25-84131512-ITB EDP Attachment M Historical Loss Report.pdf

Solicitation No. 25-84131512-ITB Electronic Data Processing Equipment Insurance

Attachment M Historical Loss Experience Report

A loss run report dated March 13, 2025 is provided on the following pages.

06696877 06/05/2015 - 06/05/2016 INLAND MAR 12 $0 $33,352 $0 $33,352 $0 $33,352

06696877 06/05/2016 - 06/05/2017 INLAND MAR 15 $0 $9,445 $0 $9,445 $0 $9,445

06696877 06/05/2017 - 06/05/2018 INLAND MAR 10 $0 $69,764 $41 $69,805 $-26,176 $43,629

06696877 06/05/2018 - 06/05/2019 INLAND MAR 9 $0 $4,939 $110 $5,049 $0 $5,049

06696877 06/05/2019 - 06/05/2020 INLAND MAR 10 $0 $55,573 $296 $55,869 $0 $55,870 06696877 06/05/2020 - 06/05/2021 INLAND MAR 8 $0 $38,045 $11,446 $49,491 $0 $49,491

06696877 06/05/2021 - 06/05/2022 INLAND MAR 5 $0 $2,688 $45 $2,733 $0 $2,733

06696877 06/05/2022 - 06/05/2023 INLAND MAR 7 $0 $44,397 $46 $44,443 $0 $44,443

06696877 06/05/2023 - 06/05/2024 INLAND MAR 2 $0 $17,626 $0 $17,626 $0 $17,626

06696877 06/05/2024 - 06/05/2025 INLAND MAR 1 $0 $6,047 $0 $6,047 $0 $6,047

Totals: 79 $0 $281,876 $11,984 $293,860 $-26,176 $267,685

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Summary:

Policy # Policy Term Policy Type No of

Claims/Occurrences Loss & Expense Reserves

Losses Paid Expenses Paid Losses & Expenses Paid

Recovery Total Incurred

- SEE IMPORTANT NOTICE FOLLOWING LOSS RUN DETAILS -

06696877 040515045069 000014

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

06/13/2015 Melbourne, FL

07/14/2015 07/15/2015

$0 $0

$215 $0 $0

$215 $0

$215 Claimant Name: State of Florida-EDP/Florida Department of Transportation Loss Description: Wallet w/house key was stolen from car - then break in to house where labtop was stolen Writing Company: FEDERAL INSURANCE COMPANY 06696877 040515051258 000017

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

07/05/2015 Orlando, FL

08/07/2015 09/18/2015

$0 $0

$9,400 $0 $0

$9,400 $0

$9,400 Claimant Name: State of Florida-EDP Loss Description: Lightening storm caused AC to shut down and due to AC being shut down, equipment was damaged.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047515037280 000018

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

08/08/2015 Lake Mary, FL

08/13/2015 08/20/2015

$0 $0

$2,025 $0 $0

$2,025 $0

$2,025 Claimant Name: State of FL Loss Description: Laptop stolen from EE veh - Est $2,000.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047515050568 000019

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

10/13/2015 Lake Charles, LA

11/16/2015 11/20/2015

$0 $0

$498 $0 $0

$498 $0

$498 Claimant Name: State of Florida-EDP/Florida Department of Transportation Loss Description: Laptop was stolen from vehicle while in the hotel parking.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040515076213 000020

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

10/06/2015 Orlando, FL

11/30/2015 12/03/2015

$0 $0

$219 $0 $0

$219 $0

$219 Claimant Name: State Of Florida - Edp Loss Description: Apartment burglarized and laptop was stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040516010646 000021

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

01/15/2016 Jacksonville, FL

02/18/2016 02/29/2016

$0 $0

$219 $0 $0

$219 $0

$219 Claimant Name: Cheryl Cox Loss Description: Insd discovered vehicle was broken into and laptop was stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047516010740 000022

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

07/22/2015 Tampa, FL

03/10/2016 08/10/2016

$0 $0

$19,500 $0 $0

$19,500 $0

$19,500 Claimant Name: State of Florida - EDP Loss Description: Circuit board driving the high speed camera was damaged when it was moved to a new PC. That caused a separation of some components from the board.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040516031294 000023

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

05/18/2016 Kissimmee, FL

05/23/2016 05/24/2016

$0 $0

$266 $0 $0

$266 $0

$266 Claimant Name: State of Florida - EDP Loss Description: State of Florida reported stolen equipment.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040516032632 000024

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

05/09/2016 Ocoee, FL

05/31/2016 06/01/2016

$0 $0

$765 $0 $0

$765 $0

$765 Claimant Name: State of Florida Edp Loss Description: The insured reported that one of their tablets was stolen out of an employees home.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047516027129 000026

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

12/18/2015 Tallahassee, FL

06/22/2016 09/28/2016

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State of Flordia EDP Loss Description: Laptop belonging to FAMU stolen from employee home.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040516039589 000027

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

05/04/2016 Miami, FL

06/29/2016 06/29/2016

$0 $0

$148 $0 $0

$148 $0

$148 Claimant Name: State Of Florida - EDP Loss Description: Dell Latitude E5440 stolen from employee's veh.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047516028357 000028

06/05/2015 - 06/05/2016

INLAND MAR

Closed Coml Inland Marine

04/26/2016 Atlanta, GA

06/29/2016 07/01/2016

$0 $0

$96 $0 $0

$96 $0

$96 Claimant Name: State of Florida Loss Description: Stolen Dell Latitude E5450 Serial # 4PYS162 Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040516037013 000025

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

06/15/2016 Tallahassee, FL

06/17/2016 06/20/2016

$0 $0

$276 $0 $0

$276 $0

$276 Claimant Name: State Of Florida - EDP Loss Description: The insured reported that a Dell Latituled E5430 was stolen from the trunk of a vehicle.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040516048788 000030

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

08/08/2016 Tallahassee, FL

08/10/2016 08/30/2016

$0 $0

$508 $0 $0

$508 $0

$508 Claimant Name: State Of Florida EDP Loss Description: Microsoft Surface 4 with a specialized cover fell off of van and ran over by another van.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040516056235 000031

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

07/23/2016 Miami, FL

09/13/2016 09/15/2016

$0 $0

$288 $0 $0

$288 $0

$288 Claimant Name: State Of Florida - EDP Loss Description: A Dell Lattitude E5420 was stolen out of the trunk of an employees car. See attached for supporting documents.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047516050249 000032

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

10/04/2016 Orlando, FL

11/04/2016 11/11/2016

$0 $0

$3,469 $0 $0

$3,469 $0

$3,469 Claimant Name: State of Florida Loss Description: State of Florida reported that the AC evaporator on the HVAC unit above office 202H at the Center for Emerging Media, froze due to a system failure and leaked into the below office 202H onto a professor's computer.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

047516057699 000033

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

12/29/2016 Fort Lauderdale, FL

12/30/2016 01/04/2017

$0 $0

$247 $0 $0

$247 $0

$247 Claimant Name: State of Florida Loss Description: Stolen Dell Laptop E5430.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040517002259 000034

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

11/28/2016 Miami, FL

01/12/2017 01/24/2017

$0 $0

$307 $0 $0

$307 $0

$307 Claimant Name: State Of Florida - EDP Loss Description: Stolen HP notebook.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040517006665 000035

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

12/22/2016 Tallahassee, FL

02/02/2017 02/06/2017

$0 $0

$1,441 $0 $0

$1,441 $0

$1,441 Claimant Name: State of Florida - EDP Loss Description: Theft of property of insd.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047517005135 000036

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

01/22/2017 Brooksville, FL

02/03/2017 02/06/2017

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State Of Florida Loss Description: Fire damage to ProBrook 430 G2 HP - Employee's vehicle caught fire and damaged the laptop.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040517012690 000039

06/05/2016 - 06/05/2017

INLAND MAR

Closed - RO Coml Inland Marine

02/21/2017 Tampa, FL

03/03/2017 03/22/2017

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State of Florida - EDP Loss Description: Loss of 5 MacBook Pro 15 Retina laptops. Serial numbers are: C02PHCFPG3QC, C02PHJP8G3QC, C02PHK1WG3QC, C02QM25QG8WN, C02QM25YG8WN. Unit price was $1,899.00 each.Laptops were noticed missing on 2/21/2017 after performing a routine inventory. Previous inventory was on 1/27/2017. They were kept in a locked storage cabinet. The police were promptly notified, and a report was filed for a burglary. "

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047517013676 000040

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

03/24/2017 Orlando, FL

03/30/2017 04/03/2017

$0 $0

$1,027 $0 $0

$1,027 $0

$1,027 Claimant Name: State Of Florida - EDP Loss Description: Power surge damaged uninterruptible power supply (UPS) which is required to protect the IT network switch.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047517013688 000041

06/05/2016 - 06/05/2017

INLAND MAR

Closed - RO Coml Inland Marine

03/15/2017 Miami, FL

03/30/2017 04/06/2017

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State Of Florida - EDP Loss Description: Laptop (Dell Latitude E6430-property number 10133) owned by Miami Dade County was accidently dropped by insured employee that is assigned to their county court personnel in courtroom. The cover's hinge broke and the warranty does not cover this type of damage.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040517030521 000042

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

05/03/2017 Hialeah, FL

05/25/2017 05/26/2017

$0 $0

$581 $0 $0

$581 $0

$581 Claimant Name: State of Florida - EDP Loss Description: Laptop was taken from Employee's personal vehicle. Dell Latitude E5470; Serial # H729BG2 Writing Company: FEDERAL INSURANCE COMPANY 06696877 040517032691 000043

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

05/10/2017 Tampa, FL

06/06/2017 06/06/2017

$0 $0

$184 $0 $0

$184 $0

$184 Claimant Name: State of Florida EDP/Florida Department of Transportation Loss Description: Laptop was placed on the top of the vehicle while loading the car with safety gears and driver drove away without remembering the laptop on top of the vehicle.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047517025791 000044

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

03/03/2017 Orlando, FL

06/13/2017 07/27/2017

$0 $0

$969 $0 $0

$969 $0

$969 Claimant Name: State Of Florida - EDP Loss Description: A laptop from the College Of Health And Public Affairs has either been lost or stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040517034397 000045

06/05/2016 - 06/05/2017

INLAND MAR

Closed Coml Inland Marine

04/12/2017 Miami, FL

06/14/2017 06/22/2017

$0 $0

$148 $0 $0

$148 $0

$148 Claimant Name: State of Florida - EDP Loss Description: Property stolen from an employee vehicle.. Dell Latitude E5470; Serial # 1B5YN72. See attached docs.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040517042722 000046

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

06/15/2017 Orlando, FL

07/20/2017 07/21/2017

$0 $0

$949 $0 $0

$949 $0

$949 Claimant Name: State of Florida - EDP Loss Description: Theft of insured laptop that was stolen from a vehicle. Lenovo Thinkpad X1 Yoga Ist Laptop - Serial # SR90L6JA8. See attached docs.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047517034855 000047

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

07/02/2017 Wesley Chapel, FL

08/10/2017 08/10/2017

$0 $0

$515 $0 $0

$515 $0

$515 Claimant Name: State of Florida - EDP Loss Description: The Insured had a laptop stolen from veh.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047517035016 000048

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

06/26/2017 North Miami Beach, FL

08/10/2017 08/11/2017

$0 $0

$501 $0 $0

$501 $0

$501 Claimant Name: State Of Florida - EDP Loss Description: Property stolen from employee vehicle. Dell Latitude E5470 Serial #DN73XF2.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040517054091 000049

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

08/14/2017

TALLAHASSEE, FL

09/01/2017 10/18/2017

$0 $0

$21,686 $0 $0

$21,686 $0

$21,686 Claimant Name: State of Florida - EDP Loss Description: Several relays for the control panel failed which caused the humidity in the lab to increase and damage the EBPG System equipment.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040517064638 000050

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

09/30/2017 Tallahassee, FL

10/09/2017 10/12/2017

$0 $0

$1,600 $0 $0

$1,600 $0

$1,600 Claimant Name: State of Florida - EDP Loss Description: Insured reported laptop and tablet were stolen from vehicle while he was in hotel. Estimated value of stolen items is $2000.00 Police Report is coming.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040518006053 000051

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

11/01/2017 Tampa, FL

01/26/2018 07/31/2018

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State of Florida - EDP Loss Description: Two USF employees were stealing wireless access points around campus and selling them.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040518010088 000052

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

01/22/2018 Orlando, FL

02/13/2018 04/30/2018

$0 $0

$42,976 $0

$-26,176

$42,976 $0

$16,801 Claimant Name: State of Florida - EDP Loss Description: Water leak above room 0504 caused damage to the IT equipment in the room.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040518016158 000053

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

03/08/2018 Unknown, FL

03/14/2018 04/25/2018

$0 $0

$754 $41 $0

$795 $0

$795 Claimant Name: State of Florida - EDP Loss Description: Insured laptop stolen. Tag#015484// Dell Latitude E7250.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

092018004948 000054

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

01/30/2018 Orlando, FL

03/24/2018 04/12/2018

$0 $0

$602 $0 $0

$602 $0

$602 Claimant Name: State of Florida - EDP Loss Description: During a routine generator test the UPS maintained power for 15 to 20 minutes. During the switchback to mainline power the UPS suffered damage causing component damage (burn out).

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040518022660 000055

06/05/2017 - 06/05/2018

INLAND MAR

Closed Coml Inland Marine

02/04/2018 Orlando, FL

04/13/2018 05/07/2018

$0 $0

$180 $0 $0

$180 $0

$180 Claimant Name: State Of Florida - Edp Loss Description: Insured reported that laptop fell from counter and broke.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040518053941 000056

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

08/20/2018 Orlando, FL

09/07/2018 09/11/2018

$0 $0

$382 $0 $0

$382 $0

$382 Claimant Name: STATE OF FLORIDA DEPARTMENT OF MANAGEMENT SERVICES Loss Description: Insured reported employee car was stolen with DCF Laptop in it. Laptop was a Dell Lattude 7480.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092018015942 000057

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

07/21/2018 Miami, FL

09/15/2018 09/18/2018

$0 $0

$832 $0 $0

$832 $0

$832 Claimant Name: State of Florida - EDP Loss Description: Insured's tablet and other items were stolen from his vehicle, which was parked in the hotels parking garage.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040518059495 000058

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

09/04/2018 Tallahassee, FL

10/04/2018 10/05/2018

$0 $0

$382 $0 $0

$382 $0

$382 Claimant Name: State of Florida Loss Description: Employee was in a car wreck and the laptop was damage during this wreck.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040518064212 000059

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

08/28/2018 Miami Beach, FL

10/25/2018 10/30/2018

$0 $0

$569 $41 $0

$610 $0

$610 Claimant Name: State of Florida Loss Description: Electronics valued at $1,122.07 was stolen from the insured. Contact insured for details on the item.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040518071276 000060

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

08/28/2018 Not Provided, FL

11/30/2018 12/04/2018

$0 $0

$445 $0 $0

$445 $0

$445 Claimant Name: State of Florida Loss Description: North Florida State Hospital; Bldg 31, Living area reported that laptop was thrown to the floor by resident. Laptop was damaged beyond repair.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092018021007 000061

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

12/04/2018

TALLAHASSEE, FL

12/27/2018 12/28/2018

$0 $0

$450 $0 $0

$450 $0

$450 Claimant Name: State of Florida Loss Description: Insured's laptop was stolen from the Department of Children and Families.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040519005616 000062

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

12/19/2018 Unknown, FL

01/31/2019 05/06/2019

$0 $0

$1,081 $45 $0

$1,126 $0

$1,126 Claimant Name: State of Florida Loss Description: Equipment was damaged when a worker stretched cables damaging the circuits inside equipment. This piece of equipment was not a total loss but damaged the inside when cables were stretched.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047519021548 000063

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

05/30/2019 West Palm Beach, FL

06/27/2019 08/01/2019

$0 $0

$447 $12 $0

$459 $0

$459 Claimant Name: State Of Florida Loss Description: Employees vehicle was burglarized resluting in the insureds HP Elite X2 computer being stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047519024818 000065

06/05/2018 - 06/05/2019

INLAND MAR

Closed Coml Inland Marine

05/26/2019 Winter Haven, FL

07/24/2019 07/25/2019

$0 $0

$350 $12 $0

$362 $0

$362 Claimant Name: State of Florida Loss Description: Employee returned home from being out of town and when she approached her door and walked in she found that her house was broken into and discovered her work laptop was missing among other items.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

092019018227 000064

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

07/14/2019 Orlando, FL

07/20/2019 07/30/2019

$0 $0

$19,438 $112

$0

$19,550 $0

$19,549 Claimant Name: State of Florida - EDP Loss Description: Insured's computer equipment was stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040519036805 000066

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

07/12/2019

TALLAHASSEE, FL

07/26/2019 08/13/2019

$0 $0

$833 $57 $0

$890 $0

$890 Claimant Name: State Of Florida - EDP Loss Description: Armando A. Luis, employee, reported that belongings were stolen from inside of vehicle. SAO work laptop # 5480, S/A 28VJBH2 with power cord was stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040519042579 000067

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

08/12/2019 Miami, FL

08/24/2019 08/28/2019

$0 $0

$9,252 $42 $0

$9,294 $0

$9,294 Claimant Name: State of Florida Loss Description: Theft of 6 laptop computers (Dell, Latitude 7390 2 in1 Laptops) from our office space.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092019023805 000068

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

08/08/2019

TALLAHASSEE, FL

09/13/2019 10/15/2019

$0 $0

$500 $0 $0

$500 $0

$500 Claimant Name: State of Florida Loss Description: An employee left their laptop in a hot car which caused the screen to crack and the device is now unusable.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

092019027560 000069

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

07/30/2019 Unknown, FL

10/24/2019 10/29/2019

$0 $0

$2,174 $0 $0

$2,174 $0

$2,174 Claimant Name: State of Florida Loss Description: An employee reported that the insured's MacBook Pro was lost on a connecting flight in Europe.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047520012786 000070

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

03/01/2020

TALLAHASSEE, FL

06/11/2020 09/02/2020

$0 $0

$8,485 $41 $0

$8,526 $0

$8,526 Claimant Name: State of Florida Loss Description: ThorLabs NIR Galvo-Resonant Scanner/Controller imaging system (microscope attachment). Plugged into outlet and received a high load from the power surge. Item was sent to the manufacturer for diagnostic and has been determined to be non-repairable.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047520018944 000071

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

05/27/2020 Miami, FL

08/15/2020 09/15/2020

$0 $0

$739 $0 $0

$739 $0

$739 Claimant Name: State of Flordia Loss Description: Insured reported stolen Dell Latitude E5490 stolen. Antonio Wilson's home was broken into and laptop was stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092020018819 000072

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

02/17/2020 Jacksonville, FL

08/19/2020 10/07/2020

$0 $0

$8,457 $45 $0

$8,502 $0

$8,502 Claimant Name: State of Florida - EDP Loss Description: Theft of photographic equipment from UNF.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

047521001122 000076

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

02/10/2020 Miami, FL

01/16/2021 02/23/2022

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State of Florida Loss Description: Commercial burglary of 6 laptops. - Nick Battaglia Writing Company: FEDERAL INSURANCE COMPANY 06696877 047521001476 000077

06/05/2019 - 06/05/2020

INLAND MAR

Closed Coml Inland Marine

02/10/2020 Miami, FL

01/22/2021 01/29/2021

$0 $0

$5,696 $0 $0

$5,696 $0

$5,696 Claimant Name: State of Florida Loss Description: The department of elder affairs was broken into and several laptops were stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092020020053 000073

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

08/25/2020

TALLAHASSEE, FL

09/02/2020 04/14/2021

$0 $0

$18,898 $11,446

$0

$30,344 $0

$30,344 Claimant Name: State of Florida Loss Description: 2 of the spectrometers' turbo pumps failed due to a power failure in the building.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040520042009 000074

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

09/02/2020 Sarasota, FL

10/29/2020 11/03/2020

$0 $0

$9,448 $0 $0

$9,448 $0

$9,448 Claimant Name: State of Florida Loss Description: Insured reported that pipe above machine was leaking causing damage to printer beyond repair.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

047520025821 000075

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

09/21/2020 Tallahassee, FL

10/31/2020 11/06/2020

$0 $0

$4,279 $0 $0

$4,279 $0

$4,279 Claimant Name: State of Florida Loss Description: Insured reported break in and several computers were stolen.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092021001578 000078

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

09/28/2020 Orlando, FL

01/29/2021 02/01/2021

$0 $0

$618 $0 $0

$618 $0

$618 Claimant Name: State of Florida Loss Description: While servicing the laptop, the battery began smoking. Microsoft Surface Pro 3 burned hardware resulting in a complete loss Writing Company: FEDERAL INSURANCE COMPANY 06696877 092021003101 000079

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

02/08/2021 San Francisco, CA

02/19/2021 02/27/2021

$0 $0

$573 $0 $0

$573 $0

$573 Claimant Name: State of Florida Loss Description: State issued HP Elite Tablet & additional items were stolen from employee, Craig Prough's rental vehicle after a window was smashed while parked at a restaurant in San Francisco.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 047521006590 000080

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

02/17/2021 Oakland, CA

03/21/2021 05/12/2021

$0 $0

$408 $0 $0

$408 $0

$408 Claimant Name: State of Florida Loss Description: During out of state travel, Laptop stolen from rental vehicle.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040521011599 000081

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

02/01/2021 Oakland, CA

03/31/2021 05/03/2021

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State of Florida /Justice Administrative Commission Loss Description: During an out of state travel, the employee made a stop on the way to the airport, leaving the laptop in the truck of the locked rental car. The car was broken into, the laptop was stolen from rental vehicle.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040521037367 000085

06/05/2020 - 06/05/2021

INLAND MAR

Closed Coml Inland Marine

05/14/2021 Tallahassee, FL

10/07/2021 10/19/2021

$0 $0

$3,820 $0 $0

$3,820 $0

$3,820 Claimant Name: State Of Florida - EDP Loss Description: Pieces of roof and other building debris, as well as water, fell onto and damaged computers at the insured property.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092021018381 000083

06/05/2021 - 06/05/2022

INLAND MAR

Closed Coml Inland Marine

08/27/2021 Unknown, CA

09/24/2021 10/25/2021

$0 $0

$949 $0 $0

$949 $0

$949 Claimant Name: State of Florida-EDP Loss Description: (Please update the insured name to Office of Legislative Services: The Florida Senate District 24. This is a different Senate District #24 and the claim is a different date of loss 08-27-2021- this claim occurred in California.) Car broken into and laptop stolen.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040521035854 000084

06/05/2021 - 06/05/2022

INLAND MAR

Closed Coml Inland Marine

08/22/2021 Miami, FL

09/25/2021 10/06/2021

$0 $0

$949 $0 $0

$949 $0

$949 Claimant Name: State of Florida-EDP Loss Description: Please ensure that the named insured is updated to: Office of Legislative Services ; The Florida Senate District 38). - Car broken into and insured's laptop stolen Writing Company: FEDERAL INSURANCE COMPANY 06696877 040521040343 000086

06/05/2021 - 06/05/2022

INLAND MAR

Closed Coml Inland Marine

10/16/2021

TALLAHASSEE, FL

11/01/2021 11/15/2021

$0 $0

$450 $0 $0

$450 $0

$450 Claimant Name: State of Florida- EDP Loss Description: Lenovo ThinkPad E15 was allegedly stolen from rear floor of vehicle. Pls see attached incident report and other documentation Writing Company: FEDERAL INSURANCE COMPANY 06696877 040521044392 000087

06/05/2021 - 06/05/2022

INLAND MAR

Closed Coml Inland Marine

08/20/2021 Unkown, FL

12/09/2021 01/14/2022

$0 $0

$340 $45 $0

$385 $0

$385 Claimant Name: State of Florida - EDP Loss Description: Insured reported that her backseat window was smashed and her laptop was taken. Dell Latitude 5480 Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040522012170 000088

06/05/2021 - 06/05/2022

INLAND MAR

Closed Coml Inland Marine

04/05/2022 Crawfordville, FL

04/08/2022 04/26/2022

$0 $0

$0 $0 $0

$0 $0 $0

Claimant Name: State of Florida-EDP Loss Description: Laptop fell out of backpack and landed on its edge. No external damage, the screen has visible damage in the upper left corner, when the laptop is powered on.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040522023973 000089

06/05/2022 - 06/05/2023

INLAND MAR

Closed Coml Inland Marine

06/27/2022 Crawfordville, FL

07/01/2022 07/08/2022

$0 $0

$388 $0 $0

$388 $0

$388 Claimant Name: State of Florida-Dept. Justice Administration Commission Loss Description: Coffee Spill damaged laptop motherboard, the computer is inoperable.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 092022030615 000090

06/05/2022 - 06/05/2023

INLAND MAR

Closed Coml Inland Marine

08/03/2022 Unknown, FL

09/23/2022 11/21/2022

$0 $0

$38,808 $0 $0

$38,808 $0

$38,808 Claimant Name: State of Florida Loss Description: Sensor damaged caused by hard impact with ground following drone motor failure.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040522040399 000091

06/05/2022 - 06/05/2023

INLAND MAR

Closed Coml Inland Marine

10/24/2022 Miami, FL

11/09/2022 11/16/2022

$0 $0

$1,190 $0 $0

$1,190 $0

$1,190 Claimant Name: State of Florida Loss Description: Stolen BTX Base Laptop Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

092023000841 000092

06/05/2022 - 06/05/2023

INLAND MAR

Closed Coml Inland Marine

01/04/2023 Tallahassee, FL

01/09/2023 01/13/2023

$0 $0

$382 $0 $0

$382 $0

$382 Claimant Name: State Of Florida Loss Description: Stolen property - Laptop Writing Company: FEDERAL INSURANCE COMPANY 06696877 040523009374 000093

06/05/2022 - 06/05/2023

INLAND MAR

Closed Coml Inland Marine

01/13/2023 Neptune Beach, FL

03/03/2023 03/17/2023

$0 $0

$1,417 $0 $0

$1,417 $0

$1,417 Claimant Name: FL House of Representatives - HD 15 Rep.

Loss Description: Laptop & backpack case stolen from car.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040523011530 000094

06/05/2022 - 06/05/2023

INLAND MAR

Closed Coml Inland Marine

01/05/2023 Orlando, FL

03/17/2023 03/29/2023

$0 $0

$1,021 $0 $0

$1,021 $0

$1,021 Claimant Name: State of Florida / Department of Children & Family Loss Description: Insured property was stolen - DELL Latitude 5300.

Writing Company: FEDERAL INSURANCE COMPANY 06696877 040523012265 000095

06/05/2022 - 06/05/2023

INLAND MAR

Closed Coml Inland Marine

03/19/2023 Unspecified, FL

03/22/2023 04/05/2023

$0 $0

$1,192 $46 $0

$1,238 $0

$1,238 Claimant Name: State Of Florida Loss Description: Stolen Laptop from Vehicle (DELL Latitude 5330 Serial No. 8NXG7S3.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

040523028736 000096

06/05/2023 - 06/05/2024

INLAND MAR

Closed Coml Inland Marine

06/22/2023 Tallahassee, FL

07/11/2023 08/09/2023

$0 $0

$16,626 $0 $0

$16,626 $0

$16,626 Claimant Name: University of Central Florida - EDP Loss Description: Lightning strike to UL00081 Graz Tracking Mount Writing Company: FEDERAL INSURANCE COMPANY 06696877 092024027140 000097

06/05/2023 - 06/05/2024

INLAND MAR

Closed Coml Inland Marine

04/25/2024 Atlanta, GA

04/29/2024 05/24/2024

$0 $0

$1,000 $0 $0

$1,000 $0

$1,000 Claimant Name: State of Florida Loss Description: Insured's laptop was stolen Writing Company: FEDERAL INSURANCE COMPANY 06696877 092024075321 000098

06/05/2024 - 06/05/2025

INLAND MAR

Closed Coml Inland Marine

09/16/2024 Destin, FL

10/09/2024 11/05/2024

$0 $0

$6,047 $0 $0

$6,047 $0

$6,047 Claimant Name: State of Florida Loss Description: Insureds equipment damaged when it fell during unpacking due to a carrying strap that detached.

Writing Company: FEDERAL INSURANCE COMPANY

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 03/13/2025 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 10

Loss Run Detail:

Policy # Claim Reference # Claim/Occurrence # Claimant #

Policy Term Policy Type

Claim Status Claim Type

Loss Date Loss Location

Reported Date Close Date

Loss Reserve Expense Reserve

Losses Paid Expenses Paid Recovery

Losses and Expenses Paid Deductible Amount Total Incurred

- IMPORTANT NOTICE -

THE INFORMATION CONTAINED HEREIN IS PROVIDED “AS IS” AND HAS NOT BEEN AUDITED OR REVIEWED. WE MAKE NO REPRESENTATION AS TO THE ACCURACY OF THIS INFORMATION. THIS INFORMATION IS NOT INTENDED TO AND SHOULD NOT BE RELIED ON TO COMPLY WITH ANY STATUTE, REGULATION OR OTHER LEGAL OR REGULATORY REQUIREMENT. WE RESERVE THE

RIGHT IN OUR DISCRETION TO WITHHOLD SPECIFIC LOSS INFORMATION.

THE WORKERS COMPENSATION CLAIMS SHOWN ON THIS LOSS RUN DO NOT INCLUDE CLAIMS IN THE FOLLOWING STATES: ALASKA, HAWAII, IDAHO, MAINE, MONTANA, NEVADA, NEW MEXICO, AND OREGON. IF YOU ARE A CHUBB INSURANCE AGENT, PLEASE CONTACT YOUR UNDERWRITER FOR LOSS INFORMATION IN THESE STATES. IF YOU ARE A CHUBB INSURED, PLEASE CONTACT YOUR

INSURANCE AGENT FOR GUIDANCE ON GETTING LOSS INFORMATION IN THESE STATES.

BY RECEIVING THIS INFORMATION, RECIPIENT ACKNOWLEDGES AND AGREES THAT: 1.) WE ARE PROVIDING THIS INFORMATION BASED ON RECIPIENT'S EXPRESS REPRESENTATION THAT RECIPIENT IS REQUESTING SUCH INFORMATION ON BEHALF OF AND/OR WITH THE CONSENT OF RECIPIENT'S CUSTOMER; 2.) RECIPIENT WILL USE THIS INFORMATION ONLY FOR ITS OWN INTERNAL PURPOSES OR FOR SUCH PURPOSES AUTHORIZED BY RECIPIENT'S CUSTOMER; 3.) SUCH INFORMATION IS CONFIDENTIAL AND PROPRIETARY AND MAY BE SUBJECT TO PRIVACY LAWS, REGULATIONS OR OTHER LEGAL REQUIREMENT; 4.) RECIPIENT AGREES TO

PROTECT AND SAFEGUARD THE INFORMATION FROM UNAUTHORIZED USE OR DISCLOSURE.

RHODE ISLAND INSUREDS: IN ACCORDANCE WITH SECTION 27-29-17.5 OF CHAPTER 27-29 OF THE GENERAL LAWS OF RHODE ISLAND, ADDITIONAL INFORMATION ON LOSS RESERVES MAY BE AVAILABLE UPON REQUEST OF THE FIRST NAMED INSURED OR SUCH

INSURED'S AUTHORIZED AGENT OR BROKER.

FOR QUESTIONS REGARDING THE CONTENT OF THIS CHUBB LOSS RUN REPORT, PLEASE CONTACT YOUR CHUBB OFFICE.

Loss Run Header Section:

Agency Name - The name of the current agent or broker associated with the policy.

Current as of Date - This is the date for which the data is valid.

Insured Name - The named insured as stated on the policy of insurance.

Number of Loss Years Requested – This is the 3, 5, 7 or 10 year historical range with the timeframe determined by the most recent policy effective date listed.

Policy Summary:

Policy Number - The number which uniquely identifies a policy for an insured.

Policy Term - The Effective and Expiration Dates for the Policy Term.

Policy Type - The type of policy issued by the company.

Number of Claims/Occurrences - The number of Claims/Occurrences for each Policy Number, Term and Type.

Loss and Expense Reserves - The sum of the outstanding Loss and Expense Reserves for each Policy Number, Term and Type. “*” will be displayed for open Specialty claims only.

Losses Paid - The indemnity paid for each Policy Number, Term and Type. This excludes the Net Salvage/Subrogation and reimbursable deductible amounts actually received.

Expenses Paid - The sum of the defense and LAE expenses paid for each Policy Number, Term and Type. This excludes the Net Salvage/Subrogation and reimbursable deductible amounts actually received.

Losses and Expenses Paid - The sum of Losses Paid and Expenses Paid for each Policy Number, Term and Type. This excludes the Net

Salvage/Subrogation and reimbursable deductible amounts actually received.

Recovery - The sum of the Salvage/Subrogation Recovery including expenses paid or payments received for each Policy Number, Term and Type. A positive figure indicates that recovery expenses exceeded receipts.

Total Incurred - The sum of the Loss and Expense Reserves and Losses and Expenses Paid including Recovery for each Policy Number, Term and

Type. “*” will be displayed for open Specialty claims only.

Totals:

Number of Claims/Occurrences - The number of Claims/Occurrences for all Policy Numbers, Terms and Types in the Summary Section.

Loss and Expense Reserves - The sum of the outstanding Loss and Expense Reserves for all of the Policy Numbers, Terms and Types in the

BUSINESS LOSS RUN

Summary Section. This does not include Specialty claims.

Losses Paid - The sum of Losses Paid for all of the Policy Numbers, Terms and Types in the Summary Section. This excludes the Net

Salvage/Subrogation and reimbursable deductible amounts actually received.

Expenses Paid - The sum of Expenses Paid for all of the Policy Numbers, Terms and Types in the Summary Section. This excludes the Net

Salvage/Subrogation and reimbursable deductible amounts actually received.

Losses and Expenses Paid - The sum of Losses Paid and Expenses Paid for all of the Policy Numbers, Terms and Types in the Summary Section.

This excludes the Net Salvage/Subrogation and reimbursable deductible amounts actually received.

Recovery - The sum of the Salvage/Subrogation Recovery including expenses paid or payments received for all of the Policy Numbers, Term and

Types in the Summary Section. A positive figure indicates that recovery expenses exceeded receipts.

Total Incurred - The sum of the Loss and Expense Reserves and Losses and Expenses Paid including Recovery for all the Policy Numbers, Term and Types in the Summary Section. “*” will be displayed for open Specialty claims only.

* – In the Loss and Expense Reserves column: This information is not disclosed.

TPA - Denotes claims/occurrences processed by a third party administrator (TPA). Can reflect full or partial term TPA. Actual numbers do not include claims/occurrences processed by TPA's.

Loss Run Details:

Policy # - The number which uniquely identifies a policy for an insured.

Claim Reference # - A unique identifier for a Chubb claim.

Claim/Occurrence # - The unique number for an occurrence of claim associated with a policy. This is used in conjunction with the policy number to identify a claim. It is sequential within a policy number.

Claimant # - The unique number associated with Claimant Name.

Policy Term - The Effective and Expiration Dates for the Policy Term.

Policy Type - The type of policy issued by the company.

Claim Status - The status of a claim as of the Current as of Date. An 'RO' next to the status indicates a Report Only Claim.

Claim Type - The type(s) of loss associated with a coverage on a claim.

Loss Location - The City and State where the loss occurred.

Loss Date - The date on which the loss occurred.

Reported Date - The date on which the loss was reported.

Close Date - The date the claim was closed.

Loss Reserve - The sum of the outstanding Loss Reserve for the Claim/Occurrence in the Detail Section. “*” will be displayed for open Specialty claims only.

Expense Reserve - The sum of the outstanding Expense Reserve for the Claim/Occurrence in the Detail Section. “*” will be displayed for open Specialty claims only.

Losses Paid – The indemnity paid for the Claim/Occurrence in the Detail Section. This excludes the Net Salvage/Subrogation and reimbursable deductible amounts actually received.

Expenses Paid - The sum of the defense and LAE expenses paid for the Claim/Occurrence in the Detail Section. This excludes the Net

Salvage/Subrogation and reimbursable deductible amounts actually received.

Losses and Expenses Paid – The sum of Losses and Expenses Paid for the Claim/Occurrence in the Detail Section. This excludes the Net

Salvage/Subrogation and reimbursable deductible amounts actually received.

Recovery - The sum of the Salvage/Subrogation Recovery including expenses paid or payments received for the Claim/Occurrence in the Detail

Section. A positive figure indicates that recovery expenses exceeded receipts.

Total Incurred - The sum of the Loss and Expense Reserves and Losses and Expenses Paid including Recovery for the Claim/Occurrence in the Detail

Section. “*” will be displayed for open Specialty claims only.

Claimant Name - The name(s) of the claimant associated with the Claim/Occurrence.

Deductible Amount – Actual deductible recovery, if any, applied to the Claim/Occurrence.

Loss Description - A synopsis of the loss as entered by the claim examiner.

* – In the Loss and Expense Reserve column: This information is not disclosed.

All dollar amounts displayed represent US dollars.