EDP 23-84131512-ITB Attachment J Loss Experience Report P2.pdf

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 3 $0 $40,385 $0 $40,385 $0 $40,385

Totals: 35 $0 $141,630 $11,897 $153,527 $0 $153,528

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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 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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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 06696877 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

BUSINESS LOSS RUN

Agency Name: ONE80 INTERMEDIARIES INC Current As of Date: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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

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: 01/11/2023 Insured Name: STATE OF FLORIDA Number of Loss Years Requested: 5

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.

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.