regarding terminology used coverages provided product 050157 read quote carefully may match coverages requested page 2 prior mseo16f3346 general liability endorsements cgooo1 12/07 commercial general liability coverage l-472 07/08 exclusion injury performers form entertainers cgo068 05/09 recording distribution material l-526 01/15 absolute war terrorism exclusion information violation law exclusion cg2011 04/13 additional insured-managers lessors l-535 03/15 exclusion products-completed premises operations hazard food beverage products cg2107 05/14 exclusion access disclosure l-536 09/09 exclusion participation athletic confidential personal information activity physical activity sports data-related liability limited bodily injury exception included cg2136 03/05 exclusion new entities l-599 10/12 absolute exclusion pollution organic pathogen silica asbestos lead hostile fire exception cg2139 10/93 contractual liability limitation l-607 7 02/11 exclusion climbing rebounding interactive games devices cg2144 07/98 limitation coverage designated l-608 02/11 exclusion firearms fireworks premises project pyrotechnic devices cg2147 12/07 employment-related practices exclusion l-609 02/11 animal exclusion l-387 03/06 exclusion mechanical rides l-686 10/12 absolute exclusion liquor related liability l-423 02/11 exclusion structure collapse spe 300 05/09 special events property damage amendment l-461 12/11 assault battery exclusion triadn 02/15 policyholder disclosure notice terrorism insurance coverage liquor liability endorsements cg0033 12/07 liquor liability coverage form l-657 01/11 absolute pollution exclusion liability cg2406 04/13 liquor liability bring alcohol lq-202 12/11 assault battery exclusion establishments l-559 11/10 additional insured manager lessors lq-352 09/08 event vendor insurance premises l-616 11/09 host/special event coverage form lq-354 10/09 limitation coverage insured change endorsement premises iv offer optional coverage based information provided following additional coverages available applicant currently included quotation additional premium may subject taxes fees_ firm final amount please contact us revise quote_ coverage rate option set-up andlor take-down coverage 0.100 important information coverage purchased add l-563 set-up andlor take-down coverage special events set-up take-down coverage available wish purchase please submit following bind request dates requested confirm heavy machinery used set-up take-down bulldozers backhoes excavators type industrial machinery note 10 first rate set-up andlor take-down apply coverage additional premium option 2 rain date coverage s50 important information coverage purchased add l-562 rain date coverage special events coverage additional premium option 3 banner coverage s100 please contact us questions regarding terminology used coverages provided product 050157 read quote carefully may match coverages requested page 3 day day mseo16f3346 coverage additional premium option 4 terrorism coverage s100.00 important information terrorism coverage per terrorism risk insurance program reauthorization act 2015 available additional premium 100 5 total policy premium whichever greater making decision purchase terrorism coverage please aware coverage `` insured losses '' defined act subject coverage terms conditions amount limits policy applicable losses arising events acts terrorism desired attach triadn disclosure notice terrorism insurance coverage add form nte notice terrorism exclusion terrorism premium shown calculated percentage quoted coverages coverages added removed binding additional premium show subject change coverage added mid-term please contact us questions regarding terminology used coverages provided product 050157 read quote carefully may match coverages requested page

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Workers' Compensation||Date : 8/5/2015

hull company llc 8400 e. prentice ave suite 535 hul greenwood village co 80111 303 218-4070 fax 866 610-8043 company mcpo18y53g7 version 2 quote valid 9/15/2018 please bind effective zzvg confirm optional coverages john roberta stack include optional coverages renewal cp 1566231e expiration date 9/15/2018 include following optional coverages section v taxes fees may apply optional premium purchased option 1 add 5100.00 terrorism coverage see terrorism section exact pricing terms attn roboita e_ jack signature sx katie frazier katie frazier hullden com 303 218-4070 premium underwriting notesirequirements commercial package policy information carrier united states liability insurance company status admitted best rating a++ superior x term quoted annual coverage part premium commercial property s435.00 commercial general liability sso0.00 total premium due carrier s935.00 additional costs wholesaler broker fee so.oo total amount due s935.00 free discounted business services available usli insureds visit bizresourcecentercom details undenwriting notes call us want work retain business risk may eligible reduction premium applicant business 3 years current location please contact us questions regarding terminology used coverages provided read quote carefully may match coverages requested page 4 al policyholder disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance act `` act '' amended right purchase insurance coverage losses arising acts terrorism defined section 102 1 act term `` act terrorism '' means act acts certified secretary treasury consultation secretary homeland security attorney general united states act terrorism violent act act dangerous human life property infrastructure resulted damage within united states outside united states case certain air carriers vessels premises united states mission committed individual individuals part effort coerce civilian population united states influence policy affect conduct united states government coercion know coverage losses caused certified acts terrorism partially reimbursed united states formula established federal law formula united states reimburses 85 2015 84 beginning january 1 2016 83 beginning january 1 2017 82 beginning january 1 2018 81 beginning january 1 2019 80 beginning january 1 2020 f covered terrorism losses exceeding statutorily established deductible insurance company providing coverage premium charged coverage provided include charges portion loss covered federal government act coverage `` insured losses defined act subject coverage terms conditions amounts limits policy applicable losses arising events acts terrorism know act amended contains 100 billion cap limits u.s government reimbursement insurers liability losses resulting certified acts terrorism amount losses one calendar year exceeds 100 billion aggregate insured losses insurers exceed 100 billion coverage may reduced also know federal law required purchase coverage losses caused certified acts terrorism rejection selection qf terrorisminsurance cqverage please x '' one boxes return notice company decline purchase terrorism coverage understand coverage losses arising_from acts terrorism elect purchase coverage certified acts terrorism premium 0f note respond offer return notice company terrorism coverage policy lctck rsbrh e =ic applicant name print named insured zbe_axxk gbles authorized signature date triadn 02-15 page 1 1 paid well j agency customer id prior carrier information continued year category general liability automobile property carrier policy number premium effective date expiration date carrier policy number premium effective date expiration date loss history check none attach loss summary additional loss information enter claims losses regardless fault whether insured occurrences may give rise claims last years total losses subro claim date line type description occurrence claim date claim amount paid amount reserved gation open occurrence yin yin signature notice information practices privacy given applicant required states contact agent broker state 's requirements personal information including information credit investigative report may collected persons connection application insurance subsequent amendments renewals_ information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization credit scoring information may used help determine either eligibility insurance premium charged_ may use third party connection development score may right review personal information files request correction inaccuracies may also right request writing consider extraordinary life circumstances connection development credit score rights may limited states please contact agent broker learn rights may apply state instructions submit request us detailed description rights practices regarding personal information applicable az ca de ks mn nd ny va wv specific acord 38s available applicants states applicants initials applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss or_ benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company- penalties may include imprisonment fines denial insurance civil damages insurance company r insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written statement part support application issuance rating insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky ny oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person t0 criminal civil penalties exceed five thousand dollars stated value claim violation applies ny applicable tn va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits_ applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties applicable 'person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars 5,000 ten thousand dollars s10,000 fixed term imprisonment three 3 years penalties aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present reduced minimum two 2 years_ undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge state producerticenise producer '' signature producer '' name please print required florida chris koedler chris koester applicant 's signature date national producer number stocl aabita ashcl 3bl2us acord 125 2016/03 page 4 4 copy agent may oa agency customer id general information continued explain `` yes '' responses past present operations yin 16. applicant active currently active joint ventures n 17_ lease employees employers n workers workers lease compensation lease compensation coverage carried yin coverage carried yin 18. labor interchange business subsidiaries 19. day care facilities operated controlled n 20. crimes occurred attempted premises within last three 3 years n 21. formal written safety security policy effect n 22 businesses promotional literature make representations safety security premises remarks acord 101 additional remarks schedulemay attached space_is required signature applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company penalties may include imprisonment fines denial insurance civil damages insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written electronic electronic impulse facsimile magnetic oral telephonic communication statement part support application issuance insurance policy personal commercial insurance claim payment benefit pursuant t0 insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties t0 exceed thousand dollars stated value claim violation applies ny applicable tn va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact violating state law_ applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars 5,000 ten thousand dollars s10,000 fixed term imprisonment three 3 years penalties aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hismher knowledge_ producer 's signature producer 's name please print state produceer licenseno required florida chris koesler chris koester applicant 's signature national producer number abtaxdtdl acord 126 2016/09 page 4 4 rating ny five may eiews

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: EMPLOYEMENT PRACTICES LIABILITY POLICY||Date : 1/29/2016

mcpozou4abo quote valid 9/15/2020 please bind eftective izlzuzl confirm optional coverages zpo include optional coverages john roberta stack include following optional coverages section v renewal cp 1566231g expiration date 9/15/2020 taxes fees may apply optional premium purchased option 1 add s100.00 terrorism coverage ~see terrorism section exact pricing tems premium underwriting notesirequirements commercial package policy information carrier united states liability insurance company status admitted best rating a++ superior xli term quoted annual coverage part premium commercial praperty s711.00 commercial general liability s500.00 total premium due carrier 81,211.00 additional costs wholesaler broker fee so.o0 total amount due 81,211.00 free discounted business services available usl insureds visit bizresourcecenter.com details account subject to_the_tollowing sections band c please note able t0 bind coverage satisfy prior fo binding requirements a_ prior bind requirements please contact us wlth queslions regarding lerminology used coverages provided read quote carefully may match coverages requestedt+ page 5 policyholder disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance act `` act '' amended right purchase insurance coverage losses arising ut acts terrorism detined section 102 1 act term `` act terrorism '' means act acts certified secretary treasury consultation secretary homeland security attorney general united states act terrorism violent act act dangerous human life property infrastructure resulted damage within united states outside united '' states case certain air carriers vessels premises united states mission committed individual individuals part effort coerce civilian population united states influence policy affect conduct united states government coercion know coverage losses caused certified acts terrorism partially reimbursed united states formula established federal law formula united states reimburses 85 2015 84 beginning january 1 2016 83 beginning january 1 2017 82 beginning january 1 2018 81 beginning january 1 2019 80 beginning january 1 2020 covered terrorism losses exceeding statutorily established deductible insurance company providing coverage premium charged coverage provided ad include charges portion loss covered federal government act coverage `` insured losses '' defined act subject coverage terms conditions amounts limits policy applicable losses arising events acts terrorism know act amended contains 100 billion cap limits u.s. government reimbursement well insurers liability losses resulting certified acts terrorism amount losses one calendar year exceeds 100 billion aggregate insured losses insurers exceed 100 billion coverage may reduced also know federal required purchase coverage losses caused certified acts terrorism rejection qr selection qf terrorisminsurance cqverage please x '' one boxes return notice company- decline purchase terrorism coverage understand coverage_for losses arising acts_ of_terrorism elect purchase coverage certified acts terrorism premium note respond offer return notice company terrorism coverage policy jeh dsteck liauwcke f skck applicant name print named insured stas riudkez_skc lla 1 authorized signature date triadn 02-15 page 1 1 paid law

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Workers' Compensation||Date : 01/04/2016

hull company albuquerque qffice p. 0. box 90365 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 quqte confirmation date 1/14/08 agent insurance one inclallison prospect sos managed waste inc. coverage contractors equipment floater limits 15,966.00 total amount insured amount unscheduled tools/equip max per item 1,000 15,966.00 amount scheduled items amount rented tools/equip 1,000 deductible coverage broad form acv 80 coinsurance premium 750.00 10 commission fee 200.00 fee fully earned tax 28.53 state sl tax 978.53 total company underwriters lloyds london non-admitted carrier please sure check carriers best rating satisfy clients interests termsi conditions include limited following terms conditions exclusions mold excl fungi excl biological chemical materials excl war terrorism excl ferrorism buy-back available per tria 2002 see following page signed form requred binding quote subject 25 minimum earned premium original signed completed acord locked vehicle end't applies app quotation offered basis indicated incumbent upon ascertain accuracy quotereand review applicant terms quote carefully coverage terms condtions different requested please remember dealing specialty markets may forms coverage forms used may include additional exclusions andlor coverage enhancements noc respective above_ specimen policy forms available review upon request 25 deposit required iosted coverage 25 minimum earned premium minimum deposipapplieguebalance fdebe paicquitfed 2id2 bording effective date unless otherwise indicated quote offered requested renewal date 1/29/08 days aehiicunttr029/08 coverage backdated presumeduo boenewaithaue confz tionhrose aerms authorized representative hull co. inc requests bind advised hull co. inc received coverage must received office writing consider response expiration date quote quotation closed agency binding authority therefore binders certificates issued hull co inc. acceptance quote behalf applicant confirms fulreexplained tne terms conditions forms applicanteand aaid terenap conditiongrand fofras voe understood applicant fully hull co. inc. representative policyholder disclosure offer terrorism insurance coverage zozare hereby notified terrorism risk insurance act 2002 effective 2002ithat right purchase insurance coverage november 26 defined section 102 1 act term act losses arising acts terrorism secretary treasury concurrence terrorism means act certified united states act secretary state attorney general terrorism violent act act dangerous human life btotertr neiczastructure resulted damage within uritedastateange cutsite hue anited states case air carrier vessel premises united states committed individual individuals acting behalf mission part effort coerce civilian foreign person foreign interest conduct united population united states influence policy affect states government coercion youtsfipuld knowthat coverage provided policy certified acts qe terrorism partially reimbursed losses caused formula established federal united states pays 90 covered law formula united states pedsoqibofpowererheersorasceoosesaexceeding nhestatutorily established chargedlorairib coverhsgrianrocoeda beloroxidntothie ccverage premium portion /frprovided include charges loss covered federal government act zozersagheedns uredeosses_as deflned terrorism risk insurance 2002 amended subject to_the coverage terms act lits inthis policy applicable losses arising conditions amounts terrorism events acts coueshoulronow federal law arenot required coverage losses caused certified acts terrorsuif purchase please `` x '' one lines return notice company erebelect purchase terrorism coverage prospective premium 103.00 lines tax added amount surplus decline purchase terrorism coverage understand arising acts terrorism coverage losses applicant 's signature sos managed waste inc print name applicant certain underwriters lloyd 's london date policyicert number

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: General liability||Date : 2/18/2016

hull company albuquerque qffice p 0. box 90365 albuquerque nm 87199-0365 505 889-9111 fax 505 889-9353 revisedrenewal_quqte confirmation date 01/21/2009 agent insurance one inc chris koester insured werner gilchrest llc coverage cgl occurrence form limits 5 2,000,000 general aggregate excluded prodicomp ops aggregate ,000,000 personal advertising injury 1,000,000 occurrence 100,000 fire damage legal 5,000 medical payments coverage property limits 250,000 building value basic form excluding sprinkler leakage actual cash value 80 coinsurance 1,000 deductible premium 2,450.00 minimum deposit premium 10 comm 200.00 fee fully earned 79.55 state sl tax 2,729.58 total_ annual pqlicy company mt vernon fire ins co non-admitted carrier please sure check carrier 's a.m. best rating satisfy clients interests terms conditions include limited following terms conditions exclusions service suit product-completed ops excl cgl coverage form excl new entities contractual liability limitation nuclear energy liab excl additional exclusions conditions includes employment related punitive exemplary asbestos lead absolute pollution mold fungi bacteria organic pathogens exclusions classification limitation endt premises limitation endt assault battery excl absolute liquor liab excl independent contractors excl minimum earned premium endt exclusion bodily injury employees volunteer workers temporary workers casual laborers contractors subcontractors excl violation statutes govern emails faxes etc excl construction operations excl exterior work four stories absolute war terrorism excl disclosure notice terrorism insurance coverage see 2nd page details premiums signed terrorism nqtice required binding heat warranty excl loss loss use data computer hardware systems vacancy permit sprinkler leakage excl asbestos material excl lead contamination excl absolute pollution excl mold fungus bacteria virus organic pathogen excl quote subiect 25 mep satisfactory inspection original signed completed acord app subject audit class 68606 vacant building ail vacant buildings must fully secured locked bind complete updated vacant building application signed tria quotation offered basis indicated incumbent upon ascertain accuracy quote review applicant terms quote carefully coverage terms conditions may different requested please remember dealing specialty markets respective forms coverage forms used may include additional exclusions andlor coverage erharcements iisted specimen policy forms available review upon request 25 deposit required prior binding coverage 25 mep_ minimum deposit applies balance within 20 effective date unless otherwise indicated_ quote offered requested renewal date 01/21/2009 12:01am terms valid 01/21/2009 12:01am coverage backdated presumed bound without confirmation authorized representative hull co. inc. ail requests bind coverage must received office writing advised hull co. inc. received response expiration date quote_ consider quotation closed_ agency binding authority therefore binders issued hull co. inc acceptance quote behalf applicant confirms fullyexplained te-terms conditions forms applicant said terms conditions forms understood gpplicant_ hull co. inc. representative paid days fully disclosure notice terrorism insurance coverage hereby notified terrorism risk insurance program reauthorization act 2007 `` act '' effective december 26th 2007_ right purchase insurance coverage losses arising acts terrorism defined section 102 1 act term act terrorism '' means act certified secretary treasury concurrence secretary state attorney general united states act terrorism violent act act dangerous human life property infrastructure resulted damage within united states outside united states case air carrier vessel premises united states mission committed individual individuals effort coerce civilian population united states influence policy affect conduct united states government coercion know coverage losses caused certified acts terrorism partially reimbursed united states formula established federal law formula united states pays 85 covered terrorism losses exceeding statutorily established deductible paid insurance company providing coveragc cach program year january december 31 premium charged coverage provided include charges portion loss covered federal government act coverage `` insured losses defined act subject coverage terms conditions amounts limits policy applicable losses arising events acts terrorism know act amended contains 100 billion cap limits u.s. government reimbursement well insurers liability losses resulting certified acts terrorism amount losses insurers exceeds 100 billion coverage may reduced also know federal required purchase coverage losses caused certified acts terrorism rejection selection qf_terrorism insurance cqverage please x~ one boxes return notice company decline purchase terrorism coverage understand coverage losses arising_from acts terrorism elect tc purchase coverage tor certified acts terrorism premium 123 aus_lx note respond offer return notice company terrorism coverage policy applicant name print named insured authorized signature date united states liability insurance company u.s. underwriters insurance company mt vernon fire insurance company triadn 01-08 part iaw

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Package Policy||Date : 1/21/2009

please complete personal lines quote name mailing address date birth social security spouse 's name spouse date birth spouse 's social security homeowners quote address year built year updates roof plumbing electrical square footage construction frame adobe etc bedooms baths 1 2 story 1or 2 car garage attached detached roof pitched tile/flat tar gravel etc basement pool hot tub trampoline dogs breeds current insurance carrier premium expiration date liability limits value home mortgagee auto quote drivers name dob drivers license name dob drivers license name dob drivers license name dob drivers license vehicles year make model vin year make model vin year make model vin year make model vin current insurance carrier premium expiration date liability limits deductibles lienholders also write toys motorcycles atvs boats etc_ n't forget let us know high end items jewelry coins firearms art work sports equipl

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Quote||LINE OF BUSINESS: Package Policy||Date :

op id cm acord commercial insurance application date mmiddnyyy applicant information section 12/21/2009 agency carrier naic code insurance one inc western pacific 5501 eagle rock ave ne ste a-3 underwriter underwriter office albuquerque nm 87113 policies orprogram requested policy number larry koester wpin5021706 indicate sections attached electronic data proc truckersmotor carrier hacoable pferisable equipment floater umbrella contact larry koester boiler machinery garage dealers vehicle schedule name phone 505-888-6333 business auto glass sign workers compensation aic ext fax 505-888-6334 x gomererclability installationbuilders risk yacht aic_not e-mail crimemmiscellaneous crime open cargo address code sub code dealers property agency customer id artiss driver info schedule teansprbf iqnr status transaction package policy information x quote issue policy renew enter information common dates terms apply several ines monoline policies_ bound give date andfor attach copy proposed eff date proposed exp date billing plan payment plan audit change date time direct bill cancel pm 12131/09 12/31/10 agency bill package policy premium applicant information name first named insured named insureds mailing address incl zip+4 first named insured artistic homes inc tom wade 4420 tower rd sw ste albuquerque nm 87121 fein soc sec phone 505-247-8400 first named insured aic ext e8bresslesl reba '' computer fax 244.8359 abreees individual corporation subchapter llc members cr bureau name b4arpes corporation managers partnership joint venture prgeqrrg bbusiness type id number inspection contact reba harper accounting records contact phone 505-247-8400 email phone e-mail aic ext address aic ext address premises information acord 823 attached additional premises yr loc bld street city county state_ zip+4 city limits interest annual revenues built employeest occupied 4420 tower rd sw inside owner albuquerque nm 87121 outside x tenant 2000 inside owner outside tenant inside owner outside tenant inside owner outside tenant nature qf businessidescription operations premise acord 125 2007/10 page 3 1993-2007 acord corporation ail rights reserved acord name logo registered marks acord agency customer id artis-5 op id cm general information explain `` yes '' responses yin 1a applicant subsidiary another entity 1b applicant subsidiaries formal safety program operation exposure flammables explosives chemicals catastrophe exposure insurance company submitted policy coverage declined cancelled non-renewed prior three 3 years applicable mo past losses claims relating sexual abuse molestation allegations discrimination negligent hiring last five years ten ri applicant indicted convicted cf degree crime fraud bribery arson arson-related crime connection property ri question must answered applicart tor property insurance failure disclose existence arson conviction misdemeanor punishable sentence ofup one year imprisonment uncorrected fire code violations 10 bankruptcies_ tax credit liens applicant past five 5 years 11. business placed trust `` yes '' name trust 12. foreign operations foreign products distributed usa usproducts soldidistributed foreign countries `` yes '' attach acord 815 iability exposure andlor acord 816 property exposure_ remarksprocessing instructions attach additional sheets space required copy notice informationpractices privacy given applicant applicable states_ consult agent broker state 's requirements nqtice qf_isurance information practices personal information abqut including information credit report may colle tec persons connection application insurance subsequent policy renewals information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization right review personal information files request correction inaccuracies detailed description rights practices regarding information available upon request contact agent broker instructions submit request tous_ person knowingly intent defraud insurance company another person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal ny substantial civil penalties applicable co fl hi ne oh ok vt dc la tn va wa insurance benefits may also denied florida_ person knowingly intent injure_ defraud deceive insurer files statement claim application containingany false_ incomplete misleading information guilty felony third degree undersigned authorized representativve applicant represents reasonable enquiryhas made obtain answers questions application_ heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print state producer license required florida larry koester applicant signature date national producer number acord 125 2007/10 page 2 3 agency customer id artis-5 op id cm priqr carrier infqrmation line category carrier policy number claim8 claim8 claim8 claim8 claims policy type made occurrence madf occurrence madf occurrence madf occurrence mukdf occurrence retro date eff-exf date general aggregate g 1 pbs rughseomp personal adv inj occurrence e fire damage 8 medical expense 4 occurrence bodil injury aggregate ccurrence property damage aggregate comeined single limit modification factor total fremium carrier policy number policy type eff-exf date 1 8 combined single limit bodily ea person injury ea accident e property damage modification factor total fremium carrier policy number policy type 8 eff-exf date building amt r pers prop amt modification factor total fremium carrier policy number policy type eff-exf date limit modification factor total fremium loss history enferhflprcoeis osses regardless fault whether insured occurrences may give rise claims chk see attached priqr 5_years 3 yearsinks ny osssummary claim date line typeidescription occurrence claim date amount amount status occurrence claim paid reserved openclsdi remarks note fidelity requires five year loss history attachments state supplement applicable acord 125 2007/10 page 3 3 op id cm acord date mmiddnyyy commercial general liability section 12/21/2009 agency phone 505-888-6333 applicant artistic homes inc aic no_ext fax first aic_noh 505-888-6334 named insured insurance one inc 5501 eagle rock ave ne ste a-3 effective date expiration date payment plan audit direct bill albuquerque nm 87113 12131/09 12131/10 x agency bill larry koester compan code sub code use agenc artis-5 customfrds coverages limits x commercial general liability general aggregate 2,000,000 premiums claims made occurrence products completed operations aggregate 2,000,000 premisesioperations owner 's contractor 's protective personal advertising injury 1,000,000 occurrence 1,000,0001 products deductibles damage rented premises occurrence 50,0001 property damace medical expense oneperson 5,000 per bodily injury claim employee benefits x policy 15,000 occuerence total coverages restrictions andior endorsements hiredinon-owned auto coverages attach applicable state business auto section acord 137 schedule hazards loc haz classification class premium exposure terr rate premium code basis premiops products premiops products contractor single family pwellings 4-plexes 27000000 rating premium basis p payroll per 1,0ooppay ci totalcost per ooo/cost u unit per unit gross sales per ooo/sales area per ooosq admissions per qoojadm claims made explain `` yes '' responses explain 'yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number qf employees retroactive date acord 126 2007/05 page 4 acord corporation 1993-2007 ail rights reserved acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 12/21/2009

applica tion date acqrd smeaersiorvnsurco section 12/11/2006 producer phone 505 888-6333 carrier naic code underwriter nc ext fax 505 888-6334 zurich n amer insurance insurance one inc policies program requested 5728 osuna ne albuquerque nm 87109 indicate sections attached equipment floater garage dealers x property installationbuilders risk vehicle schedule glass sign electronic data proc boiler machinery code sub code ascqufsprfcriyablej e nmerclabiltty wcrkers compensation agency customer id crimemiscellaneous crime business auto umbrella 00000060 motor tenspsietionrgq truckersimotor carrier status submission package policy information quote issue policy enter information wen common dates terms apply_to several lines monoline policies bound give data anor attach copy proposed eff date proposed exp date billing plan payment plan audit date time direct bill 01/01/2007 01/01/2008 pm x agency bill applicant information name firet namad insured named insureds fein soc sec oo0-00-0o00 mailing address incl zip+4 ot flirst named insured flrst named ineured artistic homes inc phonia 505 247-8400 4420 tower rd sw ext suite albuquerque nm 87121 corporation e3b88efon7 `` 5 '' cr bureau id number yearpys individual profit org name partnership joint venture 8qrfsration inspection contact phone accounting records contact pho nio ext 505 247-8400 ac reba harper premises information loc bld street city cqunty state zip:4 city limits interest yr built part occupied 4420 tower rd sw inside owner entire 0o001 oooo1 suite outsiqe x tenant 1998 office albuquerque nm 87121 inside owner outside tenant inside owner outside tenant nature qe businessidescription qef qperations premiseisl residential general contractor general_infqrmation explain `` yes '' responses yes explain responses yes applicant subsidiary anqther entity cr x past losses cr claims relating sexual abuse x applicant subsidiaries molestation allegations discrimination negligent hiring formal safety program operatiqon last ten years applicant convicted qf degree crime arson ri question must x exposure flammables explosives chemicals answered applicant property insurance failure disclose existence arson conviction misdemeanor punishable catastrophe exposure 1 sentence la one year 0f imprisonment qther insurance company qr submitted uncorrected fire code violations x policy declined led nonrenewed 10. epkshfttierstax credit liens applicant burina prior isqvera9es9f nepecngele inmo wthepast 5 remarks person whq knqwingly intent tq pefraud any_insurance cqmpany qrancther persomtiles anapplicationfor stirance qr statemen claimconitaining vaterially false information conceals eor therurpose ofmsleading informatonconcerning fact material thereto commits fraudulent insurance act whichis crime sibjects tie er304,48criminal a4dtstg iiicwt 8en5ltes enot applicable co hne oti_ ok_or inmeandva insurance benefitsmay alsobe denied applicants producer 's signature signature acord corporation 1993 acord 125 7198 please complete reverse side ext `` yes '' prior carrier informa tion une category carrier policy mumber claims claims occurrence claims claim claims policy type occurrence occurrence occurrence occurrence made_ made made made made retro date eff-exp date general aggregate r8r2819 comp 05 1 personal e adv inj occurrence 88 damage medical expense 1 bodily occurrence injury aggregate property occurrence damage aggregate combined single limit modification factor total premium carrier policy number policy type eff-exp date 0 combined single limit 1 bodily ea person injury ea accident v property damage modification factor tqtal premium carrier policy number policy type 8 eff-exp date 1 building amt pers prop modification factqr tqtal premium carrier policy number policy type eff-exp date limit modification factor iqtal premim lqss hisiqry f8rehelpf claims losses regardless fault whether insured occurrences may give rise claims chk see attached prior 5 none loss date date amount amount claim occurrence lne typeidescription occurrence claim claim paid reserved status open closed qpen closer remarks note fidelity requires five year loss history notice insurance information practices personal information including information credit report may collected persons you.such information well personal privileged informaton collected us_or agents may certain circumstances disclosed third parties right review personal information files request correction qf inaccuracies detailed description rights practces regarding information available upon requesl contaclyoir agenlor broker fsrinstructiononhowiq submiiareqlesl tqus acord 125 7/98 date mmddny acord business auto section 12/11/2006 087rx838280x applkant artistic homes inc_ producer phone 505 888-6333 nc_no ext flrt fax 505 888-6334 namod ingured insurance one inc_ expiratkon date x payment plan audit 5728 osuna ne effectne date direct bill ibuquerque nm 87109 01/01/2007_ 01/01/2008 agency bill company use code sub code cgefsmer id 00ooo06o coveragesivimts coverages covered auto symbols limits coverages covered auto symbols limits x x csl ba per 1,000 000 liability bi accident property damage deductible personal injury equivalent physical damage protection nofault coverage total wic towing additional labor plp mee 1,000 medical person 5 0oo comprehensive payments x x csl ba per 1,000 000 specified causes loss uninsured bi accident motorist property damage collision 1,000 x csl inc x x ea per underinsured bi accident motorist property damace states days vex coverageideductible nates cost hire x basis hirediborrowed comp liability spec states group type number hired c nm physical coll x employees damage non-owned liability volunteers coverageis primary secondary partners endorsements forms conditions auto 4 owned autos private passenger autos specified schedule covered owned autos 5 owned autos require fault coverage 8 hired autos sutbols owned private passenger autos 6 owned autos subject compulsory um law non-owned autos driver information list drivers including family members wll drive company vehkcles employees drive vehicles company business driver name include address h requlred date birth year docirs sec8k95 number strze wise use jerry wade 012185561 nm 0001 09/06/1940 thomas j wade 033224206 nm 0002 02/05/1970 stephanie wade 09/18/1967 028242271 nm 0004 margaret brown 100211084 nm 0oo5 02/02/1974 joe e pierce 009202561 nm 0oo6 08/25/1956 joooz fernando aragones 11/15/1967 121759501 nm vehicledescription symage cost new vek year make chev bopy pickup oooo1 1988 modelc1o vln 1gcdc14h9jz226985 5 200 terr gwwigcw class sic factor seat cp radius farthest term city state zip 100 garaged spec drive workischool use comml eufekages add l pip x hnrbns lsp deductibles acv comp 15 miles pleasure retail x liab x med pay tqnbt comp aa st amt 15 miles cr farm x service pip x 4jnsr 8f86 ftw coll coll acord 4127 8194 mn please complete reverse side acord corporation 1993 vericle description continued veh year 00002 make jeep bopy cherokee sywage cost new 1996 model_ vlm 1j4fj27s6tl228947 1,700_ city state zip terr gwwigcw class sic factor seat cp radius farthest term garaged 100 drive wrkischool use comm l edecragest add l pip x undrins deductibles `` bpec motor lsp acv comp 15 miles pleasure retail x liab x med pay towing c 8 labor ft comp aa st amt 15 miles cr farm x service pip unins spec motor ccf ftw coll coll veh year make ford to38 pi truck sywage cost new 00003 2006 mdel f150 van 1ftre14wo6ha23477 citystate zip terr gwwigcw class sic factor seat cp radius farthest term garaged 100 drive workischool use comml ejeckages add l pip x undrins lsp deductibles spec motor acv comp cof 15 miles pleasure retail x liab x med pay towing ccmp labor aa st amt 15 miles farm x service pip x unins spec mqtor ftw coll coll veh year make fopr sywage cost new model vln_ city state zip terr gvwigcw class sic factor seat cp radius farthest term garaged drive workischool use comml eueekages '' ado l pip hopbis lsp deductibles 'spec acv comp 15 miles pleasure retail liab med pay towing comp labor aa st amt 15 miles farm service pip unins spec motor c ftw coll col veh year make fog symiage cost new model vln_ city state zip terr gvwigcw class sic factor seat cp radius farthest term garaged drive workischool use comml e8eckages add l pip uoons lsp deductibles acv comp spec c 15 miles pleasure retail liab med pay towbt comp aa st amt 15 miles farm service pip yjnsr spec ftw coll c coll additional interesticertificate recipiemt attach acord 45 additional names interest rank name address reference certificate required interest item number additional insured location building loss payee vehicle boat mortgagee sckeouled item number venholder employee lessor item description general information explain 'yes '' responses yes operations involve transporting hazardous material 1. exception encumbrances vehicles solely 8 hold harmless agreements owned registered applicant x 9.any vehicles used family members 2.do 50 employees use autos business 5o please iqentify remarks 3. vehicle maintenance program operation x 10 applicant obtain mvr verifications vehicles leased toothers 11 applicant specific driver recruiting method 5. vehicles customized altered special equipment x 12 drivers covered workers compensation 1 6 areicc puc filings required x 13 vehicles owned scheduled application description garageistorage locations maximum dollar value subject tq remarks jnnsured underinsured motorists coverages check appropriate box/es sign applicable use ar az ca ct de fl ga 14 il md nj nv ok pa ri sc wv use specific state supplement minimum um limits required dc mn mo vt va wa wi selecting um uim limits equal liability limits understand acknowledge uninsured motcrists um underinsured motorists uim coverages selecting um uim limits lower liability limits explained offered options of_ rejecting coverage entirely understand cov- select um uim limits indic app applicant 's signature erage selection limit reject um bodily injury coverage applicant 's signature choices indicated afply future policy reject uim bodily injury coverage applicant 's signature renewals continuations reject um property damage coverage applicant 's signature changes unless notify otherwise writing reject uim property damace coverage applicant 's signature acord 127 8/94 attach tq applicant information section ckup

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Business Auto||Date : 12/11/2006

commercialwnsurance application date acord applicant information section 12/03/2007 producer prore carrier naic code undertrter ac ext 505 888-6333 fax `` 505 888-6334 policies program requested insurance one inc 5728 osuna ne albuquerque nm 87109 indicate sections attached equipment floater garage dealers property installationibuilders risk vehicle schedule glass sign electronic data proc boiler machinery code sub code agcoabes pafcriyablei gpnerercuability workers compensation agency customer crimeimiscellaneous crime business auto umbrella 00006171 tbispoructipnrgo truckersimotor carrier status submission package policy information issue policy enter information wen common dates terms apply several lines monoline policies quote bound give date andlor attach copy proposed eff date proposed exp date billing plan payment plan audit date mme oirect bill 01/26/2008 01/26/2009 agency bill pm applicant information feior soc yec 85-0295553 mailing address incl zip+4 first named insured rooseve name first named insured named insureds first named insured sos managed waste inc ph8nc ext po box 659 portales nm 88130 cr bureau id number yearb individual corporation 883goratfon profit org name partnership joint venture eorporation 1984 inspection contact phone accounting records contact ph8n_ ext 505 356-8720 ac ext adam_sprunger premises information loc bld street city county state zip+4 city limits interest yr built part occupied 113 n_ ave inside owner 00001 |000o1 roosevelt outside tenant office/ yard portales nm 88130 inside owner outside tenant inside owner outside tenant nature businessidescription operations premise general information explain `` yes '' responses yes explain `` yes '' responses yes applicant subsidiary qf another entity past losses claims relating sexual abuse qr x applicant subsidiaries molestation allegations discrimination negligent hiring formal safety program operation last ten years applicant convicted degree crime f arson ri question must exposure flammables explosives chemicals answered applicant property insurance failure t0 disclose x existenca arson conviction misdemeanor punishable catastrophe exposure sentenca one year imprisonment insurance wth company submitted uncorrected fire code violations x policy coverage declined cancelled non-renewed 10. bankruptcies tax credit liens applicant prior 3 years applicable mo past 5 years remarks person whq knowingly intent tq defraud any_insurance company anqther person files applicationfor insurance statement claimcontainng materially false information conceals purpose qf misleading information concerning fact material thereto commits fraudulent insurance act isa crime subjects person crimnal iny substantiali civil penalties bene8o applicable co hi ne oh ok va insurance benefits may also e applicants producer 's signature signature acord 125 7/98 please complete reverse skde acord corporation 1993 prior carrier information line category none carrier policy number clams clams clams occurrence claims occurrence claims occurrence policy type occurrence made occurrence made made made made retro date eff-exp date 2 general aggregate products comp op aggregate personal adv inj f occurrence 0 fire damage medical expense occurrence bodily injury aggregate property occurrence damage aggregate combined single limit modification factor total premium carrier policy number policy type eff-exp date 8 combined single limit bodily ea person injury ea accident e property damagce modification factor total premium carrier policy number policy type 8 eff-exp date 1 building amt pers prop amt modification factor total premium carrier policy number policy type eff-exp date limit modification factor total premium loss history enter claims losses regardless fault whether insured occurrences may give rise claims chk ~ee attached prior none loss date line typeidescription occurrence claim date amount amount claim occurrence claim paid reserved status open closed open closed remarks note fidelity requires five year loss history notice insurance information practices personal information including information credit report may collected persons information well personal privileged information collected us agents may certain circumstances disclosed third parties_ right review personal information files request correction inaccuracies_ detailed description rights practices regarding information available upon request contact agent broker instruction qnhqwto submit request tqus acord 125 7/98 sos managed waste inc app icant information supplementa schedules 12/03/2007 insurance_one inc named insureds named insured entity type insured type sos managed waste inc. corporation first named insured contact names contact name responsibility phone number ext adam sprunger accounting records 505 356-8720 date mmddny fqulri 07 0 12/03/2007 atfairdd 373003r487700004402824 applicant producer phone 505 888-6333 sos managed waste inc. fax 505 888-6334 proposed eff date proposed exp date billing plan payment plan audit insurance one inc agency 5728 osuna ne 01/26/2008 01/26/2009 ibuquerque nm 87109 direct company use terriory 0f operatoy tfeofoff ation portales nm waste hauler covraoededutttee pcheduled equipment 1,000 deductible eoufmentstorzc3 unscheduced eouffment maximum value description maximum item amt insurance coins loc_ mo type security storage building outside additonal intereetcertificate rectpients nnach 7ep3ete heottereeaty name address name address wetis fargo equipment finance inc 733 marquette avenue 700 mac n9308-070 minneapolis mn 55402 interest loss payee/add 1 interest certification interest certification p10-dc/wp-240 western mule crane24 required required name address name address we1 fargo equipment finance inc 733 marquette ave stezoo mac n9308-070 minneapolis mn 55402 interest loss payee/add '1_ interest certification interest certification 1997 930jcb 662779 jcb forklift required required ttg explain `` yes '' responses_ yes explain `` yes '' responses yes equipment rented loaned toifrom others property used underground wthmthout operators work done afloat applicant operating equipment listed remarks equipment schedule onreverse side oacord corporation7190

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Equipment Policy||Date : 12/3/2007

date application 05/30/2007 acord sbmwerseoewneenti section underwriter carrier naic code hart producer roma ext 505 888-6333 hartford insurance fax '505 888-6334 '' requested policies program insurance one inc 5728 osuna ne equipment flqater garage dealers albuquerque nm 87109 indicate sections attached schedule installationibuilders risk vehicle property electronic data prcx boiler machinery glass sign accounts sjaferyablei 3oneerciaxbility workers compensation sub code valuable code crimemiscellaneous crime business auto umbrella agency customer id tranksporuationrgo truckersmmqtor carrier 00008401 mqtor status submission package policy information monoline pclicies enter information common dates terms apply several lines quote issue policy payment plan audit proposed eff date proposed exp date billing plan bound give date andlor attach copy direct bill date time 05/31/2007 05/31/2008 agency bill pm applicant informaton fein soc sec 75-3114553 mailing address incl zip+4 first named insured bernat tttt name flrat namad ingured named insureds oi first named insured menau bi vd ne 828-4432 11501 phenes ext albuquerque nm 87112 accu stat medical transcription inc year bus e8rf8 a56n cr rureau id number started individual corporation profit org partnership joint venture eokfbration accounting records contact phone 505 828-4432 inspection contact phone nc ext nc ext tony pino premises information city limits interest yr built part occupied loc bld street city county state zip+4 11501 menaul bivd ne inside owner office 00001 00001 bernal iil0 outside tenant albuquerque nm 87112 inside owner outside tenant inside owner outside tenant nature qf businessidescripiion qe qperations premiseisl oni ine cal ranscription office general infqrmation explain `` yes '' responses yes explain `` yes '' responses yes nq applicant subsidiary anqther entity x past losses claims relating sexual abuse x theapplicant subsidiaries molestation allegations discrimination negligent hiring formal safety program operation x last ten years applicant convicted degree crime arscn ri question must x exposure flammables explosives chemicals answered applkant property insurance_ failure disclose existence arson conviction misdemeanor punishable catastrophe exposure sentence one year ot imprisonment any_qther insurance company submitted uncorrected fire code violations x policy coverage cancelled non-renewed x 10 bankruptcies tax credit liens afplicant burroygy prisqveresesd pecy nfrpgcngeye mo wntkepast 5 years remarks person knowingly intent qefraud any_insurance company qr anqther personglles a4appiicajonfor istrnce stajev en oe ckaimcomaniganyctirterzally false information conceals rirpose msleading informatonconcerning fact material tereto commits fraqpulent nsuranceact wchs sr1te anr stbjects thepers01i4ocrmmnal anr1nsuestiticml renaltes e-not applicable co hne_oh_ok_or iinme andva insurance benefits may also dened larry koester 8x4 applicants producer 's alliso signature signature please complete reverse side acord corporation 1993 acord 125 7/98 medi= 36 '' prior carrier information none une category carrier policy number claims occurrence claims occurrence clams occurrence claims occurrence made made claims occurrence made policy type made male retro date eff-exp date general aggregate products comp cp agaregate r personal adv inj occurrence 2 fire damage 6 medical expense occurrence bodily injury aggregate property occurrence damage aggregate combined single limit modificaticn factor total premium carrier policy number policy type exp date 1 8 combined single limit bodily ea person injury ea accident 0 property damage modification factor tqtal premium carrier policy number policy type 8 eff-exp date 1 building amt pers prop amt modificaticn factor iotal premium carrier policy number policy type_ eff-exp date limit mqdification factor tqtal premilm eqerahistobor losses regardless fault whether insured occurrences may give rise clams x chk see attached fra4rcorims none loss date date amount amount claim line typeidescription occurrence claim claim paid reserved status occurrence qpen clqsed qpen closeq_ remarks note fidelity requires five year loss history pcrgofinsnrorcvanformaecuproticncluding information credit report may collected persons thanyouesuch reormaticrswezion 8oueryalrsccluding nforeghonfrgm tcredo recoedev us.35,8456 gens ncerfouersorrecttos bfdiuatiseasowehrossrher peosoae tilrighi eorevievyour personai informationinpurt les anpcan reruestvcorbeetpo inaccuracies amore detailed descripton rights fracjces regarding information available upon requestacomtaciyouragentzorerokereqr insiructiomonhowto submiiarequest tqus acord 125 7/98 eff date acordi workers compensation application 05/30/2007 underwriter company producer dhena exj 5052888-6333 hartford insurance fax 505 888-6334 accu stat medical transcr ption inc applicant name insurance one inc. 11501 menau blvd ne 5728 osuna ne nbdings albuquerque nm 87112 albuquerque nm 87109 gslalrf berna i1o yrs bus sic individual corporaticn limited corp partnership subchapter `` '' corp otker id number code sub code gbe94u name rating bureau id state federal employer id number ncci id number gmpesyenwc444543988,884 agency customer id 75-3114553 00008401 status qf submission billingiaudit informatiqn billing plan payment plan audit quote issue policy expiration monthly agency bill annual bqund give date andor attach copy x direct bill semi-annual semi-annual assigned risk attach acord 133 quarterly quarterly locations street city county state zip code 11501 menau1 blvd ne 0o001 albuquerque berna lo nm 87112 pqlicy information proposed exp date normal anniversary rating date participating retro plan proposed eff date 05/31/2007 05/31/2008 non participating part 3 states ins deductibles amounti coverages part workers part 2 employer 's liabilty compensation states 100 000 nm medical usl 8h_ `` arasfqion accident voluntary nm 500 ,000 disease policy limit indemnity comp 100,000 disease-each employee foreign cov dividend planisafety group additional company information rating information com employees estima ted estimated state loc class code pany categories duties classifications fule part remunnuation rate annual premium use time clerical nm 8810 25 0o0 specify additional coveragesiendorsements factor factored premium total increased limits dequctible experience mcdification loss constant assigned risk surcharge arap premium discount expense constant deposilpremium total esiannualpremm mnmum premm acord 130 7/98 please complete reverse side indivduals wncludediexcluded_ included excluded remuneratlon ineluded must part rating informatlon sectlon partners officers relatives be_ title owner inciexc class code remuneration name date birth relationshie ship duties 09/03/1957 president 51 clerical exc 8810 julie pino 05/03/1956 vp 49 clerical exc 8810 tony pino prior carrier informationloss hisiory attached loss run provide information past years use remarks section loss details annual premium mod claims amount paid reserve year carrier policy number_ co pol co pol co pol co pol co pol nature of_businessidescription qf qperations materials esses equipment contractor type pescriptrns 2hksnanbisp rsyomeryqersdhcs serveectyfitc 'gcatiom parvlacrergesatimalesoduthinquip mencsqres iorcoumejrn pesgercarns ormbksnendis fustamers ontine medica transcription office general_information yes yes explain `` yes '' responses explain al `` yes '' responses x 16 physicals required offers employment made applicant operate lease aircraftmatercraft2 2 domhave past present discontinued operations involve x 17 insurance wththis insurer storing treating discharging applying disposing transporting 18 exxcriredsqyererereshners priqr coverage applicable mo hazardous material e g landfills wastes fuel tanks etc last 3 years work performed underground 15 feet x 19. employee health plans provided barges vessels docks bridge water x 20 labor interchange businessisubsidiary work performed business x 21. dq yqu lease employees toor employers 5 applicant engaged type 6. sub-contractors used yes give work subcontracted x 22 dq employees predominantly work home certificates oe.ins 23 tax liens bankruptcy wthin last 5 years work sublet without x 8 written safety program operation 9 grqup transportation provided contact information 10any emplqyees 16 qver 60 years qf age x im- phone_ spection name 11 seasonal employees 505 828-4432 12 i5 volunteer donated labor x acctng phone record name tony pino 13. employees physical handicaps x phone 14 employees travel state claims x info name 15are athletic teams spcnscred applicable tennessee crime knowngly provide false incomplete misleading information parisiuq avrkerecom pensation iransacioneor purpose qe commi iing eraud enaltes include imprisonment eines anddenial oe insurance beneeiis person whioknowmnglyand wth intent defraud insurance companx orenotherperson eil essanadrgcafowforonsurance oryspareqen c kcvow contaninganymaterialy falsenformaticn 8r concealefcr rurposeroe misleadinconfgcrioiaconi orrningeany kactmaterial thereto ccmmitsafraudulent nsuranceact vhchis criand ya ectsmn pers8ndocrmminal substamtialcivilrenaliies notapplcablennco_hne ziokoruinmeandva insirance beneelis mayalso bedenied ny remarks applicant 's signature producer 's signature an4n larry koeste iallisq acord 130 7/98 `` 4itn ''

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Workers' Compensation||Date : 5/30/2007

date acqrdo workers compensation application 01/02/2007 company underwriter producer rnemo exty 505 888-6333 food industry self ins fund nm fax 505 888-6334 h h sales services inc. applicant name insurance one inc 5728 osuna ne dennis hughes albuquerque nm 87109 nbbangs p 0 box 3008 ecasa aibuquerque nm 87190 yrs bus sic individual x corporation limited corp partnership subchapter '' corp code sub code sbe9fu name id number agency customer id feoeral employer id number ncci id number pmye8rnthc `` hggbyrertor q8134pe 00000411 status submission billingiaudit information x quote issue policy billing plan payment plan audit bound give date andlor attach copy agency bill annual x expiration monthly assigned risk attach acord 133 x direct bill semi-amnual semi-annual quarterly quarterly locations street city county state zip code 3340 columbia dr ne 00001 albuquerque berna nm 87107 policy information proposed eff date proposed exp date normal anniversary rating oate participating retro plan 01/01/2007 01/01/2008 non-participating part 1 workers part 3 states ins deductibles amountpk coverages part 2 employer '' 's liability compensa tion states nm managed 500 ,000 accident medical usl h care option nm 500 ,000 disease-policy limit indemnity ohntary x pdis 500 000 disease-each employee foreign cov x excnt dividend planisafety group additional company information rating infqrmation com- employees estimated estimated state loc class code pany categories duties classifications full part annual rate annual premium use time time remuneration outside sales 8742 18,6560 60000 111.94 electric wiring within nm 5190 drivers 118,7054.05000 4 ,807 55 clerical nm 1 8810 67 ,8330.35000 237 42 specify additional coveragesiendorsements factor factored premium total 4,695.00 increased limits deductible experience modification loss constant assigned risk surcharge arap premium discount expense constant 3 287 00 deposit premum tqtaleslannlal pbemim mhnimlmpbemum acord 130 7/98 please complete reverse side bldgs individuals includediexcluded partners officers relatives included excluded remureration included must part rating information section name date birth relahsrship oier duties inceexc class code remuneration dennis hughes president 80 sales exc doug gough vice 20 admin exc president prior carrier informationiloss history provide information past 5 years use remarks section loss details loss run attached year carrier policy number annual premium mod claims amount paid reserve 2006 co fisif 4,693.00 2007 pol 0558a co pol co pol co pol co pol nature qe businessidescription qf operations comments descriptions products manufacturing_raw materials processes product equipment contractor- type sorkoumetnsn pesc ttqtie oeehsne bse crsome rs deliveries service-type location farm-acreage animals machinery sub contracts fales service repair restaurant equ pment general information explain `` yes '' responses yes explain `` yes '' responses yes applicant operate lease aircraftmatercraft x 16. physicals required offers employment made 2. doihave past present discontinued operations involve x 17. insurance tkis insurer storing treating discharging applying disposing transporting 18 prior jinedi hazardous material e.g landfills wastes uel tanks etc enneriqrgoyeragewes last 3 years applicable mo 3. work performed underground 15 feet 19. employee health plans provided x 4 work performed barges vessels docks bridge water 20. labor interchange businessisubsidiary 5. applicant engaged type business 21.do lease employees employers 6. sub-contractors used yes give work subcontracted 22. employees predominantly work home 7 work sublet without certificates ins. 23. tax liens bankruptcy within last 5 years 8.is written safety program operation 1 9. croup transportation provided contact information 10.any employees 16 60 years age in- phone 11 seasonal employees x spection name 12. volunteer donated labor x acctng phone 505 883-9172 13. employees physical handicaps record name dennis hughes 14. employees travel state x claims phone x info j5_abe athletic teams sponsored name applicable tennessee crime tq knowingly provide false incomplete misleading information party tq workers com pensatiqn transactioneorthe purpose qecomml ing eraud penalties include imprisonmeni_eines denialoe inslrance beneeits person whq knowingly intent tq defraud insurance company oranother person fileslanapplication fqr insurance statement claim containing materially false information conceals purpose of_misleading information con cerning fact material thereto.commits fraudulent_insurance act crime subjects person criminal nysubstantialcivilpenalties notaeplicableinco_hl ne oh okor-inmeandlva_inslrance beneelis may alsq denied remarks producer 's signa ture applicants signature acord 130 7/98 827 7 2 1v 3 3 1 wi 2 v p 1 2 1u 11 1 0 f 1 2 0 iv 8 1 0 0 1 1 e 1 1 3 1 1 6 3 1 2 3 1 7 17 h h 0 l 3 0 2 3 1 1 5 8 3 1 l 1 3 7 1 17 2 9 1 1 1 3 1 k 11 5 1 6 1 5 1

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Commercial Package Policy||Date : 7/23/2008

op id ck acord commercial insurance application date mmddiyyyy applicant information sectiqn 7/23/2008 underwriter underwriter agency carrier naic code insurance one inc vernon fire insurance 6101 moon ne suite 1000 policies program requested policy number albuquerque nm 87111 cp2138771a chris koester indicate sections attached equipment floater garage dealers phone property installationibuilders risk vehicle schedule jnc_no ext 505-822-8114 electronic data proc boiler machinery fax 505-822-0341 glass sign nc receivablei workers compensation email afcouyes e papers genererclaability address crimeimiscellaneous crime business auto umbrella code sub code agency customer idwerne-2 trxnspprhaticngo truckersimotor carrier status qf transaction package policy information quote issue policy renew enter information common dates terms apply several lines fqr monoline policies bound give date andlor attach copy proposed eff date proposed exp date billing plan payment plan audit change date time direct bill cancel pm 01/21/08 07/21/08 x agency bill applicant information mailing address incl zip+4 first named insured name first named insured named insureds werner gilchrest llc toni ponic 202 cornell se albuquerque nm 87106 fein soc sec phone ot first naned insurede ac no_exthi e-mail nebeeesi aqdressles `` '' llc cr bureau id number date bus individual corporation 88bp8r7ff8n x name started partnership joint venture frofprrg nslqeaneueebs inspection contact accounting records contact e-mail phone email pveneo ex 505-268-1200 address iac extli address premises information yr annual loc bld street city county state zip+4 city limits interest built employees revenues occupied 202 cornell se inside owner 1902 albuquerque nm 87106 outside tenant 206 corell s2 inside owner 1960 2 albuquerque nm 87106 outside tenant nature qf businessidescription qe qperations premiselse vacant house vacant house 2 general information explain `` yes '' responses yes explain `` yes '' responses yes lastfive years ten ri applicant applicant subsidiary another entity indicted convicted degree crime fraud 1b applicant subsidiaries bribery arson arson-related crime connection property x formal safety program operation ri_ question must answered applicant property insurance failure 1 disclose existence arson conviction misdemeanar punishable exposure flammables explosives chemicals sentence one year imprisonment catastrophe exposure uncorrected fire code violations insurance company submitted 10 nybaekehete teffstax credit liens agatnst applicant x policy coverage declined cancelled non-renewed t1 business placed trust x yes_name trust prior 3 years applicable mo 12 foretgn operations foreignproducts distributed usa us past losses claims relating sexual abuse molestation products soldidistributed foreign countries `` yes '' attach x allegations discrimination negligent hiring x acord 815 for_liability exposure andlor acord 816 property exposure remarksiprocessing instructions attach additional sheets space required business type description person knowingly intent defraud insurance company another person files application insurance statement claim containing materially false information_ conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal ny substantial civil penalties applicable co hi ne oh ok vt dc la tn ad va insurance benefits may also denied undersigned authorized representative applicant certifies reasonable enquiry made obtain answers questions application heishe certifies answers true correct complete best hisiher knowedge applicants signature date producer 's signature national producer number chris koester acord 125 2005/06 please complete reverse side acord corporation 1993-2005 mt werne-2 op id ck prior carrier information line category carrier policy number claims claims claims occurrence claims occurrence claims occurrence policy type made occurrence made cccurrence made made made retro date eff-exp date general aggregate r rroregas comp op ie personal adv inj occurrence fire damage 8 medical expense bodily occurrencei injury aggregate occurrence property damage aggregate combined single imit modification factor total premium carrier policy number policy type 0 eff-exp date 8 combined single limit 8 bodily ea person injury ea accident property damage modification factor total premium carrier policy number policy type 8 eff-exp date r building amt pers prop amt modification factor total premium carrier policy number policy type eff-exp date limit modification factor total premium loss history enter claims losses regardless fault whether insured occurrences may give rise claims chk see attached fqr priqr 5 years years inks nxj ienqne loss summary claim date amount amount status date line typeidescription occurrence claim claim paid reserved open clse occurrence remarks note fidelity requires five year loss history attachments state supplement applicable copy notice information practices privacy given applicant applicable stales consult agent broker state 's requirements notice insurance information practices personal information yqu_ including information credit report may collected persons connection wth application insurance subsequent policy_renewals_ information well personal privileged information collected us agents_ may certain circumstances disclosed third parties wthout authorization right review personal information files request correction inaccuracies description rights practices regarding information available upon request contact agent broker detailed instructions tq submia request tqus acord 125 2005/06 werne 2 op id ck page 1 additional premises information loc 3 building city limits wnterest yr bullieemployees annual revenues occupied streetcity_cqunty_state_zip cqde 208 corhrll se inside x owner albuquerau nm 87106 outside tenant 1960 nature businessidescription operations vacant house loc building street_city_cqunty state zip code city limits wterest yr buili employees annual revenues occupied inside owner outside tenant nature f businessidescription operations loc building street_city_cqunty state_zip cqde city limts wnterest yr bultlemployees annual_revenues occipied inside owner outside tenant nature qf businessidescription operations loc building street city_cqunty_state_zip cqde city limits interest yr builtlemployees annual revenues loccupiep_ inside owner outside tenant nature businessidescription operations loc building streel city_cqunty_siate zip cqde city limits interest yr builiemployees annual_revenuesloccupiep inside owner outside tenant nature businessidescription operations '' loc building street city county_state zip cqde city limits interest yr builieemplqyees annual revenues pccupieq inside owner outside tenant nature businessidescription operations loc building streel city_cqunty_state zip cqde city limis iterest yr built iemployees annual revenues occfpied inside owner outside tenant nature businesstdescription operations loc building streel ciy _cqunty state_zip cqde city limits interest yr built iemplqyees annual revenues ioccupied inside owner outside tenant nature businessidescription operations applied t25api 2005706

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 6/30/2008

acord commercial insurance application op id aw date mmiddryyy applicant information section 6/30/2008 agency carrier insurance one inc nac code underwriter underwrter ofr 6101 moon ne sulte 1000 colony insurance albuquerque nm 87111 tolicies qr prooram requestrd fol cy number koostar gl3337206 aadeeaa indicate sections attached equipment flqater garaoe dealers digne exu _505-822-8114 property inbtallationbuildere risk vehkci_e schedule eneli 505-822-0341 glas8 sign electronic data prdc boiler machinery ecac addres3 aggounes-aferiable 82n3e gua3ility workers compensation code sub code crimemiscellaneous crime bubine8s autq umbrella agency customer idsosma-| iaaneparfetirnco truckerbimotor carrier status qf transaciion package policy information quote is8ue folicy renew enter ihi8 infqrmatonwien common dates terms apply -severallinel formonqiine policigs aenenn bound give data andor attach copy proposed eff date propqsed exp date billing plan date time payment plan audit change c direct bill cancel 07/28/08 07/25/09 aqency bill applicant information nake firat namct injurod namod inburoda mailing addresr incl e1pra 07flrat mnmad inaurod 50s managed waste inc richard griffith po box 659 portales nm 88130 fznoreuc se0 qrfrtnume ineuredh roxeezt desxe3 neeked individual corporation 2he9ua48n llc oreienu i0 number piabes partnership joint venture n28h18oba aesranespees inspection contact accquntinq records contact samo fibno_ext 5024 eat fi2n neexti 0tla premises informatiqn loc bld street city county state zipt4 city umits intcrest yir annual occumieq built employees revenubs inside owner albuquarque nm qutsioe tenant 4401 hobbs intenr| alrpoart r inside owner hobbs nm 88240 qutside tnt nature qe businessidescrieiion qfoperations bypremiseisl general information explain `` yes '' responbes yes explain `` yes '' responseb yes 10 applicant subsidiary o1 another entity x durinc lasttwe yearstenwti hau afflicant 1b dqes applicant ^ny sudsidiaries indicted convicted degree crime qf fraud brirery arson othfr ar8on-related crime connection formal 8afety program operationt maek hasorton yotherprope `` auasllon munt anayerea appllaant tor proporty inauranco fallure exposure flammari es fxplosives chemicals lo dleclose ute existonca 0f 7 droon canvieiion iu mladomoanr punlshabka catastrophe lt jantanca oyptq qnaxzar l lmpoloznmenul expobure uncorrected fire cqde viqi ationg inburance vth company submit ted 10 taxur crzdtt liens tie applicnnt mawtiar pqlicy coverace declined cancelled non- renewed habbueinee3eeen flaced wnatrust prior 3 yfars appllcabla mo x lybs fordid operatons tnyfast lossesor clnime rhng sexunl abuse molostation 12. oretennprrooucts qstributeuin tusa ofus allecations diicrimination negligent hiring proqucts soldmdistriduted foreign countries k `` yes '' attadh acr0 415 00 kablly expoeungendio acord 8letpr piopeny exporure remarksiprocessing instructions attecl adklltlonma ahnera epaco roqulrod bdsiness type descriftion wytereon vrid kndwngly witi wntent defraud insurance company qr anqther perion files applicatiqn insuranct statement clam containino materially false information conceal8 purpose mibleadinc_ information concerning fact material thereto commit8 fraudulent insurance act i8 crime subjects thie person criminaland ny substantial civil penalties ndi rppikabia n co hi ne qx qk qr vt dc l^ mb _wnand va _ineurance beneibs msy olpobo dgnted undersigned gesha e4zip representative applicant certifi6s reasonaale gnquiry mas deen made oetain ti-e answers questions applicatidn anbwers true correct complete thz best hisher knowledce licants sighature date producer 's iignature national producer number mau z-fa lary koester cord 126 2005/05 please complete reverse side acord corporation 1993-2005 larry othar ldjo 4 policyholder disclosure notice terrorism insurance coverage covcam hereby nhed tatunder te torrcrism rlsk irsurance act e8 emendad ihatyouhave raht l purchage ingurence covcrage rbesse resullilng frot erts ottenerlsm €2 demed soolon 762 v orta act ten uct enonsm '' means act salis cortied ino sacielary tha treasury concurtance wtn ne cecrevvv 07 slats attamoy ganal aftta ujraey slales lo ah ct pftefrongm vkkant ect xt dangerous tuman tie property irfraetizekiure uked indamege within tha niled slates dr quarrie te unkted stetodn ine cage certain careis vereats prerieds gf unteenied sinls gon hav bcon commitedby en indkidue ndwcudle 85 parof eion coerce ihe civlfan population uniled stuitee b intuence policy afiect ina conduct 0f ha united states oovernmanf cperojan ychshoulr knw thatwhiere coveragejs provided poligy losses resulting certified acts terrorism suchloeeer may parmally reimbursed ey unmed states government undera formula estabuishedey gederal lwhowever policy may containqther excluisions mhich migrt affett coverage anexclusionfornuclear lvents lnder theformula united states sovernment generlly reimburses b5aof cqvered terrorismlosces exceeding statutorly fstat- sherprrqctible paqby t3e insuranceco pany eroviding coverage `` 4e premium charged forthis coveraqe sprovided belowandloesnot include charoes tie portion l08s covzreq federal gomernment uncer act yqu al8q knqwthat terroricm risk insurance act amended contains 810q billion cap limi9 4 6 gqvernment reimbursement agwell asins rers liabiuty lo8ses resulting certified acts terrorism whien theamount buch losses inany one calendar year exceeds 5100 billiqn thie acgreqate insured losse8 isurers exceed s10 billion coverage may 8e reduced please al8o aware yolr policy nqi provide coverage acts terrorism cermfied gecretary treasury acceptance er eelestion ot terorstu ineurnca coverde muet accert ar rckeet hls insurance covarage lossee arleing oul acts ot terrotism 88 defned seclbn 102 1 befovo tha elective date ttis poliky yotr cpvers lecannothebreduilere oulrepreser _lue leg tecelved tb fom nicnadbyyey q kdalqallinaurede wlh allpiemiuma coverago zccoptance heteby elect puchase gaverage ga eied cts dterorsn e2 dalinod saction 10201 aterd prospecive annual pretnlum understand hat wi caverage kos8es teeuling non-curtllad cts af arorsm coverage relecllon hereby dectne pulchalee 7gsse53 cerlllled acte f tenoistn 8 dofined sacllon 10201 iho act understand het wll nct hiuve cova mstag fror ellher cartifed non-cortified df enoriam cploy incurance comgqny hcant si8r zao- insurance company must eutharltad slgn foral mateoa2i7o ralliiede print wnemg pollgy number ss iinieue leste zne submit 1on nuibar wamed ihuyed zct= producerwumber datd n xuletkoske naj 28100 yne street addrean nm 31jil tha producer show le wholedale incuranae broker ydur insurnee agent ueed place insuranco coverugc wlth 43. plcase discuee thle dicclaau agont beforc signing triazdornotice-0108 page 1 af 1 tha aot 4e 'te mtahaao alomged fycer loec elwde quotatton americane 5299 dtc blvd_ suito 900 greenwood co 80111 telephone 303-751-7974 facsimile 303-745-8278 june 23 2008 insurance one inc telephone 505-888-8333 attn allison wylie facsimile 505-888-8334 6101 moon ne suite 1000 number qf pagea albuquerque nm 87111 pleased provlde followlng quotatkn response subrission carrier colony insurance company company non-admitted carrier new mexico policy provides surplus lines insurance insurer otherwise authorized transact business new mexico policy subject supervision review approval superintendent insurance insurance 5q provided within protection guaranty fund law f new mexico designed protect public event insurer 's insolvency insured sos managed waste inc address po box 659 portales nm 88130 proposed term 07/25/2008 07/25/2009 coverages commerclal general liabllity/occurrence form llmlts 32,000,000 ceneral aggregate sincluded productsicorpleted operationa goneral aggregate s1,000,000 personal advertising injury 81,000,000 occurenca 100,000 fire damage s000 medical expense deductible 500 biipd per claim exclusion olal pollution asbestos silica dust toxic substance punllve exemplary damages lead contaminatlan employment related practices emplovers ilability warlterrorism moldlfunglbacteria rotlwer-tot nuclear energy land subsldence profesgional liabllty others per is0 company foms mandetory exclusion may apply forms list atlached ~terrorism coverage additional m100 plus surplus lines tax desired coverage bebound wihqut wesigned rejectionform_unless cqveraceis desired `` american e insurance brokers village dry- quotation americane sublect completed nd slgned terrorism form completed akgned affdavit attachad quate ks based expiring expasures end operations blnding please comn hava changes exposuras operatlons last year new application roqulred h changes bound amendments coverage mugt specifically requested approved insurance company underwriters effective thraugh issuance af certificates insurance gross minimum premium 81,181,00 npte additioral insured 's must policy fee s150.00 submitted priar approval charged surplus lines tax 539.37 accbrdingly total 51350.37 commission 10 cross premium excluding taxes fees quote offered using carrier licensed state qf colorado requires maintain documentation file compliance `` due dilignce '' set forth regulation 90.14. /s minimum deposit premum evvent annual premium less minimum premium shown premum adjustable upwards rate reflected quote payment terms 20 days effective dale sublect minlmum retained 2594 tlat cancellations fees 100 retalned ai inceptlon retum premiums fnanced polickes wiii remiited dlrectly filnance company retailar regponsibk retutn 0f uneaiad commisslon thig quotation based upon fax inail /or telaphone advicos ffam ne insurerand i8 fssued american e 5 insurance brokers inc. without liability whatsaever ingurer thla insurance gubject terms conditions cover note may issued terme condiltlons thls quotatlon may broad requested submlasbn carefully read terma conditons contained quotatlon ghall affective 30 12.01 standard time date quote untll reguested effective date whlchever occurs firat bok forward receiving written instuctions appreclate interest facility thank opportunity quote renewal behalf leigh ann richmond underwriteribroker ext 229 lelghann_richmond aesbrokers com american e insurance brokers policy days

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 1/8/2010

op id cm acord date mmiddnyyy commercial general liability section 1/8/2010 agency phone 505-888-6333 applicant artistic homes inc aic no_ext fax first aic_noh 505-888-6334 named insured insurance one inc 6751 academy rd ne suite effective date expiration date payment plan audit direct bill albuquerque_ nm 87109 12131/08 12/31/09 x agency bill larry koester compan code sub code use agenc artis-5 customfrds coverages limits x commercial general liability general aggregate 2,000,000 premiums claims made occurrence products completed operations aggregate 2,000,000 premisesioperations owner 's contractor 's protective personal advertising injury 1,000,000 occurrence 1,000,0001 products deductibles damage rented premises occurrence 50,0001 property damace medical expense oneperson 5,000 per bodily injury claim employee benefits x policy 15,000 occuerence total coverages restrictions andior endorsements hiredinon-owned auto coverages attach applicable state business auto section acord 137 schedule hazards loc haz classification class premium exposure terr rate premium code basis premiops products premiops products contractor single family pwellings 4-plexes 13,000,000 rating premium basis p payroll per 1,0ooppay ci totalcost per ooo/cost u unit per unit gross sales per ooo/sales area per ooosq admissions per qoojadm claims made explain `` yes '' responses explain 'yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number qf employees retroactive date acord 126 2007/05 page 4 acord corporation 1993-2007 ail rights reserved acord name logo registered marks acord contractors artis-5 op id cm explain `` yes '' responses past present operations /n applicant draw plans designs specifications others operations include blasting utilize store explosive material operations include excavation tunneling underground work earth moving subcontractors carry coverages limits less subcontractors allowed work without providing certificate insurance applicant lease equipment others without operators describe type work subcontracted paid tq sub- work full- part contractors subcontracted time staff time staff productsicqmpleted qperations time expected products annual gross sales units market life intended use principal comp onents 13,0001 explain 'yes '' responses past r prese product operation please attach literature brochures labels warnings etc yin applicant install service demonstrate products foreign products sold distributed used components `` yes '' attach acord 815 research development conducted new products planned guarantees warranties hold harmless agreements products related aircraftispace industry products recalled_ discontinued_ changed products others sold re-packaged applicant label products label others vendors coverage required 10 named insured sell named insureds acord 126 2007/05 attach acord 125 ent additional interesticertificate recipient acord 45 attached additional names artis-5 op id cm interest rank name andaddress reference certificate required interest item number additional insured location building loss payee vehicle boat mortgagee scheduled item number lienholder employee lessor item description general information explain 'yes '' responses past present operations y/n medical facilities provided medical professionals employed contracted n exposure radioactienuclear materials doihave past present discontinued operations involve storing_ treating_ discharging applying disposing n transporting hazardous material e.g landfills wastes fuel tanks etc operations sold acquired discontinued last five 5 years machinery equipment loaned rented others n watercraft docks floats owned hired leased n parking facilities ownedirented fee charged parking n recreation facilities provided 10. swimming pool premises 11_ sporting social events sponsored n 12. structural alterations contemplated 13_ demolition exposure contemplated n 14_ applicant active currently actie joint ventures 15_ lease employees employers n 16. labor interchange business subsidiaries acord 126 2007/05 page 3 4 general information continued artis-5 op id cm explainall 'yes responses past present operations /n 17_ day care facilities operated controlled 18_ crimes occurred attempted premises within last three 3 years 19. therea formal written safety security policy effect 20_ businesses promotional literature make representations safety security premises remarks sub-contracting costs s17,000,000 estimated payroll 5300,000 person whq knowingly intent defraud insurance company another person files application insurance statement claim containing materially false information_ conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal ny substantial ciil penalties applicable co fl hl ne oh ok vt dc la tn va wa insurance benefits may also denied florida person knowingly intent injure_ defraud deceive insurer files statement claim application containing false incomplete_ misleading information guilty ofa felony third degree acord 126 2007/05 page 4 4

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 9/9/2009

op id kel acord commercial insurance application date mmiddnyyy applicant information section 9/9/2009 agency carrier naic code insurance one inc western pacific 5501 eagle rock ave ne ste a-3 albuquerque nm 87113 underwriter underwriter office policies program requested policy number larry koester wpin5012129 indicate sections attached electronic data proc truckersmotor carrier vacoes pafery emable equipment floater umbrella rmact larry koester boiler machinery garage dealers vehicle schedule ptne_ extl 505-888-6333 business autq glass sign workers compensation fenel 505-888-6334 genefercumabiliy installationibuilders risk yacht euhess crimeimiscellaneous crime open cargo code sub code dealers property aqency cusiqmeed artis-5 driver info schedule jrssspaeiat motob 8tqngo siatus qf transaction package policy information quote issue policy renew enter information common dates terms apply several lines monoline policies aantantatna lulllctttatatanltlcattaclccclrtt hacaccaacacacacccnccacacacctccacacacaca bound give date andor attech copy proposed eff date proposed exp date billing plam payment plan audit change date time direct bill cancel pm 12/31/09 12/31/10 x agency bil package policy premium applicant ineqrmatiqn mame first named insured named insureds mailing address incl zip+4 first named insured artistic homes inc tom wade 4420 tower rd sw ste albuquerque nm 87121 747- fen soc seect ihince phome t0t-834-5+28- tflnt numed inured inc nos exth de ssesl reba computer tax 3.8j59 website addressies individual corporation 881882f87 `` 8 llc noof miembers cr bureau date bus managers name started partnership joint venture feuerors_lz id number inspection contact accounting records contact rvens extl ebhe5 renl exi rouess premises information acord 823 attached additionalpremises loc blo street city county state zip+4 city limits interest yr annual revenues built employees occupied 4zo tbwer ex- scw inside owner outside tenant bedd nm 8712- nside owner outside tenant nside owner outside tenant inside owner outside tenant nature qe businessidescription qf qperations premise acord 125 2007/10 page 3 1993-2007 acord corporation_ ail rights reserved acord name logo registered marks acord 54458 mb agency customer id artis-5 op id kel anetnnatenattaenat general information explain `` yes '' responses yin 1a applicant subsidiary another entity ib applicant subsidiaries formal safety program operation exposure flammables explosives chemicals catastrophe exposure insurance company submit ed policy coverage declined cancelled non-renewed prior three 3 years applicable mo past losses claims relating sexual abuse molestation allegatidns discrimination neclicent hirinc last five years ten ri applicant indicted convicted degree crime fraud bribery arson arson-related crime connection property ri question must answerad applicant ior property insurance failure disclose existerce arson coriviction risdemeanor punishable gentence ona year imprisonment uncorrected fire code violations 10 bankruptcies tax credit liens applicant past five 5 years business placed trust `` yes '' name trust- 12. foreign operations foreign products distributed usa us products soldidistributed foreign countries `` yes '' attach acord 815 liabllity exposure andior acord 816 property exposure remarksiprocessing instructions attach additlonal hoets opace ia required business type description copy notice information practices prmacy given applicant applicable states consult agent broker statets requirements nqiice qe_insurance neormation praciices personal information including information credit report_ may colleai persons thaan inv connection application insurance subsequent policy renewals information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization right review personal information files request correction inaccuracies detailed description rights practices regarding information available upon request contact agent broker instructions submit request us_ person knowingly intent defraud insurance company another person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal ny substantial civil penalties applicable co_ fl hi ne oh ok or_ vt= dc la tn va ad wa insurance benefits may also denied florida person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty qf felony third degree undersigned authorized representative applicant represents reasonable enquiry made obtain answers questions application_ heshe represents answers true correct complete best hisiherknowledge producer 's signature producer 's name pleare print ja7e producer ucenseto requlred florida larry koester larry koester applicants signature date national producer number acord 125 2007/10 2 of3 page agency customer id artis-5 op id kel priqr carrier informatiqn line category carrier policy number claims clais clais clnms claims policy type made occurremce made occurrence made occurrence e occurrence maqe occurrence retro date eff-exp date general aggregate scowp 0 r raa8uth personal adv inj occurrence fire damage hencttccccaattctc medical expense bodily occurrenc injury aqgregate property occurrence damage aggregate combineo single imit modification factor tqtal premium carrier policy number policy type eff-exp date 1 combined single limit f bodily ea person injury ea accident e property damage modification factor total premium mat carrier policy number policy type 8 eff-exp date r building amt pers prop amt modification factor total premium carrier policy number policy type eff-exp date limit modification factor total premium mn loss hisiory claims losses regaroless fault whether insured occurrences thatmaay give rise claims chk seeattached eoeeeer srns r 9sshagec rrdhess fnqne oss cl date line typeidescriptkon qf occurrence claim date amount amount s4u5 occurrence claim paid reserved openclse remarks note fidelity requires five yearloss history attachments state supplement applicable acord 126 2007/10 3 3 8 ettel pago op id kel acord date mmiddiyyy commercial general liability section 9/9/2009 agency wen 505-888-6333 applicant artistic homes inc lnoexl `` irlrat ttc_no 505-888-6334 named insured insurance one inc 5501 eagle rock ave ne ste a-3 effectivve date expira tion date direct bill payment plan audit 12/31/09 12/31/10 x agency bill albuquerque nm 87113 company code sub code use 9aere enc artis5 id coverages limis x commercial general liability general aggregate 2,000,000 premiums claims made occurrence products completed operations aggregate 2,000,000 premisesioperations owner 's contractor 's protective personal advertising injury 1,000,000 occurrence 1,000,0001 products deductibles damage rented premises occurtence 50,0o0 property damage medical expense one pereon 5,000| per bodily injury claim employee benefits x policy 15,000 occurrence total coverages restrictions andior endorsements hlredinon-owned juto coverages attach appllcable state business auto section acord 137 schedule qf hazards haz classification class premium exposure terr lttttttlaeltttttttlaltttttttlatleallalltltnlallttllllalhlllaalllallallll rate premium code basis premiops products premiops products contractor single famlly ppwellings 13,000,000 rating premium basis payroll per 51 doo/pay c total cost per 1 ooicost u unit per unit gross sales per 1 oooisales area per oocsq ft admissions per coqadm claims made explainall yes responses explain yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident_ location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number qf employees retrqactwve date 3ae eneeeennnnnnnnnnen nnnnnnnnnn acord 126 2007/05 page 1 acord corporation 1993-2007 ail rights reserved_ acord name logo regietered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 12/28/2010

op id cm acord commercial insurance application date mmiddnyyy applicant information section 12/28/2010 agency carrier naic code insurance one inc western pacific 6751 academy rd ne suite underwriter underwriter office albuquerque nm 87109 policies orprogram requested policy number larry koester wpin5023776 indicate sections attached electronic data proc truckersmotor carrier hacoable pferisable equipment floater umbrella contact larry koester boiler machinery garage dealers vehicle schedule name phone 505-888-6333 business auto glass sign workers compensation aic ext fax 505-888-6334 x gomererclability installationbuilders risk yacht aic_not e-mail crimemmiscellaneous crime open cargo address code sub code dealers property agency customer id artiss driver info schedule teansprbf iqnr status transaction package policy information x quote issue policy renew enter information common dates terms apply several ines monoline policies_ bound give date andfor attach copy proposed eff date proposed exp date billing plan payment plan audit change date time direct bill cancel 12:00 12131/10 12/31/11 agency bill package policy premium applicant information name first named insured named insureds mailing address incl zip+4 first named insured artistic homes inc 4420 tower rd sw ste albuquerque nm 87121 fein soc sec phone 505-247-8400 first named insured aic ext e8bresslesl reba '' computer fax 244.8359 abreees individual corporation subchapter llc members cr bureau name b4arpes corporation managers partnership joint venture prgeqf org id number inspection contact reba harper accounting records contact phone 505-247-8400 email phone e-mail aic ext address aic ext address premises information acord 823 attached additional premises yr loc bld street city county state_ zip+4 city limits interest annual revenues occupied built employeest 4420 tower rd sw inside owner albuquerque nm 87121 outside x tenant 2000 inside owner outside tenant inside owner outside tenant inside owner outside tenant nature qf businessidescription operations premise acord 125 2007/10 page 3 1993-2007 acord corporation ail rights reserved acord name logo registered marks acord pm agency customer id artis-5 op id cm general information explain `` yes '' responses yin 1a applicant subsidiary another entity 1b applicant subsidiaries formal safety program operation exposure flammables explosives chemicals catastrophe exposure insurance company submitted policy coverage declined cancelled non-renewed prior three 3 years applicable mo past losses claims relating sexual abuse molestation allegations discrimination negligent hiring last five years ten ri applicant indicted convicted cf degree crime fraud bribery arson arson-related crime connection property ri question must answered applicart tor property insurance failure disclose existence arson conviction misdemeanor punishable sentence ofup one year imprisonment uncorrected fire code violations 10 bankruptcies_ tax credit liens applicant past five 5 years 11. business placed trust `` yes '' name trust 12. foreign operations foreign products distributed usa usproducts soldidistributed foreign countries `` yes '' attach acord 815 iability exposure andlor acord 816 property exposure_ remarksprocessing instructions attach additional sheets space required copy notice informationpractices privacy given applicant applicable states_ consult agent broker state 's requirements nqtice qf_isurance information practices personal information abqut including information credit report may colle tec persons connection application insurance subsequent policy renewals information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization right review personal information files request correction inaccuracies detailed description rights practices regarding information available upon request contact agent broker instructions submit request tous_ person knowingly intent defraud insurance company another person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal ny substantial civil penalties applicable co fl hi ne oh ok vt dc la tn va wa insurance benefits may also denied florida_ person knowingly intent injure_ defraud deceive insurer files statement claim application containingany false_ incomplete misleading information guilty felony third degree undersigned authorized representativve applicant represents reasonable enquiryhas made obtain answers questions application_ heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print state producer license required florida larry koester applicant signature date national producer number acord 125 2007/10 page 2 3 agency customer id artis-5 op id cm priqr carrier infqrmation line category carrier policy number claim8 claim8 claim8 claim8 claims policy type made occurrence madf occurrence madf occurrence madf occurrence mukdf occurrence retro date eff-exf date general aggregate g 1 pbs rughseomp personal adv inj occurrence e fire damage 8 medical expense 4 occurrence bodil injury aggregate ccurrence property damage aggregate comeined single limit modification factor total fremium carrier policy number policy type eff-exf date 1 8 combined single limit bodily ea person injury ea accident e property damage modification factor total fremium carrier policy number policy type 8 eff-exf date building amt r pers prop amt modification factor total fremium carrier policy number policy type eff-exf date limit modification factor total fremium loss history enferhflprcoeis osses regardless fault whether insured occurrences may give rise claims chk see attached priqr 5_years 3 yearsinks ny osssummary claim date line typeidescription occurrence claim date amount amount status occurrence claim paid reserved openclsdi remarks note fidelity requires five year loss history attachments state supplement applicable acord 125 2007/10 page 3 3 op id cm acord date mmiddnyyy commercial general liability section 12/28/2010 agency phone 505-888-6333 applicant artistic homes inc aic no_ext fax first aic_noh 505-888-6334 named insured insurance one inc 6751 academy rd ne suite effective date expiration date payment plan audit direct bill albuquerque_ nm 87109 12131/10 12131/11 x agency bill larry koester compan code sub code use agenc artis-5 customfrds coverages limits x commercial general liability general aggregate 2,000,000 premiums claims made occurrence products completed operations aggregate 2,000,000 premisesioperations owner 's contractor 's protective personal advertising injury 1,000,000 occurrence 1,000,0001 products deductibles damage rented premises occurrence 50,0001 property damace medical expense oneperson 5,000 per bodily injury claim employee benefits x policy 15,000 occuerence total coverages restrictions andior endorsements hiredinon-owned auto coverages attach applicable state business auto section acord 137 schedule hazards loc haz classification class premium exposure terr rate premium code basis premiops products premiops products contractors subcontacted work 91583 7000000 executive supervisor 91580 16400 real estate development property 47051 25 acres vacant land 49451 mbdel homes campentry 91340 p 120000 rating premium basis p payroll per 1,0ooppay ci totalcost per ooo/cost u unit per unit gross sales per ooo/sales area per ooosq admissions per qoojadm claims made explain `` yes '' responses explain 'yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number qf employees retroactive date acord 126 2007/05 page 4 acord corporation 1993-2007 ail rights reserved acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 8/25/2017

agency customer id date mmiddiyyyy acord commercial general liability section 08/25/2017 agency carrier naic code vip insurance services llc policy number effective date applicant first named insured john roberta stack important claims made checked coverage limits section application claims-made policy_ read provisions policy carefully- coverages limits commercial general liability general aggregate 2000000 premiums claims made occurrence limit applies per policy location premisesioperations owner 's contractor 's protective project products completed operations aggregate products deductibles personal advertising injury 1000000 property damage occurrence 1000000 per bodily injury claim damage rented premises occurrence 100000 per total occurrence medical expense one person 5000 employee benefits coverages restrictions andior endorsements hiredlnon-owned auto coverages attach applicable state business auto section acord 137 applicable wisconsin non-owned auto coverage provided policy um uim coverage available medical payments coverage available schedule hazards_ acord 211 schedule hazards may attached space required class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 61217 1596 classification description building premises- bank office-mercantile manufacturing class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 1628 classification description vacant building class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 3209 classification description vacant building rating premium basis payroll per s1 ooo/pay c total cost per 1 o00/cost u unit per unit gross sales per 1 ooo/sales area per 1,000/sq ft admissions per 1 ooo/adm claims made explain yes responses '' explain yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident_ location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number employees retroactive date acord 126 2016/09 attach acord 125 1993-2016 acord corporation ail rights reserved acord name logo registered marks acord agency customer id contractors explain yes '' responses past present operations yin applicant draw plans designs specifications others operations include blasting utilize store explosive material operations include excavation tunneling underground work earth moving subcontractors carry coverages limits less subcontractors allowed work without providing certificate insurance applicant lease equipment others without operators describe type work subcontracted spai sub offwork full part contractors subcontracted time staff time staff products completed operations tmetn expected products annual gross sales units market life intended use principal components explain yes '' responses past present products operations please attach literature brochures_ labels warnings etc_ yin applicant install service demonstrate products n foreign products sold distributed used components `` yes '' attach acord 815 n research development conducted new products planned n guarantees warranties hold harmless agreements n products related aircraftispace industry n products recalled discontinued changed n products others sold re-packaged applicant label n products label others n vendors coverage required n 10. named insured sell named insureds acord 126 2016/09 page 2 4 agency customer id additional interest certificate recipient acord 45 attached additional names interest name address rank evidence certificate interest item number additional insured location building employee lessor class item lender 's loss payable item description lienholder loss payee mortgagee reference loan general information explain `` yes '' responses past present operations yin medical facilities provided medical professionals employed contracted exposure radioactiveinuclear materials n doihave past present discontinued operations involve storing treating discharging applying disposing n transporting hazardous material e.g landfills wastes fuel tanks etc operations sold acquired discontinued last five 5 years rent loan equipment others n equipment type equipment instruction given yin small tools large equipment small tools large equipment watercraft docks floats owned hired leased n parking facilities ownedirented n fee charged parking n recreation facilities provided n 10. lodging operations including apartments `` yes '' answer following n apts total apt area describe lodging operations sq ft 11. swimming pool premises check apply n approved fence limited access diving board slide ground ground life guard 12. social events sponsored n 13_ athletic teams sponsored n type sport contact type sport contact sport yin age group 13 18 sport yin age group 13 18 12 18 12 18 extent sponsorship extent sponsorship 14_ structural alterations contemplated n 15_ demolition exposure contemplated acord 126 2016/09 page 3 4 agency customer id general information continued explain yes '' responses past present operations yin 16. applicant active currently active joint ventures lease employees employers workers workers lease compensation lease compensation coverage carried yin coverage carried yin 18_ labor interchange business subsidiaries 19_ day care facilities operated controlled n 20_ crimes occurred attempted premises within last three 3 years n 21_ formal written safety security policy effect n 22_ businesses promotional literature make representations safety security premises remarks acord 101 additional remarks schedule may attached space required signature applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company_ penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written electronic electronic impulse facsimile magnetic oral telephonic communication statement part support application issuance insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky ny oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading- information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny only_ applicable tn_ va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits_ applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties_ applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss_ shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars s5,000 ten thousand dollars 810 fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge_ producer 's signature producer 's name please print statepproducerticenseno required florida kelly mancha applicants signa ure date national producer number acord 126 2016/09 page 4 4 rating 000

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Property Policy||Date : 8/25/2017

agency customer id date mmiddiyyyy acord property section 08/25/2017 agency name carrier naic code vip insurance services llc policy number effective date named insured john roberta stack blanket summary blkt amount type blkt amount type premises street address 11300 central ave se premises information building bldg description subject insurance amount coins hi8q causes loss 8ar8od ded ided blk forms conditions apply type building 159700.00 80 rc special 500.00 additional information business income extra expense attach acord 810 value reporting information attach acord 811 additional coverages options restrictions endorsements rating information spoilage description property covered limit refrig maint options coverage n agreement breakdown contamination n selling deductible power outage price n sinkhole coverage required florida accept coverage reject coverage limit mine subsidence coverage required ky wv accept coverage reject coverage limit property designated historical landmark open sides structure construction type distance fire district code number prot cl stories basmts yr built total area hydrant fire stat frame mi 2016 1596 building improvements bldg code tax code roof type occupancies grade wiring yr plumbing yr wind class feating source incl woodburning date roofing yr hheating yr semi- resistive stove fireplace insert installed yr resistive manufacturer primary heat secondary heat boiler solid fuel boiler solid fuel boiler insurance placed elsewhere /n boiler insurance placed elsewhere /n right exposure distance left exposure distance front exposure distance rear exposure distance burglar alarm type certificate expiration date central local station gong keys burglar alarm installed serviced extent grade guards watchmen clock hourly premises fire protection sprinklers standpipes co2 chemical systems sprnk fire alarm manufacturer central station local gong additional interest acord 45 attached additional names interest name address rank evidence certificate interest item number lender 's loss payable location building loss payee ttem class item mortgagee item description reference loan acord 140 2016/03 attach acord 125 1985-2015 acord corporation_ rights reserved_ acord name logo registered marks acord agency customer id additional premises street address premises information building bldg description subject insurance amount coins ffb causes loss `` a8ar8os ded type blkt forms conditions apply additional information business income extra expense attach acord 810 value reporting information attach acord 811 additional coverages options restrictions endorsements rating information spoilage description property covered limit refrig maint options coverage agreement breakdown contamination n n selling deductible power outage price sinkhole coverage required florida accept coverage reject coverage limit mine subsidence coverage required il ky wv accept coverage reject coverage limit property designated historical landmark open sides structure construction type distance tq fire district code number prot cl stories basmts yr built total area hydrant fire stat mi building improvements bldg code tax code roof type occupancies grade wiring yr iplumbing_ yr wind class feating source incl woodburning date roofing yr iheating yr semi- resistive stove fireplace insert installed yr resistive manufacturer primary heat secondary heat boiler solid fuel boiler solid fuel boiler insurance placed elsewhere boiler insurance placed elsewhere n right exposure distance left exposure distance front exposure distance rear exposure distance burglar alarm type certificate expiration date central cocac station gong keys burglar alarm installed serviced extent grade guards watchmen clock hourly premises fire protection sprinklers standpipes co2 chemical systems sprnk fire alarm manufacturer central station local gong additional interest acord 45 attached additional names interest name address rank evidence certificate interest item number lender 's loss payable location building loss payee class item mortgagee item description reference loan remarks acord 101 additional remarks schedule may attached space required acord 140 2016/03 page 2 3 agency customer id signature applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company_ penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree t_ applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written statement part support application issuance rating insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act_ applicable ky ny oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny applicable tn va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits_ applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars 85,000 ten thousand dollars s10,000 fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print statepproducerticenseno required florida kelly mancha applicant's-signatuf date national producer number acord 140 2016/03 page 3 3

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 8/21/2018

agency customer id date mmiddiyyyy acord commercial general liability section 08/21/2018 agency carrier naic code vip insurance services llc policy number effective date applicant first named insured john roberta stack important claims made checked coverage limits section application claims-made policy_ read provisions policy carefully- coverages limits commercial general liability general aggregate 2,000,000 premiums claims made occurrence limit applies per policy location premisesioperations owner 's contractor 's protective project products completed operations aggregate excluded products deductibles personal advertising injury 1,000,000 property damage occurrence 1,000,000 per bodily injury claim damage rented premises occurrence 100,000 per total occurrence medical expense one person 5,000 employee benefits coverages restrictions andior endorsements hiredlnon-owned auto coverages attach applicable state business auto section acord 137 applicable wisconsin non-owned auto coverage provided policy um uim coverage available medical payments coverage available schedule qf hazards_ acord 211 schedule hazards may attached space required class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 61217 1,596 classification description building premises- class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 1,628 classification description vacant building class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 3,209 classification description vacant building rating premium basis payroll per s1 ooo/pay c total cost per 1 o00/cost u unit per unit gross sales per 1 ooo/sales area per 1,000/sq ft admissions per 1 ooo/adm claims made explain yes responses '' explain yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident_ location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number employees retroactive date acord 126 2016/09 attach acord 125 1993-2016 acord corporation ail rights reserved acord name logo registered marks acord agency customer id contractors explain yes '' responses past present operations yin applicant draw plans designs specifications others operations include blasting utilize store explosive material operations include excavation tunneling underground work earth moving subcontractors carry coverages limits less subcontractors allowed work without providing certificate insurance applicant lease equipment others without operators describe type work subcontracted spai sub offwork full part contractors subcontracted time staff time staff products completed operations tmetn expected products annual gross sales units market life intended use principal components explain yes '' responses past present products operations please attach literature brochures_ labels warnings etc_ yin applicant install service demonstrate products n foreign products sold distributed used components `` yes '' attach acord 815 n research development conducted new products planned n guarantees warranties hold harmless agreements n products related aircraftispace industry n products recalled discontinued changed n products others sold re-packaged applicant label n products label others n vendors coverage required n 10. named insured sell named insureds acord 126 2016/09 page 2 4 agency customer id additional interest certificate recipient acord 45 attached additional names interest name address rank evidence certificate interest item number additional insured location building employee lessor class item lender 's loss payable item description lienholder loss payee mortgagee reference loan general information explain `` yes '' responses past present operations yin medical facilities provided medical professionals employed contracted exposure radioactiveinuclear materials n doihave past present discontinued operations involve storing treating discharging applying disposing n transporting hazardous material e.g landfills wastes fuel tanks etc operations sold acquired discontinued last five 5 years rent loan equipment others n equipment type equipment instruction given yin small tools large equipment small tools large equipment watercraft docks floats owned hired leased n parking facilities ownedirented n fee charged parking n recreation facilities provided n 10. lodging operations including apartments `` yes '' answer following n apts total apt area describe lodging operations sq ft 11. swimming pool premises check apply n approved fence limited access diving board slide ground ground life guard 12. social events sponsored n 13_ athletic teams sponsored n type sport contact type sport contact sport yin age group 13 18 sport yin age group 13 18 12 18 12 18 extent sponsorship extent sponsorship 14_ structural alterations contemplated n 15_ demolition exposure contemplated acord 126 2016/09 page 3 4 agency customer id general information continued explain yes '' responses past present operations yin 16. applicant active currently active joint ventures lease employees employers workers workers lease compensation lease compensation coverage carried yin coverage carried yin 18_ labor interchange business subsidiaries 19_ day care facilities operated controlled n 20_ crimes occurred attempted premises within last three 3 years n 21_ formal written safety security policy effect n 22_ businesses promotional literature make representations safety security premises remarks acord 101 additional remarks schedule may attached space required signature applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company_ penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written electronic electronic impulse facsimile magnetic oral telephonic communication statement part support application issuance insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky ny oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading- information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny only_ applicable tn_ va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits_ applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties_ applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss_ shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars s5,000 ten thousand dollars 810 fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge_ producer 's signature producer 's name please print statepproducerticenseno required florida chris koesler chris koester applicant 's signature date national producer number acord 126 2016/09 page 4 4 rating 000

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Property Policy||Date : 8/21/2018

agency customer id date mmiddiyyyy acord property section 08/21/2018 agency name carrier naic code vip insurance services llc policy number effective date named insured john roberta stack blanket summary blkt amount type blkt amount type premises street address 11300 central ave se premises information building bldg description subject insurance amount coins hi8q causes loss bar8on ded ided blk forms conditions apply type building 159,700 80 rc special 500 additional information business income extra expense attach acord 810 value reporting information attach acord 811 additional coverages options restrictions endorsements rating information spoilage description property covered limit refrig maint options coverage n agreement breakdown contamination n selling deductible power outage price n sinkhole coverage required florida accept coverage reject coverage limit mine subsidence coverage required ky wv accept coverage reject coverage limit property designated historical landmark open sides structure construction type distance fire district code number prot cl stories basmts yr built total area hydrant fire stat frame mi albuquerque fd 2016 1596 building improvements bldg code tax code roof type occupancies grade wiring yr plumbing yr wind class feating source incl woodburning date roofing yr hheating yr semi- resistive stove fireplace insert installed yr resistive manufacturer primary heat secondary heat boiler solid fuel boiler solid fuel boiler insurance placed elsewhere /n boiler insurance placed elsewhere /n right exposure distance left exposure distance front exposure distance rear exposure distance burglar alarm type certificate expiration date central local station gong keys burglar alarm installed serviced extent grade guards watchmen clock hourly premises fire protection sprinklers standpipes co2 chemical systems sprnk fire alarm manufacturer central station local gong additional interest acord 45 attached additional names interest name address rank evidence certificate interest item number lender 's loss payable location building loss payee ttem class item mortgagee item description reference loan acord 140 2016/03 attach acord 125 1985-2015 acord corporation_ rights reserved_ acord name logo registered marks acord agency customer id additional premises street address premises information building bldg description subject insurance amount coins ffb causes loss `` a8ar8os ded type blkt forms conditions apply additional information business income extra expense attach acord 810 value reporting information attach acord 811 additional coverages options restrictions endorsements rating information spoilage description property covered limit refrig maint options coverage agreement breakdown contamination n n selling deductible power outage price sinkhole coverage required florida accept coverage reject coverage limit mine subsidence coverage required il ky wv accept coverage reject coverage limit property designated historical landmark open sides structure construction type distance tq fire district code number prot cl stories basmts yr built total area hydrant fire stat mi building improvements bldg code tax code roof type occupancies grade wiring yr iplumbing_ yr wind class feating source incl woodburning date roofing yr iheating yr semi- resistive stove fireplace insert installed yr resistive manufacturer primary heat secondary heat boiler solid fuel boiler solid fuel boiler insurance placed elsewhere boiler insurance placed elsewhere n right exposure distance left exposure distance front exposure distance rear exposure distance burglar alarm type certificate expiration date central cocac station gong keys burglar alarm installed serviced extent grade guards watchmen clock hourly premises fire protection sprinklers standpipes co2 chemical systems sprnk fire alarm manufacturer central station local gong additional interest acord 45 attached additional names interest name address rank evidence certificate interest item number lender 's loss payable location building loss payee class item mortgagee item description reference loan remarks acord 101 additional remarks schedule may attached space required acord 140 2016/03 page 2 3 agency customer id signature applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company_ penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree t_ applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written statement part support application issuance rating insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act_ applicable ky ny oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny applicable tn va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits_ applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars 85,000 ten thousand dollars s10,000 fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print statepproducerticenseno required florida chris koester applicant 's signature date national producer number acord 140 2016/03 page 3 3

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 8/2/2019

agency customer id date mmiddiyyyy acord commercial general liability section 08/02/2019 agency carrier naic code vip insurance services llc policy number effective date applicant first named insured john roberta stack important claims made checked coverage limits section application claims-made policy_ read provisions policy carefully- coverages limits commercial general liability general aggregate 2,000,000 premiums claims made occurrence limit applies per policy location premisesioperations owner 's contractor 's protective project products completed operations aggregate products deductibles personal advertising injury 1,000,000 property damage occurrence 1,000,000 per bodily injury claim damage rented premises occurrence 100,000 per total occurrence medical expense one person 5,000 employee benefits coverages restrictions andior endorsements hiredlnon-owned auto coverages attach applicable state business auto section acord 137 applicable wisconsin non-owned auto coverage provided policy um uim coverage available medical payments coverage available schedule qf hazards_ acord 211 schedule hazards may attached space required class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 61217 1,596 classification description building premises- class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 1,628 classification description vacant building class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 3,209 classification description vacant building rating premium basis payroll per s1 ooo/pay c total cost per 1 o00/cost u unit per unit gross sales per 1 ooo/sales area per 1,000/sq ft admissions per 1 ooo/adm claims made explain yes responses '' explain yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident_ location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number employees retroactive date acord 126 2016/09 attach acord 125 1993-2016 acord corporation ail rights reserved acord name logo registered marks acord agency customer id contractors explain yes '' responses past present operations yin applicant draw plans designs specifications others operations include blasting utilize store explosive material operations include excavation tunneling underground work earth moving subcontractors carry coverages limits less subcontractors allowed work without providing certificate insurance applicant lease equipment others without operators describe type work subcontracted spai sub offwork full part contractors subcontracted time staff time staff products completed operations tmetn expected products annual gross sales units market life intended use principal components explain yes '' responses past present products operations please attach literature brochures_ labels warnings etc_ yin applicant install service demonstrate products n foreign products sold distributed used components `` yes '' attach acord 815 n research development conducted new products planned n guarantees warranties hold harmless agreements n products related aircraftispace industry n products recalled discontinued changed n products others sold re-packaged applicant label n products label others n vendors coverage required n 10. named insured sell named insureds acord 126 2016/09 page 2 4 agency customer id additional interest certificate recipient acord 45 attached additional names interest name address rank evidence certificate interest item number additional insured location building employee lessor class item lender 's loss payable item description lienholder loss payee mortgagee reference loan general information explain `` yes '' responses past present operations yin medical facilities provided medical professionals employed contracted exposure radioactiveinuclear materials n doihave past present discontinued operations involve storing treating discharging applying disposing n transporting hazardous material e.g landfills wastes fuel tanks etc operations sold acquired discontinued last five 5 years rent loan equipment others n equipment type equipment instruction given yin small tools large equipment small tools large equipment watercraft docks floats owned hired leased n parking facilities ownedirented n fee charged parking n recreation facilities provided n 10. lodging operations including apartments `` yes '' answer following n apts total apt area describe lodging operations sq ft 11. swimming pool premises check apply n approved fence limited access diving board slide ground ground life guard 12. social events sponsored n 13_ athletic teams sponsored n type sport contact type sport contact sport yin age group 13 18 sport yin age group 13 18 12 18 12 18 extent sponsorship extent sponsorship 14_ structural alterations contemplated n 15_ demolition exposure contemplated acord 126 2016/09 page 3 4 agency customer id general information continued explain yes '' responses past present operations yin 16. applicant active currently active joint ventures lease employees employers workers workers lease compensation lease compensation coverage carried yin coverage carried yin 18_ labor interchange business subsidiaries 19_ day care facilities operated controlled n 20_ crimes occurred attempted premises within last three 3 years n 21_ formal written safety security policy effect n 22_ businesses promotional literature make representations safety security premises remarks acord 101 additional remarks schedule may attached space required signature applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company_ penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written electronic electronic impulse facsimile magnetic oral telephonic communication statement part support application issuance insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky ny oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading- information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny only_ applicable tn_ va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits_ applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties_ applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss_ shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars s5,000 ten thousand dollars 810 fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print statepproducerticenseno required florida clark neff applicant 's signature date national producer number acord 126 2016/09 page 4 4 rating 000

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 9/12/2019

agency customer id date mmiddiyyyy acord commercial general liability section 09/12/2019 agency carrier naic code vip insurance services llc policy number effective date applicant first named insured john roberta stack important claims made checked coverage limits section application claims-made policy_ read provisions policy carefully- coverages limits commercial general liability general aggregate 2,000,000 premiums claims made occurrence limit applies per policy location premisesioperations owner 's contractor 's protective project products completed operations aggregate products deductibles personal advertising injury 1,000,000 property damage occurrence 1,000,000 per bodily injury claim damage rented premises occurrence 100,000 per total occurrence medical expense one person 5,000 employee benefits coverages restrictions andior endorsements hiredlnon-owned auto coverages attach applicable state business auto section acord 137 applicable wisconsin non-owned auto coverage provided policy um uim coverage available medical payments coverage available schedule qf hazards_ acord 211 schedule hazards may attached space required class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 61217 1,596 classification description building premises- class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 3,209 classification description vacant building class premium rate premium loc haz exposure terr code basis prem ops products prem ops products 68606 1,628 classification description vacant building rating premium basis payroll per s1 ooo/pay c total cost per 1 o00/cost u unit per unit gross sales per 1 ooo/sales area per 1,000/sq ft admissions per 1 ooo/adm claims made explain yes responses '' explain yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident_ location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number employees retroactive date acord 126 2016/09 attach acord 125 1993-2016 acord corporation ail rights reserved acord name logo registered marks acord agency customer id contractors explain yes '' responses past present operations yin applicant draw plans designs specifications others operations include blasting utilize store explosive material operations include excavation tunneling underground work earth moving subcontractors carry coverages limits less subcontractors allowed work without providing certificate insurance applicant lease equipment others without operators describe type work subcontracted spai sub offwork full part contractors subcontracted time staff time staff products completed operations tmetn expected products annual gross sales units market life intended use principal components explain yes '' responses past present products operations please attach literature brochures_ labels warnings etc_ yin applicant install service demonstrate products n foreign products sold distributed used components `` yes '' attach acord 815 n research development conducted new products planned n guarantees warranties hold harmless agreements n products related aircraftispace industry n products recalled discontinued changed n products others sold re-packaged applicant label n products label others n vendors coverage required n 10. named insured sell named insureds acord 126 2016/09 page 2 4 agency customer id additional interest certificate recipient acord 45 attached additional names interest name address rank evidence certificate interest item number additional insured location building employee lessor class item lender 's loss payable item description lienholder loss payee mortgagee reference loan general information explain `` yes '' responses past present operations yin medical facilities provided medical professionals employed contracted exposure radioactiveinuclear materials n doihave past present discontinued operations involve storing treating discharging applying disposing n transporting hazardous material e.g landfills wastes fuel tanks etc operations sold acquired discontinued last five 5 years rent loan equipment others n equipment type equipment instruction given yin small tools large equipment small tools large equipment watercraft docks floats owned hired leased n parking facilities ownedirented n fee charged parking n recreation facilities provided n 10. lodging operations including apartments `` yes '' answer following n apts total apt area describe lodging operations sq ft 11. swimming pool premises check apply n approved fence limited access diving board slide ground ground life guard 12. social events sponsored n 13_ athletic teams sponsored n type sport contact type sport contact sport yin age group 13 18 sport yin age group 13 18 12 18 12 18 extent sponsorship extent sponsorship 14_ structural alterations contemplated n 15_ demolition exposure contemplated acord 126 2016/09 page 3 4 agency customer id general information continued explain yes '' responses past present operations yin 16. applicant active currently active joint ventures lease employees employers workers workers lease compensation lease compensation coverage carried yin coverage carried yin 18_ labor interchange business subsidiaries 19_ day care facilities operated controlled n 20_ crimes occurred attempted premises within last three 3 years n 21_ formal written safety security policy effect n 22_ businesses promotional literature make representations safety security premises remarks acord 101 additional remarks schedule may attached space required signature applicable al ar dc la md nm rl wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company_ penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer files statement claim application containing false incomplete misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written electronic electronic impulse facsimile magnetic oral telephonic communication statement part support application issuance insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky ny oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading- information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny only_ applicable tn_ va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits_ applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties_ applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss_ shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars s5,000 ten thousand dollars 810 fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print statepproducerticenseno required florida clark neff applicant 's signature date national producer number acord 126 2016/09 page 4 4 rating 000

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 8/2/2019

acord commercial insurance application date mmiddiyyyy applicant information section 08/02/2019 agency carrier naic code vip insurance services llc 9221 e. via de ventura company policy program name program code scottsdale az 85258 policy number contact chris koester underwriter underwriter office name phone 4806966438 aic ext e noji quote issue policy renew status eodhess chris vipinsuranceservices.com transaction bound give date andlor attach copy code subcode change date time agency customer id cancel pm lines business indicate lines business premium premium premium boiler machinery cyber privacy yacht business auto fiduciary liability business owners garage dealers commercial general liability liquor liability commercial inland marine motor carrier commercial property truckers crime umbrella attachments accounts receivable valuable papers glass sign section statement schedule values additional interest schedule hotel motel supplement state supplement applicable additional premises information schedule installation builders risk section vacant building supplement apartment building supplement international liability exposure supplement vehicle schedule condo assn bylaws coverage international property exposure supplement contractors supplement loss summary coverages schedule open cargo section dealers section premium payment supplement driver information schedule professional liability supplement electronic data processing section restaurant tavern supplement policy information proposed eff date proposed exp date billing plan payment plan method payment audit deposit premium policy premium direct agency applicant information name first named insured mailing address including zip+4 gl code sic naics fein soc sec john roberta stack 6461 shaw cr business phone 530 591-0712 website address magalia ca 95954 corporation joint venture profit org subchapter `` '' corporation ot no_ members individual llc managers partnership trust name named insured mailing address including zip+4 gl code sic naics fein soc sec business phone website address corporation joint venture profit org subchapter `` '' corporation members individual llc managers partnership trust name named insured mailing address including zip+4 gl code sic naics fein soc sec business phone website address corporation joint venture profit org subchapter `` '' corporation members individual llc managers partnership trust acord 125 2016/03 page 4 1993-2015 acord corporation ail rights reserved acord name logo registered marks acord agency customer id contact information contact type contact type contact name robbie stack contact name priar home bus cell secondary home bus cell priar home bus cell secondary home bus cell phone phone phone phone 530 873-7732 primary e-mail address robbiesranch gmail.com primary e-mail address secondary e-mail address secondary e-mail address premises information attach acord 823 additional premises loc street 11300 central ave se city limits interest full time empl annual revenues 54,000 inside owner occupied area sq ft bld city albuquerque state nm outside tenant part time empl open public area sq ft county bernalillo zip 871232902 total building area sq ft description operations new mexico title loan area leased others n loc street 11300 central ave se city limits interest full time empl annual revenues 54,000 inside owner occupied area sq ft bld city albuquerque state nm outside tenant part time empl open public area sq ft county bernalillo zip 871232902 total building area sq ft description operations vacant building area leased others n loc street 11300 central ave se city limits interest full time empl annual revenues 54,000 inside owner occupied area sq ft bld city albuquerque state nm outside tenant part time empl open public area sq ft county bernalillo zip 871232902 total building area sq ft description operations vacant building area leased others /n loc street city limits interest full time empl annual revenues inside owner occupied area sq ft bld city state outside tenant part time empl open public area sq ft county zip total building area sq ft description operations area leased others /n nature qf business date business apartments contractor manufacturing restaurant service started mmiddiyyyy condominiums institutional office retail wholesale description primary operations installation service repair work premises installation service repair work retail stores service operations total sales description operations named insureds additional interest fields apply scenarios provide necessary data attach acord 45 additional interests interest name address rank evidence certificate policy send bill interest item number additional lienholder location building insured breach loss payee vehicle boat warranty co-owner mortgagee airport_ aircraft employee owner ttem item lessor class leaseback registrant item description owner lender 's trustee reference loan interest end date loss payable lien amount phone aic ext fax aic reason interest e-mail address acord 125 2016/03 page 2 4 agency customer id general information explain yes '' responses y/n 1a_ applicant subsidiary another entity parent company name relationship description owned ib applicant subsidiaries subsidiary company name relationship description owned formal safety program operation safety manual safety position monthly meetings osha exposure flammables explosives chemicals n insurance company list policy numbers n line business policy number line business policy number policy coverage declined cancelled non-renewed prior three 3 years premises n operations missouri applicants answer question non-payment agent longer represents carrier non-renewal underwriting condition corrected describe past losses claims relating sexual abuse molestation allegations discrimination negligent hiring last five years ten ri applicant indicted convicted degree crime fraud bribery arson arson-related crime connection property ri question must answered applicant property insurance failure disclose existence arson conviction misdemeanor punishable sentence one year imprisonment uncorrected fire andior safety code violations occur date explanation resolution resolve date applicant foreclosure repossession bankruptcy filed bankruptcy last five 5 years occur date explanation resolution resolve date 10_ applicant judgement lien last five 5 years occur date explanation resolution resolve date 11. business placed trust name trust n 12. foreign operations foreign products distributed usa orus products sold distributed inforeign countries n `` yes '' attach acord 815 liability exposure andlor acord 816 property exposure 13. applicant business ventures coverage requested n 14 applicant lease operate drones `` yes '' describe use 15. applicant hire others operate drones `` yes '' describe use remarks processing instructions acord 101 additional remarks schedule may attached space required prior carrier information year category general liability automobile property carrier policy number premium effective date expiration date acord 125 2016/03 page 3 4 agency customer id prior carrier information continued year category general liability automobile property carrier policy number premium effective date expiration date carrier policy number premium effective date expiration date loss history check none attach loss summary additional loss information enter claims losses regardless fault whether insured occurrences may give rise claims last years total losses subro- claim date gation open occurrence line type description occurrence claim date claim amount paid amount reserved yin yin signature notice information practices privacy given applicant required states contact agent broker state 's requirements personal information including information credit investigative report may collected persons connection application insurance subsequent amendments renewals information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization credit scoring information may used help determine either eligibility insurance premium charged may use third party connection development score may right review personal information files request correction inaccuracies_ may also right request writing consider extraordinary life circumstances connection development credit score rights may limited states please contact agent broker learn rights may apply state instructions submit request us detailed description rights practices regarding personal information_ applicable az ca de ks mn nd ny va wv specific acord 38s available applicants states applicant 's initials applicable al ar dc la md nm ri wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer statement claim application containing false incomplete_ misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written statement part support application issuance rating insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny applicable tn_ va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties_ applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law_ applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss_ shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars s5,000 ten thousand dollars s10 c fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print ttate producerlicense required florida clark neff applicant 's signature date national producer number acord 125 2016/03 page 4 4 copy files ny o00

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 9/12/2019

acord commercial insurance application date mmiddiyyyy applicant information section 09/12/2019 agency carrier naic code vip insurance services llc 9221 e. via de ventura company policy program name program code scottsdale az 85258 policy number contact chris koester underwriter underwriter office name phone 4806966438 aic ext e noji quote issue policy renew status eodhess chris vipinsuranceservices.com transaction bound give date andlor attach copy code subcode change date time agency customer id cancel pm lines business indicate lines business premium premium premium boiler machinery cyber privacy yacht business auto fiduciary liability business owners garage dealers commercial general liability liquor liability commercial inland marine motor carrier commercial property truckers crime umbrella attachments accounts receivable valuable papers glass sign section statement schedule values additional interest schedule hotel motel supplement state supplement applicable additional premises information schedule installation builders risk section vacant building supplement apartment building supplement international liability exposure supplement vehicle schedule condo assn bylaws coverage international property exposure supplement contractors supplement loss summary coverages schedule open cargo section dealers section premium payment supplement driver information schedule professional liability supplement electronic data processing section restaurant tavern supplement policy information proposed eff date proposed exp date billing plan payment plan method payment audit deposit premium policy premium direct agency applicant information name first named insured mailing address including zip+4 gl code sic naics fein soc sec john roberta stack 6461 shaw cr business phone 530 591-0713 website address magalia ca 95954 corporation joint venture profit org subchapter `` '' corporation ot no_ members individual llc managers partnership trust name named insured mailing address including zip+4 gl code sic naics fein soc sec business phone website address corporation joint venture profit org subchapter `` '' corporation members individual llc managers partnership trust name named insured mailing address including zip+4 gl code sic naics fein soc sec business phone website address corporation joint venture profit org subchapter `` '' corporation members individual llc managers partnership trust acord 125 2016/03 page 4 1993-2015 acord corporation ail rights reserved acord name logo registered marks acord agency customer id contact information contact type contact type contact name robbie stack contact name priar home bus cell secondary home bus cell priar home bus cell secondary home bus cell phone phone phone phone 530 873-7732 primary e-mail address robbiesranch gmail.com primary e-mail address secondary e-mail address secondary e-mail address premises information attach acord 823 additional premises loc street 11300 central ave se city limits interest full time empl annual revenues 54,000 inside owner occupied area sq ft bld city albuquerque state nm outside tenant part time empl open public area sq ft county bernalillo zip 871232902 total building area sq ft description operations new mexico title loan area leased others n loc street 11300 central ave se city limits interest full time empl annual revenues 54,000 inside owner occupied area sq ft bld city albuquerque state nm outside tenant part time empl open public area sq ft county bernalillo zip 871232902 total building area 3209 sq ft description operations vacant building area leased others n n loc street 11300 central ave se city limits interest full time empl annual revenues 54,000 inside owner occupied area sq ft bld city albuquerque state nm outside tenant part time empl open public area sq ft county bernalillo zip 871232902 total building area 1628 sq ft description operations vacant building area leased others n loc street city limits interest full time empl annual revenues inside owner occupied area sq ft bld city state outside tenant part time empl open public area sq ft county zip total building area sq ft description operations area leased others /n nature qf business date business apartments contractor manufacturing restaurant service started mmiddiyyyy condominiums institutional office retail wholesale description primary operations installation service repair work premises installation service repair work retail stores service operations total sales description operations named insureds additional interest fields apply scenarios provide necessary data attach acord 45 additional interests interest name address rank evidence certificate policy send bill interest item number additional lienholder location building insured breach loss payee vehicle boat warranty co-owner mortgagee airport_ aircraft employee owner ttem item lessor class leaseback registrant item description owner lender 's trustee reference loan interest end date loss payable lien amount phone aic ext fax aic reason interest e-mail address acord 125 2016/03 page 2 4 agency customer id general information explain yes '' responses y/n 1a_ applicant subsidiary another entity parent company name relationship description owned ib applicant subsidiaries subsidiary company name relationship description owned formal safety program operation safety manual safety position monthly meetings osha exposure flammables explosives chemicals n insurance company list policy numbers n line business policy number line business policy number policy coverage declined cancelled non-renewed prior three 3 years premises n operations missouri applicants answer question non-payment agent longer represents carrier non-renewal underwriting condition corrected describe past losses claims relating sexual abuse molestation allegations discrimination negligent hiring last five years ten ri applicant indicted convicted degree crime fraud bribery arson arson-related crime connection property ri question must answered applicant property insurance failure disclose existence arson conviction misdemeanor punishable sentence one year imprisonment uncorrected fire andior safety code violations occur date explanation resolution resolve date applicant foreclosure repossession bankruptcy filed bankruptcy last five 5 years occur date explanation resolution resolve date 10_ applicant judgement lien last five 5 years occur date explanation resolution resolve date 11. business placed trust name trust n 12. foreign operations foreign products distributed usa orus products sold distributed inforeign countries n `` yes '' attach acord 815 liability exposure andlor acord 816 property exposure 13. applicant business ventures coverage requested n 14 applicant lease operate drones `` yes '' describe use 15. applicant hire others operate drones `` yes '' describe use remarks processing instructions acord 101 additional remarks schedule may attached space required prior carrier information year category general liability automobile property carrier policy number premium effective date expiration date acord 125 2016/03 page 3 4 agency customer id prior carrier information continued year category general liability automobile property carrier policy number premium effective date expiration date carrier policy number premium effective date expiration date loss history check none attach loss summary additional loss information enter claims losses regardless fault whether insured occurrences may give rise claims last years total losses subro- claim date gation open occurrence line type description occurrence claim date claim amount paid amount reserved yin yin signature notice information practices privacy given applicant required states contact agent broker state 's requirements personal information including information credit investigative report may collected persons connection application insurance subsequent amendments renewals information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization credit scoring information may used help determine either eligibility insurance premium charged may use third party connection development score may right review personal information files request correction inaccuracies_ may also right request writing consider extraordinary life circumstances connection development credit score rights may limited states please contact agent broker learn rights may apply state instructions submit request us detailed description rights practices regarding personal information_ applicable az ca de ks mn nd ny va wv specific acord 38s available applicants states applicant 's initials applicable al ar dc la md nm ri wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer statement claim application containing false incomplete_ misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written statement part support application issuance rating insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny applicable tn_ va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties_ applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law_ applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss_ shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars s5,000 ten thousand dollars s10 c fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print ttate producerlicense required florida clark neff applicant 's signature date national producer number acord 125 2016/03 page 4 4 copy files ny o00

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial Property ||Date : 8/2/2019

acord commercial insurance application date mmiddiyyyy applicant information section 08/02/2019 agency carrier naic code vip insurance services llc 9221 e. via de ventura company policy program name program code scottsdale az 85258 policy number contact chris koester underwriter underwriter office name phone 4806966438 aic ext e noji quote issue policy renew status eodhess chris vipinsuranceservices.com transaction bound give date andlor attach copy code subcode change date time agency customer id cancel pm lines business indicate lines business premium premium premium boiler machinery cyber privacy yacht business auto fiduciary liability business owners garage dealers commercial general liability liquor liability commercial inland marine motor carrier commercial property truckers crime umbrella attachments accounts receivable valuable papers glass sign section statement schedule values additional interest schedule hotel motel supplement state supplement applicable additional premises information schedule installation builders risk section vacant building supplement apartment building supplement international liability exposure supplement vehicle schedule condo assn bylaws coverage international property exposure supplement contractors supplement loss summary coverages schedule open cargo section dealers section premium payment supplement driver information schedule professional liability supplement electronic data processing section restaurant tavern supplement policy information proposed eff date proposed exp date billing plan payment plan method payment audit deposit premium policy premium direct agency applicant information name first named insured mailing address including zip+4 gl code sic naics fein soc sec john roberta stack 6461 shaw cr business phone 530 591-0712 website address magalia ca 95954 corporation joint venture profit org subchapter `` '' corporation ot no_ members individual llc managers partnership trust name named insured mailing address including zip+4 gl code sic naics fein soc sec business phone website address corporation joint venture profit org subchapter `` '' corporation members individual llc managers partnership trust name named insured mailing address including zip+4 gl code sic naics fein soc sec business phone website address corporation joint venture profit org subchapter `` '' corporation members individual llc managers partnership trust acord 125 2016/03 page 4 1993-2015 acord corporation ail rights reserved acord name logo registered marks acord agency customer id contact information contact type contact type contact name robbie stack contact name priar home bus cell secondary home bus cell priar home bus cell secondary home bus cell phone phone phone phone 530 873-7732 primary e-mail address robbiesranch gmail.com primary e-mail address secondary e-mail address secondary e-mail address premises information attach acord 823 additional premises loc street 11300 central ave se city limits interest full time empl annual revenues inside owner occupied area 1596 sq ft bld city albuquerque state nm outside tenant part time empl open public area sq ft county bernalillo zip 871232902 total building area 1596 sq ft description operations new mexico title area leased others n loc street city limits interest full time empl annual revenues inside owner occupied area sq ft bld city state outside tenant part time empl open public area sq ft county zip total building area sq ft description operations area leased others n loc street city limits interest full time empl annual revenues inside owner occupied area sq ft bld city state outside tenant part time empl open public area sq ft county zip total building area sq ft description operations area leased others n loc street city limits interest full time empl annual revenues inside owner occupied area sq ft bld city state outside tenant part time empl open public area sq ft county zip total building area sq ft description operations area leased others /n nature business date business apartments contractor manufacturing restaurant service started mmiddiyyyy condominiums institutional office retail wholesale description primary operations lro installation service repair work premises installation service repair work retail stores service operations total sales description operations named insureds additional interest fields apply scenarios provide necessary data attach acord 45 additional interests interest name address rank evidence certificate policy send bill interest item number additional lienholder location building insured breach loss payee vehicle boat warranty co-owner mortgagee airport_ aircraft employee owner ttem item lessor class leaseback registrant item description owner lender 's trustee reference loan interest end date loss payable lien amount phone aic ext fax aic reason interest e-mail address acord 125 2016/03 page 2 4 loan agency customer id general information explain yes '' responses y/n 1a_ applicant subsidiary another entity parent company name relationship description owned ib applicant subsidiaries subsidiary company name relationship description owned formal safety program operation safety manual safety position monthly meetings osha exposure flammables explosives chemicals n insurance company list policy numbers n line business policy number line business policy number policy coverage declined cancelled non-renewed prior three 3 years premises n operations missouri applicants answer question non-payment agent longer represents carrier non-renewal underwriting condition corrected describe past losses claims relating sexual abuse molestation allegations discrimination negligent hiring last five years ten ri applicant indicted convicted degree crime fraud bribery arson arson-related crime connection property ri question must answered applicant property insurance failure disclose existence arson conviction misdemeanor punishable sentence one year imprisonment uncorrected fire andior safety code violations occur date explanation resolution resolve date applicant foreclosure repossession bankruptcy filed bankruptcy last five 5 years occur date explanation resolution resolve date 10_ applicant judgement lien last five 5 years occur date explanation resolution resolve date 11. business placed trust name trust n 12. foreign operations foreign products distributed usa orus products sold distributed inforeign countries n `` yes '' attach acord 815 liability exposure andlor acord 816 property exposure 13. applicant business ventures coverage requested n 14 applicant lease operate drones `` yes '' describe use 15. applicant hire others operate drones `` yes '' describe use remarks processing instructions acord 101 additional remarks schedule may attached space required prior carrier information year category general liability automobile property carrier policy number premium effective date expiration date acord 125 2016/03 page 3 4 agency customer id prior carrier information continued year category general liability automobile property carrier policy number premium effective date expiration date carrier policy number premium effective date expiration date loss history check none attach loss summary additional loss information enter claims losses regardless fault whether insured occurrences may give rise claims last years total losses subro- claim date gation open occurrence line type description occurrence claim date claim amount paid amount reserved yin yin signature notice information practices privacy given applicant required states contact agent broker state 's requirements personal information including information credit investigative report may collected persons connection application insurance subsequent amendments renewals information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization credit scoring information may used help determine either eligibility insurance premium charged may use third party connection development score may right review personal information files request correction inaccuracies_ may also right request writing consider extraordinary life circumstances connection development credit score rights may limited states please contact agent broker learn rights may apply state instructions submit request us detailed description rights practices regarding personal information_ applicable az ca de ks mn nd ny va wv specific acord 38s available applicants states applicant 's initials applicable al ar dc la md nm ri wv person knowingly willfully presents false fraudulent claim payment loss benefit knowingly willfully presents false information application insurance guilty crime may subject fines confinement prison applies md applicable co unlawful knowingly provide false incomplete misleading facts information insurance company purpose defrauding attempting defraud company penalties may include imprisonment fines denial insurance civil damages_ insurance company agent insurance company knowingly provides false incomplete misleading facts information policyholder claimant purpose defrauding attempting defraud policyholder claimant regard settlement award payable insurance proceeds shall reported colorado division insurance within department regulatory agencies_ applicable fl ok person knowingly intent injure defraud deceive insurer statement claim application containing false incomplete_ misleading information guilty felony third degree applies fl applicable ks person knowingly intent defraud presents causes presented prepares knowledge belief presented insurer purported insurer broker agent thereof written statement part support application issuance rating insurance policy personal commercial insurance claim payment benefit pursuant insurance policy commercial personal insurance person knows contain materially false information concerning fact material thereto conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act applicable ky oh pa person knowingly intent defraud insurance company person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal civil penalties exceed five thousand dollars stated value claim violation applies ny applicable tn_ va wa crime knowingly provide false incomplete misleading information insurance company purpose defrauding company penalties may include imprisonment fines denial insurance benefits applies applicable nj person includes false misleading information application insurance policy subject criminal civil penalties_ applicable person knowingly intent defraud solicit another defraud insurer submitting application containing false statement material fact may violating state law_ applicable pr person knowingly intention defrauding presents false information insurance application presents helps causes presentation fraudulent claim payment loss benefit presents one claim damage loss_ shall incur felony upon conviction shall sanctioned violation fine less five thousand dollars s5,000 ten thousand dollars s10 c fixed term imprisonment three 3 years penalties_ aggravating circumstances present penalty thus established may increased maximum five 5 years extenuating circumstances present may reduced minimum two 2 years undersigned authorized representative applicant represents reasonable inquiry made obtain answers questions application heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print ttate producerlicense required florida clark neff applicant 's signature date national producer number acord 125 2016/03 page 4 4 copy files ny o00

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Workers' Compensation||Date : 1/2/2007

x insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.millikan ins-one.com mame aman sharma j4dn cindy millikan company super 8 motel fnges 6 mumber 505-287-8700 date 01-11-2013 notes workers compensation dtne comments good afternoon thank allowing insurance one inc opportunity serve time start process renewing workers compensation policy effective 01-01-2013. review attached application make changes need sign return iwill forward request changes insuring company questions please give call keep mind insurance one inc handles full line property casualty professional liability workers compensation employment practices liability commercial personal umbrella/excess bonding personal lines life health benefits individuals businesses obligation quotation close phone call away making big push next year expand company assist insurance issues get referrals associates please let know op opj cm acord '' date mmiddiyyyy workers compensation application 1m11/2013 agency name address company fisif-food ind self-ins fund ilnsurance one inc underwriter 6751 academy rd ne suite albuquerque nm 87109 applicant name super 8 motel chris koester office phone mobile pkone mailing address including zip 4 canadian postal code yrs bus 1604 e santa fe ave grants nm 87020 sic producer name chris koester naics cs representative wvebsite name cindy_millikan address 8eeice phone505-888-6333 e-mail address mobile phone sole proprietor x corporation llc trust ee noki 505-888-6334 partnership subchapter `` '' corp joint venture rddhess chris koester ins-one.com sokpau name id number code sub code federal employerid number ncci risk id number gmpeafer rating bureau id state registration number agency customer id super-2 161737854 13226 status qf submsson billigiaudii iformation quote issue policy billing plan payment plan audit bound give date andlor attach copy agency bill x annual x expiration monthly assigned risk attach acord 133 x direct bill semi-annual semi-annual quarterly quarterly logations loc street city cqunty state zip code joo1 11604 e santa fe ave grants nm 87020 cibola policy information proposed eff date proposed exp date normal anniversary rating date participating retro plan 01/01/13 01/01/14 x non-participating part 1 workers part employer 's liability part states ins deductibles amqunti otker coverages compensation states nm 500 ooqeach accident medical u.sl maraofrion 500,000 disease-policy limit indemnity cbhyntary 500,000 disease-each employeei foreign cov dividend planisafety group additional company information specify additional coveraces endorsements total estimated annual premum states total estimated annual premum states total mnimum premium states total deposit premium states 951 contact information type name office pkone mobile phone e-mail inspection aman sharma acctng record clamms wnfq dmdualswncludedeexcluded partners officers relatives must employed business operations included excluded remuneration/payroll included must part information section owner istate loc name date birth relaieshe shie duties inciexc class code remunerationipayrole jaman sharma nm ownet excl jharpreet singh nm excl ld acord 130 2007/11 page 4 1980-2007 acord corporation_ ail rights reserved acord name logo registered marks acord rating state rating sheet sheets agency customer id super-2 op id cm state rating worksheet multiple states attach additional page 2 form rating information state nm descr employees estimated annual estimated loc class code code categories duties classifications full part sic naics remunerationi rate annual manual time iime payroll premium 001 8810 clerical 60,000 27 68.61 001 9052 ihotel others 85,000 2.45 881.93 premium state nm factor factqred premium factor factored premium total 950.54 increased limits schedule rating deductible ccpap standard premium experience ormerit modification 1.00 premium discount 33.27 expense constant nia assigned risk surcharge taxes assessments nia arap total estimated annual premiumk minimum premium deposit premium 917.00 remarks acord 130 2007/11 page 2 4 agency customer id super-2 op id cm prior carreriformatiqnloss history provide nformation past 6 years use remarks section loss details loss run attached year carrier policy number annual premium mod claims amount paid reserve 6oi1 co zurich 3,193.00f pol wc0486135900 po12 co fisif shortterm 917.00 pol 1585a co pol co pol co pol nature qe businessidescriion qe operations give comments descriptions qf business operations products manufacturing raw materials processes product equipment contractor type work sub-contracts mercantile merchandise customers deliveries service type location farm acreage animaes machinery sub-contracts_ thisi5afranchisemotel general iformaiion explain `` yes '' responses yes| applicant operate lease aircraftwatercraft i4 doikave past present discontinued operations involve storing treating discharging applying disposing transporting hazardous material e.g landiills wastes fuel tanks etc work performed underground 15 feet work performed barges vessels docks bridge water applicant engaged type business sub-contractors used `` yes '' give work subcontracted work sublet without certificates insurance `` yes '' payroll work must inciuded state rating worksheet 2 written safety program operation group transportation provided 10. employees 16 60 years age 11_ seasonal employees 12 volunteer donated labor `` yes '' please specify acord 130 2007/11 page 3 4 page

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: commercial general liability ||Date : 11/4/2009

op id cm acord commercial insurance application date mmiddnyyy applicant information section 11/4/2009 agency carrier naic code insurance one inc western pacific 5501 eagle rock ave ne ste a-3 underwriter underwriter office albuquerque nm 87113 policies orprogram requested policy number larry koester wpin5012129 indicate sections attached electronic data proc truckersmotor carrier hacoable pferisable equipment floater umbrella contact larry koester boiler machinery garage dealers vehicle schedule name phone 505-888-6333 business auto glass sign workers compensation aic ext fax 505-888-6334 x gomererclability installationbuilders risk yacht aic_not e-mail crimemmiscellaneous crime open cargo address code sub code dealers property agency customer id artiss driver info schedule teansprbf iqnr status transaction package policy information quote issue policy renew enter information common dates terms apply several ines monoline policies_ bound give date andfor attach copy proposed eff date proposed exp date billing plan payment plan audit change date time direct bill cancel pm 12131/09 12/31/10 agency bill package policy premium applicant information name first named insured named insureds mailing address incl zip+4 first named insured artistic homes inc tom wade 4420 tower rd sw ste albuquerque nm 87121 fein soc sec phone 505-934-5728 first named insured aic ext e-mail e8bresslesl reba '' computer fax 244.8359 abreees individual corporation subchapter llc members cr bureau name b4arpes corporation managers partnership joint venture prgeqrrg bbusiness type id number inspection contact accounting records contact phone email phone e-mail aic ext address aic ext address premises information acord 823 attached additional premises yr loc bld street city county state zip+4 city limits interest annual revenues occupied built employeest inside owner outside tenant inside owner outside tenant inside owner outside tenant inside owner outside tenant nature qf businessidescription operations premise acord 125 2007/10 page 3 1993-2007 acord corporation ail rights reserved acord name logo registered marks acord agency customer id artis-5 op id cm general information explain `` yes '' responses yin 1a applicant subsidiary another entity 1b applicant subsidiaries formal safety program operation exposure flammables explosives chemicals catastrophe exposure insurance company submitted policy coverage declined cancelled non-renewed prior three 3 years applicable mo past losses claims relating sexual abuse molestation allegations discrimination negligent hiring last five years ten ri applicant indicted convicted cf degree crime fraud bribery arson arson-related crime connection property ri question must answered applicart tor property insurance failure disclose existence arson conviction misdemeanor punishable sentence ofup one year imprisonment uncorrected fire code violations 10 bankruptcies_ tax credit liens applicant past five 5 years 11. business placed trust `` yes '' name trust 12. foreign operations foreign products distributed usa usproducts soldidistributed foreign countries `` yes '' attach acord 815 iability exposure andlor acord 816 property exposure_ remarksprocessing instructions attach additional sheets space required copy notice informationpractices privacy given applicant applicable states_ consult agent broker state 's requirements nqtice qf_isurance information practices personal information abqut including information credit report may colle tec persons connection application insurance subsequent policy renewals information well personal privileged information collected us agents may certain circumstances disclosed third parties without authorization right review personal information files request correction inaccuracies detailed description rights practices regarding information available upon request contact agent broker instructions submit request tous_ person knowingly intent defraud insurance company another person files application insurance statement claim containing materially false information conceals purpose misleading information concerning fact material thereto commits fraudulent insurance act crime subjects person criminal ny substantial civil penalties applicable co fl hi ne oh ok vt dc la tn va wa insurance benefits may also denied florida_ person knowingly intent injure_ defraud deceive insurer files statement claim application containingany false_ incomplete misleading information guilty felony third degree undersigned authorized representativve applicant represents reasonable enquiryhas made obtain answers questions application_ heishe represents answers true correct complete best hisiher knowledge producer 's signature producer 's name please print state producer license required florida larry koester applicant signature date national producer number acord 125 2007/10 page 2 3 agency customer id artis-5 op id cm priqr carrier infqrmation line category carrier policy number claim8 claim8 claim8 claim8 claims policy type made occurrence madf occurrence madf occurrence madf occurrence mukdf occurrence retro date eff-exf date general aggregate g 1 pbs rughseomp personal adv inj occurrence e fire damage 8 medical expense 4 occurrence bodil injury aggregate ccurrence property damage aggregate comeined single limit modification factor total fremium carrier policy number policy type eff-exf date 1 8 combined single limit bodily ea person injury ea accident e property damage modification factor total fremium carrier policy number policy type 8 eff-exf date building amt r pers prop amt modification factor total fremium carrier policy number policy type eff-exf date limit modification factor total fremium loss history enferhflprcoeis osses regardless fault whether insured occurrences may give rise claims chk see attached priqr 5_years 3 yearsinks ny osssummary claim date line typeidescription occurrence claim date amount amount status occurrence claim paid reserved openclsdi remarks note fidelity requires five year loss history attachments state supplement applicable acord 125 2007/10 page 3 3 op id cm acord date mmiddnyyy commercial general liability section 11/4/2009 agency phone 505-888-6333 applicant artistic homes inc aic no_ext fax first aic_noh 505-888-6334 named insured insurance one inc 5501 eagle rock ave ne ste a-3 effective date expiration date payment plan audit direct bill albuquerque nm 87113 12131/09 12131/10 x agency bill larry koester compan code sub code use agenc artis-5 customfrds coverages limits x commercial general liability general aggregate 2,000,000 premiums claims made occurrence products completed operations aggregate 2,000,000 premisesioperations owner 's contractor 's protective personal advertising injury 1,000,000 occurrence 1,000,0001 products deductibles damage rented premises occurrence 50,0001 property damace medical expense oneperson 5,000 per bodily injury claim employee benefits x policy 15,000 occuerence total coverages restrictions andior endorsements hiredinon-owned auto coverages attach applicable state business auto section acord 137 schedule hazards loc haz classification class premium exposure terr rate premium code basis premiops products premiops products contractor single family pwellings 4-plexes 13,000,000 rating premium basis p payroll per 1,0ooppay ci totalcost per ooo/cost u unit per unit gross sales per ooo/sales area per ooosq admissions per qoojadm claims made explain `` yes '' responses explain 'yes '' responses yin proposed retroactive date entry date uninterrupted claims made coverage product work accident location excluded uninsured self-insured previous coverage tail coverage purchased previous policy employee benefits liability deductible per claim number employees covered employee benefits plans number qf employees retroactive date acord 126 2007/05 page 4 acord corporation 1993-2007 ail rights reserved acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Acord Application||LINE OF BUSINESS: Workers' Compensation||Date : 1/11/2013

date mmiddnyyy acord certificate liability insurance o18 5 aw 11/26/07 producer certificate issued matter information confers rights upon certificate ingurance one inc holder certificate amend extend 6101 moon nb suite 1000 alter coverage afforded policies albuquerque nm 87111 phone 505-822-8114 fax 505-822-0341 insurers affording coverage naic insured insurer zurich smal1 busines3 insurer b probuilders etinade homeg inc insurer c tom 4420 tower rd sw h13ite insurer albuquerque nm 8 insurer e coverages policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies aggregate limits shown may reduced paid claims_ insr addi insurance policy number phamnebe pbfsy eibbon limits ltrinsry type qf general liability occurrence 1000000 damage torented x x commercial general liability wpin5012129 11/01/06 12/31/07 premises ea occurence 50000 claims made x occur med exp one person 5000 personal adv injury 1000000 general aggregate 2000000 genl aggregate limit applies per products compiop agg 2000000 x policy pe8 loc automobile liability combined single limit ea accident auto owned autos bodily injury per person scheduled autos hired autos bodily injury per accident non-owned autos property damage per accldent garage liability auto ea accioent auto ea acc auto agg excessiumbrella liability occurrence occur claims made aggregate deductible retention wc statu oma workers compensation tory limits er employers liability el accident proprietorpartneruexecutive officerimember excluded el disease ea employee 'pecidesertvigders el disease policy limit 4 builders risk br62908118 01/01/07 01/01/08 per local 3000000 perdisast 5o00000 description operations locations vehicles exclusions added endorsement special provisions 2506 green valley_ lot 32 2512 green valley /lot 31 2501 green valley/lot 14 2033 heritage/lot 8 2109 highland dr. /lot 65 2032,2036 2040 2102 babt arbors 4-plex/lots 9-12 tanglewood subdivibion hobbg nm reba/artistic delivery certificate holder cancellation described policies cancelled expiration miscell date thereof issuing insurer endeavor mail 10 days written charter bank notice certificate holder named left failure shall attn scott browning impose obligation liability kind upon insurer agents 4400 osuna rd ne representatives albuquerque nm 87109 authorized representative larry koester ybn acord corporation 1988 acord 25 2001/08 important certificate holder additional insured policy ies must endorsed statement certificate confer rights certificate holder iieu endorsement subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder lieu endorsement disclaimer certificate insurance reverse side form constitute contract issuing insurer authorized representative producer certificate holder affirmatively negatively amend extend alter coverage afforded policies listed thereon acord 25 2001/08

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Chrter Bank||Date : 11/26/2007

date mmiddnyyy acqrd certificate of_liability insurance 09/23/2007 certificateis issueraas amatter oeinformation producer 505 888-6333 fax 505 888-6334 onlyand confers rights upon certificate insurance one inc holder certificate notamend extend ne alierthecoverage affordedby thepolicies 5728 osuna aibuquerque nm 87109 insurers affording coverage naic aitison wylie insurer central mutual ins companijes 47 insured asds inc. dba aadf warehouse corp p.0_ drawer 26928 insurer b deep south_of _colorado 37 nm 87125 insurer c mexico mutua casualty co_ albuquerque insurer insurer € cqverages_ insurance listed issued insured named policyperrodficricater beoissuesornding policies contract document respect towhich certificate may issued pr requirement_ term condition herein subject terms exclusions conditions may pertain insurance afforded policies described policies aggregate limits shown may reduced paid claims insr rrh type insurance policy number pohg yees poh bebtov limits ir clp7970608 10/01/2007 10/01/2008 occurrence 1 0o0 ooc general liability damage rented 300 ooc commercial general liability eremises ea occurencel med exp one person 5,00c claims made x occur personal adv injury 1,000,00c x general aggregate 2,000,00c products compiop agg 3,000,0oc genl aggregate limit applies per x policy peo loc automobile liability cn300000253 10/01/2007 1070172008 combined single limit ea accident 1,000,0oc auto owned autos bodily injury per person scheduled autos x hired autos bodily injury per accident non owned autos property damage per accident auto ea accident garage liability ea acc auto auto agg cxs8370028 10701/2007 10/0172008 occurrence 1,000 00cl excessiumbrella liability aggregate occur claims made 1,000 ooc deductible retention wc statu oth workers compensation 008117 114 03/0172007 037/0172008 x tory limiis er employers liability el accioent 500,0oc onficerrrietoreacinseexecutive e l disease ea employee 500 ooc hf yes descnbe e.l disease policy limit 500 ooo special provisions description operations locations vehicles exclusions added endorsement special provisions general certificate revised rertificate holder naned additiona insured genera iiabi ity interest may appear except 10 days notice cancel iation non-payment premium certhigate hqlder gancellatiqn described policies cancelled expiration date thereof issuing insurer willendeavor mail 30 days written notice certificate holder named left failure mail notice shall mpose obligation liability matson integrated logistics kind upon insurer agents qr representatives po box 6480 villa par il 60181 authorized representamive ux tz chris koester/alliso acord 25 2001/08 fax 630 916-8803 acord corporation 1988 new important certificate holder additional insured policylies must endorsed statement cerlificate confer rights certificate holder lieu endorsement subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder iieu endorsement disclaimer certificate insurance reverse side form constitute contract issuing insurer authorized representative producer certificate holder affirmatively negatively amend extend alter coverage afforded policies listed thereon acord 25 2001/08

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: AEL Financial||Date : 5/28/2008

date mwddnyyy acord certificate liability insurance qie_32 aw 11/26/07 producer certificate issued matter information confers rights upon certificate ingurance one inc holder certificate amend extend 6101 moon nb suite 1000 alter coverage afforded policies below_ albuquerque nm 87111 phone 505-822-8114 fax 505-822-0341 insurers affording coverage naic insured insurer contral nutual ior ccmpanlan insurer b inc insurer c atpdec8 tower ra sw suite insurer albuquerque nm 87121 insurer e- coverages policies insurance listed issued insured nameo policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies aggregate limits shown may reduced paid claims_ isrn h type insurance policcy number ehac yhhbew pgry ebbwon limits general liability occurrence dawaage torenteo commercial general liability premises ea occurence claims made occur med exp person personal adv injury general aggregate genl aggregate limit applies per products compiop agg prq policy ject loc automobile liability combined single limit ea accident 1000000 x auto bap8121626 01/01/07 01/01/08 owned autos bodily injury scheduled autos per person hired autos bodily injury per accident non-owned autos property damage per accident garage liability auto ea accident auto ea acc auto agg excessiumbrella liability occurrence occur claims made aggregate deductible retention wc statu- workers compensation tory limits er employers liability el accident proprietoripartneriexecutive officervmember excluded el disease ea employee describe speci ial provisions el disease policy limit description f operations locations vehicles exclusions added endorsement special provisions 1996 jaep cherokee 1j4fj2853tl229102 marcie vabquez hag covered driver thig vehicle certificate holder cancellation miscel1 described policies cancelled expiration date thereof issuing insurer endeavor mail 10 days written notice certificate holder named left failure shall proof insorance impose obligation liability kind upon insurer agents representatives authorized representatiye larty koegter onq corporation 1988 acord 25 2001/08 one important certificate holder additional insured policy ies must endorsed statement certificate confer rights certificate holder iieu endorsement subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder iieu endorsement disclaimer certificate insurance reverse side form constitute contract issuing insurer authorized representative producer certificate holder affirmatively negatively amend extend alter coverage afforded policies listed thereon acord 25 2001/08

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 9/9/2009

date mmddiyy agord certificate f property insurance aw 05/28/08 :3~ 3 certificate issueda5s7a tatter ofinformation producer confers rights upon certificate holder_ certificate amend extend ingurance one inc alter coverage afforded policies belqw 6101 moon ne suite 1000 companies affording coverage albuquerque nm 87111 company advanstaff inc hartford ingurance company phone 505_822-8114 fax:5o5e822-0341 insured company company advangtaff_ inc 501 8 rancho 8518653 company las vegas nv coverages certify policies insurance listed issued insured named forthe policyperiod notwithstanding requirement term condition contract document respect towhich indicated may pertain insurance afforded policies described herein subject terms certificate may issued exclusions conditions policies limits shown may reduced paid claims_ policy effective policy expiration covered property limits co type insurance policy number date mmiddiyy date mmiddiy ltr x property 34sbaih5696sc 11/09/07 11/09/08 building personal property causes loss business income basic extra expense broad blanket building special blanket pers prop earthquake blanket bldg pp flood x bpp 104500 x x special x deductible 1000 x x raplacomant inland marine type policy causes loss named pcrils crime type policy boiler machinery location premisesidescription propert special conditionsiother coverages ael financial_ llc and/or itg a8gign8 named lobb payee regarding property damage regarding leaged property certificate holder cancellation described policies cancelled miscell expiration date thereof issuing company endeavor mail ael financial 10 days written notice tq certificate holder named left attn irina teyrkipa failure mail notice shall impose obligation liability 600 north buffalo grove ra kind upon company agents representatives buffalo grove il 6po89 authorized representative acord 24l195 ilnatz acorqcorporation 1995 ayl

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ICA Mortgage Capital LLCISAOA||Date : 4/22/2011

10/02/2008 17:44 505-9987827 roberts truck center page 02/02 date nmddiyyy acord certificate liability insurance 988921 04o3/08_ producer tis trmacatetistsnved7n3ataterofinzoenatiqn confers rights upon cermfkcate icplrence one inc holoer certificate notamend exzend 6101 moon ne guite 1000 alter covrace affqrded policies albuquertue mm 37111 prone 505-832-9114 fax:505-b22-0341 insurers affording coverage naic ji4e tnswred nnsurer redlana ins co insurer inc insurer c 1 2 887125 insurerd quetgun wnjurz coverages policies qf insurance listed belouy hava issuedto insured named ^drove folicy period indiqated motwithstandinq reourement termor condion contract document wih rzsrect mo certificate may iusued qr may pertain ineurance affordeq ry policies described herfi cuibvect te termi exclusions conditions qf polici6s aqgrecate limita cholnn may kave bccn reouced faid claims eitzf tpe induaakkce policy number mheei eteeeb limt3 gengqal liability oocurrence ofentto commercial general liabilny frewgdzzuenco cliims made occur med exp ona perjon personal acv inuury deneral acorbqate gen l aocrcqate limit applies prr prolucs compiqp acg policy 989 loc automkorilt liabilmty single limtt 100000 x auto cr300000253 10/01/07 10/01/08 gh8ne6 owned autos dodily injury pcy pcrson ichedul ed autos x hired autob dodily injury per accivani x non-owied autos phygical_danage_ profarty damace pfi gacideni qarage vability autoonly ea accident auto eaaoc auto 0g excessnumdrplla liabivty occurrence occur claims made agoreqatl ceductidle retfntiqn workers compenation gtm ola employer '' liabilnty elbach accident enyiserrftgrpattnbeexecutive el disease ea emfloyee execttz vdons 6 l risense policy limkm otrer colligion c1300000353 10/01/07 10/01/08 coll ded 51000 cemprensnofve c3300000253 10/04/07 10/01/08 comp_ded 21000_ deecritin v operatons locatun8t veircles exalvsiowy a56e5 6yendorsenectt spogial provisions 3003 international 9400 tractor 00307 6 2003 international 9200 trectora 0305 cartificata holder i0 namad addltional inrurod regaralng auto liabiitr lobb pay0e regarding phyaical damage liec04 vebiclag 28 labbor certificade holder cancellaion yiscel1 sholld qg described policiro d8 cancelled befqre yhe expirationi roberta truck cenear ideal date thcreqf issuih imwurer wll endeavor 10 mail 30 dayb written leabe izc fax 998-7827 nomce tq cgrmacate holder namied totha laft failvre tq qd r0 bhall atcd traay impose obligatiom uarility kind updn mburda it3 agents po box 25086 albuquarquo nm 87125 repregentawvbr authorie5 representntive acord 25 2001/08 jempewta acord corporation 7988 10/02/2008 17:44 505-9987827 roberts truck center page 01/02 idealease roberts ddealease 1623aspen ave nw albuquerque nm phone 505-217-3434 fax 505-998-7827 tf 800-999-8653 tnsuren42 q md__s fax 22 034l pages _2 wlcouer phone date 1.2-dx subject larabal_lyttcatz comments lpdolsd yank_hy axxer 0 nen j 0 fla4 qon 18+

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Taos Soil & water Conservation||Date : 3/1/2011

date mmiddiyyyy acord certificate liability insurance op id cm artis-5 09/09/09 froducer certificate issued matter information confers rights upon certificate insurance one inc holder certificate amend extend 5501 eagle rock ave ne ste a-3 alter coverage afforded policies albuquerque nm 87113 phone 505-888-6333 fax:505-888-6334 insurers affording coverage naic insured insurer probuilders insurer e central mutual ins companies otjsgicy tom hoaae inc insurer € new mexico mutual casualty 4420 tower rd sw ste insurer zurich albuquerque nm 87121 insurer e coverages policies insurance isted bel ow issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies accrecate limits showvn may reduced paid claims_ insrtadd polict effective exprration ltr nnsrd type insurance policy number date mmiddnyyy brfe mrdeyp limits general liability occurrence 10ooo00 damage rented x commercial general liability wpin5012129 12/31/08 12/31/09 premises occurence 50000 claims made occur med exp one person 5000 personal adv injury 1000000 general aggregate 2000000 enl aggregate imit applies per products compiop agg 2000000 policy ject loc automobile liability combined single imit 1000000 b x auto bap8121629 01/01/09 01/01/10 ea accicent owvned autos bodily injury per person scheduled autos hired autos bodily injury non-owned autos per accident property damage per accident garage liability auto eaaccident auto eaacc auto onl agg excess umbrella liability occurrence occur claims made aggregate deductible retention workers compensation statu employers liability x tory limits n proprietoripartnerjexecutive 12148_ 114 01/01/09 01/01/10 el accident 100000 officerimember excluded mandatory nh el disease ea employee 100000 yes describe special provisions el disease policy limit 50oo00 builders risk br62908118 01/01/09 01/01/10 location 3 ,000 000 disaster 5,000 0o0 description operations locations vehicles exclusions added endorsement special provisions certificate holder cancellation described policies cancelled expiration date thereof issuing insurer endeavor mail days written notice certificate holder named left failure shall impose obligation liability kind upon insurer agents insurance purposes onlx representatives authorized representative larry koester acord 25 2009/01 1988-2009 acord corporation ail rights reserved acord name logo registered marks acord ea important certificate holder additional insured policy ies must endorsed statement certificate confer rights certificate holder lieu endorsement subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder lieu endorsement disclaimer certificate insurance constitute contract issuing insurer authorized representative producer certificate holder affirmatively negatively amend extend alter coverage afforded policies listed thereon acord 25 2009/01

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: The Hutton Company||Date : 9/22/2011

acord certificate liability insurance op id c date mwvddiyyt 10/07/10 certticate issuedasamatterof information confers norights upon certiricate holder ths `` certificate dqes affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representativve producer certificate kolder tmportant trthe cortiicate holdett6a zdditionalinsured tho pollcy iom muateo ondorzed tsubrotationts waied oubjoctto tha terms conditions policy certaln policles may requlre endorsement statement thls certlflcate confer rights tho certlficate holder ilou ol endoreemenue producer gtlet insurance one inc meno ac 6751 academy rd nb suite o84e88 albuquerque 87109 8i9288r wingb-1 phone 505-888-6333 fax 505-888-6334 inburer affording coveraqe naic inbured insurer colorado cagualty bagket fizgeeedeitt insurer b inburer c aibuquerque 87193 insurer ineurer e inburer f coverages certificate number revision number certify tke policies f insurnnce listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issueo may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims type insurance eeu policy number 999mwmtnabm limits general liability occurrence 1000000 x commercial general liabiliy cbp1417857 08/18/10 08/18/11 pramse erenueenca 100000 claims-made occur med exp one peraon 15000 personal adv injury 1000000 hixed/non-owned general aggregate 2000000 genil aggregate limit applies per products compiop agg 2000000 policy bb8 loc automobile liability combined single limt ea accident 1000000 auto cbp1417857 08/18/10 o8/18/11 bodily injury per person owned autos bodily injury per eccldant scheduled autos property damage x hired autos per accidani x non-owned autos x ubrella liad occur cu8719302 08/18/10 08/18/11 occurrence 2oo0o00 excess liab claims-made aggregate deouctible x retention 10000 workers compenbatiom wci4t7853 08/18710 08/10/11 x essa employerb liability yin proprietoripartneriexecutive el accident 1000000 qecror,5n /86r excluded7 yia andatory nh el disease ea employee 1000000 describe dyecde ho8 ud8peraiions el disease policy limit 1000000 descripmon qf operamons logation8 vehicle8 attaoh acqrd 101 addltlonal romarks schudule hmort epuas roqulrod square e8 8993388 635637 bevadne5 iobooeecaa 'n8 47889 34 llc 8535 san mateo blyd nz avenue 350 4i3445 qua,27 a58 eoog625 named bed eadfteazai o8ug8d3 certificate holder cancellation oebcribed policies cancelled bepore expiration date thereof notke wll delivered accordance policy provibionb shefeield square clo goodman realty group authorized representative 100 sun avenue ne ste 100 albuquerque 87109 jeff wilgon 1988-2009 aco corforiaton rights reserved acord 25 2009/09 acord name logo reglstered marke ot acord exti box 454485348r988 adals noz epad iincbae pase iurersele 06ng baakat ohencve ta 49/7 /d0 general liability per contractual agreement 30 cancel noticet day

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Bernallio Country Purchasing||Date : 12/14/2011

opid cm acord date mmiddiyyy certificate liability insurance 04/22/11 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend_ extend alter coverage afforded policies certificate insurance constitute contract tke issuing insurer authorized representative producer certificate holder_ important certificate holder additional insured policy ies must endorsed subrogation waived subject t0 terms conditions policy certain policies may require endorsement statement certificate confer rights certitilcate holder iieu endorsement producer 505-888-6333 contact insurance one inc nane 6751 academy rd ne suite 505-888-6334evone ed ienol albuquerque nm 87109 e-mail larry koester rocutsr cusioner dgfinch wnsurer affording cqverace maic insured lois e finch finch 1988 trust insurer safeco clo commercial real estatemgmt insurer b 4801 lang ave ne suite 120 insurer c albuquerque nm 87109 insurer insurer e insurer f cqverages certificate number revisionnumber certify policies insurance listed issued insured named tke policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims_ insr adolisuer policyeff policy exp l type insurance insr policy number mmiddnyyy mwddnyy limits mttttttttntt general liability occurrence 2,000,000_ x commercial general liability lozbp3289706 04/26/11 04/26/12 peegeszrbctud 2,000,006 occuttonce claims-made x occur med exp arly ore person 10,000 personal adv injury 2,000,000 general aggregate 4,000,000 genl accregate limit applies per products compiop agg included x policy pro loc automobile liability combined single limit ea accident ,000,00 auto j02bp3289706 04/26/11 04/26/12 bodily injury per person owned autos bodily injury per accident scheduleq autos property damage kired autos par accident x non-owned autos umbrella liab occur occurrence excess liab claims-made aggregate deductible retention workers compensation ris js oth- employers liability fr yin amy froprietorpartneriexecutive eack accident officerumember excluded nia mandatory nh el disease ea employee describe eecdeiioeg operations bel el disease policy limit description qf operations locations vehicles attach acord 101 addltlonal remarke schedule epace requlred f 888-3158 3517 wyoming ne albuquerque nm 87111_ certificaite holqer cancellation shquld described policies cancelled ica expiration date thereof notice delivered mortgage capital llcisaoa accordance policy provisions_ clo q10 realty mortgage investment company 5201 venice ne suite b authorized representatie albuquerque nm 87113 larry koester 1988-2003 acord corporation ail rights reserved acord 25 2009/09 acord name logo registered marks acord ow op id cm acord date mmiddiyyyy evidence property insurance 04/22/2011 evidence property insurance issued matter information confers rights upon additional interest named evidence affirmatively negatively amend extend alter coverage afforded tke policies evidence insurance constitute contract issuing insurer authorized representative producer additional interest_ agency inc exth505-888-6333 company insurance one inc safeco 6751 academy rd ne suite 1600 north collins blvd 300 albuquerque nm 87109 richardson tx 75080-3580 larry koester heno1505-888-6334 eus code su8 code toency finch-a4 customeridg insured loan number policy number 02bp3289706 effective date expiration da te lois € finch finch 1988 trust continued clo commercial real estatemgmt 04/26/11 04/26/12 terminated checked 4801 lang ave ne suite 120 replaces prior evidence dated albuquerque nm 87109 property information locationidescription 3517 wyoming ne albuquerque nm 87111 policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect evidence property insurance may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown may reduced paid claims cqverage information coverage perils forms amount insurance deductible premise 001 building 001 building replacement cost speclal tor 8330001 2502 bi als 12 mos terrorism included remarks lncluding special conditions_ f88885158 cancellation described policies cancelled expiration date thereof notice delivered accordance policy provisions addiiiqnal interest name address x mortgagee additional insured x loss payee loan ica mortgage capitalllcisaoa clo q10 realty mortgage authorized representa tive 5201 venice ne ste b larry koester albuquerque nm 87113 al acord 27 20091/12 1993-2009acord coriporation rights reserved acord name logo registered marks acord pfonc producing broker affidavit affidavit shall completed producing broker e-g agent selling product submitted t0 surplus lines broker within fifteen issuance policy_ producing broker affida vit required nmsa 1978 section 59a-4-1ib licensed individuals namel producing broker tttttttttttttyn address broker 62s1 academy road ne ste lbuquerquen 87102 duly sworn affirm 1_ engaged obtain following policy insurer mount vernon fire co policy number ruwl cp2556860 coverage multi-line effective date 05107/11 name insured werer _gilchrest llc check either b appropriate making diligent search found full amount type insurance requested could obtained authorized insurers new mexico within last year tried place type coverage least four insurers authorized new mexico including insurers appointed therefore know substantial recent experience coverage obtained authorized insurer new mexico 3_ expressly advised insured prior placing insurance insurance policy states insurer insurance placed authorized insurer new mexico subject supervision superintendent insurance event insurer becomes insolvent claims paid new mexico guaranty association ihave asked insured best knowledge coverage replacing existing coverage authorized insurer willing continue providing coverage 5 certify licensed new mexico department insurance type coverage provided information true correct compliance applicable provisions mexico insurance code rule date days ins new sigrtature

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Harder Custom Builders||Date : 5/24/2012

insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.millikan ins-one.com insurance verification cindy millikan ullrich construction 2 development 281-1137 03/01/2011 aesops 's gables gale f 505-275-1805 comments thank cm op id cm acord date mwiddiyyyy certificate liability insurance 03/01/11 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certilicate holder_in lieu endorsementls producer 505-888-6333 cqwact naqe insurance one inc phone 6751 academy rd ne suite 505-888-6334|79n__exth_ aic_noj albuquerque nm 87109 etatc koester tooodii customerid abeyt-3 insurer affording coverace naic insured abeyta engineering insurer lloyd's_ot_london alex abeyta insurer b p0 box 1499 insurer c ranchos de taos nm 87557 insurer insurer e hnsurer f cqverages certificate number revisionnumber tkis certify tke policies insurance listed issued insured named policy period indicated_ notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims trer type insurance aldlisubrt policy number ebgn poucyexp limits insr mnd mmiodxyyy general liability occurrence commercial general liability daaage orented premises ea occurrencel claims-made occur med exp one person personal adv injury general aggregate genl aggregate limit applies per products compiop agg policy 8e8 loc automobile liability combined single limit ea accident auto bodily injury per person owned autos bodily injury par accident scheduled autos property damage hired autos per accident non-owneo autos umbrella liab occur occurrence excess liab claims-made acgregate deductible retention workers compensation wvc employers liability iqby_ hmt tttarattctttc j34 yin proprietorpartnereexecutive accident officermmember excluded nia mandatoty el.disease ea employee describe beschetios bjoperations __ el disease policy limit professional liab x 71044999033/008 0112871 01128012 pper claim 1,000,000 lwls5ooo deductibl aggregate 0o0 do0 description operations locations vehicles attach acord 101 addltlonal remarka schedule pace tequlred certificate holder cancellation kaaneuunna aunanaunannuuuuouunruutauunaaaaat described policies cancelled expiration date thereof notice delivered hn taos soil water conservation accordance wth policy provisions district po box 2787 ranchos de taos nm 87557 autkorized representatike larry koester 1988-2009 acord corporation ail rights reserved acord 25 2009/09 acord name regietered marks acord larry nh logo

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Universal Constructors Inc||Date : 7/13/2012

op id cm acord date mmiddiyyyy certificate liability insurance 09/22/11 certificate issued matter information confers rights upon tke certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder iieu endorsementls producer 505-888-6333 ranec insurance one inc phone 6751 academy rd ne suite 505-888-6334llh8 extli noi albuquerque nm 87109 bma address koester frotucer customer abeyt 3 insureris affording coveraqe naic insured abeyta engineering jnsurer lloyd 's of_ london alex abeyta insurer b po box 1499 insurer c ranchos de taos nm 87557 insurer jnsurer e_ insurer e coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims type insurance reeur ynq policy number eobs7 policy bbhr limits llalllllllll general liability occurrence damage torente commercial general liability premises ea occurrence claims-made occur med exp one person personal adv imjury general aggregate genl aggregate limit applies per products compiqp agg pro- policy ject loc automqbile liability combined single limit ea accident auto bodily injury per person owned autos bodily injury per accident scheduled autos property damage hired autos per accident non-owned autos umbrella liab occur occurrence excess liab claims-made aggregate deductiale retention workers compensation wc statu employers liability jqry limits proprietoripartneruexecutive el accident officerimember excluded na mandatory nh e.l disease ea employee describe de escdiii3e-3doperations belov el disease pqlicy imit |professional liab 7044999033/008 01/28/11 01028112 per claim o00,000 wlssodo deductibl aggregate j000,000 description opera tions locations vehicles attach acord 101 additional remarks schedule space required certificate holder cancellation described policies cancelled expiration date thereof_ notice delivered hutton company accordance wth policy provisions_ 736 cherry street chattanooga tn 37402 authorized representative larry koester 1988-2009 acord poration rights reserved_ acord 25 2009/09 acord name logo registered marks acord ne larry

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Knowledge Learning Corporation||Date : 10/2/2012

12/1412011 09.21 harakce 0e ax5058885114 p.002/020 opdicm acord '' date mmidoiyyy certificate liability insurance 12n411 thi8 cermficate 18 i9bued 48 matter information confers riahts upon certifkate holder certificate dozs affirmatively qr neqatnely amend extend alter coverage afforded pouicies certificate insurance doe8 constitute contract betwneen issving insurer authorizzd representative produceriand ihe cermficate holder iportant mftho certificate hoker addiional insured iha polcyllas muot bo endorood 0t subroqation 9 waved jubjoct tho tenns condltlena ot pollay cartaln pollclea may raqulra endoremant atatement thlo cortlficato dort confar right jto cortlcetoholderdnteugtauchendonenentlaz procucbr 606 838 j3j310hze injurenco inc 0764 acedemy runne sulto 505-888-8314 wc k l nm 57109 jeft dubhzhcoue dudi gua 4n acmera inllllulllordlioaom zao nadd nbured acme fencee inc jnjunr sontlnel insurnco cempany 7001 znd st nw iniuk3o trumbuli insuranco companx albuquerque nm 87107 n ur3g jnevesrd iniue ie eerf coverage8 cerwficatenuwberi remeonnumberi ths 18 certify thaat policifs qf insurance visted pelow issued insured named poucy period indicated notwithatanling requirement term qr condition df contract document wth respect ths certificate mmay issued may pertain wsura afforded povciz8 debcrbed kerein i8 su3jject tq terms exclubions conditions suchpoucies limits shown may reduced paid claimb eez typi inrurangl fx pol eynumeer lajit qeneral labilty occurzence 1000,004 x dommercial general liability x k4sbap j3266 0a2t11 03029012 3heh 481l ~nvap g0 d0c claime made occur madexr ee4 eie- dooc| personal aadv injury 1000poci ceneral adorecawl z002,000 genlaccreoaie limt mplie per produci8 compior agd 2000,000 poliy x fo log automolilg laetlity cqmained rinolel7 1,000,0.0 ea eroieant auto rauec jj8304 0320111 owz8t12 bodily injury perayuc owned alntqs bodily injurt per kor 8checuled autos proferty damace kred autqb p ixont nonowned autos cdrella lmd x occur occlzrence 00,004 exceej liab clais-made aggrecaie 343bapj3268 0329/14 03/0lz deductiblz x elmon worr ds co vpenonton x ihne q4x andemployers lmdhity eysesheorex80ecd,4cutia p4wecvp4813 02129m11 03129t12 el eachaccden 100,004 excluredr nia ualrrotq el diseasl u imployee 100,006 beear5nzirzeratiqni yct elt el dijeace polic lmi 800 o0c descriptidnd7 ophnatoni locatioh /vehcled ntm acold 101 jaba jeheduttt weprer tequkeah bornallllo counly 1o adqlitonal inaurad er gono0| iieiz7 196708r4n3033tae jg tno axtnt tsha provlalant pollcy certificate holder gancellatkon 3hould described pquicies cancelled defore expiration date thereor kotice wll delnered bernallllo county purchaelng accordancewthte policy provibkona clvlc piaza ioth floor albuquarqun nm 87102 authoriid repreoentatne 1988-2005 acord corporatiqn alitluhta ranerved acord 25 2000/09 tha acord nama bpo ar0 regletarod marko ot acord one itmore

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Gardner Zemke||Date : 1/17/2013

accur-1 op id cm acord date mmiddnyyy certificate liability insurance 05124/12 certificate issued matter informaton confers rights upon certificate holder_ certificate affirmatively nega tvely amend extend alter coverage afforded policies below_ certificate insurance consttute contract issuing insurer authorized representative producer certficate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certifcate confer rights certificate holder lieu endorsementls producer 505-888-6333 sanact insurance one inc phone fax 6751 academy rd ne suite 505-888-63341 aic exth jajc_no albuquerque nm 87109 rdbress larry koester insurer affording coverage naic insurer new mexico mutual insured accurate roofing insurer b severiano hernandez insurer c 429 el cerro loop albuquerque nm 87031 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown mayhave reduced paid claims insr addl subr poe eff policy exp ltr type qf insurance insr wd policy number mmiddiyyyy mmiddiyyy limits general liability occurrence damag rent commerci al general liability remises ea occurrence claims-made occur med exp one person personal adv injury general aggregate gen l aggregate limit applies per products compiop agg policy automobile liability ombined single limt eaaccident auto bodily injury per person owned scheduled bodily injury per accident autos autos non-owned proper damage hired autos autos accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation x toesemis employers liability /n 144742107ar 08/30/11 08/30/12 el accident 100 o00 offieerpriebor eaetnbeexecutive n/ mandatory nh el disease ea employee 100 oo0 ifves describe und description perations el disease policy limit 500,000 description operations locations vehicles attach acord 101 additional remarks schedule space required robin buildharder com certificate holder cancellation described policies cancelled expiration date thereof notce delivered harder custom builders accordance policy provisions po box 20127 albuquerque nm 87154 authorized representative mmkan 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Hepker Inc||Date : 7/23/2012

wingb-1 qpjjd cm acord date mmiddiyyyy certificate liability insurance kt= 08/24/11 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies tkis certificate insurance constitute contract issuing insurer authorized representative qr producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policles may require endorsement statement certificate confer rights certiticate holder lieu endorsementle w producer cowact 505-888-63330 name insurance one phone 6751 academy rd ne suite 505-888-6334 phome9_exuz aicnoji albuquerque nm 87109 e-ma jeff wilson aqdress insurer affording cqverage maic insurer colorado casualty 41785 insured wing basket insurer b po box 67975 insurer € albuquerque nm 87193 insurer insurer e insurer f cqverages certificate number revision number certify policies insurance listed belqw issuedto insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims_ lalaalala alllalllltu mf type insurance eeeoi pqlicy number iegbgy eyyimahss limits mllt general liability occurrence 1,000,0o0 x commercial general liability x icbp1417857 08/18/11 08/18/12 dawiage orented `` ulullla 100,000 eremses eaoccurrence claims-made x occur med exp one person 15,000 personal adv injury 1,000,000 x hiredinon-owned general aggregate 2,000,000 cen l aggregate limit applies per prooucts compiop agg 2,0od o00 falllattttettttettttt x policy frs loc automobile liability ~comuined single lim ,0o0,00c eaaccident auto cbp1417857 08/18/11 08/18/12 bodily injury per person owned scheduled autos autos bodily injury per accident hired autos x non-owned propert qamage autos lee_accident x umbrella liab x occur occurrence 2,000 ooc excess liab claims-made cu8719302 08/18/11 08/18/12 aggregate ded x retention 1o001 workers compensation x igehm employers liability iimis yin proprietorpartneriexecutive wc1417853 08/18/11 03/18/12 el eachaccident oo0 ooc officerimember excluded mia mandatory nh el qisease ea employee 1,000,000 describe descre tiebsperations belw el disease policy limit 1,000 oo0 description operations locations vehicles atach acord 101 addltlonal remarke schedule spaca le requlred sheftield square llc 5001 5031 montgomery blvd ne albuquerque nm87109= montgomery plaza llc 441 4605 san mateo blvd ne= nm 871093 montogmery plaza two llc 4591 4595 san mateo bivd 40494094uer4uenas 87109 integrated property servies dba goodman realty 100 sun avenue ne suite 100 albuquerque nm complete certificate grogerao certificate holder cancellatiqn described policies cancelled expiration date thereof notice delivered sheffield square accordance witx policy provisions clo goodman realty group 100 sun avenue ne ste 100 authorized representative albuquerque nm 87109 jeff wilson 1988-20 orporation rights reserved_ acord 25 2010/05 acord name logo registered marks aoord inc endorsement changes policy please read carefully additional insured owners lessees contractors automatic status required construction agreement endorsement modifies insurance provided following commercial general liability coverage part paragraph 2 section h 3 ie insured amended include additional insured person organization person organization agreed writing contract agreement guch person organization added additional insured policy person organization additional insured respect liability bodily injury '' `` property damage '' 'personal advertising injury '' caused whole part acts omissions 2 acts omissions acting behalt performance ongoing operations additional insured subject written contract agreement provided `` bodily injury '' `` property damage '' occurs personal advertising injury '' committed subsequent execution contract person 's organization 's status additional insured endorsement ends operations additional insured completed duty defend additional insured endorsement receive writlen nolice claim `` suit '' required provision b condition 2. dutles event occurrence offense claim suit section iv commercial general liability conditions b. respect t0 insurance afforded additional insureds following additional exclusions apply insurance apply 1 'bodily injury '' `` property damage '' arising sole negligence additional insured 2 `` bodily injury '' `` property damage '' occurs prior commencing operations location `` bodily injury '' `` property damage '' occurs 3 `` bodily injury '' `` property damage '' `` personal advertising injury '' arising rendering failure render professional architectural engineering surveying services including preparing approving failing prepare approve maps shop drawings opinions reports surveys field orders change orders drawings specifications p supervisory inspection architectural engineerlng activities `` bodily injury '' `` property damage '' occurring work including materials parts equipment furnished connection work project olher service maintenance repairs performed behalf additional insured location covered operations completed portion `` work '' wich injury damage arises put intended use person organization another contractor subcontractor engaged performing operations principal part project includes copyrighted material insurance services office inc_ pcrmission 22-132 01/08 page of2 5 person r organization specifically designated additional insured ongoing operations separate additional insured -owners lessees contractors endorsement issued us made policy limits insurance applicable additional insured specified written contract written agreement limits insurance stated declarations policy defined section iii limits insurance policy whichever less limits inclusive addition t0 limits insurance available policy respect coverage afforded endorsement section ivv commercial general liability amended follows 1 following added condition 2. duties event occurrence claim sult additional insured endorsement soon practicable give written notice `` occurrence '' offense may result claim `` suit '' insurance us b tender defense indemnity claim `` suit '' insurers also insurance available additional insured agree advise us insurance wich additional insured loss cover coverage part however condition affect whether insurance provided t0 additional insured endorsement primary described condition 4.a amended endorsement 2. condition inaurance amended follows following added paragraph a. prlmary insurance respect insurance wich additional insured designated named insured insurance primary additional insured agreed writing contract agreement insurance primary primary non-contributory obligations affected unless insurance also primary share insurance method described provision 4.0 method ot sharing b following added paragraph b. excees insurance written agreement additional insured require insurance primary primary non-contributory insurance excess insurance additiona insured designated named insured regardless written agreement additional insured insurance excess insurance whether primary excess contingent basis additional insured added additional insured attachment endorsement otherwise includes copyrighted materiel insurance services office inc permission_ 22-132 01/08 page 2 of2 part il 02 98 09 07 endorsement changes policy please read carefully new mexico changes cancellation nonrenewal endorsement modifies insurance provided following capital assets program output policy coverage part commercial general liability coverage part commercial inland marine coverage part commercial property coverage part crime fidelity coverage part employment-related practices liability coverage part equipment breakdown coverage part farm coverage part liquor liability coverage part pollution liability coverage part productsicompleted operations liability coverage part professional liability coverage part paragraph 2 cancellation common policy c cancel subject 2.b condition replaced following mail deliver first named insured 2 permissible reasons notice period written notice cancellation least a. policy effect less 60 1 10 days effective date may cancel reason mailing cancellation reason set forth delivering first named insured written 2.b 1 notice cancellation least 10 days be- 2 30 days effective date fore effective date cancellation cancellation reason set forth b. policy effect 60 days 2.b 2 may cancel one fol- 3 15 days effective date lowing reasons canceliation reason set forth 1 nonpayment premium 2.b 3 2.6 4 2.6 5 2 substantial change written notice state reason cancel- risk assumed us since policy lation except statement may omitted issued notice mailed additional insured lienholder policy 3 policy obtained mate- rial misrepresentation fraudulent state- b. following condition added ments omissions concealment fact nonrenewal material acceptance risk decide renew policy mail hazard assumed us deliver first named insured written notice 4 willful negligent acts omission nonrenewal less 30 days insured substantially increased expiration date policy hazards insured 5 presented claim based fraud material misrepresentation il 02 98 09 07 iso properties inc- 2006 page 1 1 days

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Roses Southwest||Date : 11/27/2012

send result report kyocera mfp taskalla 250ci 07/13/2012 15:14 firmware version 2h7 2f0o 010.007 2010.09.15 2j7_1000 020 003 2h7 1100 002 003 2h7_7000 010 007 job 049437 total time 0 00 37 page 002 complete document doc20120713151329 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.milllkan ins-one com wringao eehlalm-lwlll l narne carol cindy milikan jjndarai inntetnya dtntt kcgettetak gmil -ckh unlversal constructors company pages 2 inc ~uer lelaallracdllalal numiber 344-8646 date 7 13-2012 wmcoll iiunnen elt4 notes acme fencez inc otner ja4rtjuni eanenetitaaat comments date time destination times type result resolution/ecm 001 07/13/12 15.14 3448646 0 00 37 '' fax ok 20ox1o0 norma ion qjh9401981 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.millikan ins-one.com nome carol bton cindy millikan universal constructors company pages 2 inc number 344-8646 07-13-2012 nolcs acme fences inc othe comments thank great weekend cm date acmef- op id cm acord date mmiddiyyyy certificate liability insurance 07/13/12 certificate issued matter information confers rights upon certificate holder_ certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject t0 terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder endorsementls producer 505-888-6333 contact name insurance one inc phone fax 6751 academy rd ne suite 505-888-63340148-9_exth_ ac_nol albuquerque nm 87109 bmail apdress jeff wilson isureris affording cqverage naic insurer sentinel ins co lmtd insured acme fences inc insurer b sentinel ins co lmtd 7001 znd st nw insurer € trumbull ins co albuquerque nm 87107 insurer insurer e wnsurer f cqverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims wer type insurance addltsubr policy number ohsyhn moswm limits jsr lwp general liability occurrence 1,000,000 x commercial general liability b34sbapj3256 03/29/12 03/29/13 presescrocerence 1,000,000 claims-made x occur med exp one person 10,000 personal adv injury 1,000,000 x eplis1o,0oo general aggregate 2,000,000 genl aggregate limt applies per products compiop agg 2,000,000 policy x prs loc automobile liability combined single limit 1,000,000 eaaccident x auto 34uecjj8354 03/29m12 03/29/13 'bodily injury per person owned scheduled bodily injury per accident autos autos non-owned property damage hired autos autos peraccident x umbrella liab x occur occurrence 1,000,000 excess liab claims-made 34sbapj3256 03/29/12 03/29/13 aggregate ded x retention workers compensation x wc statu- oth employers liability iory lmmts er yin proprietoripartneriexecutive 34wecvp4813 03/29/12 03/29/13 el accident 500,000 officerimember excluded nta mandatory nh el disease ea employee 500,0001 describe bgscsesstbe doperations el disease policy imit 500,000| description operations locations vehicles rttach acord 101 additional remarks schedule space required 344-8646 certiicate holder cancellation skould described policies cancelled expiration date thereof notice delivered universal constructors inc accordance witx policy provisions po box 6008 albuquerque nm 87197 autkorized representative mmka~ 1988-2010 ford corporation aii rights reserved acord 25 2010/05 ord name logo registered marks a~ ~rd lieu

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Sun Desert Homes||Date : 9/24/2012

send result report kyocera mfp taskaba 250ci 10/03/2012 07 21 firmware version 2h7 2foo 010.007 2010.09.15 2jz_1000 020 003 2h7 1100.002 003 zh7_7000.010 007 job 053044 total time 0 00 51 '' page 002 complete document doc20121003071642 insurance one inc 505-888-6333 6751 academy road nej_ ste fax 505-888-6334 albuquerque nm 87109 cindy.mllllkan ins-one.com lelad naine facilities ajui management cindy milkkan comuany knowledge learning paqes 2 corporatlon number 877-439-4770 dale 10-02-2012 diorae noles acme fences inc terry f 345-591 eeeutieie 9wd blel comments date time destination times type result resolution/ecm 001 10/03/12 07:16 18774394770 0 00 '51 '' fax ok 20ox100 norma /0n qjh9401981 send result report kyocera mfp taskala 250ci 10/02/2012 13:46 firmware version 2h7_2foo 010 007 2010.09.15 2jz 1000 020 003 2h7_1100 002 003 2h7_7000 010 007 job 053011 tota time 0 00 '46 '' page 002 complete document doc20121002134452 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.milllkan ins-one.com iare facilitiez_managenent trom clndy_mikan_ compary knowledge learning pages 2 hdai cgrperatlon number 877-439-4770 dale 10-02-2012 nules acme fences inc terry f 345-5914 etitei cta hnetea 44 nil mlr lal ai447n hete chtant jrtt 01arp amtiawi comments date time destination times type result resolution/ecm 001 10/02/12 13.45 3455914 0900 46 '' fax ok 20oxloo norma ion qjh9401981 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.millikan ins-one com name facilities_management cindy millikan comnpanv knowledge learning pages 2 corporation_ wumber 877-439-4770 date 10-02-2012 nale acme fences inc terry f 345-5914 comments thank cm jeran acmef-1 op id cm acord date mmiddiyyyy certificate liability insurance 10/02/12 certificate issued matter information confers rights upon tke certificate kolder_ certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insureris authorized representative producer certificate holder_ important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder lieu endorsementls producer phone 505-888-6333 srmact insurance one inc phone fax 6751 academy rd ne suite fax 505-888-6334|78 no_ext ac albuquerque nm 87109 address e-mail jeff wilson wsureris affording coverage naic insurer sentinel ins co lmtd insured acme fences inc insurer b sentinel ins co lmtd 7001 znd st nw insurer c trumbull ins co albuquerque nm 87107 insurer insurer e jnsurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain_ insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims tnsr type insurance addlisubri polcy eff policy exp limits ltr jnsb wd policy number mmddiyyy mmddxyxy general lability occurrence 1,000,000 x commercial general liability k34sbapj3256 03/29/12 03/29/13 preages erecced 1,000,000 ea pccurrence claims-made x occur med exp one person 10,000 personal adv injury 1,000,000 x epli 10,000 general aggregate 2,000,000 genl aggregate limit applies per products compiop agg 2,000,000 policy x prs loc automobile liability combined single limit 1,000,000 eaaccicent x auto 134uecjj8354 03/29/12 03/29/13 bodily injury per person owned scheduled bodily injury per accident autos autos non-owned property damage hired autos autos per accident x umbrella liab x occur occurrence 1,000,000 excess liab claims-made i34sbapj3256 03/29/12 03/29/13 aggregate ded x retention workers compensation x wc statu oth- employers liability tory jmits er yin proprietoripartneriexecutive 34wecvp4813 03/29/12 03129/13 el accident 500,000 officermmember excluded nfa mandatory nh el disease ea employee 500,000 descripe beschecre bdoperations el disease policy limit 500,000 description operations locations vehicles attach acord 101 additional remarks schedule space requlred f 877-439-4770 certificate holder cancellation described policies cancelled expiration date thereof_ notice delivered knowledge learning corporation accordance policy provisions_ attn facilities management department authorized representative 850 ne holladay street ste1400 portland 97228 mmk 1988-2010 acord corporation_ rights reserved acord 25 2010/05 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: TSD||Date : 5/9/2014

acmef-1 op id cm acord date mmiddnyyy certificate liability insurance 01/17/2013 certificate issued matter informaton confers rights upon certificate holder_ certificate affirmatively nega tvely amend extend alter coverage afforded policies below_ certificate insurance consttute contract issuing insurer authorized representative producer certficate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certifcate confer rights certificate holder lieu endorsementls producer phone 505-888-6333 sanact insurance one inc phone fax 6751 academy rd ne suite fax 505-888-6334 aic exth jajc_no albuquerque nm 87109 rdbress jjeff wilson insurer affording coverage naic insurer sentinel ins co lmtd insured acme fences inc insurer b sentinel ins co lmtd 7001 2nd st nw insurer c trumbull ins co albuquerque nm 87107 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown mayhave reduced paid claims insr addl subr poe eff policy exp ltr type qf insurance insr wd policy number mmid mmiddiyyy limits general liability occurrence 000,000 x commercial general liability 34sbapj3256 03/29/2012 03/29/2013 premses erettedenc 000 o00 claims-made occur med exp one person 10,000 personal adv injury 000,000 x epli 10,000 general aggregate 2,000,000 gen l aggregate limit applies per products compiop agg 2,000,00= policy x pe8 automobile liability ombined single limt 000 o00 eaaccident auto i34uecjj8354 03/29/2012 03/29/2013 bodily injury per person owned scheduled bodily injury per accident autos autos non-owned propel damage hired autos autos accident umbrella liab x occur occurrence oo0,0o0 excess liab claims-made 34sbapj3256 03/29/2012 03/29/2013 aggregate ded x retention workers compensation x toe3lmi limts employers liability /n i34wecvp4813 03/29/2012 03/29/2013 el accident 500,000 offieerpriebor eaetnbeexecutive n/ mandatory nh el disease ea employee 500,000 yes_ describe und desc tion perations el disease policy limit 500,000 description operations locations vehicles attach acord 101 additional remarks schedule space required certificate holder cancellation described policies cancelled expiration date thereof notce delivered gardner zemke accordance policy provisions 6821 academy parkway ne albuquerque nm 87109 authorized representative mmkan 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord acmef-1 page 2 notepad insured 's name acme fences inc op id cm date 01/17/13 hgoo01 06-05 general liability hgo001 06-05 general liiability per project aggregate 'primary non-contr ibutory

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: TSD||Date : 7/19/2013

send result report kyocera mfp taskalta 250ci 07/23/2012 13:50 firmware version 2h7 zfoo 010 0072010.09.15 2jz 1000 020 0031 2h7 1100.002.003 2h7_7000 010 007 job 049696 total time 0 00 '51 '' page 002 complete document doc20120723134621 insurance one inc 505-388-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy millikan ins-ane-com nane inzurance_complance_ cindy millikan `` harriee tnan ener elneinonenntt hiae f company hepkerinc_ pages 2 mumber 797-8892 qate 07-23-2012 ktnjelz notes accurata roofing rntt tticto bti4e~lulx fenenelettn l eenenen 4a'_j comments date time destination times type result resolution/ecm 001 07/23/12 13.46 7978892 200 '51 '' fax ok 20oxloo norma /on qjh9401981 fax insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.millikan ins-one.com nare insurance compliance hom cindy_ millikan company hepker inc 2 numbar 797-8892 dale 07-23-2012 note accurate roofing gtha cceerrtta settt comments thank c page accur-1 op id cm acord date mmiddiyyyy certificate liability insurance 07/23/12 certificate issued matter information confers rights upon certificate kolder certificate affirmatively negatively amend extend alter coverage afforded policies tkis certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions 0f policy certain policies may require endorsement statement certificate confer rights certificate holder iieu endorsement producer 505-888-63331sontact name insurance one inc pmone fax 6751 academy rd ne suite 505-888-6334 dh9n10 exth inc _noh albuquerque nm 87109 e-mail larry koester address wnsureris affording cqverage naic insurer new mexico mutual insured accurate roofing insurer b severiano hernandez insurer € 429 el cerro loop albuquerque nm 87031 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims insr addltsueri policyeff policy exp ltr type insurance jnsr wnd policy number mmddiyyyx mmddxyxy limits general liability occurrence damage orented commercial general liability eremises ea occurrence claims-made occur med exp one person personal adv injury general aggregate genl aggregate limit applies per products compiop agg pro- policy ject loc automobile liability combined sincle limit ea accident auto bodily injury per person attov owned schsbuled bodily injury per accident non-owned property damage hired autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation x wc statu- oth- employers liability tory limts er yin proprietoripartneriexecutive 44742107ar 08/30/11 08/30/12 el accident 100,000 officermmember excluded n /a mandatory nh el disease ea employee 100,000 yes describe descriftion operations el disease policy limit 500,000 description operations locations vehicles attach acord 101 additional remarks schedule space required f 797-8892 certificate holder cancellation described policies cancelled expiration date thereof notice delivered hepker inc accordance policy provisions_ 6809 cherry blossom ln ne albuquerque nm 87111 authorized representative mmkan 1988-2010 acord corporation rights reserved acord 25 2010/05 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: JCH Design Build||Date : 11/12/2013

send result report kyocera mfp taskala 250ci 11/27/2012 11.33 firmware version zh7 2foo 013.006 2012.01 06 2jz 1000 020 003 2h7_1100 002.003 2h7 7000 013 006 job 055111 total time= 0900 '38 '' page 002 complete document doc20121127112836 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy millikan ins-one com leitie name kenneth rearlck cindy millkan 3e teinr jeee enteeedteeee utar company roses southwest pages 2 mutcribi jn1 el mlern '' jci nurnber 242-0342 date 11-27- 2012 ietite iliiimietitct elgzuiu wanacetl notes acme fencas inc ntnmttttm ttttt ltt tto fttimtittaneteitttttttttt titim mttnmlle 9ela naner hn enar fnefeeteericlittirata li44n wij 'rfenghittif4itt comments date time destination times type result resolution/ecm 001 11/27/12 11.29 2420342 0 00 38 '' fax ok 20ox100 norma /on qjh9401981 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.millikan ins-one.com name kenneth rearick rom cindy_millikan company roses southwest pages 2 numher 242-0342 date 11-27-2012 noles acme fences inc oler comments= thank op acmef:1 op id cm acord date mmiddiyyyy certificate liability insurance 11/27/12 certificate issued matter information confers rigkts upon certificate holder_ tkis certificate affirmatively negatively amend extend alter coverage afforded tke policies tkis certificate insurance constitute contract issuing insurer authorized representative producer certificate holder_ important certificate holder n additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder lieu endorsementls producer phone 505-888-6333 sqmact insurance one inc phone fax 6751 academy rd ne suite fax 505-888-6334 jac noext iaic_noli albuguerque nm 87109 address jeff wilson wsureris affording cqverage naic jnsurera sentinel ins co lmtd insured acme fences inc insurer b sentinel ins co lmtd 7001 znd st nw insurer € trumbull ins co albuquerque nm 87107 nsurer insurer e wsurer f coverages certificate number revision number certify tke policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown may reduced paid claims_ insr addcisueri policy eff policy exp lir type nsurance jnsr mr policy number mmddnyxy mmddiyyyy limits general liability occurrence 1,000,000 x commercial general liability 34sbapj3256 03/29/12 03/29/13 preases rectetence 1,000,000 claims-made x occur med exp one person 10,000 personal adv injury 1,000,000 x epli s10,000 general aggregate 2,000,000 gen l aggregate limit applies per products compiop agg 2,000,000 policy x pbs loc automobile liability combined singtetmmit 1,000,000 ea accideni x auto 134uecjj8354 03129/12 03/29/13 bodily injury per person autos owned sgfsbuled bodily injury per accident non-owned property damage hired autos autos per accident x umbrella liab x occur occurrence 1,000,000 excess liab claims-made 34sbap j3256 03/29/12 03/29/13 aggregate ded x retention workers compensation x ioestms oth employers liability limts er yin proprietoripartneriexecutive 34wecvp4813 03/29/12 03/29/13 el accident 500,000 officerimember excluded nia mandatory nh el disease ea employee 500,000 yes describe description qf operations el disease policy limit 500,000 description operations locations vehicles attach acord 101 additional remarks scheduie space required 24242-0342 certificateholder cancellation described policies cancelled tke expiration date thereof notice delivered roses southwest accordance wth policy provisions 1701 znd st sw albuquerque nm 87102 authorized representative mmikn 1988-2010 acord corporation rights reserved_ acord 25 2010/05 acord name logo registered marks acord rx date/time 11/2712012 09 51 505 345 5914 p.0o1 11/27/2012 10:35 505-345-5914 acme fences page 01 faxy 058 86334 pvv4ivur 0iszo/zo 1 14,10nsarce one certiiicate insurance request irasurarce ote 6751 academy rd ne sulte albuquerque nm 87109 please fax requests insurance one 505-888-6334 data/time jl2z-jv2 8 22 v.n ingured le cartlicate holder rese s_ rlll j22l zusl w ~llst alm- 82lo2 attn kekngh reeesk fax 241-0342 emnait kares lik feses_ im en certlficate following coverage generaf llability catir chletnnn property automoblle liabilitv builder risklinstallatlon floater excess llablllty auto piysical darage workers comp comp coll contractors equlpment speclfled perlls_ leasedfrented equlpment llt ntttt descriptlan 0f operations remarks speclfic verbage regulred ltll leduaa l martgagee loss payee addilional insured damlazf 7 waiver subrogatian enle ttnc wesl

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Ethicon Endo Surgery||Date : 7/13/2012

send result report kyocera mfp taskalla 250ci 09/24/2012 15:15 firmware version 2h72foo 010.007 2010.09.15 2jz_1000 020 003 2h7_1100 002.003 2h7_7000 010 007 job 052501 total time 0 00 '43 '' page 002 complete document doc20120924151330 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy milllkanmins-one.com name steve cindy milllkan copany sundesert hones pages 2 mmlaahahae wamnanannnaglhza tit wfti numher 867-8459 date 0g-24-2012 notes accurate roofing 'etntcth ctemertantttiettste ceatal yjmieaitemaiealwaihoga cuchtt unltlla lltlkz ty comments good afternoon requested certlilcate wiii follow think date time destination times type result resolution/ecm 001 09/24/12 15.15 15058678459 00 43 '' fax ok 200xloo norma /on1 qjh9401981 culyc ax insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy.millikan ins-one.com name steve rom cindy millikan coipany sun desert homes pages 2 number 867-8459 date 09-24-2012 nates work art plastering othel comments thank cm worko-1 op id cm acord date mmiddiyyyy certificate liability insurance 09/24112 tkis certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded tke policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder_ mportant certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder iieu endorsement producer phone 505-888-6333 grnect insurance one inc phone fax 6751 academy rd ne suite fax 505-888-6334ph9n2_exth ac albuquerque nm 87109 robhess chris koester isurerisiaffording coverage naic wnsurer hartford insured work 0f art plastering insurer b arturo cadena jr insurer c 10455 cross cut nw albuquerque nm 87114 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract otker document respect tkis certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims insr type insurance addcisubr polcy ef policy exp limits ltr jsblnd policy number mmddiyyyy mmddiyyyy general liability occurrence 1,000,000 x commercial general liability i34sbapk7838 10/01/12 10/01/13 bregetretuencel 50,000 claims-made x occur med exp one person 5,000 personal adv injury 1,000,000 general aggregate 2,000,000 genl aggregate limit applies per products compiop agg 2,000,000 policy x pes loc automobile liability combined single limit eaaccident_ auto bodily injury per person autos owned sgtgbuled bodily injury per accidenf non-owned proferty damage hired autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retentiqn workers compensation x wc statu oth- employers liability iorylmmis er yin proprietoripartnereexecutive 34wecbh7890 10/01/12 10/01/13 el accident 100 oo0/ officerimember excluded nia mandatory nh el disease ea employee 100,000 yes describe description qf operations el disease policy limit 500,000 description operations locations vekicles attach acord 101 additional remarks schedule space required 867-8459 certiicateholder cancellation described policies cancelled expiration date tkereof notice delivered sun desert homes accordance wtx policy provisions po box 978 placitas nm 87043 autkoried representative mmkar 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord nok

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Pinon Mechanical Services ||Date : 9/10/2013

bajae-1 op id cm acord date mmiddnyyy certificate liability insurance 07i1 1/12 certificate issued matter informaton confers rights upon certificate holder_ certificate affirmatively nega tvely amend extend alter coverage afforded policies below_ certificate insurance consttute contract issuing insurer authorized representative producer certficate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certifcate confer rights certificate holder lieu endorsementls producer 505-888-6333 sanact insurance one inc phone fax 6751 academy rd ne suite 505-888-63341 aic exth jajc_no albuquerque nm 87109 rdbress chris koester insurer affording coverage naic insurer allied insurance insured baja elite llc insurer b texas mutual insurance co 1634 doe lane insurer c odessa tx 79762 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown mayhave reduced paid claims insr addl subr poe eff policy exp ltr type qf insurance insr wd policy number mmid mmiddiyyy limits general liability ccurrence 000 o00 x commercial general liability acp7215019865 05/25/12 05/25/13 premses erettedenc 100,0o01 claims-made occur med exp one person 5,000 personal adv injury 000,000 general aggregate 2,000,000 gen l aggregate limit applies per products compiop agg 2,000,00= policy x pex automobile liability ombined single limt 0oo,0o0 eaaccident auto acp7215019865 05/25/12 05/25/13 bodily injury per person owned scheduled bodily injury per accident autos autos non-owned propel damage hired autos autos accider umbrella liab occur occurrence oo0,0o0 excess liab claims-made acp7215019865 05/25/12 05/25/13 aggregate 0oo,000 ded x retention workers compensation x toe3lmi limts employers liability /n b x sbpoo01226266 07/09/12 07/09/13 el accident 1,000,000 offieerpriebor eaetnbeexecutive n/a mandatory nh el disease ea employee 1,000,000 yes_ describe und description perations el disease policy limit 1,000,000 description operations locations vehicles attach acord 101 additional remarks schedule space required compass llc compass oil gas lp additional insureds general 'pabatieg auto liability waiver subrogation workers compensation favor certificate holders extent terms land provisions policy certificate holder cancellation described policies cancelled expiration date thereof notce delivered compass operating llc accordance policy provisions compass oil gas lp po box 1389 authorized representative midland tx 79702 mmkan 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord ing

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Ronco Investments||Date : 6/7/2013

mikeg-1 op id cm acord date mmiddnyyy certificate liability insurance 05/0912014 certificate issued matter informaton confers rights upon certificate holder_ certificate affirmatively nega tvely amend extend alter coverage afforded policies below_ certificate insurance consttute contract issuing insurer authorized representative producer certficate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certifcate confer rights certificate holder lieu endorsementls producer contact name insurance one inc phone fax 6751 academy rd ne suite aic exth jajc_no albuquerque nm 87109 rdbress jjeff wilson insurer affording coverage naic insurer berkley regional specialty insured mike griego insurer b 4205 san mateo blvd ne insurer c albuquerque nm 87110 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown mayhave reduced paid claims insr addl subr pol eff policy exp ltr type qf insurance insr mnd policy number mmidi mmiddiyyy limits general liability occurrence 000 o00 commercial general liability glo7152013 07/15/2013 07/15/2014 premses erettedenc 50,000 claims-made occur med exp one person 5,000 personal adv injury 000,000 general aggregate 2,000,000 gen l aggregate limit applies per products compiop agg 2,000,000 policy x pex automobile liability ombined single limt eaaccident auto bodily injury per person owned scheduled bodily injury per accident autos autos non-owned propel amage hired autos autos umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation wc statu employers liability ory limts /n el accident offieerpriebor eaetnbeexecutive n/ mandatory nh el disease ea employee yes_ describe und description perations el disease policy limit description operations locations vehicles attach acord 101_ additional remarks schedule space required f 277-8975 locations 4205 san mateo blvd ne albuquerque nm 87110 925 east main st farmington_ nm 87401 tsd additional insured general liability 30-day cancel notice 10-day nonpay extent al1 terms provisions policy certificate holder cancellation described policies cancelled expiration date thereof notce delivered tsd accordance policy provisions po box 1149 santa fe nm 87504 authorized representative mjkm~ 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: US Bank ||Date : 8/1/2016

send result report kyocera mfp taskalfa 250ci 07/19/2013 15.20 firmware version 2h7 2foo 013.006 2012 01.06 zjz_100o 020 003_ 2h7_ 1100 002 003 2h7_7000 013 006 job 064366 total time 0 01'01 '' 002 complete document doc20130719151913 insurance inc 605-888-6333 6751 academy road ne ste fax 505-838-6334 albuquerque nm 87109 .millikan ins-one.com tett lj ataac mame brian ftom cir millikan 428 je snen enen lorntrwliehiviniilinicujvitingngyibuaitwimitiocei teaett eate tagumu coipony installernet pages 2 jiu ui eee aane nunber 978-645-6599 date 07-19-2013 han lri l notes mike griego leaell wudil 514i iltefe camments date time destination times type result resolution/ecm 001 07/19/13 15.19 19786456599 '01 01 fax ok 20oxloo norma ion 0jh9401981 page one cindy- indy fax insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 iibuquerque nm 87109 cindy millikan ins-one.com nane brian fran cindy millikan compan installernet peges 2 number 978-645-6599 dete 07-19-2013 noies mike griego oiner comments thank um 4 making big push year expand company assist insurance issues eet referrals associates please let know_ mikec-1 opid cm acord date mmiddiyyy certificate liability insurance 07/19/2013 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies tkis certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject t0 terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder lieu endorsement producer phone 505-888-633j1nanect insurance one inc phone fax 6751 academy rd ne suite fax 505-888-63341 incnno_extl ac_nohi albuguerque nm 87109 emaic address jeff wilson insureris affording cqverage naic insurera berkley regional specialty insured mike griego insurer b 4205 san mateo blvd ne insurer € albuquerque nm 87110 insurer insurere wsurere cqverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown may reduced paid claims_ inrr addlisuer polcyeff policy exp lir type insurance jselwd policy number mmddiyyxy mmddxyxy limits general liability occurrence 1,000,000 x commercial general liability gl07152013 07/15/2013 07/15/2014 prmmses serocced 50,000 occurrence claims-made x occur med exp one person 5,000 personal adv injury 1,000,000 general aggregate 2,000,000 gen l aggregate limit applies per products compiop agg 2,000,000 policy x per__ loc automobile liability combined single limit eq aocidcnt auto bodily injury per persan owned scheduled autos autos bodily injury per accident non-owned property damage kired autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation wc statu oth- employers liability iqrylms_ er yin proprietorppartneriexecutive el accident officerimember excluded nta mandatory nh el disease ea employee describe bysckeecrbe adoperations belew el disease policy limit description operations locations vehicles attach acord 101 addltional remarks schedule space required 978-645-6599 certhicateholder ancellation tke described policies cancelled expiration date thereof notice delivered tsd accordance wtx policy provisions_ po box 1149 santa nm 87504 authorized representative mmkar 1988-2010 acord corporation rights reserved acord 25 2010/05 acord name logo registered marks acord fe

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Verus Research||Date : 9/11/2017

send result report kyocera mfp taskalta 250ci 11/12/2013 09 02 firmware version 2h7_2foo .013 006 2012.01.06 2jz_1000 020 003 2h7_1100.002.003 2h7_7000,013.006 job 068921 tota time 0 00 23 002 complete document doc20131112090140 insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 albuquerque nm 87109 cindy millikan ins-ane.cam nme ciarlasa fromn cindy millikan aerchao ini alaahmhahlahaadia aaaaamtat hchiaie company jch design build _inc pagzs jauciamhir nurnber 890-5012 date 14-12-2013 notcs acme fences inc jnn wlt comments date time destination times type result resolution/ecm 001 11/12/13 09:02 8905012 0 00 '23 '' fax ok 20oxl00 norma /on qjh9401981 page l insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 ibuquerque nm 87109 cindy millikan ins-one.com none clarissa scoh cindy_millikan company jch design build inc. poges 2 murber 890-5012 dhte 11-12-2013 netes acme fences inc. oiner comments om grateful thanksgiving making big push year expand company assist insurance issues get referrals associates please let know acmef-1 op id cm acord date mmiddiyyyy certificate liability insurance 11/12/2013 certificate issued matter information confers richts upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms nd conditions tne policy certain poiicies may require endorsement statement certificate confer rights certificate holder lieu endorsement producer contact name insurance one inc phone fax 6751 academy rd ne suite incnoexth aic nol albuquerque nm 87109 e-mail address jeff wilson insurerisl affording cqverage naic insurer hartford insured acme fences inc 303573 insurer union standard 7001 znd st nw insurer c albuquerque nm 87107 insurer insurer e insurer f cqverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions suck policies limits shown may reduced paid claims insr addlisuer folic policy lr type insurance jnsr wd policy number mbbxhtnbni limits general liability occurrence 1,000,000 x commercial general liability cpa4625519-10 03/29/2013 03/29/2014 premges rtee 100,000 eaoccurtence claims-made x occur med exp one person 6,00 personal adv injury 1,000,00 general aggregate 2,000,000 gent aggregate limit applies per products compiop agg 2,000,00 pro- policy jecl loc automobile liability combined single limit 1,000,000 eeeocidenf x auto caa4625522-10 03/29/2013 03/29/2014 bodily injury per person owned scheduled autos autos bodily injury per accident non-owned property damage hired autos autos per accidentl umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation x wc statu- oth employers liability tqry imts er yin proprietoripartneriexecutive 34wecvp4813 03/29/2013 03/29/2014 el accident 500,000 officermmember excluded n mandatory nh el disease ea employee 500,000 describe bkssresgrbe moperations el disease policy limit 500,000 description qperations locations vehicles attach acord 101 additlonal remarks schedufe space required f 890-5012 certiicateholder gancellation described policies cancelled expiration date thereof notice delivered jch design build inc. accordance policy provisions po box 66297 albuquerque nm 87193 authorized representative mmikr 1988-2010 acord corporation rights reserved_ acord 25 2010/05 acord name logo registered marks acord rx dateftime 11/08/2013 09.02 505 345 5914 p.oo1 11/08/2013 09:41 505-345-5914 acme fences page 01 fjx4m052 9344 wusquvr 04,2m4231 adomeu ke certliicate insurance request insurance one 6751 academy rcl ne sulte albuquerquc nm 87109 please fax requests insurance one 505-888-6334 date/time l_ -43_ kee ih insured acne celc s_ tlc certiflcate halder ishdeaiau buld_zuo kana bo bez lka9z ml_lb_izi aten clalssa far 605 880-5e14 ernail certlficate forthe follawing coverage genera liability property automoblle llability builder rlskjinstallation floates excess lia auta physical damage workers comp coll cantractors equlpment speclfied perils_ ~er894 leased/rented equipment lnlsiitittoztot other_ '2rr= escrlptlon f operations remarks specific verbare required martpa3ed loss payee addlelonal insured waiver uf subrogatlon blllty comp

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 1/27/2020

acmef-1 op id cm acord date mmiddnyyy certificate liability insurance 07113/12 certificate issued matter informaton confers rights upon certificate holder_ certificate affirmatively nega tvely amend extend alter coverage afforded policies below_ certificate insurance consttute contract issuing insurer authorized representative producer certficate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certifcate confer rights certificate holder lieu endorsementls producer 505-888-6333 sanact insurance one inc phone fax 6751 academy rd ne suite 505-888-63341 aic exth jajc_no albuquerque nm 87109 rdbress jjeff wilson insurer affording coverage naic insurer sentinel ins co lmtd insured acme fences inc insurer b sentinel ins co lmtd 7001 2nd st nw insurer c trumbull ins co albuquerque nm 87107 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown mayhave reduced paid claims insr addl subr poe eff policy exp ltr type qf insurance insr wd policy number mmid mmiddiyyy limits general liability ccurrence 000,000 x commercial general liability 34sbapj3256 03/29/12 03/29/13 premses erettedenc 000 o00 claims-made occur med exp one person 10,000 personal adv injury 000,000 x epli 10,000 general aggregate 2,000,000 gen l aggregate limit applies per products compiop agg 2,000,00= policy x pe8 automobile liability ombined single limt 000 o00 eaaccident auto i34uecjj8354 03/29/12 03/29/13 bodily injury per person owned scheduled bodily injury per accident autos autos non-owned propel damage hired autos autos accider umbrella liab x occur occurrence oo0,0o0 excess liab claims-made 34sbapj3256 03/29/12 03/29/13 aggregate ded x retention workers compensation x toe3lmi limts employers liability /n i34wecvp4813 03/29/12 03/29/13 el accident 500,000 offieerpriebor eaetnbeexecutive n/ mandatory nh el disease ea employee 500,000 yes_ describe und desc tion perations el disease policy limit 500,000 description operations locations vehicles attach acord 101 additional remarks schedule space required certificate holder cancellation described policies cancelled expiration date thereof notce delivered ethicon endo surgery accordance policy provisions 3801 university se uerque nm 87106 authorized representative mmkan 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord albuqe acmef-1 page 2 notepad insured 's name acme fences inc op id cm date 07/13/12 pprovisions policy_

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 1/19/2017

send result report kyocera mfp taskala 250ci 09/10/2013 09:34 firmware version 2h7_2foo.013.006 2012.01 06 zjz_1000 020 003 2h7_1100 002 003 2h7_7000 013 006 job 066371 total time 0 00 '46 '' 002 complete document doc20130910093250 insurance one inc 505-888-6333 6751 academy road ne ste fax 605-888-6334 ibuquerque nm 87109 cindy millikan ins-one com nanl ingurance_complance fron cindx_millikan_ eattgaeenanoee pinon mechanical services_ campany pages '' inc tjelaiatelil 04jijen4 feear teaeta juhibe 344-8531 dcte 09-10-2013 notes acme_tences heneter nnaidha- aazi mia comments no_ date time destination times type result resolution/ecm 001 09/10/13 09.33 3448531 0 00 '46 '' fax ok 20ox1o0 norma ion qjh9401981 page insurance one inc 505-888-6333 6751 academy road ne ste fax 505-888-6334 ilbuquerque nm 87109 cindy millikan ins-one.com name insurance compliance cindy millikan pinon mechanical services company 2 inc number 344-8531 pe € 09-10-2013 notes acme fences omner comments making big push year expand company assist insurance issues get referrals associates please let know_ pages acmef 1 opid cm acord date mmiddnyyy certificate liability insurance 09/10/2013 tkis certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract tke issuing insurer authorized representative producer certificate holder important ifthe certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement 4 statement certificate confer rights certificate holder lieu endorsementls producer phone 505-888-6333 tontact name insurance one inc phone 6751 academy rd ne suite fax 505-888-6334 jnc_no_extb cne albuguerque nm 87109 emal address jeff wilson insurer affording coverage naic insurer hartford insured acme fences inc 303573 insurer b union standard 7001 znd st nw insurer c albuquerque nm 87107 wsurer insurer e wnsurer f cqverages certificate number revision number certify policies insurance listed issued insured named tke policy period indicated notwithstanding requirement term condition contract document respect tkis certificate may issued may pertain tke insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims_ tr type insurance eeeubrl policy number ohswht eobswx limits general liability occurrence 1,000,000 x commercial general liability icpa4625519-10 03/29/2013 03/29/2014 damage orented 100,000 premses ea occurrence claims-made x occur med exp one person 5,000 personal adv injury 1,000,000 general aggregate 2,000,000 genl acgregate limit applies per products compiop agg 2,000,000 policy pes loc automobile liability combined single limi 1,000,000 eaaccident auto caa4625522-10 03/29/2013 03/29/2014 bodily injury per person owned scheduled bodily injury per accident autos autos non-owned property damage hired autos autos per_accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation x wc statu ot- employers liability iqry lmmis er yin proprietorpartneriexecutive 34wecvp4813 03/29/2013 03/29/2014 e.l. eack accident 500,000 officerimember excluded nia mandatory e.l disease ea employee 500,000 describe bxecdeecresdcperations el disease policy limit 500,000 description operations locations vehicles attach acorp 101 additional remarks schedule space required 24344-8531 certificate holder cancellation described policies cancelled expiration date tkereof notice delivered pinon mechanical services inc accordance wth policy provisions po box 25847 albuquerque nm 87125 autkorized representative mdkr 1988-2010 acord corporation rights reserved_ acord 25 2010/05 acord name logo registered marks acord eff jnd nh

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 5/15/2017

aceen-1 op id cm acord date mmiddnyyy certificate liability insurance 06/0712013 certificate issued matter informaton confers rights upon certificate holder_ certificate affirmatively nega tvely amend extend alter coverage afforded policies below_ certificate insurance consttute contract issuing insurer authorized representative producer certficate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certifcate confer rights certificate holder lieu endorsementls producer phone 505-888-6333 sanact insurance one inc phone fax 6751 academy rd ne suite fax 505-888-6334 aic exth jajc_no albuquerque nm 87109 rdbress chris koester insurer affording coverage naic insurer union standard ins group 43435 insured ace enterprises insurer b po box 50513 insurer c albuquerque nm 87181 insurer insurer e insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies_ limits shown mayhave reduced paid claims insr addl subr poe eff policy exp ltr type qf insurance insr wd policy number mmidi mmiddiyyy limits general liability occurrence 000 o00 x commercial general liability cla 4636189-10 05/17/2013 05/17/2014 premses erettedenc 100,0o01 claims-made occur med exp one person 5,000 personal adv injury 000,000 general aggregate 2,000,000 gen l aggregate limit applies per products compiop agg 2,000,000 policy automobile liability ombined single limt eaaccident auto bodily injury per person owned scheduled bodily injury per accident autos autos non-owned proper damage hired autos autos accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation x wc statu employers liability qry limis /n wca 4636197-10 05/17/2013 05/17/2014 el accident 500,000 offieerpriebor eaetnbeexecutive n/ mandatory nh el disease ea employee 500,000 yes_ describe und description perations el disease policy limit 500,000 description operations locations vehicles attach acord 101 additional remarks schedule space required certificate holder cancellation described policies cancelled expiration date thereof notce delivered ronco investments inc_ accordance policy provisions 8950 w. olympic blvd ste 372 beverly hills 9021 1-3565 authorized representative mmkan 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord ca

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 11/2/2018

bajae-1 op id cm acord date mmiddiyyyy certificate liability insurance 06/24/2013 txis certificate issued matter information confers rights upon tke certificate holder certificate dqes affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract tke issuing insurer autkorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder iieu endorsementfs producer phone 505-888-6333tfrmect insurance one inc phone 6751 academy rd ne suite fax 505-888-6334l48 exl te albuquerque nm 87109 rdhess chris koester insurerisaffording cqverace naic insurer century surety company insured baja elite llc insurer 8 arch insurance company 1634 doe lane insurer € odessa tx 79762 insurer hnsurer e wnsurer f coverages certificate number revision number tkis certify policies insurance listed issued tq insured named policy period indicated_ notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims imsr addltsubr policy eff policyezf lir type insurance wnsb wva policy number jmmddiyyy mmmddniyyl_ limits general liability occurrence 1,000,000 x commercial general liability x x iccp-823796 06/13/2013 06/13/2014 damage torented 000 premses ea occurrence claims-made x occur med exp one person 5,000 personal adv injury 1,000,000 x pollution 100k general aggregate 2,000,000 genl aggregate limit applies per products compicp agg 2,000,000 policy x ps loc automobile liability zomeined single limt 1,000,000 eaaccident auto ibap06212013 06/21/2013 06/21/2013 bodily injury per person x owned scheduled bodily injury per accident autos autos non-owned property damage x hired autos autos per accident x umbrella liab x occur occurrence 5,000,000 excess liab claims-made x lccp-823797 06/13/2013 06/13/2014 aggregate 5,000,000 ded x retention 259 workers compensation wc statu oia- employers liability tory jmits er yin proprietoripartneriexecutive el accident officermmember excluded nia mandalory nh el disease ea employeef describe degchegibe doperations el disease policy limit description operations locations vericles attach acord additional remarks schedule space ig required f 817-877-1906 cog operating llc 18 additional insured general liability waiver subrogation general liability extent terns provisions policy certificate holder cancellation qf described policies cancelled expiration date thereof notice delivered cog operating llc accordance policy provisions clo ica box 2566 authorized representative fort worth tx 76113 mdka 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord noj 50 101 po fnsurance ssrtafisateors supplement acord 25 date 06-24-2013 insured baja elite llc certificate holder cog operating llc 1634 doe lane po box 2566 odessa tx 79762 fort worth tx 76113 commercial general lliabily yes additional insured endorsement policy wording extends coverage additional insured iimit coverage provided additional insured bodily injury property damage least caused whole part named insured ja acting behalf 5 jb bodily injury property damage caused sole negligence additional insured 5 2 policy primary relates additional insured 5 3 policy non-contributory relates additional insured 5 contractual liability coverage definition limit coverage provided bodily injury property damage least caused whole part named insured acting behalf 5 5 policy cover 'in rem '' 5 6 policy cover non-owned watercraft 262 5 policy cover sudden accidental pollution provide sublimit _if 7a sublimit 100000 any_claims pending paid could reduce aggregate much 8a amount arethe following excluded imited law 9 independent contractors 5 1 blowout/cratering 5 11 explosion x 5 12 collapse c 5 13 underground u 5 14 punitive damages 5 15 third party actions workerscompensation_donot write workers_compensation yes states endorsement 2 alternate employer outer continental shelf lands act ocsla united states longshore harborworkers compensation act usleh excessumbrella liabilities please_mark policy scheduled primary the_excesstumbrella commercial general liability insurance automobile liability insurance employers liability insurance protection indemnity insurance pollution liability insurance ifprovided separate policy yesl policy provide coverage follows form terms nd conditions certified primary commercial general liability subject annual aggregate excess drop act primary aggregate impaired agreed coverages endorsements conditions shown pages effect fsignature lpply indicated coverages certified attached acord certificate insurance_ form neither affirmatively negatively amends extends alters coverage afforded policy summarized hereon qualified reference policy form konstitute contract issuing insurer authorized representatives producer certificote holder a25 016 01-12

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 3/26/2019

bajae-1 op id cm acord date mmiddiyyyy certificate liability insurance 06/24/2013 txis certificate issued matter information confers rights upon tke certificate holder certificate dqes affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract tke issuing insurer autkorized representative producer certificate holder important certificate holder additional insured policy ies must endorsed subrogation waived subject terms conditions policy certain policies may require endorsement statement certificate confer rights certificate holder iieu endorsementfs producer phone 505-888-6333tfrmect insurance one inc phone 6751 academy rd ne suite fax 505-888-6334l48 exl te albuquerque nm 87109 rdhess chris koester insurerisaffording cqverace naic insurer century surety company insured baja elite llc insurer 8 arch insurance company 1634 doe lane insurer € odessa tx 79762 insurer hnsurer e wnsurer f coverages certificate number revision number tkis certify policies insurance listed issued tq insured named policy period indicated_ notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims imsr addltsubr policy eff policyezf lir type insurance wnsb wva policy number jmmddiyyy mmmddniyyl_ limits general liability occurrence 1,000,000 x commercial general liability x x iccp-823796 06/13/2013 06/13/2014 damage torented 000 premses ea occurrence claims-made x occur med exp one person 5,000 personal adv injury 1,000,000 x pollution 100k general aggregate 2,000,000 genl aggregate limit applies per products compicp agg 2,000,000 policy x ps loc automobile liability zomeined single limt 1,000,000 eaaccident auto ibap06212013 06/21/2013 06/21/2013 bodily injury per person x owned scheduled bodily injury per accident autos autos non-owned property damage x hired autos autos per accident x umbrella liab x occur occurrence 5,000,000 excess liab claims-made x lccp-823797 06/13/2013 06/13/2014 aggregate 5,000,000 ded x retention 259 workers compensation wc statu oia- employers liability tory jmits er yin proprietoripartneriexecutive el accident officermmember excluded nia mandalory nh el disease ea employeef describe degchegibe doperations el disease policy limit description operations locations vericles attach acord additional remarks schedule space ig required f 817-877-1906 cog operating llc 18 additional insured general liability waiver subrogation general liability extent terns provisions policy certificate holder cancellation qf described policies cancelled expiration date thereof notice delivered cog operating llc accordance policy provisions clo ica box 2566 authorized representative fort worth tx 76113 mdka 1988-2010 acord corporation ail rights reserved acord 25 2010/05 acord name logo registered marks acord noj 50 101 po fnsurance ssrtafisateors supplement acord 25 date 06-24-2013 insured baja elite llc certificate holder cog operating llc 1634 doe lane po box 2566 odessa tx 79762 fort worth tx 76113 commercial general lliabily yes additional insured endorsement policy wording extends coverage additional insured iimit coverage provided additional insured bodily injury property damage least caused whole part named insured ja acting behalf 5 jb bodily injury property damage caused sole negligence additional insured 5 2 policy primary relates additional insured 5 3 policy non-contributory relates additional insured 5 contractual liability coverage definition limit coverage provided bodily injury property damage least caused whole part named insured acting behalf 5 5 policy cover 'in rem '' 5 6 policy cover non-owned watercraft 262 5 policy cover sudden accidental pollution provide sublimit _if 7a sublimit 100000 any_claims pending paid could reduce aggregate much 8a amount arethe following excluded imited law 9 independent contractors 5 1 blowout/cratering 5 11 explosion x 5 12 collapse c 5 13 underground u 5 14 punitive damages 5 15 third party actions workerscompensation_donot write workers_compensation yes states endorsement 2 alternate employer outer continental shelf lands act ocsla united states longshore harborworkers compensation act usleh excessumbrella liabilities please_mark policy scheduled primary the_excesstumbrella commercial general liability insurance automobile liability insurance employers liability insurance protection indemnity insurance pollution liability insurance ifprovided separate policy yesl policy provide coverage follows form terms nd conditions certified primary commercial general liability subject annual aggregate excess drop act primary aggregate impaired agreed coverages endorsements conditions shown pages effect fsignature lpply indicated coverages certified attached acord certificate insurance_ form neither affirmatively negatively amends extends alters coverage afforded policy summarized hereon qualified reference policy form konstitute contract issuing insurer authorized representatives producer certificote holder a25 016 01-12

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Matson Integrated Logistics||Date : 9/23/2007

op id dc acord date mmiddiyyy certificate property insurance 08/01/2016 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded .the policies certificate insurance constitute contract issuing insurer authorized representative producer tke certificate holder certificate prepared party insurable interest property_ use form use acord 27 acord 28 producer sonect dana casex insurance one inc etwc exd 505-888-6333 ic _no 505-888-6334 6751 academy rd ne suite emaic albuquerque nm 87109 zodress dana casey ins-one com chris koester producer abuel-1 cusiomer insurerii affording coverage naic insured abuelitas new mexican kitchen insurer union standard ins group 31325 2 llc insurer 8 kathy martinez insurer c 6083 isleta blvd sw insvrerd albuquerque nm 87105 insurer € insurer e coverages certificate number revision number location premises zresabuqu property attach acord 101 additlonal remarke scheduie gpace raquired 6083 isleta blvd_ albuquerque nm'87105 tkis certify policies insurance listed issued tke insured named policy period 'indicated_ notwithstanding requrrement term condition contract document respect certificate may issued may pertain_ insurance afforded policies described herein subject terms exclusions conditions policies limits shown may reduced paid claims insr policy effective policy expiration ltr type insurance policy number date mmiddiyyy date covered property limits mmiddiyyyy x property cpa4709951-10 01/19/2016 01/19/2017 x building 655,000 causes loss deductibles x personal property 165,000 basic building x business income als 1,000 broad x extra expense contents special 1,000 rental value earthquake blanket building wind blanket pers prop flooo blanket bldg pp x stgns 25,000 inland miarine type policy causes loss named perils policy number crime type policy boiler machinery equipment breakdown special conditions coverages attach acord 101 acditlonal remarke schadule space ts requlred replacement cost building business personal property us bank 1st mortgagee lenders loss payable loan 71-6517560513. certificate hqlder cancellation described policies cancelled expiration date thereof notice delivered u bank n accordance policy provisions isaoa 9918 hibert st 2nd floor authorved representa tive san diego ca 92131-1018 chris koester 1995-2089 acord corporation rights reserved acord 24 2009/09 acord name iogo registered marks acord oux

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 11/26/2007

date mmiddiyyyy acord certificate liability insurance 9/11/2017 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important ifithe certificate holder additional insured policy ies must additional insured provisions endorsed subrogation waived subject terms conditions policy certain policies may require endorsement_ statement certificate confer rights certificate holder lieu endorsement producer contact estep name vip insurance services llc pnono ext 505-888-6333 aic 505-369-0925 dial 9221 e via de ventura address joy vipinsuranceservices.com insurer affording coverage naic scottsdale az 85258 insurer hartford cas ins co 29424 insured insurer b hartford ins co midwest 37478 asr corporation insurer c 5901j wyoming blvd ne 317 insurer insurer e albuquerque nm 87109 insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims_ inbsr addlisubr pol eff polic exp ltr type insurance insd wvd policy number mmiddiyyyy mmiddiyyy limits commercial general liability occurrence 1000000 damage orented claims-made occur premises ea occurrence 300000 med exp one person 10000 34sbaih4043 09/17/2017 09/17/2018 personal adv injury 1000000 gen l aggregate limit applies per general aggregate 2000000 policy peo loc products compiop agg 2000000 automobile liability combined single limit ea accident auto bodily injury per person owned scheduled bodily injury per accident autos autos hired non-owned propert damage autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation sfrtute ota- employers liability er yin jfficerrrmbgrieaetnbeexecutive n /a el accident 1000000 excluded 34weca00615 09/17/2017 09/17/2018 mandatory nh e.l. disease ea employee 1000000 yes describe description operations el disease policy limit 1000000 description operations locations vehicles acord 101 additional remarks schedule may attached space required certificate holder cancellation described policies cancelled expiration date thereof notice delivered verus research accordance policy provisions_ 6100 uptown blvd ne ste 260 authorized representative albuquerque nm 87110 1988-2015 acord corporation_ rights reserved_ acord 25 2016/03 acord name logo registered marks acord joy

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Robertc Truck Centar & Ideal||Date : 4/3/2008

date mmiddiyyyy acord certificate liability insurance 01/27/2020 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important ifithe certificate holder additional insured policy ies must additional insured provisions endorsed subrogation waived subject terms conditions policy certain policies may require endorsement_ statement certificate confer rights certificate holder lieu endorsement producer rame act chris koester vip insurance services llc pnono ext 4806966438 aic dial 9221 e via de ventura address chris vipinsuranceservices.com insurer affording coverage naic scottsdale az 85258 insurer insured insurer b abuelitas nm kitchen llc insurer c 6083 isleta blvd sw insurer insurer e albuquerque nm 87105 insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims_ inbsr addlisubr pol eff polic exp ltr type insurance insd wvd policy number mmiddiyyyy mmiddiyyyl limits commercial general liability occurrence 1,000,000 damage orented claims-made occur premises ea occurrence 300,000 med exp one person 5,000 cpa4709951 01/19/2017 01/19/2018 personal adv injury 1,000,000 gen l aggregate limit applies per general aggregate 2,000,000 policy peo loc products compiop agg 2,000,000 automobile liability combined single limit ea accident auto bodily injury per person owned scheduled bodily injury per accident autos autos hired non-owned propert damage autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention iworkers compensation sfrtute ota- employers liability er yin aany proprietoripartneriexecutive el accident jofficerimember excluded n /a mandatory nh e.l. disease ea employee yes describe description operations el disease policy limit propc cpa4709951 01/19/2017 01/19/2018 description operations locations vehicles acord 101 additional remarks schedule may attached space required certificate holder cancellation described policies cancelled expiration date thereof notice delivered accordance policy provisions_ authorized representative 1988-2015 acord corporation_ rights reserved_ acord 25 2016/03 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Compass Operating ||Date : 7/11/2012

date mmiddiyyyy acord certificate liability insurance 1/19/2017 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important ifithe certificate holder additional insured policy ies must additional insured provisions endorsed subrogation waived subject terms conditions policy certain policies may require endorsement_ statement certificate confer rights certificate holder lieu endorsement producer rame act montine haynes vip insurance services llc pnono ext 480 378-6754 aic dial 4900 n scottsdale rd address montine vipinsuranceservices com ste 6000 insurer affording coverage naic scottsdale az 85251 insurer ohio security insurance company insured insurer b ace enterprises llc insurer c po box 50513 insurer insurer e albuquerque nm 87181 insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims_ inbsr addlisubr pol eff polic exp ltr type insurance insd wvd policy number mmiddiyyyy mmiddiyyyl limits commercial general liability occurrence 2,000,000 damage orented claims-made occur premises ea occurrence 300,000 med exp one person 15,000 bls57769845 01/19/2017 01/19/2018 personal adv injury 1,000,000 gen l aggregate limit applies per general aggregate 2,000,000 policy peo loc products compiop agg 2,000,000 automobile liability combined single limit ea accident auto bodily injury per person owned scheduled bodily injury per accident autos autos hired non-owned propert damage autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation sfrtute ota- employers liability er yin jfficerrrmbgrieaetnbeexecutive n /a el accident excluded mandatory nh e.l. disease ea employee yes describe description operations el disease policy limit description operations locations vehicles acord 101 additional remarks schedule may attached space required certificate holder cancellation described policies cancelled expiration date thereof notice delivered accordance policy provisions_ authorized representative 1988-2045 acord corporation_ rights reserved_ acord 25 2016/03 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: COG Operating LLC||Date : 6/24/2013

date mmiddiyyyy acord certificate liability insurance 05/15/2017 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important ifithe certificate holder additional insured policy ies must additional insured provisions endorsed subrogation waived subject terms conditions policy certain policies may require endorsement_ statement certificate confer rights certificate holder lieu endorsement producer contact estep name vip insurance services llc pnono ext 505-888-6333 aic 505-369-0925 dial 4900 n scottsdale rd address joy vipinsuranceservices.com ste 6000 insurer affording coverage naic scottsdale az 85251 insurer twin city fire ins co co 29459 insured insurer b accu stat medical insurer c 6105 kingston ave ne insurer insurer e albuquerque nm 87109 insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims_ inbsr addlisubr pol eff polic exp ltr type insurance insd wvd policy number mmiddiyyyy mmiddiyyyl limits commercial general liability occurrence 1,000,000 damage orented claims-made occur premises ea occurrence 1,000,000 med exp one person 10,000 34sbaij8343 04/14/2017 04/14/2018 personal adv injury 1,000,000 gen l aggregate limit applies per general aggregate 2,000,000 policy peo loc products compiop agg 2,000,000 automobile liability combined single limit ea accident auto bodily injury per person owned scheduled bodily injury per accident autos autos hired non-owned propert damage autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation sfrtute ota- er employers liability yin aany proprietoripartneriexecutive el accident jofficerimember excluded n /a mandatory nh e.l. disease ea employee yes describe description operations el disease policy limit limit s13,000 leased/rented equipment 34sbaij8343 04/14/2017 04/14/2018 description operations locations vehicles acord 101 additional remarks schedule may attached space required certificate holder cancellation described policies cancelled expiration date thereof notice delivered accordance policy provisions_ authorized representative 1988-2015 acord corporation_ rights reserved_ acord 25 2016/03 acord name logo registered marks acord joy

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: COG Operating LLC||Date : 6/24/2013

date mmiddiyyyy acord certificate liability insurance 06/13/2017 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important ifithe certificate holder additional insured policy ies must additional insured provisions endorsed subrogation waived subject terms conditions policy certain policies may require endorsement_ statement certificate confer rights certificate holder lieu endorsement producer rame act kelly mancha vip insurance services llc pnono ext 4806966438 aic dial 9221 e via de ventura address kelly vipinsuranceservices com insurer affording coverage naic scottsdale az 85258 insurer republic underwriters insurance copany insured insurer b esperanza enterprises iii llc dba jackson 's insurer c 4209 san mateo blvd ne insurer insurer e albuquerque nm 87110 insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims_ inbsr addlisubr pol f7 polic exp ltr type insurance insd wvd policy number mmiddiyyyy mmiddiyyy limits commercial general liability occurrence 1000000 damage orented claims-made occur premises ea occurrence 300000 med exp one person 5000 tbd 6/13/2017 6/13/2018 personal adv injury 1000000 gen l aggregate limit applies per general aggregate 2000000 policy peo loc products compiop agg 2000000 automobile liability combined single limit included ea accident auto bodily injury per person owned scheduled tbd 6/13/2017 6/13/2018 bodily injury per accident autos autos hired non-owned propert damage autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation sfrtute ota- er employers liability yin jfficerrrmbgrieaetnbeexecutive n /a el accident excluded mandatory nh e.l. disease ea employee yes describe description operations e.l. disease policy limit liquor liability 1000000 2000000 description operations locations vehicles acord 101 additional remarks schedule may attached space required certificate holder cancellation described policies cancelled expiration date thereof notice delivered accordance policy provisions_ authorized representative 1988-2015 acord corporation_ rights reserved_ acord 25 2016/03 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: ||Date : 6/13/2017

date mmiddiyyyy acord certificate liability insurance 11/2/2018 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important ifithe certificate holder additional insured policy ies must additional insured provisions endorsed subrogation waived subject terms conditions policy certain policies may require endorsement_ statement certificate confer rights certificate holder lieu endorsement producer rame act clark neff vip insurance services llc pnono ext 505.924.6393 aic dial 9221 e via de ventura address clark vipinsuranceservices.com insurer affording coverage naic scottsdale az 85258 insurer firemen 's insurance company washington d.c insured insurer b abuelitas nm kitchen llc insurer c 6083 isleta blvd sw insurer insurer e albuquerque nm 87105 insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims_ inbsr addlisubr pol f7 polic exp ltr type insurance insd wvd policy number mmiddiyyyy mmiddiyyy limits commercial general liability occurrence 1,000,000 damage orented claims-made occur premises ea occurrence 300,000 med exp one person 5,000 cpa 4709951 12 1/19/2018 1/19/2019 personal adv injury 1,000,000 gen l aggregate limit applies per general aggregate 2,000,000 policy peo loc products compiop agg 2,000,000 automobile liability combined single limit ea accident auto bodily injury per person owned scheduled bodily injury per accident autos autos hired non-owned propert damage autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation sfrtute ota- employers liability er yin jfficerrrmbgrieaetnbeexecutive n /a el accident excluded mandatory nh e.l. disease ea employee yes describe description operations el disease policy limit description operations locations vehicles acord 101 additional remarks schedule may attached space required certificate holder cancellation described policies cancelled expiration date thereof notice delivered accordance policy provisions_ authorized representative clark neff 1988-2015 acord corporation_ rights reserved_ acord 25 2016/03 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Sheffield Square||Date : 10/7/2010

date mmiddiyyyy acord certificate liability insurance 03/26/2019 certificate issued matter information confers rights upon certificate holder certificate affirmatively negatively amend extend alter coverage afforded policies certificate insurance constitute contract issuing insurer authorized representative producer certificate holder important ifithe certificate holder additional insured policy ies must additional insured provisions endorsed subrogation waived subject terms conditions policy certain policies may require endorsement_ statement certificate confer rights certificate holder lieu endorsement producer rame act samantha sanchez vip insurance services llc pnono ext 505-910-4009 aic dial 9221 e via de ventura address samantha vipinsuranceservices.com insurer affording coverage naic scottsdale az 85258 insurer twin city fire ins co co 29459 insured insurer b accu stat medical insurer c 6105 kingston ave ne insurer insurer e albuquerque nm 87109 insurer f coverages certificate number revision number certify policies insurance listed issued insured named policy period indicated notwithstanding requirement_ term condition contract document respect certificate may issued may pertain insurance afforded policies described herein subject terms_ exclusions conditions policies limits shown may reduced paid claims_ inbsr addlisubr pol eff polic exp ltr type insurance insd wvd policy number mmiddiyyyy mmiddiyyy limits commercial general liability occurrence 1,000,000 damage orented claims-made occur premises ea occurrence 1,000,000 med exp one person 10,000 34sbaij8343 04/14/2019 04/14/2020 personal adv injury 1,000,000 gen l aggregate limit applies per general aggregate 2,000,000 policy peo loc products compiop agg 2,000,000 automobile liability combined single limit ea accident auto bodily injury per person owned scheduled bodily injury per accident autos autos hired non-owned propert damage autos autos per accident umbrella liab occur occurrence excess liab claims-made aggregate ded retention workers compensation sfrtute ota- employers liability er yin jfficerrrmbgrieaetnbeexecutive n /a el accident excluded mandatory nh e.l. disease ea employee yes describe description operations el disease policy limit description operations locations vehicles acord 101 additional remarks schedule may attached space required certificate holder cancellation described policies cancelled expiration date thereof notice delivered accordance policy provisions_ authorized representative samantha sanchcz 1988-2015 acord corporation_ rights reserved_ acord 25 2016/03 acord name logo registered marks acord

identify the TYPE OF DOCUMENT: ||LINE OF BUSINESS: ||Date :

TYPE OF DOCUMENT: Certificate||LINE OF BUSINESS: Sheffield Square||Date : 8/24/2011