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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 />Z/OVDMFBS <br />Cpejmz!jokvsz!ps!qspqfsuz!ebnbhf; <br />2/b/Xjui!sftqfdu!up!xijdi!bo!jotvsfe!voefs!uif!Qpmjdz!jt!bmtp!bo!jotvsfe!voefs!b!ovdmfbs!fofshz! <br />mjbcjmjuz!Qpmjdz!jttvfe!cz!Ovdmfbs!Fofshz!Jotvsbodf!Bttpdjbujpo-!Nvuvbm!Bupnjd!Fofshz! <br />Mjbcjmjuz!Voefsxsjufst-!Ovdmfbs!Jotvsbodf!Bttpdjbujpo!pg!Dbobeb!ps!boz!pg!uifjs!tvddfttpst-!ps! <br />xpvme!cf!bo!jotvsfe!voefs!boz!tvdi!Qpmjdz!cvu!gps!jut!ufsnjobujpo!vqpo!fyibvtujpo!pg!jut!mjnju! <br />pg!mjbcjmjuz<!ps <br />c/Sftvmujoh!gspn!uif!ib{bsepvt!qspqfsujft!pg!ovdmfbs!nbufsjbm!boe!xjui!sftqfdu!up!xijdi!b* <br />boz!qfstpo!ps!pshboj{bujpo!jt!sfrvjsfe!up!nbjoubjo!gjobodjbm!qspufdujpo!qvstvbou!up!uif!Bupnjd! <br />Fofshz!Bdu!pg!2:65-!ps!boz!mbx!bnfoebupsz!uifsfpg-!ps!c*!uif!jotvsfejt-!ps!ibe!uijt!Qpmjdz!opu! <br />cffo!jttvfe!xpvme!cf-!foujumfe!up!joefnojuz!gspn!uif!Vojufe!tubuft!pg!Bnfsjdb-!ps!boz!bhfodz! <br />uifsfpg-!voefs!boz!bhsffnfou!foufsfe!joup!cz!uif!Vojufe!Tubuft!pg!Bnfsjdb-!ps!boz!bhfodz! <br />uifsfpg-!xjui!boz!qfstpo!ps!pshboj{bujpo/ <br />3/Cpejmz!jokvszps qspqfsuz!ebnbhf!sftvmujoh!gspn!uif!ib{bsepvt!qspqfsujft!pg!ovdmfbs!nbufsjbm- <br />jg; <br />b/Uif!ovdmfbs!nbufsjbmb*!jt!bu!boz!ovdmfbs!gbdjmjuz!pxofe!cz-!ps!pqfsbufe!cz!ps!po!cfibmg!pg-! <br />bo!jotvsfe!ps!c*!ibt!cffo!ejtdibshfe!ps!ejtqfstfe!uifsfgspn< <br />c/Uif!ovdmfbs!nbufsjbm!jt!dpoubjofe!jo!tqfou!gvfm!ps!xbtuf!bu!boz!ujnf!qpttfttfe-!iboemfe-! <br />vtfe-!qspdfttfe-!tupsfe-!usbotqpsufe!ps!ejtqptfe!pg!cz!ps!po!cfibmg!pg!bo!jotvsfe<!ps <br />d/Uif!cpejmz!jokvsz!ps!qspqfsuz!ebnbhf!bsjtft!pvu!pg!uif!gvsojtijoh!cz!bo!jotvsfe!pg!tfswjdft-! <br />nbufsjbmt-!qbsut!ps!frvjqnfou!jo!dpoofdujpo!xjui!uif!qmboojoh-!dpotusvdujpo-!nbjoufobodf-! <br />pqfsbujpo!ps!vtf!pg!boz!ovdmfbs!gbdjmjuz-!cvu!jg!tvdi!gbdjmjuz!jt!mpdbufe!xjuijo!uif!Vojufe!Tubuft! <br />pg!Bnfsjdb-!jut!ufssjupsjft!ps!qpttfttjpot!ps!Dbobeb-!uijt!Tvc.qbsbhsbqi!d/bqqmjft!pomz!up! <br />qspqfsuz!ebnbhf!up!tvdi!ovdmfbs!gbdjmjuz!boe!boz!qspqfsuz!uifsfbu/ <br />4/Bt!vtfe!jo!uijt!Fydmvtjpo!Z/; <br />b/Ib{bsepvt!qspqfsujft!jodmvef!sbejpbdujwf-!upyjd!ps!fyqmptjwf!qspqfsujft< <br />c/Ovdmfbs!nbufsjbm!nfbot!tpvsdf!nbufsjbm-tqfdjbm!ovdmfbs!nbufsjbm!ps!cz.qspevdu <br />nbufsjbm< <br />d/Tpvsdf!nbufsjbm-tqfdjbm!ovdmfbs!nbufsjbm-!boe!cz.qspevdu!nbufsjbm!ibwf!uif!nfbojoht! <br />hjwfo!uifn!jo!uif!Bupnjd!Fofshz!Bdu!pg!2:65!ps!jo!boz!mbx!bnfoebupsz!uifsfpg< <br />e/Tqfou!gvfm!nfbot!boz!gvfm!fmfnfou!ps!gvfm!dpnqpofou-!tpmje!ps!mjrvje-!xijdi!ibt!cffo!vtfe! <br />ps!fyqptfe!up!sbejbujpo!jo!b!ovdmfbs!sfbdups< <br />SSS EXS 0001 CW 03 21 Page 11 of 16 <br /> <br />