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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 />f/Uibu!qbsujdvmbs!qbsu!pg!sfbm!qspqfsuz!po!xijdi!zpv!ps!boz!dpousbdupst!ps!tvcdpousbdupst!ejsfdumz! <br />ps!joejsfdumz!po!zpvs!cfibmg!bsf!qfsgpsnjoh!pqfsbujpot-!jg!uif!qspqfsuz!ebnbhf!bsjtft!pvu!pg! <br />uiptf!pqfsbujpot<!ps <br />g/Uibu!qbsujdvmbs!qbsu!pg!boz!qspqfsuz!uibu!nvtu!cf!sftupsfe-!sfqbjsfe!ps!sfqmbdfe!cfdbvtf!zpvs! <br />xpsl!xbt!jodpssfdumz!qfsgpsnfe!po!ju/ <br />3/Tvc.qbsbhsbqit b/-!d/!boe!e/pg!uijt!fydmvtjpo!ep!opu!bqqmz!up!qspqfsuz!ebnbhf!)puifs!uibo! <br />ebnbhf!cz!gjsf*!up!qsfnjtft-!jodmvejoh!uif!dpoufout!pg!tvdi!qsfnjtft-!sfoufe!up!zpv!gps!b!qfsjpe! <br />pg!8!ps!gfxfs!dpotfdvujwf!ebzt/ <br />4/Tvc.qbsbhsbqi c/pg!uijt!fydmvtjpo!epft!opu!bqqmz!jg!uif!qsfnjtft!bsf!zpvs!xpsl!boe!xfsf!ofwfs! <br />pddvqjfe-!sfoufe!ps!ifme!gps!sfoubm!cz!zpv/ <br />5/Tvc.qbsbhsbqit d/-!e/-!f/boe g/pg!uijt!fydmvtjpo!ep!opu!bqqmz!up!mjbcjmjuz!bttvnfe!voefs!b! <br />tjefusbdl!bhsffnfou/ <br />6/Tvc.qbsbhsbqi g/pg!uijt!fydmvtjpo!epft!opu!bqqmz!up!qspqfsuz!ebnbhf!jodmvefe!jo!uif!qspevdut.! <br />dpnqmfufe!pqfsbujpot!ib{bse/ <br />K/QSPQFSUZ!EBNBHF!UP!ZPVS!QSPEVDU <br />Qspqfsuz!ebnbhf!up!zpvs!qspevdu!bsjtjoh!pvu!pg!ju!ps!boz!qbsu!pg!ju/ <br />L/QSPQFSUZ!EBNBHF!UP!ZPVS!XPSL <br />Qspqfsuz!ebnbhf!up!zpvs!xpsl!bsjtjoh!pvu!pg!ju!ps!boz!qbsu!pg!ju!boe!jodmvefe!jo!uif!qspevdut.dpnqmfufe! <br />pqfsbujpot!ib{bse/!Uijt!fydmvtjpo!epft!opu!bqqmz!jg!uif!ebnbhfe!xpsl!ps!uif!xpsl!pvu!pg!xijdi!uif! <br />ebnbhf!bsjtft!xbt!qfsgpsnfe!po!zpvs!cfibmg!cz!b!tvcdpousbdups/ <br />M/QSPQFSUZ!EBNBHF!UP!JNQBJSFE!QSPQFSUZ <br />Qspqfsuz!ebnbhf!up!jnqbjsfe!qspqfsuz!ps!qspqfsuz!uibu!ibt!opu!cffo!qiztjdbmmz!jokvsfe-!bsjtjoh!pvu!pg; <br />2/B!efgfdu-!efgjdjfodz-!jobefrvbdz!ps!ebohfspvt!dpoejujpot!jo!zpvs!qspevdu!ps!zpvs!xpsl<!ps <br />3/B!efmbz!ps!gbjmvsf!cz!zpv!ps!bozpof!bdujoh!po!zpvs!cfibmg!up!qfsgpsn!b!dpousbdu!ps!bhsffnfou!jo! <br />bddpsebodf!xjui!jut!ufsnt/ <br />Uijt!fydmvtjpo!epft!opu!bqqmz!up!uif!mptt!pg!vtf!pg!ubohjcmf!qspqfsuz!bsjtjoh!pvu!pg!tveefo!boe! <br />bddjefoubm!qiztjdbm!jokvsz!up!zpvs!qspevdu!ps!zpvs!xpsl!bgufs!ju!ibt!cffo!qvu!up!jut!joufoefe!vtf/ <br />N/QSPEVDU!SFDBMM <br />Ebnbhft!dmbjnfe!gps!boz!mptt-!dptu!ps!fyqfotf!jodvssfe!cz!zpv!ps!puifst!gps!uif!mptt!pg!vtf-! <br />xjuiesbxbm-!sfdbmm-!jotqfdujpo-!sfqbjs-!sfqmbdfnfou-!bekvtunfou-!sfnpwbm!ps!ejtqptbm!pg; <br />SSS EXS 0001 CW 03 21 Page 6 of 16 <br /> <br />