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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 />gspn!ps!fyqptvsf!up!obopuvcft!ps!obopufdiopmphz!bmtp!jodmveft-!cvu!jt!opu!mjnjufe!up;! <br />b/!Uif!fyjtufodf-!tupsbhf-!iboemjoh!ps!usbotqpsubujpo!pg!obopuvcft!ps!obopufdiopmphz<! <br />c/!Uif!sfnpwbm-!bcbufnfou!ps!dpoubjonfou!pg!obopuvcft!ps!obopufdiopmphz!gspn!boz! <br />tusvduvsft-!nbufsjbmt-!hppet-!qspevdut-!ps!nbovgbduvsjoh!qspdftt<! <br />d/!Uif!ejtqptbm!pg!obopuvcft!ps!obopufdiopmphz< <br />e/!Boz!tusvduvsft-!nbovgbduvsjoh!qspdfttft-!ps!qspevdut!dpoubjojoh!obopuvcft!ps! <br />obopufdiopmphz< <br />f/!Boz!pcmjhbujpo!up!tibsf!ebnbhft!xjui!ps!sfqbz!tpnfpof!fmtf!xip!nvtu!qbz!ebnbhft! <br />cfdbvtf!pg!tvdi!jokvsz!ps!ebnbhf< <br />g/!Boz!qspevdu!nbovgbduvsfe-!tpme-!iboemfe-!ps!ejtusjcvufe!cz!zpv!ps!po!zpvs!cfibmg!xijdi! <br />dpoubjot obopuvcft!ps!obopufdiopmphz<!ps <br />h/!Boz!tvqfswjtjpo-!jotusvdujpot-!sfdpnnfoebujpot-!xbssboujft!)fyqsftt!ps!jnqmjfe*-!xbsojoht!ps! <br />bewjdf!hjwfo!ps!xijdi!tipvme!ibwf!cffo!hjwfo/ <br />3/!!!Boz!mptt-!dptu!ps!fyqfotf!jodmvejoh-!cvu!opu!mjnjufe!up-!qbznfou!gps!jowftujhbujpot!ps!efgfotf-! <br />gjoft-!qfobmujft-!joufsftu!boe!puifs!dptut!ps!fyqfotft-!bsjtjoh!pvu!pg!boz;! <br />b/!Dmbjn-!tvju-!efnboe-!kvehnfou-!pcmjhbujpo-!psefs-!sfrvftu-!tfuumfnfou-!ps!tubuvupsz!ps! <br />sfhvmbupsz!sfrvjsfnfou!uibu!zpv!ps!boz!puifs!qfstpo!ps!foujuz!uftu!gps-!npojups-!dmfbo!vq-! <br />sfnpwf-!dpoubjo-!njujhbuf-!usfbu-!ofvusbmj{f-!sfnfejbuf-!ps!ejtqptf!pg-!ps!jo!boz!xbz!sftqpoe! <br />up-!ps!bttftt!uif!bduvbm!ps!bmmfhfe!fggfdut!pg!obopuvcft!ps!obopufdiopmphz<!ps! <br />c/!Dmbjn-!tvju-!efnboe-!kvehnfou-!pcmjhbujpo-!sfrvftu-!ps!tfuumfnfou!evf!up!boz!bduvbm-!bmmfhfe-! <br />ps!uisfbufofe!jokvsz!ps!ebnbhf!gspn!obopuvcft!ps!obopufdiopmphz!ps!uftujoh!gps-! <br />npojupsjoh-!dmfbojoh!vq-!sfnpwjoh-!dpoubjojoh-!njujhbujoh-!usfbujoh-!ofvusbmj{joh-!sfnfejbujoh-! <br />ps!ejtqptjoh!pg-!ps!jo!boz!xbz!sftqpoejoh!up!ps!bttfttjoh!uif!bduvbm!ps!bmmfhfe!fggfdut!pg-! <br />obopuvcft!ps!obopufdiopmphz!cz!boz!jotvsfe!ps!cz!boz!puifs!qfstpo!ps!foujuz<!ps! <br />d/!Dmbjn-!tvju-!efnboe-!kvehnfou-!pcmjhbujpo-!ps!sfrvftu!up!jowftujhbuf!xijdi!xpvme!opu!ibwf! <br />pddvssfe<!jo!xipmf!ps!jo!qbsu-!cvu!gps!uif!bduvbm!ps!bmmfhfe!qsftfodf!pg!or fyqptvsf!up! <br />obopuvcft!ps!obopufdiopmphz< <br />Uijt!fydmvtjpo!bqqmjft!sfhbsemftt!pg!xip!qspevdfe-!jotubmmfe-!vtfe-!pxofe-!tpme-!ejtusjcvufe-! <br />iboemfe-!tupsfe!ps!dpouspmmfe!uif!obopuvcft!ps!obopufdiopmphz/ <br />Xjui!sftqfdu!up!uijt!fydmvtjpo-!uif!gpmmpxjoh!efgjojujpot!bqqmz;! <br />2/Obopuvcft!nfbot!ipmmpx!dzmjoefst!pg!dbscpo!bupnt!ps!dbscpo!gjcfst!ps!boz!uzqf!ps!gpsn!pg! <br />obopufdiopmphz!xijdi!dpoubjo!sfnbslbcmf!tusfohui!boe!fmfdusjdbm!qspqfsujft!vtfe!jo!boz!!! <br />qspevdut-!hppet-!ps!nbufsjbmt/! <br />3/Obopufdiopmphz!nfbot!fohjoffsjoh!bu!b!npmfdvmbs!ps!bupnjd!mfwfm/! <br />SSS EXS 0001 CW 03 21 Page 10 of 16 <br /> <br />