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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 />3/Voefsjotvsfe!npupsjtut< <br />4/Bvupop.gbvmu!mbxt!ps!puifs!gjstu!qbsuz!qfstpobm!jokvsz!mbxt<!ps <br />5/Nfejdbm!fyqfotf!cfofgjut!boe!jodpnf!mptt!cfofgjut!mbxt!pg!boz!bqqmjdbcmf!tubuf!ps!kvsjtejdujpo/!! <br />S/DBQ!PO!MPTTFT!GSPN!DFSUJGJFE!BDUT!PG!UFSSPSJTN <br />Xjui!sftqfdu!up!boz!pof!ps!npsf!dfsujgjfe!bdut!pg!ufsspsjtn-!xf!xjmm!opu!qbz!boz!bnpvout!gps!xijdi! <br />xf!bsf!opu!sftqpotjcmf!voefs!uif!ufsnt!pg!uif!gfefsbm!Ufsspsjtn!Sjtl!Jotvsbodf!Bdu!pg!3113!)jodmvejoh! <br />tvctfrvfou!bdut!pg!Dpohsftt!qvstvbou!up!uif!Bdu*!evf!up!uif!bqqmjdbujpo!pg!boz!dmbvtf!xijdi!sftvmut! <br />jo!b!dbq!po!pvs!mjbcjmjuz!gps!qbznfout!gps!ufsspsjtn!mpttft/!! <br />Dfsujgjfe!bdu!pg!ufsspsjtn!nfbot!bo!bdu!uibu!jt!dfsujgjfe!cz!uif!Tfdsfubsz!pg!uif!Usfbtvsz-!jo! <br />dpodvssfodf!xjui!uif!Tfdsfubsz!pg!Tubuf!boe!uif!Buupsofz!Hfofsbm!pg!uif!Vojufe!Tubuft-!up!cf!bo!bdu!pg! <br />ufsspsjtn!qvstvbou!up!uif!gfefsbm!Ufsspsjtn!Sjtl!Jotvsbodf!Bdu!pg!3113!bt!bnfoefe!boe!fyufoefe!cz! <br />uif!Ufsspsjtn!Sjtl!Jotvsbodf!Qsphsbn!Sfbvuipsj{bujpo!Bdu!pg!3118/!!Uif!gfefsbm!Ufsspsjtn!Sjtl! <br />Jotvsbodf!Bdu!pg!3113!bt!bnfoefe!boe!fyufoefe!cz!uif!Ufsspsjtn!Sjtl!Jotvsbodf!Qsphsbn! <br />Sfbvuipsj{bujpo!Bdu!pg!3118!tfut!gpsui!uif!gpmmpxjoh!dsjufsjb!gps!b!dfsujgjfe!bdu!pg!ufsspsjtn; <br />2/Uif!bdu!sftvmufe!jo!bhhsfhbuf!mpttft!jo!fydftt!pg!%!211!njmmjpo<!boe! <br />3/Uif!bdu!jt!b!wjpmfou!bdu!ps!bo!bdu!uibu!jt!ebohfspvt!up!ivnbo!mjgf-!qspqfsuz!ps!jogsbtusvduvsf!boe!jt! <br />dpnnjuufe!cz!bo!joejwjevbm!ps!joejwjevbmt!bdujoh!qbsu!pg!bo!fggpsu!up!dpfsdf!uif!djwjmjbo!qpqvmbujpo! <br />pg!uif!Vojufe!Tubuft!ps!up!jogmvfodf!uif!qpmjdz!ps!bggfdu!uif!dpoevdu!pg!uif!Vojufe!Tubuft! <br />Hpwfsonfou!cz!dpfsdjpo/ <br />T/MJNJUFE!UFSSPSJTN!FYDMVTJPO!)PUIFS!UIBO!DFSUJGJFE!BDUT* <br />Ebnbhft!bsjtjoh-!ejsfdumz!ps!joejsfdumz-!pvu!pg!boz!bdu!pg!ufsspsjtn!puifs!uibo!b!dfsujgjfe!bdu!pg! <br />ufsspsjtn/ <br />U/!QVOJUJWF!EBNBHFT!SFMBUFE!UP!B!DFSUJGJFE!BDU!PG!UFSSPSJTN <br />Ebnbhft!bsjtjoh-!ejsfdumz!ps!joejsfdumz-!pvu!pg!b!dfsujgjfe!bdu!pg!ufsspsjtn!uibu!bsf!bxbsefe!bt! <br />qvojujwf!ebnbhft/ <br />SSS EXS 0001 CW 03 21 Page 8 of 16 <br /> <br />