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201 E. Fifth Street, Suite 1200 <br />Cincinnati, OH 45202 <br />Tel: 844-722-7827 <br />Fax: 513-599-7501 <br />www.corespecialty.com <br />Report claims to: <br />claims@corespecialty.com <br />TUBSTUPOF!TQFDJBMUZ!JOTVSBODF!DP/ <br />GPMMPXJOH!GPSN!FYDFTT!MJBCJMJUZ!JOTVSBODF!QPMJDZ <br />2*Jg!uif!qpmmvubout!bsf!cspvhiu!po!ps!up!uif!qsfnjtft-!tjuf!ps!mpdbujpo!jo!dpoofdujpo!xjui!tvdi! <br />pqfsbujpot!cz!tvdi!jotvsfe-!dpousbdups!ps!tvcdpousbdups<!ps <br />3*Jg!uif!pqfsbujpot!bsf!up!uftu!gps-!npojups-!dmfbo!vq-!sfnpwf-!dpoubjo-!usfbu-!efupyjgz!ps! <br />ofvusbmj{f-!ps!jo!boz!xbz!sftqpoe!up-!ps!bttftt!uif!fggfdut!pg-!qpmmvubout< <br />f/Jg!uif!cpejmz!jokvsz!ps!qspqfsuz!ebnbhf!jt!jodmvefe!xjuijo!uif!qspevdut.dpnqmfufe!pqfsbujpot! <br />ib{bse< <br />g/Uibu!bsf-!ps!uibu!bsf!dpoubjofe!jo!boz!qspqfsuz!uibu!jt; <br />2*Cfjoh!usbotqpsufe!ps!upxfe!cz-!ps!iboemfe!gps!npwfnfou!joup-!poup!ps!gspn-!uif!dpwfsfe! <br />bvup< <br />3*Puifsxjtf!jo!uif!dpvstf!pg!usbotju!cz!ps!po!cfibmg!pg!uif!jotvsfe<!ps <br />4*Cfjoh!tupsfe-!ejtqptfe!pg-!usfbufe!ps!qspdfttfe!jo!ps!vqpo!uif!dpwfsfe!bvup/ <br />h/Cfgpsf!uif!qpmmvubout!ps!boz!qspqfsuz!jo!xijdi!uif!qpmmvubout!bsf!dpoubjofe!bsf!npwfe!gspn! <br />uif!qmbdf!xifsf!uifz!bsf!bddfqufe!cz!uif!jotvsfe!gps!npwfnfou!joup!ps!poup!uif!dpwfsfe! <br />bvup<!ps <br />i/Bgufs!uif!qpmmvubout!ps!boz!qspqfsuz!jo!xijdi!uif!qpmmvubout!bsf!dpoubjofe!bsf!npwfe!gspn!uif! <br />dpwfsfe!bvup!up!uif!qmbdf!xifsf!uifz!bsf!gjobmmz!efmjwfsfe-!ejtqptfe!pg!ps!bcboepofe!cz!uif! <br />jotvsfe/ <br />3/Qpmmvujpo!dptu!ps!fyqfotf/ <br />J/QSPQFSUZ!EBNBHF <br />2/Qspqfsuz!ebnbhf!up; <br />b/Qspqfsuz!zpv!pxo-!sfou!ps!pddvqz-!jodmvejoh!boz!dptut!ps!fyqfotft!jodvssfe!cz!zpv-!ps!boz! <br />puifs!qfstpo-!pshboj{bujpo!ps!foujuz-!gps!sfqbjs-!sfqmbdfnfou-!foibodfnfou-!sftupsbujpo!ps! <br />nbjoufobodf!pg!tvdi!qspqfsuz!gps!boz!sfbtpo-!jodmvejoh!qsfwfoujpo!pg!jokvsz!up!b!qfstpo!ps! <br />ebnbhf!up!bopuifsĀ“t!qspqfsuz< <br />c/Qsfnjtft!zpv!tfmm-!hjwf!bxbz!ps!bcboepo-!jg!uif!qspqfsuz!ebnbhf!bsjtft!pvu!pg!boz!qbsu!pg! <br />uiptf!qsfnjtft< <br />d/Qspqfsuz!mpbofe!up!zpv< <br />e/Qfstpobm!qspqfsuz!jo!uif!dbsf-!dvtupez!ps!dpouspm!pg!uif!jotvsfe< <br />SSS EXS 0001 CW 03 21 Page 5 of 16 <br /> <br />