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Home My WebLink About11-5824IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION - LAW THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA, Plaintiff, No. I[- W- V Zvi l 'Nt c ' zM c ` r C7 x> c-, 3 • z? tp cn NOTICE rn ;:OCD CQ C) h M. - d v. AIRCRAFT MANAGEMENT SERVICES INC., Defendant You have been sued in court. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this complaint and notice are served, by entering a written appearance personally or by attorney and filing in writing with the court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the court without further notice for any money claimed in the complaint or for any other claims or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. CUMBERLAND COUNTY BAR ASSOCIATION 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 1-800-990-9108 717-249-3166 FITZPATRICK LENTZ & BUBBA, P.C. BY: Barbara S. Zi6herman ID #207348 4001 Schoolhouse Lane, P.O. Box 219 Center Valley, PA 18034-0219 (610) 797-9000 Attorneys for Plaintiff 94C 00 Pp 14117 at lo! aa7 of dwX77 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL DIVISION - LAW THE INSURANCE COMPANY OF THE No. STATE OF PENNSYLVANIA, Plaintiff, V. ; AIRCRAFT MANAGEMENT SERVICES INC., Defendant COMPLAINT Plaintiff, The Insurance Company of the State of Pennsylvania, by its attorneys, Fitzpatrick Lentz & Bubba, P.C., files the within Complaint against the Defendant, Aircraft Management Services, Inc., and, in support thereof, avers as follows: 1. Plaintiff, The Insurance Company of the State of Pennsylvania, is a Pennsylvania corporation with an office address of 175 Water Street, 18`h Floor, New York, New York, 10038, and is engaged in the underwriting and sale of workers compensation policies in the state of Pennsylvania. 2. Defendant, Aircraft Management Services, Inc. is, upon information and belief, a Pennsylvania corporation, with a business address of 228 Airport Road, Hangar 7, New Cumberland, Pennsylvania, 17070. COUNTI 3. Plaintiff incorporates by reference the averments contained in Paragraphs 1 and 2 as if fully set forth herein. 4. The Insurance Company of the State of Pennsylvania issued a workers compensation and employers liability insurance policy for the period March 15, 2008 through March 15, 2009 to Aircraft Management Services, Inc. pursuant to a policy of insurance (Policy No. 121-16-71) (the "2008/2009 Policy"). A true and correct copy of the 2008/2009 Policy and endorsements thereto is attached hereto as Exhibit "A," and is incorporated herein by reference. 5. At all times relevant hereto, and in accordance with the terms of the 2008/2009 Policy, Aircraft Management Services, Inc. agreed to be responsible for the premium due under the 2008/2009 Policy and to pay timely the amount due. 6. Further, the 2008/2009 Policy provides that the final premium will be determined after the 2008/2009 Policy ends by using the actual, not estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by the 2008/2009 Policy. 7. In order to determine the final premium, Aircraft Management Services, Inc. contractually bound itself to allow The Insurance Company of the State of Pennsylvania to examine and audit its records that relate to the 2008/2009 Policy. 8. In accordance with the 2008/2009 Policy, The Insurance Company of the State of Pennsylvania conducted an audit of Aircraft Management Services, Inc.'s records relating to the policy. A true and correct copy of the audit worksheets are attached hereto as Exhibit "B," and are incorporated herein by reference. 9. At the conclusion of the audit, Aircraft Management Services, Inc.'s office manager, Melanie Green, signed the "Insured's Verification of Audit Performance" which confirmed that the auditor reviewed the records necessary to complete an audit of the policy, that the audit was reviewed with Ms. Green, and that Ms. Green fully understood what records were used and how the exposures were derived. See Exhibit B at 12. 10. Based on the audit, The Insurance Company of the State of Pennsylvania calculated the total final premium for the 2008/2009 Policy to be $20,916. A true and correct copy of the Audit Advice and Audit Advice Summary setting forth the basis of the final premium for the 2008/2009 Policy is attached hereto as Exhibit "C." 11. The Insurance Company of the State of Pennsylvania then deducted $19,166 in premium payments made by Aircraft Management Services, Inc. towards the 2008/2009 Policy to determine that there is a remaining balance of $1,750 due and owing under the 2008/2009 Policy. A true and correct copy of a Statement of Account is attached hereto as Exhibit "D" and is incorporated herein by reference. 12. At all times, The Insurance Company of the State of Pennsylvania fully performed all of its obligations under the 2008/2009 Policy. 13. Despite repeated demands for payment, Aircraft Management Services, Inc. has failed and refused, and continues to fail and refuse, to pay the outstanding balance due under the 2008/2009 Policy in the amount of $1,750. See, e.g., 4/19/2011 letter to Aircraft Management Services, Inc. attached hereto as Exhibit "E." WHEREFORE, Plaintiff, The Insurance Company of the State of Pennsylvania, demands judgment in its favor and against Defendant, Aircraft Management Services, Inc., in the amount of $1,750.00, together with prejudgment interest from May 3, 2011 and its costs of suit. COUNT II 14. Plaintiff incorporates by reference the averments contained in Paragraphs 1 through 13 as if fully set forth herein. 15. The Insurance Company of the State of Pennsylvania issued a workers compensation and employers liability insurance policy for the period March 15, 2009 through March 15, 2010 to Aircraft Management Services, Inc. pursuant to a policy of insurance (Policy No. 018-73-6121) (the "2009/2010 Policy"). A true and correct copy of the 2009/2010 Policy and endorsements thereto is attached hereto as Exhibit "F," and is incorporated herein by reference. 16. At all times relevant hereto, and in accordance with the terms of the 2009/2010 Policy, Aircraft Management Services, Inc. agreed to be responsible for the premium due under the 2009/2010 Policy and to pay timely the amount due. 17. Further, the 2009/2010 Policy provides that the final premium will be determined after the 2009/2010 Policy ends by using the actual, not estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by the 2009/2010 Policy. 18. In order to determine the final premium, Aircraft Management Services, Inc. contractually bound itself to allow The Insurance Company of the State of Pennsylvania to examine and audit its records that relate to the 2009/2010 Policy. 19. In accordance with the 2009/2010 Policy, The Insurance Company of the State of Pennsylvania conducted an audit of Aircraft Management Services, Inc.'s records relating to the policy. A true and correct copy of the audit worksheets are attached hereto as Exhibit "G," and are incorporated herein by reference. 20. At the conclusion of the audit, Aircraft Management Services, Inc.'s office manager, Melanie Green, signed the "Insured's Verification of Audit Performance" which confirmed that the auditor reviewed the records necessary to complete an audit of the policy, that the audit was reviewed with Ms. Green, and that Ms. Green fully understood what records were used and how the exposures were derived. See Exhibit G at 12. 21. Based on the audit, The Insurance Company of the State of Pennsylvania calculated the total final premium for the 2009/2010 Policy to be $22,773. A true and correct copy of the Audit Advice and Audit Advice Summary setting forth the basis of the final premium for the 2009/2010 Policy is attached hereto as Exhibit "H." 22. The Insurance Company of the State of Pennsylvania then deducted $13,965 in premium payments made by Aircraft Management Services, Inc. towards the 2009/2010 Policy to determine that there is a remaining balance of $8,808 due and owing under the 2009/2010 Policy. A true and correct copy of a Statement of Account is attached hereto as Exhibit "I" and is incorporated herein by reference. 23. At all times, The Insurance Company of the State of Pennsylvania fully performed all of its obligations under the 2009/2010 Policy. 24. Despite repeated demands for payment, Aircraft Management Services, Inc. has failed and refused, and continues to fail and refuse, to pay the outstanding balance due under the 2009/2010 Policy in the amount of $8,808. See, e.g., Exhibit E. WHEREFORE, Plaintiff, The Insurance Company of the State of Pennsylvania, demands judgment in its favor and against Defendant, Aircraft Management Services, Inc., in the amount of $8,808.00, together with prejudgment interest from May 3, 2011 and its costs of suit, such that the Insurance Company of the State of Pennsylvania demands judgment in its favor and against Defendant, Aircraft Management Services, Inc. in the aggregate amount of $10,558 with applicable prejudgment interest and its costs of suit. FITZPATRICK LENTZ & BUBBA, P.C. Date: July 20, 2011 BY: Barbara S. Zicherman ?- ID #207348 4001 Schoolhouse Lane, P.O. Box 219 Center Valley, PA 18034-0219 (610) 797-9000 Attorneys for Plaintiff VERIFICATION I, Barbara Babich, do hereby verify that I am a Custodian of Records with Chartis U.S. Law Department and am authorized to make this affidavit on behalf of The Insurance Company of the State of Pennsylvania, which is a wholly owned subsidiary of Chartis U.S., a division of Chartis, Inc., and that as such, make this verification and aver that the facts set forth in the within Complaint are true and correct to the best of my knowledge, information and belief and that I am making these statements subject to the penalties of 18 PA C.S.A. 4904 relating to unsworn falsifications to authorities. Dated: '7 0 POLICYHOLDER NOTICE Thank you for purchasing insurance from a member company of American International Group, Inc. (AIG). The AIG member companies generally pay compensation to brokers and independent agents, and may have paid compensation in connection with your policy. You can review and obtain information about the nature and range of compensation paid by AIG member companies to brokers and independent agents in the United States by visiting our website at www.aigproducercompensation.com or by calling AIG at 1-800-706-3102. 91222 (7i06Archive Copy EXHIBIT A THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA 13889 AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 SEE NAME AND ADDRESS SCHEDULE - WC990610 OA C7Q(1(] DA I1144- 88687-0000 WC 121-16-71 014-17-0308-oo 01M Member Companies of American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 C S & A FRANKLIN WORKERS COMPENSATION AND EMPLOYERS PO BOX 681209 LIABILITY POLICY INFORMATION PAGE FRANKLIN, TN 37o68-1209 INSURED IS PREVIOUS POLICY NUMBER NEW CORPORATION OTHER WORKPLACES NOT SHOWN ABOVE: SEE NAME AND ADDRESS SCHEDULE - WC 0610 ITEM 2 POLICY PERIOD 12:01 A.M. standard time at the insured's mailing address FROM 03/15/08 TO 03/15/09 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: PA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 100.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR RI SC SD TN TX UT VA VT WI ITEM a The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Code Number Estimated Total Remuneration ? Rate Per $100 OF Re- muneration Estimated Premium ? ?X 3 Year Annual 3 Year Annual SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $242 EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) MINIMUM PREMIUM $720 PA TOTAL ESTIMATED PREMIUM $1 Z, b51 If indicated below, interim adjustments of premium shall be made: ? Semi-Annually ? Quarterly ? Monthly DEPOSITPREMIUM $12,651 ENDORSEMENTS (FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC99o612 03/21/08 AIG AVIATION WORKERS COMP 17 Issue Date Issuing Office 39967 Archive Copy EXHIBIT A Authorized Representative WC 00 00 01 Policy Number: WC 121-16-71 FORTRSM W0000308 W0000406 W0000421A W0000422 WCOFAC 78052D W0000419 WC370110 WC370601 WC370602 WC370603A WC993703A LWNMANU001 WC990610 WC 99 06 12 (Ed. 1/97) Archive Copy FORMS SCHEDULE Effective Date: 03 / 15 / 2008 FOREIGN TERRORISM POLHOLDR NOT-PREM DTMN PARTNERS, OFFICERS, AND OTHERS EXCLUSION PREMIUM DISCOUNT ENDORSEMENT D-TEC PREMIUM ENDT. FOREIGN TERRORISM PREMIUM ENDT. NOTICE REG OFFICE OF FOREIGN ASSET CTRL PRIVACY POLICY PREMIUM DUE DATE ENDORSEMENT PA TERRORISM RISK INSURANCE EXT ACT ENDT PA INSPECTION OF MANUALS PA NOTICE PA ACT 86-1986 ENDORSEMENT PA NOTIFICATION OF AVAILABILITY MANUSCRIPT ENDORSEMENT NAMED INSUREDS/ADDRESSES EXHIBIT A WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY National Union Fire Insurance Company of Pittsburgh, Pa. American Home Assurance Company The Insurance Company of The State of Pennsylvania AIG Casualty Company 41? Member Companies of American International Group, Inc. EXECUTIVE OFFICES 70 PINE STREET NEW YORK, N.Y. 10270 Commerce and Industry Insurance Company Coverage is provided by the Company designated on the Information Page A Stock Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE BEGINNING ON PAGE Information Page .................................................................................................................................................................................. ... ..................i GENERAL SECTION ........................................................................................................................................................................... ........... ..........1 A. The Policy ......................................................................................................................................................................................... ........... .......................1 B. Who Is Insured ..................................................................................................................................................................................... .... ....................... 1 C. Workers Compensation Law .............................................................................................................................................................. ............ ...........1 D. State .............................................................................................................................................................................................. ................. .......................1 E. Locations .......................................................................................................................................................................................... ............ .......................1 PART ONE-WORKERS COMPENSATION INSURANCE ............................................................................................................... .................... 1 A. How This Insurance Applies .............................................................................................................................................................. .......... .............1 B. We Will Pay ........................................................................................................................................................................................ ........ .......................1 C. We Will Defend ..................................................................................................................................................................................... .... .......................1 D. We Will Also Pay ................................................................................................................................................................................... .. .......................1 E. Other Insurance .................................................................................................................................................................................... .... ...................... 2 F. Payments You Must Make ..................................................................................................................................................................... ....... ............... 2 G. Recovery From Others ......................................................................................................................................................................... ..... ..................2 H. Statutory Provisions ............................................................................................................................................................................... .......................2 THESE POLICY PROVISIONS WITH THE INFORMATION PAGE AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THIS POLICY. "INCLUDES COPYRIGHT MATERIAL OF THE NATIONAL COUNCIL ON COMPENSATION INSURANCE, USED WITH ITS PERMISSION. COPYRIGHT 1983 NATIONAL COUNCIL ON COMPENSATION INSURANCE" 39638C(04/92) Archive Copy EXHIBIT A WC 00 00 00 A (STANDARD) ED 4 92 ATTACH FORM AND ENDORSEMENTS (IF ANY) HERE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows. GENERAL SECTION A. The Policy This policy includes at its effective date the Infor- mation Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Informa- tion Page) and us (the insurer named on the Infor- mation Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who Is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an em- ployer of the partnership's employees. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any fed- eral occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A states unless you have other insurance or are self-insured for such workplaces. PART ONE - WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employ- ment. The employee's last day of last expo- sure to the conditions causing or aggravating such bodily injury by disease must occur dur- ing the policy period. C. We Will Defend We have the right and duty to defend at our ex- pense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, pro- ceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: B. We Will Pay We will pay promptly when due the benefits re- quired of you by the workers compensation law. 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; WC 00 00 00 A Archive Copy 1 of 7 EXHIBIT A 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other insur- ance or self-insurance. Subject to any limits of li- ability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required be- cause: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discrimi- nate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons en- titled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. H. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury oc- curs. 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance or; b. special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO - EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies 3. Bodily injury by accident must occur during the policy period. This employers liability insurance applies to bodily injury by accident or bodily injury by disease. 4. Bodily injury by disease must be caused or Bodily injury includes resulting death. aggravated by the conditions of your employ- 1. The bodily injury must arise out of and in the ment. The employee's last day of last expo- course of the injured employee's employment sure to the conditions causing or aggravating by you. such bodily injury by disease must occur dur- ing the policy period. 2. The employment must be necessary or inci- dental to your work in a state or territory listed 5. If you are sued, the original suit and any re- in Item 3.A. of the Information Page. lated legal actions for damages for bodily injury WC 00 00 00 A Archive Copy 2 of 7 EXHIBIT A by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. B We Will Pay 6. bodily injury occurring outside the United States of America, its territories or pos- sessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resi- dent of the United States of America or Canada who is temporarily outside these countries; We will pay all sums you legally must pay as dam- ages because of bodily injury to your employees, provided the bodily injury is covered by this Em- ployers Liability Insurance. The damages we will pay, where recovery is per- mitted by law, include damages: damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimi- nation against or termination of any employee, or any personnel practices, policies, acts or omissions. for which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed 8' against such third party as a result of injury to your employee; 2. for care and loss of services; and 3. for consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct conse- quence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. liability assumed under a contract. This ex- clusion does not apply to a warranty that your work will be done in a workmanlike manner; 2. punitive or exemplary damages because of bodily injury to an employee employed in vio- lation of law; 3. bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your execu- tive officers; bodily injury to any person in work subject to the Longshore and Harbor Workers' Compen- sation Act (33 USC Sections 901-950), the Nonappropriated Fund Instrumentalities Act (5 USC Sections 8171-8173), the Outer Conti- nental Shelf Lands Act (43 USC Sections 1331-1356), the Defense Base Act (42 USC Sections 1651-1654), the Federal Coal Mine Health and Safety Act of 1969 (30 USC Sections 901-942), any other federal workers or workmen's compensation law or other fed- eral occupational disease law, or any amend- ments to these laws. 9. bodily injury to any person in work subject to the Federal Employers' Liability Act (45 USC Sections 51-60), any other federal laws obli- gating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amend- ments to those laws. 10. bodily injury to a master or member of the crew of any vessel. 11. fines or penalties imposed for violation of fed- eral or state law. 12. damages payable under the Migrant and Sea- sonal Agricultural Worker Protection Act (29 USC Sections 1801-1872) and under any other federal law awarding damages for vio- lation of those laws or regulations issued thereunder, and any amendments to those laws. 4. any obligation imposed by a workers compen- D. We Will Defend sation, occupational disease, unemployment compensation, or disability benefits law, or any We have the right and duty to defend, at our ex- similar law; pense, any claim, proceeding or suit against you for damages payable by this insurance. We have the 5. bodily injury intentionally caused or aggravated right to investigate and settle these claims, pro- by you; ceedings and suits. WC 00 00 00 A Archive Copy 3 of 7 EXHIBIT A We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim proceeding, or suit we defend; 1. reasonable expenses incurred at our request; but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other in- surance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.6. of the Information Page. They apply as explained below. 1. Bodily Injury by Accident. The limit shown for "bodily injury by accident-each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident un- less it results directly from bodily injury by ac- cident. 2. Bodily Injury by Disease. The limit shown for "bodily injury by disease-policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of em- ployees who sustain bodily injury by disease. The limit shown for "bodily injury by disease- each employee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include dis- ease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insur- ance. You will do everything necessary to protect those rights for us and to help us enforce them. 1. Actions Against Us There will be no right of action against us under this insurance unless: 1. You have complied with all the terms of this policy; and 2. The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part. PART THREE - OTHER STATES INSURANCE A. How This Insurance Applies though that state were listed in Item 3.A. of the Information Page. 1. This other states insurance applies only if one or more states are shown in Item 3.C. of the 3. We will reimburse you for the benefits required Information Page. by the workers compensation law of that state if we are not permitted to pay the benefits di- g. If you begin work in any one of those states rectly to persons entitled to them. after the effective date of this policy and are not insured or are not self-insured for such 4. If you have work on the effective date of this work, all provisions of the policy will apply as policy in any state not listed in Item 3.A. of the WC 00 00 00 A Archive Copy 4 of 7 EXHIBIT A Information Page, coverage will not be af- forded for that state unless we are notified within thirty days. B. Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR - YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other ser- vices required by the workers compensation law. 2. Give us or our agent the names and ad- dresses of the injured persons and of wit- nesses, and other information we may need. 3. Promptly give us all notices, demands and le- gal papers related to the injury, claim, pro- ceeding or suit. 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or de- fense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE - PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifica- tions. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classi- fications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual expo- sures are not properly described by those classi- fications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy pe- riod for the services of: 1. All your officers and employees engaged in work covered by this policy; and 2. All other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and mate- rials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obli- gations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers com- pensation law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, pre- mium basis and the proper classifications and rates that lawfully apply to the business and work cov- ered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be de- termined in the following way unless our manuals provide otherwise. 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short rate WC 00 00 00 A Archive Copy 5 of 7 EXHIBIT A cancellation table and procedure. Final pre- mium will not be less than the minimum pre- mium. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. In- surance rate service organizations have the same rights we have under this provision. PART SIX - CONDITIONS A. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the con- ditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insur- ance rate service organizations have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and six- teen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. If you die and we receive notice within thirty days after your death, we will cover your legal represen- tative as insured. D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancellation notice. 4. Any of these provisions that conflicts with a law that controls the cancellation of the insur- ance in this policy is changed by this state- ment to comply with that law. E. Sole Representative C. Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancellation. WC 00 00 00 A Archive Copy 6 of 7 EXHIBIT A In Witness Whereof, the company has caused this policy to be executed and attested, but this policy shall not be valid unless countersigned by a duly authorized representative of the company. 11?- The Insurance Company of The State of Pennsylvania .?4t4 9'. ?6"' President Commerce and Industry Insurance Company 11?- President AIG Casualty Company WC 00 00 00 A 7 of 7 President National Union Fire Insurance Company of Pittsburgh, PA ax 6 "C- President American Home Assurance Company )k. ?? Secretary National Union Fire Insurance Company of Pittsburgh, PA American Home Assurance Company The Insurance Company of The State of Pennsylvania AIG Casualty Company Commerce and Industry Insurance Company Archive Copy EXHIBIT A Page 1 of 1 STANDARD WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY EXTENSION FORM WC 121-16-71 INTRAI Independent State Risk ID PENNSYLVANIA 3057899 Policy Prefix & No. o14-17-0308-oo Schedule AIRCRAFT MANAGEMENT SERVICES, INC Item 4. Classification of Operations Premium Basis Rates Entries in this item, except as specifically provided elsewhere in this policy, do not modify any of the other provisions of this policy. Code No. Estimated Total Annual Iemuneration Per $100 of Pemuneration Estimated Annual Premiums RATING GROUP: 0001-01 CLERICAL OFFICE EMPLOYEES 953 84,11 0.56 471 AIRCRAFT OPERATION, N.O.C.-INCLUDING 7424 2,0010 7.19 144 BUT NOT NECESSARYILY LIMITED TO: AIR TAXI, PATROL, PHOTOGRAPHY, MAPPING, SKYWRITING, ADVERTISING, SURVEY WORK, SIGHTSEEING, STUDENT INSTRUCTION, CROP DUSTING OR SPRAYING, OR FLIGHT TESTING-ALL MEMBERS OF THEFLYING CREW. AIRPORT OPERATION - GROUND EMPLOYEES 7428 212,521 6.37 13,538 STATE OF PENNSYLVANIA TOTALS TOTAL CLASSIFICATION PREMIUM 14,153 TOTAL UNMODIFIED PREMIUM 14,153 EXPERIENCE PREMIUM (ACTUAL) 0.922 9898 -1,104 MODIFIED STANDARD PREMIUM 13,049 UNDISCOUNTED PREMIUM 13,049 PREMIUM DISCOUNT -6-70% 0063 -874 DISCOUNTED PREMIUM 12,175 FOREIGN TERRORISM (TRIA) 3.00% 9740 425 DOMESTIC TERRORISM, ET AL 0.01 9741 51 TOTAL ESTIMATED PREMIUM 12,651 EMPLOYER ASSESSMENT (NON-COAL) 1.92% 0938 242 TOTAL DUE 12,893 EXPERIENCE RATING MODIFICATION = 0.92 WC 7754 (Ed. 4-81) See Name and Address Schedule - WC990610 Archive Copy EXHIBIT A FOREIGN TERRORISM (TRIA) POLICYHOLDER NOTICE - PREMIUM DETERMINATION As indicated in Form No. WC 00 04 22, your Foreign Terrorism (TRIA) premium is shown in Form WC 7754. The schedule below shows how the premium for Foreign Terrorism (TRIA) is determined. Schedule State Premium Determination Method Arizona ................................................................................... Rate per $100 of Remuneration in addition to rate included in Arizona premium as set forth below`. Colorado, Connecticut, Florida, Idaho, New Jersey, New Mexico and Wisconsin .................................................... Rate per $100 of Remuneration. New York ................................................................................ Rate per $100 of Remuneration and rate applied to Total Classification Premium. Kansas, Maine, New Hampshire and Virginia .......................... Included in Rates applied to Premium Basis (Remuneration) for calculation of annual premium for each applicable classification of operations. Alabama, Alaska, Arkansas, Iowa, Montana, Nevada, Tennessee and Texas ........................................................... All Other States ..................................................................... Rate per $100 of Remuneration in addition to charge included in rates applied to Premium Basis (Remuneration) for calculation of annual premium for each applicable classification of operations. Rate applied to Total Classification Premium. Refer to Item 4 of the Information Page and State Schedule Pages form WC 7754 for the premium charged for the coverage provided for workers' compensation losses caused by an act of foreign terrorism. This premium is included in your Total Estimated Premium and is an estimate. The final premium for this coverage will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. ** For policies issued by Commerce and Industry Insurance Company or New Hampshire Insurance Company the total premium for Arizona also includes a charge for this coverage in the rates applied to Premium Basis (Remuneration) for each applicable classification of operations. For policies issued by American Home Assurance Company, American International South Insurance Company, AIG Casualty Company, Granite State Insurance Company, Illinois National Insurance Co., National Union Fire Insurance Company of Pittsburgh, Pa. or The Insurance Company of the State of Pennsylvania the total premium for Arizona also includes a charge for this coverage determined by applying a rate against the Schedule Modification factor. FORTRSM (Ed. 01/06) Archive Copy EXHIBIT A PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03115/2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA The policy does not cover bodily injury to any person described in the Schedule. The premium basis for the policy does not include the remuneration of such persons. You will reimburse us for any payment we must make because of bodily injury to such persons. Schedule Partners Officers Others MICHAEL J. HARTLE WC 000308 Countersigned by ----------------- (Ed. 4-84) Archive Copy EXHIBIT A Authorized Representative PREMIUM DISCOUNT ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. Schedule Estimated Eligible Premium 1. State First Next Next $5,000 $95,000 $400,000 Balance Pennsylvania 10.90 12.60 14.40 2. Average percentage discount: 3. Other policies: 6.70 % 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see Premium Discount Endorsement attached to your policy number: WC 000406 Countersigned by_ __________ ______ (Ed. 4-84) Archive Copy Authorized Representative EXHIBIT A DOMESTIC TERRORISM, EARTHQUAKES, AND CATASTROPHIC INDUSTRIAL ACCIDENTS PREMIUM ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of domestic terrorism, earthquakes, and/or a catastrophic industrial accident. The premium charge provides funding for the risk of earthquakes, catastrophic industrial accidents, and certain acts of domestic terrorism. It does not provide funding for acts of terrorism certified as such by the Terrorism Risk Insurance Act of 2002 and any amendments resulting from the Terrorism Risk Insurance Extension Act of 2005 (the Act), or acts of foreign terrorism as that term is defined in the Foreign Terrorism Premium Endorsement (WC 00 04 22), attached to this policy. For purposes of this endorsement, the following definitions apply: Domestic terrorism: All acts of terrorism outside the scope of the Act or the Foreign Terrorism Premium Endorsement (WC 00 04 22), with aggregate workers compensation losses in excess of $50 million. Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity where aggregate workers compensation losses from the single event are in excess of $50 million. Catastrophic Industrial Accident: Any single event resulting in aggregate workers compensation losses in excess of $50 million. Schedule Refer to State Schedule Pages Form WC7754 WC000421A Countersigned by_______________________________ (Ed. 01/06) {, 0 2004 National council on Con?GA?iWr-QAPy Authorized Representative EXHIBIT A FOREIGN TERRORISM PREMIUM ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA This endorsement is notification that your insurance carrier is charging premium for losses that may occur in the event of an act of foreign terrorism. Your policy provides coverage for workers compensation losses caused by acts of foreign terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. For purposes of this endorsement, an "act of foreign terrorism" is defined as: a. Any act that is violent or dangerous to human life, property or infrastructure; and b. The act has been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. The premium charge for the coverage your policy provides for workers compensation losses caused by an act of foreign terrorism is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate per $100 of payroll Refer to Item 4 of the Information Page and State Schedule Pages form WC 7754 for the premium charged for the coverage provided for workers' compensation losses caused by an act of foreign terrorism. This premium is included in your Total Estimated Premium and is an estimate. The final premium for this coverage will be determined after this policy ends by using the actual, not the estimated, premium basis and the proper classifications and rates that lawfully apply to the business and work covered by this policy. For further information see the "Foreign Terrorism (TRIA) Policyholder Notice - Premium Determination" included with this policy. The rates and rating methodologies used to calculate the premium charged for this coverage are subject to change. This means that the rates and rating methodologies applied when your policy was issued may be different from those applied when computing your premium after the issuance of the policy, for example, at time of audit. WC 000422 Countersigned by______________ ________ (Ed. 01/06) 0 2005 National Council on Co *GWWQr.G Py Authorized Representative EXHIBIT A IMPORTANT NOTICE TO OUR CUSTOMERS REGARDING THE OFFICE OF FOREIGN ASSETS CONTROL Your rights as a policyholder and payments to you, any insured, additional insured, loss payee, mortgagee, or claimant, for loss under this policy may be affected by the administration and enforcement of U.S. economic embargoes and trade sanctions by the OFFICE OF FOREIGN ASSETS CONTROL ("OFAC"). WHAT IS OFAC? OFAC is an office of the Department of the Treasury and acts under presidential wartime and national emergency powers, as well as authority granted by specific legislation, to impose controls on transactions and freeze foreign assets under U.S. jurisdiction. OFAC administers and enforces economic embargoes and trade sanctions primarily against: • Targeted foreign countries and their agents • Terrorism sponsoring agencies and organizations • International narcotics traffickers PROHIBITED ACTIVITY OFAC enforces certain embargoes and sanctions against certain designated countries. No U.S. business or person may enter into certain transactions in or connected to such designated "sanctioned" countries. • OFAC maintains a directory known as the "Specially Designated Nationals and Blocked Persons" (" SDNBP") list. No U.S. business or person may transact business with any person or entity named on the SDNBP list. Additional and more in-depth information on OFAC is available at the following website: http://www.ustreas.gov/offices/eotffc/ofac. OBLIGATIONS PLACED ON US BY OFAC If we determine that you or any insured, additional insured, loss payee, mortgagee, or claimant are on the SDNBP list or are connected to a sanctioned country as described in the regulations enforced by OFAC, we must block or "freeze" property and payment of any funds transfers or transactions and report all blocks to OFAC within ten (10) days. POTENTIAL ACTIONS BY US 1. We may immediately cancel your coverage effective on the day that we determine that we have transacted business with an individual or entity associated with your policy on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. 2. If we cancel your coverage, you will not receive a return premium unless approved by OFAC. All funds will be placed in an interest bearing blocked account established on the books of a U.S. financial institution. 3. We will not pay a claim, accept premium or exchange monies or assets of any kind to or with individuals, entities or companies (including a bank) on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. And, we will not defend or provide any other benefits under your policy to individuals, entities or companies on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. YOUR RIGHTS AS A POLICYHOLDER If funds are blocked or frozen by us in conjunction with the OFFICE OF FOREIGN ASSETS CONTROL, you may complete an "APPLICATION FOR THE RELEASE OF BLOCKED FUNDS" and apply for a specific license to request their release. Forms are available for download at the OFAC website. See http://www. ustreas.gov/offices/eotffc/ofac/legal/forms/license. pdf WCOFAC (Ed. 07/05) Archive Copy EXHIBIT A PRIVACY POLICY Our Commitment to Privacy: The AIG Companies (AIG) believe one of our most important assets is the trust consumers place in us to respect and properly handle nonpublic personal information received by us in connection with providing our products and services. To continue earning your trust and enhance the products and services offered to you, the companies listed below have adopted the following privacy policy to govern how we treat your nonpublic personal information including such information about our former customers. It's important for you to know that this privacy policy applies only to the product or service you have just obtained or the insurance policy under which you are seeking or receiving benefits. This policy does not preclude any AIG Company from using the information you provided in order to offer you other products or services in which you may be interested. This policy also does not preclude us from sharing your information with a non-AIG affiliated company so long as the sharing is necessary to administer and process the product or service you have just obtained or the insurance policy under which you are seeking or receiving benefits. As a large worldwide leader in the delivery of financial products and services, we offer numerous products and services to many types of consumers and clients in many different states and countries around the world. Therefore, any one of our companies may have different privacy policies to fit the specific products and services it offers. Information We Collect: We collect information about you that is necessary to tailor our products and services to meet your individual needs, provide effective customer service, and comply with legal requirements. We may collect nonpublic personal information about you, from one or more of the following sources: • Information we receive from you on applications or other forms; • Information about your transactions with us, our affiliates or others; • Information we receive from a consumer-reporting agency; and ¦ Information received in handling claims. Sharing Information Within Our Family of Companies: We may share some or all of the nonpublic personal information we collect with our affiliates - the members of the AIG family of companies, unless such sharing of information is prohibited by law. In many cases, the information that is shared may be at your request or is necessary to administer, process or otherwise handle your transactions with us or settle a claim on your behalf. In addition, we may provide this information to our affiliates in order to offer you products and services in which you may be interested. Our family of companies includes many insurance companies (e.g., auto, home, and life insurance), insurance claims handling companies, other financial institutions (e.g., savings bank), and non-financial institutions. Sharing Information Outside the AIG Family: Sometimes, we use companies or businesses outside the AIG family to administer, process, or otherwise handle your transactions with us, such as for claims handling or customer service. Other times, we may enter into contracts with nonaffiliated companies to perform services on our behalf, such as marketing our products and services, or we may enter into joint marketing agreements with other financial institutions. In these and other circumstances permitted by law, we may share some or all of the information we collect above with these nonaffiliated third parties. However, whenever we utilize a nonaffiliated third party to provide these services, they are required to follow federal privacy laws governing this notice. We also may share information to combat fraud, in response to a court order, or at the request of government regulators. Nonpublic Personal Health Information: We will not disclose nonpublic personal health information about you without obtaining prior written authorization from you, except as permitted by applicable law or regulation. 78052D (Ed. 11/06) Archive Copy EPI 663A Protecting and Safeguarding Your Information: To help prevent unwarranted disclosure of your nonpublic information and secure it from theft, we utilize secure computer networks and restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. In addition, we maintain physical, electronic, and procedural safeguards that comply with applicable laws and regulations to guard our customers' nonpublic personal information. Maintaining Accurate Information: We also maintain procedures to ensure that the information we collect is accurate, up-to-date, and as complete as possible. If you believe the information we have about you in our records or files is incomplete or inaccurate, you may request that we make additions or corrections, or if it is feasible, that we delete this information from our files. You may make this request in writing to (include your name, address and policy number): Chief Privacy Officer AIG - Domestic Brokerage Group 175 Water Street, 3rd Floor New York, NY 10038 FAX: 212-785-9495 e-mail: DBG.Privacy@,AIG.com Special notice for policyholders who reside in any of the following states: Arizona, California, Connecticut, Georgia, Illinois, Kansas, Maine, Massachusetts, Minnesota, Montana, Nevada, New Jersey, North Carolina, Ohio, Oregon, Virginia or Wisconsin: You can obtain access to any nonpublic personal information we have about you if you properly identify yourself and submit a written request to us at the address above describing the information you want to review (include your name, address and policy number). Once we have received your request, and if the information is reasonably locatable and retrievable, we will, within 30 business days, take the following actions: ¦ Inform you of the nature and substance of the recorded information; • Allow you to see and copy, in person, such recorded personal information; or ¦ Send you a copy of the recorded personal information by mail (we may charge you a reasonable fee to cover the cost of this service). We will also tell you at this time the identity, if recorded, of persons to whom we have disclosed the nonpublic personal information within the preceding two years. If you ask us to correct, amend or delete any information about you, we will, within 30 business days, either correct, amend or delete the nonpublic personal information in dispute or notify you of our refusal to take such action along with the reasons for our decision. If we make the correction, amendment or deletion you've requested, we will also notify you along with any person you designate who has received the information about you within the preceding two years, together with any insurance support organization(s) which provided us with the disputed information. If we refuse to make the requested correction, amendment or deletion, you are permitted to file a concise statement setting forth what you think is the correct, relevant or fair information along with a statement of the reasons why you disagree with our refusal to correct, amend or delete the information subject to dispute. We will file your statement with the disputed personal information and make any person who reviews your file aware of your statement. We will also furnish your statement to any person who has received personal information from us within the two preceding years and any insurance support organization whose primary source of personal information is an insurer. 78052D (Ed. 11106) Archive Copy ?9ff 3A Important Information Concerning the Applicability and Future Changes to this Privacy Policy: This privacy policy applies, with respect to nonpublic personal financial information, to the particular products or services you have just obtained, which provide primarily for personal, family, or household purposes in the United States by the AIG Companies listed below, and it applies to all nonpublic personal health information these Companies may have. Although we may change this policy at any time, as it relates to the particular product or service, please rest assured that you will be notified of any changes as required by law. AIG Companies Covered by this Policy: AIG Hawaii Insurance Company AIG Casualty Company AIU Insurance Company American Home Assurance Company American International Pacific Insurance Company American International South Insurance Company Commerce and Industry Insurance Company Granite State Insurance Company Illinois National Insurance Co. National Union Fire Insurance Company of Louisiana National Union Fire Insurance Company of Pittsburgh, Pa. New Hampshire Insurance Company The Insurance Company of the State of Pennsylvania American International Specialty Lines Insurance Company American Pacific Insurance Company, Inc. Landmark Insurance Company Lexington Insurance Company Agency Management Corporation A. I. Risk Specialists Insurance, Inc. A. I. Risk Specialists of Missouri, Inc. American International Entertainment, Inc. Eastern Risk Specialists, Inc. Florida Risk Specialists, Inc. The Gulf Agency, Inc. Louisiana Risk Specialists, Inc. Medical Excess Insurance Services, Inc. Michigan Risk Specialists, Inc. Midwestern Risk Specialists, Inc. Nevada Risk Specialists, Inc. New England Risk Specialists, Inc. Northwestern Risk Specialists, Inc. Risk Specialists Companies, Inc. Risk Specialists Company (Bermuda), Ltd. Risk Specialists Company of Colorado, Inc. Risk Specialists Company of Kentucky, Inc. Risk Specialists Company of Minnesota, Inc. Risk Specialists Company of New Jersey, Inc. Risk Specialists Company of New York, Inc. Risk Specialists Company of Ohio, Inc. Risk Specialists of the Carolinas, Inc. Southeastern Risk Specialists, Inc. Southern Risk Specialists, Inc. Western Risk Specialists, Inc. American International Surplus Lines Agency, Inc. AIG Warranty Services and Insurance Agency, Inc. and other member companies of the AIG family who sent you this privacy policy statement. 78052D (Ed. 11106) Archive Copy EW 9 10f 'A PREMIUM DUE DATE ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. WC 00 04 19 Countersigned by (Ed. 01/01) Archive Copy EXHIBIT A Authorized Representative PENNSYLVANIA TERRORISM RISK INSURANCE EXTENSION ACT ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Extension Act of 2005. Definitions The definitions provided in this endorsement are based on the definitions in the Act and are intended to have the same meaning. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments resulting from the Terrorism Risk Insurance Extension Act of 2005. "Act of terrorism" means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States or outside of the United States in the case of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. " Insured terrorism loss" means any loss resulting from an act of terrorism that is covered by primary or excess property and casualty insurance issued by an insurer, if the loss occurs in the United States or at United States missions or to certain air carriers or vessels. " Insurer deductible" means: a. For the period beginning on November 26, 2002 and ending on December 31, 2002, an amount equal to 1% of our direct earned premiums as provided in the Act, over the calendar year immediately preceding November 26, 2002. b. For the period beginning on January 1, 2003 and ending on December 31, 2003, an amount equal to 7% of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding January 1, 2003. c. For the period beginning on January 1, 2004 and ending on December 31, 2004, an amount equal to 10% of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding January 1, 2004. d. For the period beginning on January 1, 2005 and ending on December 31, 2005, an amount equal to 15% of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding January 1, 2005. WC 37 01 10 (Ed. 01/06) 0 2006 Pennsylvania Compensafidlf RAfi[7OXOPY p",Q g f[ 2 e. For the period beginning on January 1, 2006 and ending on December 31, 2006, an amount equal to 17.5% of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding January 1, 2006. f. For the period beginning on January 1, 2007 and ending on December 31, 2007, an amount equal to 20% of our direct earned premiums, as provided in the Act, over the calendar year immediately preceding January 1, 2007. Limitation of Liabil The Act may limit our liability to you under this policy. If annual aggregate insured terrorism losses of all insurers exceed $100,000,000,000 during the applicable period provided in the Act and if we have met our insurer deductible, the amount we will pay for insured terrorism under this policy will be limited by the Act, as determined by the Secretary of the Treasury. Policyholder Disclosure Notice Insured terrorism losses would be partially reimbursed by the United States Government under a formula established by the Act. Under this formula, the United States Government would pay 90% for Program Year 4 and 85% for Program Year 5 of our insured terrorism losses exceeding our insurer deductible. 2. The premium charged for the coverage this policy provides for insured terrorism losses is included in the amount shown in Item 4 of the Information Page or in the Schedule in the Foreign Terrorism Premium Endorsement (WC 00 04 22) attached to this policy. WC 370110 Countersigned by_____ _______ __ _____ (Ed. 01/06) /?.. ^ 0 2006 Pennsylvania CompensCdl{ a WSOPY ` g6 2, Authorized Representative SPECIAL PENNSYLVANIA ENDORSEMENT-INSPECTION OF MANUALS This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVAN I A The manuals of rules, rating plans, and classifications are approved pursuant to the provisions of Section 654 of the In- surance Company Law of May 17, 1921, P.L. 682, as amended, and are on file with the Insurance Commissioner of the Commonwealth of Pennsylvania. WC 370601 Countersigned by___________________ ______ (Ed. 4-84) Archive Copy Authorized Representative EXHIBIT A PENNSYLVANIA NOTICE This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03 / 15 / 2008 forms a part of Policy No. WC 121-16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA An Insurance Company, its agents, employees, or service contractors acting on its behalf, may provide services to reduce the likelihood of injury, death or loss. These services may include any of the following or related services incident to the application for, issuance, renewal or continuation of, a policy of insurance: 1. surveys; 2. consultation or advice; or 3. inspections. The " Insurance Consultation Services Exemption Act" of Pennsylvania provides that the Insurance Company, its agents, employees or service contractors acting on its behalf, is not liable for damages from injury, death or loss occurring as a result of any act or omission by any person in the furnishing of or the failure to furnish these services. The Act does not apply: 1. if the injury, death or loss occurred during the actual performance of the services and was caused by the negligence of the Insurance Company, its agents, employees or service contractors; 2. to consultation services required to be performed under a written service contract not related to a policy of insur- ance; or; 3. if any acts or omissions of the Insurance Company, its agents, employees or service contractors are judicially de- termined to constitute a crime, actual malice, or gross negligence. WC 37 06 02 Countersigned by - - _ _ _ _ (Ed. 484) Archive Copy Authorized Representative EXHIBIT A PENNSYLVANIA ACT 86-1986 ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2008 forms a part of Policy No. WC 121 -16-71 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA NONRENEWAL, NOTICE OF INCREASE OF PREMIUM, and RETURN OF UNEARNED PREMIUM This endorsement applies only to the insurance provided by the policy because Pennsylvania is shown in Item 3.A. of the Information Page. The policy conditions are amended by adding the following regarding nonrenewal, notice of increase in premium, and return of unearned premium. Nonrenewal 1. We may elect not to renew the policy. We will mail to each named insured, by first class mail, not less than 60 days advance notice stating when the nonrenewal will take effect. Mailing that notice to you at your mailing address last known to us will be sufficient to prove notice. 2. Our notice of nonrenewal will state our specific reasons for not renewing. 3. If we have indicated our willingness to renew, we will not send you a notice of nonrenewal. However, the policy will still terminate on its expiration date if: a. you notify us or the agent or broker who procured this policy that you do not want the policy renewed; or b. you fail to pay all premiums when due; or c. you obtain other insurance as a replacement of the policy. 'Notice of Increase in Premium 1. We will provide you with not less than 30 days advance notice of an increase in renewal premium of this policy, if it is our intent to offer such renewal. 2. The above notification requirement will be satisfied if we have issued a renewal policy more than 30 days prior to its effective date. 3. If a policy has been written or is to be written on a retrospective rating plan basis, the notice of increase in premium provision of this endorsement does not apply. Return of Unearned Premium 1. If this policy is canceled and there is unearned premium due you: a. If the Company cancels, the unearned premium will be returned to you within 10 business days after the effective date of cancellation. WC 37 06 03 A (Ed. 08-95) Archive COPY Page 1 of 2 EXHIBIT A b. If you cancel, the unearned premium will be returned within 30 days after the effective date of cancellation. Because this policy was written on the basis of an estimated premium and is subject to a premium audit, the unearned premium specified in 1a. and 1b. above, if any, shall be returned on an estimated basis. Upon our completion of computation of the exact premium, an additional return premium or charge will be made to you within 15 days of the final computation. 3. These return of unearned premium provisions shall not apply if this policy is written on a retrospective rating plan basis. WC370603A Countersigned by___________________ _______ (Ed. 08-95) Archive Copy Page 2 of 2 Authorized Representative EXHIBIT A NOTIFICATION OF AVAILABILITY OF ACCIDENT AND ILLNESS PREVENTION SERVICES IN THE STATE OF PENNSYLVANIA AIG Consultants, Inc., a member company of American International Group, Inc. (AIG), maintains and provides accident and illness prevention services as required by the nature of the policyholder's business or its operation, in accordance with the Pennsylvania Workers' Compensation Act. A 5% premium discount is available to employers who form a certified workplace safety committee. Services include: Surveys Recommendations Training Programs Consultations Analysis of Accident Causes Industrial Hygiene Services Industrial Health Services For more information about these services, contact AIG Consultants at 212-770-5038, e-mail us at aig-consultants@aig.com or write to: AIG Consultants, Inc. 1700 Market Street-Suite 1800 Philadelphia, Pa. 19103 Fax # 215-255-6561 WC 99 37 03A (Ed. 08/02) Archive Copy EXHIBIT A ENDORSEMENT 001 This endorsement, effective 12:01 AM 03/15/2008 Forms a part of policy no.: WC 121-16-71 Issuedto:AIRCRAFT MANAGEMENT SERVICES, INC By:THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA DESIGNATED WORKPLACE EXCLUSION THE POLICY DOES NOT COVER WORK CONDUCTED AT OR FROM: 1. ANY EMPLOYEE COVERED UNDER OR EXCLUDED FROM COVERAGE UNDER ANY OTHER WORKERS' COMPENSATION POLICY. 2. ANY ACTIVITIES OTHER THAN THOSE RELATED TO CLASS CODES: 953, 7428, AND 7424 ONLY. Authorized Representative Issue Date: 03 / 21 / 08 Iw0014 Archive Copy EXHIBIT A PAGE 1 ENDORSEMENT This endorsement, effective 12:01 AM 03 / 15 / 2008 Forms a part of policy no.: WC 121-16-71 Issuedto:AIRCRAFT MANAGEMENT SERVICES, INC By:THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA LOC NO. NAME AND ADDRESS SCHEDULE 0001 AIRCRAFT MANAGEMENT SERVICES 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-0000 BUSINESS TYPE: CORPORATION FEIN 003057899 Issue Date: 03 / 21 / 08 Authorized Representative WC990610 (Ed. 1-,Archive Copy EXHIBIT A UI # BINDER CONFIRMATION 4?1 M EMBER COM PAN IES OF AMERICAN INTERNATIONAL GROUP FOR INSURANCE IN FAVOR OF: AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 PRODUCER: C S & A FRANKLIN PO BOX 881209 FRANKLIN, TN 37068-1209 ISSUING COMPANY: THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA THIS IS NOT A BILL Division 014 Producer No. 88887-0000 Endt No. 000 Branch 17 Transaction Eff Date 03/15/08 POLICY NUMBER POLICY PERIOD COMMISSION RATE WC 121-16-71 03/15/08 TO 03/15/09 7.5 PREMIUM SURCHARGE TOTAL DUE Transaction Total $12,651 $242 $12,893 Policy Total $12,651 $242 $12,893 DEPOSIT PREMIUM: SURCHARGES: WC99PS03 (Ed. 1/97) $12,851 $242 TOTAL DEPOSIT DUE: $12,893 Installment Schedule Installment Effective Date No. Amount Due Archive Copy EXHIBIT A Audit Billing Ticket Case Name: 001211671-WRP-A-6 001 Company Code: Ins Co of the State of Penn Policy Status: Completed - final Division: 014 Auditor's Name: Auditor Number: CAPXKCR Vendor Co. Name: Audit Method: Physical Audit Date Range: 04/23/2009 - 04/23/2009 Risk ID: All other Completion Date: 04/23/2009 Audit Type: Final - annual Insured Name: AIRCRAFT MANAGEMENT SERVICES, Due Date: Audit Period: 03/15/2008 - 03/15/2009 Technician Rejecting Audit: Policy Period: 03/15/2008 - 03/15/2009 Prior Policy Number: NEW Policy Prefix: WC Policy #: 001211671 LOB: WC - AIWCS Policy ID: 014017030800 Name of Program/Wrap-Up: Contract/Acct All Audits Completed: Yes Shelled: No Auditor #1 Auditor #2 Auditor 43 Travel Time: 0.50 0.00 0.00 Audit Time: 2.50 0.00 0.00 Write-Up Time: 1.00 0.00 0.00 Other (Explain): 0.00 0.00 0.00 Billing Hours: 4.00 0.00 0.00 Total Hours: 4.00 Audit States: PA Policy Numbe r COMPANION POLICIES Status. BILLING TICKET NOTES 12atg ?taCt Finish Minutes A ction Total Minutes: PROCESSING INFORMATION Date Received: 04/18/2011 Due Date: 04/28/2011 PAPC #: Technician Minutes: Technician #: Deposit Premium: Date Completed: Additional/Return Premium: Tracking Completion Done By: EXHIBIT B American International Companies,' AIRCRAFT MANAGEMENT SERVICES, Attn: Melanie Green 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 Workers' Compensation Audit Prepared for: Ins Co of the State of Penn Report prepared by: AIG Premium Audit Division Policy Number: 001211671 Policy Term: 03/15/2008 - 03/15/2009 Audit Period: 03/15/2008 - 03/15/2009 Audit Date: 04/23/2009 EZ-Audit software by InsuraTek Corp. www.insuratek.com Date Printed: 04/18/2011 9:15:30AM EXHIBIT B Workers Compensation Audit Date: 04/23/2009 Legal Entity: Corporation Auditor ID: CAPXKCR Agent ID: 0088687 Auditor Name: Account Number: 001211671-WRP-A-6 12/04/2008 001 Audit Period: 03/15/2008 03/15/2009 Policy Number: 001211671 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Exposure Summary State Cllacc .od Description EEROSLLC. From U Entity: 0001 AIRCRAFT MANAGEMENT SERVICES, Location: 0001 PA PA BLNC BALANCE CLASS 0 03/15/08 03/15/09 PA 7424 AIRCRAFT OPERATION, N.O.C.-INCLUDING 0 03/15/08 03/15/09 PA 7428 AIRPORT OPERATION - GROUND EMPLOYEE 365,067 03/15/08 03/15/09 PA 953 CLERICAL OFFICE EMPLOYEES 24,002 03/15/08 03/15/09 INSURED INFORMATION Contact: Melanie Green Phone: Title: Phone 2: Company Name: AIRCRAFT MANAGEMENT SERVICES, Mobile: Address: 228 AIRPORT ROAD HANGAR 7 Fax: NEW CUMBERLAND, PA 170702467 E-Mail: Entities Number Entity Name Federal ID State ID Date Added Date Deleted 0001 AIRCRAFT MANAGEMENT SERVICES, 3057899 Locations Location: 0001 PA Added: Deleted: Contact Name: Melanie Green Phone: Contact Title: Phone 2: Company Name: AIRCRAFT MANAGEMENT SERVICES, Mobile: Address: 228 AIRPORT ROAD HANGAR 7 Fax: NEW CUMBERLAND, PA 17070-2467 Email: Location of Records Entity: 0001 Location: 0001 Sequence: I Territory: Description: Contact Name: Melanie Green Phone: Contact Title: Phone 2: Company Name: AIRCRAFT MANAGEMENT SERVICES, Mobile: Address: 228 AIRPORT ROAD HANGAR 7 Fax: NEW CUMBERLAND, PA 17070-2467 Email: Description of Operations The insured operates an aircraft maintenance service company in New Cumberland, PA. They will complete the following services: Annual Inspections -100 Hour Inspections -Phase Inspections -Major & Minor Repair -Major & Minor Troubleshooting -Major & Minor Alterations -Airworthiness Directives -Service Bulletins -Insurance Repair -STC's & Field Approvals Date Printed: 04/18/2011 9:15:30AM American International Group Page 3 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, -All Aircraft Makes & Models The employees that complete the maintenance activities have been classified under code 7428: Aircraft operation - ground employees. There are two pilots that will take the aircrafts up to test that the repairs are complete. One is the excluded officer (per endorsement). The other employee has been classified under code 7428: Aircraft operation - ground employees. However, this employee should be classified under code 7424: Aircraft Operation NOC. This class code is on the policy, but it is not approved by the PCRB. Therefore it cannot be used on this audit. A letter has been sent to the PCRB (and attached to this audit) to review the insured's operations and approve the use of class code 7424. There is one employee that reviews financial records from her home office. This employee has been classified under code 953: Clerical Office Employees. There are other employees that will complete bookkeeping, accounting and other financial duties. However, the area that this work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the mechanical operations take place on the airplanes. Therefore these employees have been classified under code 7428. General Notes Does the insured subcontract any operations? NO Are cash payments made to any employees, subcontractors or "casual laborers"? NO Does the insured lease any employees from employee leasing companies? If yes, has the insured obtained proof of WC coverage for all leased employees? NO Does the insured use any temporary labor? If yes, has the insured obtained proof of WC coverage for all leased employees? NO Is the insured related to any other business by common ownership? NO Has the ownership of the company changed within the last 5 years through merger, consolidation, sale, transfer, or conveyance of ownership interest of physical assets? NO Has the insured changed names in the last 5 years? NO Have any of the insured's employees conducted new construction or alterations to the business premises during this policy period ? NO Do any employees own, rent or operate aircraft when conducting company business? YES Do any employees engage in stevedoring operations (loading and unloading of ships, railroad cars or airplanes) including tallying and checking? NO Do any employees engage in sawmill operations? NO Does the insured operate a daycare service for the employees' children? NO Does the insured employ clerical workers who work exclusively in an office engaged in record keeping, correspondence or phone work? Yes - but there is no physical separation for these employees. Does the insured employ clerical workers who work exclusively in a residence office engaged in record keeping, correspondence or phone work? YES Date Printed: 04/18/2011 9:15:30AM American International Group Page 4 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Does the insured employ outside salesmen, messengers, or collectors who do not engage in delivery operations? NO Does the insured employ drivers? NO Does the risk have Florida exposure? If yes, are copies of Federal and State tax forms and other documentation used for verification attached to the audit? NO Did the insured perform any construction operations covered by a separate wrap up policy? NO Is there a waiver of subrogation for any jobs the insured performed? NO Is code 0930 on the policy schedule or endorsement page? NO Is the insured entitled to a Contracting Classification Adjustment Program (CCAP)? NO Is statistical code 9046 on the policy schedule or endorsement page? NO Were there any exceptional exposure variances that require explanation? YES Did the audit period deviate from the policy period more than 16 days? NO Did the insured have any overtime payroll during the policy period that is excludable for states covered by the policy? NO Were the records properly segregated to allow for the overtime deduction? Have you shown an analysis in the worksheets? N/A Was this policy renewed? YES Were summary records used? NO Was an exit interview conducted with the insured and was the results of the audit discussed with a responsible party? YES Have all signature pages been completed? YES Has the insured signed the portion of the signature form allowing the broker/agent to receive copies of the worksheets? NO Is there a secondary business ? NO Is the secondary business a separate legal operation? N/A Is the secondary business being conducted as a separate undertaking or enterprise? N/A Are separate payroll records maintained for the secondary business? N/A Is the secondary business physically separated from the principal business by structural partitions? N/A Is there any interchange of labor between the principal business and secondary business? N/A Do all employees interchange labor between the principal and secondary business? N/A Does a different or additional basic classification apply to this risk that was not on the policy? N/A Has the description of operations included all aspects and detail of the operations as described in the HOB? YES Has a Standard Exception analysis been completed with details showing job duties and responsibilities? YES Does the records requested and audited section show proof that first and second sources were used to complete the audit? YES Was a Notice to Underwriter necessary? YES Date Printed: 04/18/2011 9:15:30AM American International Group Page 5 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Were claims properly documented in the worksheets and the proper person notified of discrepancies? YES ADDITIONAL PAME WORKERS COMPENSATION PROCEDURE NOTES Have you documented the mandatory walk through of the insured's premises and determined the proper classification of the insured? YES - The walk through took place at the time of the audit. For each entity insured on the policy have you documented a complete and thorough Description of Operations from raw material to completion of product or service? YES Have you addressed the footnotes in the PA manual? YES If referred to an insured's accountant, have you advised the insured that in order to have a complete audit a tour of his premises is required and request that the records be brought to his place of business to conduct the audit. If the insured could not have his records available at his place of business, have you visited with the insured after you met with the accountant and documented same? A physical tour of the premises and discussion regarding the description of operations and employees duties is required to take place with the insured. - N/A, audit was completed with insured at their office. Have you audited by the exact policy period with no more than a 16 day deviation from policy period if it was absolutely necessary? YES Have you audited on a date paid basis and documented the start check date and the end check date in your audit? YES - The first pay date included is 3/20/2008, last pay date included is 3/5/2009. Have you completed a mandatory verification of PA & DE Unemployment reports? YES For smaller audits (insured's with 20 employees or less) have you recorded payroll by employee. Using the left side "note" key in the payroll section of the audit given a full description of daily duties for each employee, not just a job title? YES For larger audits (insured's with more than 20 employees) have you excluded from the main classification of the business all clerical and sale employees. Have you listed names of standard exception employees whenever possible? N/A For large audits with over 20 exceptions, have you used departmental payroll and given a full analysis of departmental duties using the left side "note" key in the payroll section of the audit? N/A Have you classified Executive Officers the same as any other employee and given full descriptions of their daily duties - assigning a class code based on their regular and frequent exposure to the business. Have you applied the proper minimum and maximum remuneration? The officer is excluded per endorsement. Have you listed key employees separately? YES Have you identified all miscellaneous employees separately and given a full description of their responsibilities? N/A - No miscellaneous employees determined during audit. Have you verified in the PA manual all inclusions/exclusions to remuneration and adjusted any tips to minimum wage requirements, as well as, shown a reasonable analysis? N/A - There were no inclusions/exclusions or tips determined during audit. There is no allowance for Overtime in the states of Pennsylvania/Delaware. Have you checked Q-Mod, called the Bureau or checked the website for authorized codes for this policy period and documented it in your audit work sheets with the Bureau file number? YES - Bureau File # 3057899 - Authorized codes are 7428, 951 and 953. Have you also documented whether or not the approved codes seem to be appropriate for the business operations? YES - Class codes apply to the business of the insured. However, there are two pilots that will take the aircrafts up to test that the repairs are complete. One is the excluded officer (per endorsement). The other employee has been classified under code 7428: Aircraft operation - ground employees. This employee should be classified under code 7424: Aircraft Operation NOC. This class code is on the policy, but it is not approved by the PCRB. Therefore it cannot be used on this audit. A letter has been sent to the PCRB (and attached to this audit) to review the insured's operations and approve the use of class code 7424. Date Printed: 04/18/2011 9:15:30AN4 American International Group Page 6 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Have you e mailed a letter to the Bureau classification department if you felt a change was necessary to the approved codes? YES Have you shown monthly gross payroll totals for the business or provided an explanation as to why monthly payroll are not issued? Not available due to time constraints. Does your audit have a zero balance class showing that you accounted for all payroll? YES Have you documented whether you physically reviewed the Charter of the Corporation or the Minutes of the Board Meeting, etc. for confirmation of the corporate officers DURING THE POLICY PERIOD you are auditing? YES - 2007 Tax returns were reviewed. Operations based in PA. Insured does not travel outside PA for work. Officers: Michael Hartle - President Standard Exceptions: One employee completes clerical activities from her home office Records Reviewed: Payroll Reports, general ledger, 2007 Tax returns, quarterly returns. Anniversary Rating Date - None indicated. Subcontractors/Contract Labor: There were no subcontractors, contract labor, temporary labor, casual labor or leased employees. Exposure Variance: Class Code Estimated Exposure Audited Exposure 953 84,110 24,002 7424 2,000 0 7428 212,521 365,067 Increase in exposure due to the hiring of additional employees to complete the work. Also, due to no physical separation the clerical employees (with the exception of one home based employee) have been classified under the governing class code of 7428. Clerical Analysis: There is one employee that reviews financial records from her home office. This employee has been classified under code 953: Clerical Office Employees. There are other employees that will complete bookkeeping, accounting and other financial duties. However, the area that this work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the mechanical operations take place on the airplanes. Therefore these employees have been classified under code 7428. Zero exposure codes: Class code 7424 is on the policy, but it is not approved by the bureau. Therefore it cannot be used in this audit. This code does apply to the one employee that is a pilot. But this code will need to be approved by the PCRB before it can be used. A letter has been sent to the bureau to review the insured's operations and possibly add this class code to their file. Classes/locations added: none Claims Analysis: There were no claims made during the policy period. The claims information has been verified by the AIG claims report. Date Printed: 04/18/2011 9:15:30AM American International Group Page 7 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Key Employees: Michael Hartle is the operations manager and is essential to the operations of the bus iness. Exit Interview: Audit and Exit interview was conducted with the Insured's Office Manager, Melanie Green at the insured's address. We reviewed operations, exposures and classifications. The insured had no questions or objections to the audit figures. All FEIN Numbers correct as listed and endorsed on policy schedule. Audit Reconciliation State Class Code Deccr lWon Expo= From U Entity: 0001 AIRCRAFT MANAGEMENT SERVICES, Location: 0001 PA PA Gross Payroll 444,069 03/15/08 03/15/09 PA <Classified> -389,069 03/15/08 03/15/09 PA <Principals> -55,000 03/15/08 03/15/09 PA BLNC Balance BALANCE CLASS 0 03/15/08 03/15/09 PA 7424 AIRCRAFT OPERATION, N.O.C: INCLUDING 0 03/15/08 03/15/09 PA 7428 AIRPORT OPERATION - GROUND EMPLOYEE 365,067 03/15/08 03/15/09 PA 7428 Total AIRPORT OPERATION - GROUND EMPLO 365,067 03/15/08 03/15/09 PA 953 CLERICAL OFFICE EMPLOYEES 24,002 03/15/08 03/15/09 PA 953 Total CLERICAL OFFICE EMPLOYEES 24,002 03/15/08 03/15/09 Principals Slak Class Code Name Tjlk Dates Entity: 0001 Location: 0001 PA EXCL Michael Hartle President 03/15/08 03/15/09 1.000 Min: 18,200 Max: 96,200 Payroll: 55,000 Amount Incl: 0 Payroll Verification Entity: 0001 Location: 0001 Verification Type: O S i State Unemployment Forms State: PA dj tr tart nL, Adjustment Amount A ustment Otr Total 0 0 0 Description 1st Qtr 2008 120,006 -20,875 99,131 Less: 1/1/2008 through 3/15/2008 2nd Qtr 2008 116,804 0 116,804 3rd Qtr 2008 92,443 0 92,443 4th Qtr 2008 115,139 20,552 135,691 Add: 1/1/2009 through 3/15/2009 1 st Qtr 2009 0 0 0 Adjustment 0 0 0 Gross Total: $444,069 Verification Total: 444,069 Deviation: $0 Audit Worksheet State Class Code Name Order Dept Empl. Dates Total Entity: 0001 Location: 0001 F Gross Payroll PA Gross Payroll 180 03/15/08 03/15/09 444,069 Lump Sum: 444,069 Adjustment: 0 Total Gross Payroll 444,069 Classified PA 7428 Doersom, Keith 20 03/15/08 03/15/09 40,000 Duties: Pilot Date Printed: 04/18/2011 9:15:30AM American International Group Page 8 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 T......-eA TT.,...e AiD!`DATiTAAiANA!rV 1 NTQ1VVV1P1VQ Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Lump Sum: 40,000 Adjustment: 0 PA 7428 Green, Melanie 30 03/15/08 03/15/09 16,861 Duties: Bookkeeping Notes: This employee completes clerical activities. However, the area that the work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the machanical operations take place on the airplanes. Therefore this employee has been classified under class code 7428. Lump Sum: 16,861 Adjustment: 0 PA 7428 Steinmiller, Rick 40 03/15/08 03/15/09 1,058 Duties: General manager Notes: This employee completes clerical activities. However, the area that the work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the machanical operations take place on the airplanes. Therefore this employee has been classified under class code 7428. Lump Sum: 1,058 Adjustment: 0 PA 7428 Plouse, Daryl 50 03/15/08 03/15/09 57,999 Duties: Director of Maintenenace Lump Sum: 57,999 Adjustment: 0 PA 7428 Beddow, Don 60 03/15/08 03/15/09 8,077 Duties: Inventory Manager Lump Sum: 8,077 Adjustment: 0 PA 7428 Black, Carl 70 03/15/08 03/15/09 39,064 Duties: Tech Lump Sum: 39,064 Adjustment: 0 PA 7428 Schwende, Peter 80 03/15/08 03/15/09 10,540 Duties: Tech Lump Sum: 10,540 Adjustment: 0 PA 953 Hartle, A'Lynn 90 03/15/08 03/15/09 24,002 Duties: Administrative Notes: Works out of her home reviewing financial records. Lump Sum: 24,002 Adjustment: 0 PA 7428 Rishell, Kyle 100 03/15/08 03/15/09 30,219 Duties: Tech Lump Sum: 30,219 Adjustment: 0 PA 7428 Worley, Roger 110 03/15/08 03/15/09 42,301 Duties: Tech Lump Sum: 42,301 Adjustment: 0 PA 7428 Kinney, Bruce 120 03/15/08 03/15/09 15,588 Duties: Inventory mgr Lump Sum: 15,588 Adjustment: 0 PA 7428 Haag, Kristopher 130 03/15/08 03/15/09 12,992 Duties: Tech Lump Sum: 12,992 Adjustment: 0 PA 7428 Worley, Adam 140 03/15/08 03/15/09 9,098 Duties: Tech Lump Sum: 9,098 Adjustment: 0 PA 7428 Hartle, Gary 150 03/15/08 03/15/09 9,573 Duties: Tech Lump Sum: 9,573 Adjustment: 0 PA 7428 Krampitz, Carl Michael 160 03/15/08 03/15/09 32,688 Duties: Tech Lump Sum: 32,688 Adjustment: 0 PA 7428 Davy, Johnathon 170 03/15/08 03/15/09 7,581 Date Printed: 04/18/2011 9:15:30AM American International Group Page 9 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Duties: Tech Lump Sum: 7,581 Adjustment: 0 PA 7428 Monogan, Tamara 190 03/15/08 03/15/09 4,549 Duties: Bookkeeping Notes: This employee completes clerical activities. However, the area that the work is completed is in an open section of the shop warehouse. There is no physical barrier betwee n where the desks are and where the machanical operations take place on the airplanes. Therefore this employee has been classified under class code 7428. Lump Sum: 4,549 Adjustment: 0 PA 7428 Henry, Richard 200 03/15/08 03/15/09 4,187 Duties: Tech Lump Sum: 4,187 Adjustment: 0 PA 7428 Crout, Douglas 210 03/15/08 03/15/09 8,343 Duties: Tech Lump Sum: 8,343 Adjustment: 0 PA 7428 Neilson, Sonny 220 03/15/08 03/15/09 6,488 Duties: Tech Lump Sum: 6,488 Adjustment: 0 PA 7428 Mohler, Brett 230 03/15/08 03/15/09 7,861 Duties: Tech Lump Sum: 7,861 Adjustment: 0 Total Classified 389,069 Principals PA EXCL Michael Hartle 10 03/15/08 03/15/09 55,000 Duties: Pilot Lump Sum: 55,000 Adjustment: 0 Total Principals 55,000 Class Codes State Class Code 5= Balance Description Entity: 0001 Location: 0001 PA 7424 0 AIRCRAFT OPERATION, N.O.C: INCLUDING BUT NOT NECE PA 7428 0 AIRPORT OPERATION - GROUND EMPLOYEES PA 953 0 CLERICAL OFFICE EMPLOYEES PA BLNC 0 Balance BALANCE CLASS Records Requested/Audited Entity: 0001 Location: 0001 R A Description B A Description R ® Description 0 ? Social Security (Fed 941's) ? ? Sales Journal Entity: 0001 Location: 0001 x? x? 2007 Tax return ? ? Sales Tax Reports ? ? Cash Disbursements N O State Unemployment Reports ? ? Checkbook ? ? Individual Payroll Cards ? ? Job Costs Sheet 0 0 Payroll Book (Listings) ? ? Receipts Journal 0 0 General Ledger ? ? Summaries ? ? Certificates of Insurance ? ? Financial Statement Date Printed: 04/18/2011 9:15:30AM American International Group Page 10 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Status/Non-Productive Report Auditor Name: Auditor Number: CAPXKCR Insured: AIRCRAFT MANAGEMENT SERVICES, Policy #: 001211671 Company: 0130 Audit Period: 03/15/2008-03/15/2009 Division/Region: 014 Policy Period: 03/15/2008-03/15/2009 Location of Audit: VisitDate: Estimate %: Contact Type Contact Name Te lephone # Dak Contact Results. Date Printed: 04/18/2011 9:15.30AM American International Group Page 11 of 12 EXHIBIT B Account Number: 001211671-WRP-A-6 12/04/2008 001 Policy Number: 001211671 Audit Period: 03/15/2008 03/15/2009 Policy Period: 03/15/2008 03/15/2009 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Policies Policy Number Policy Dates 001211671 03/15/2008 03/15/2009 INSURED'S VERIFICATION OF AUDIT PERFORMANCE On 04/23/2009, Auditor visited our offices and reviewed those records necessary to complete a Premium Audit of the above listed policy(ies). The audit was reviewed with me and I fully understand what records were used and how the exposures were derived. I/We hereby certify that the foregoing truly and correctly includes all information required under the terms of the policy(ies) specified above for premium calculation. A copy of completed audit worksheets will be forwarded to you in the mail. (Signature of Insured or Authorized Representative) Melanie Green Office Manager 04/23/2009 (Printed Name) (Title) (Date) SIGNATURE OF PREMIUM AUDIT REPRESENTATIVE Kelly Christy Auditor 04/23/2009 (Signature of Premium Audit Representative) (Printed Name) (Title) (Date) Date Printed: 04/18/2011 9:15:30AM American International Group Page 12 of 12 EXHIBIT B Page 1 of 2 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA WORKERS' COMPENSATION INSURANCE 175 WATER STREET - EXECUTIVE OFFICES, NEW YORK, NY 10038 INSURED AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 PRODUCER C S & A FRANKLIN PO BOX 681209 FRANKLIN, TN 37068-1209 FOR STATE OR Pennsylvania AUDIT ADVICE POLICY PERIOD FROM: 03/15/os TO: 03/15/09 AUDIT PERIOD FROM: 03/15/08 TO: 03/15/09 CANCELLED: [ ] PRO-RATA [ ] SHORT RATE BUREAU ID: 3057899 AUDIT TYPE: PHYSICAL ISSUE DATE: o6/o1/oe DIVISION: BRANCH: 014 AIG AVIATION WORKERS COMP POLICY NO: WC 121-16-71___________ -------------- 014-17-0308-00 TYPE OF ADJUSTMENT: FINAL DESCRIPTION CODE EXPOSURE RATE PREMIUM PERIOD: 03/15/08 - 03/15/09 RATING GROUP: 0001-01 LOC NO 0001 AIRCRAFT MANAGEMENT SERVICES 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-0000 CLERICAL OFFICE EMPLOYEES 953 24,002 0.56 134 AIRCRAFT OPERATION, N.O.C.-INCLUDING 7424 7.19 BUT NOT NECESSARYILY LIMITED TO: AIR TAXI, PATROL, PHOTOGRAPHY, MAPPING, SKYWRITING, ADVERTISING, SURVEY WORK, SIGHTSEEING, STUDENT INSTRUCTION, CROP DUSTING OR SPRAYING, OR FLIGHT TESTING-ALL MEMBERS OF THEFLYING CREW. AIRPORT OPERATION - GROUND EMPLOYEES 7428 365,067 6.37 23,255 TOTAL CLASSIFICATION PREMIUM 23,389 TOTAL FOR SPLIT PERIOD: 03/15/08 - 03/15/09 TOTAL CLASSIFICATION PREMIUM 23,389 TOTAL UNMODIFIED PREMIUM 23,389 EXPERIENCE PREMIUM (ACTUAL) 0.922 9898 -1,824 MODIFIED STANDARD PREMIUM 21,565 THIS IS NOT A BILL WC990613 (Ed. 4-97) (Rev's!' 'Lowe Copy EXHIBIT C Page 2 of 2 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA WORKERS' COMPENSATION INSURANCE 175 WATER STREET - EXECUTIVE OFFICES, NEW YORK, NY 10038 INSURED AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 PRODUCER C S & A FRANKLIN PO BOX 681209 FRANKLIN, TN 37068-1209 FOR STATE OF: Pennsylvania AUDIT ADVICE POLICY PERIOD FROM: 03/ 15/os TO: 03/15/09 AUDIT PERIOD FROM: 03/15/08 TO: 03/15/09 CANCELLED: [ ] PRO-RATA [ ] SHORT RATE BUREAU ID: 3057899 AUDIT TYPE: PHYSICAL ISSUE DATE: os/o1/oe DIVISION: BRANCH: 014 AIG AVIATION WORKERS COMP POLICY NO: WC --- 121-16-71----------- ----------- 014-17-0308-00 TYPE OF ADJUSTMENT: FINAL DESCRIPTION CODE EXPOSURE RATE PREMIUM TOTAL FOR STATE Pennsylvania MODIFIED STANDARD PREMIUM 21,565 UNDISCOUNTED PREMIUM 21,565 PREMIUM DISCOUNT -8.40% 0063 -1,811 DISCOUNTED PREMIUM 19,754 FOREIGN TERRORISM (TRIA) 3.00% 9740 702 DOMESTIC TERRORISM, ET AL 0.017 9741 66 TOTAL PREMIUM 20,522 EMPLOYER ASSESSMENT (NON-COAL) 1.92% 0938 394 STATE FINAL TOTAL 20,916 TOTAL PA REMUNERATION: 389,069 TOTAL PREMIUM FOR TERRORISM COVERAGE INCLUDED IN TOTAL ESTIMATED PREMIUM $728 THIS IS NOT A BILL WC990613 (Ed. 4-97) (Rev'Ar)0ive Copy EXHIBIT C Page 1 of 1 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA WORKERS' COMPENSATION INSURANCE AUDIT ADVICE SUMMARY 70 PINE STREET - EXECUTIVE OFFICES, NEW YORK, NY 10270 INSURED AIRCRAFT MANAGEMENT SERVICES, INC POLICY PERIOD 228 AIRPORT ROAD HANGAR 7 FROM: 03/15/08 TO: 03/15/09 NEW CUMBERLAND, PA 17070-2467 AUDIT PERIOD FROM: 03/1s/o8 TO: 03/15/09 PRODUCER C S & A FRANKLIN CANCELLED: ] PRO-RATA Po Box 681209 ] SHORT RATE FRANKLIN, TN 37068-1209 AUDIT TYPE: PHYSICAL ISSUE DATE: os/o1/o9 DIVISION: BRANCH: 014 AIG AVIATION WORKERS COMP POLICY NO: WC 121-16-71 ------------------------- 014-17-0308-00 TYPE OF ADJUSTMENT: FINAL DESCRIPTION TAXES/ASSESSMENTS/ PREMIUM SURCHARGES TOTAL POLICY REMUNERATION: 389,069 AUDIT EARNED PREMIUM AMOUNT 394 20,522 PRIOR ESTIMATED EARNED AMOUNT 242 12,651 TOTAL AP/RP AMOUNT 152 7,871 TOTAL AUDIT ADJUSTMENT 8,02 THIS IS NOT A BILL PRIOR ESTIMATED EARNED AMOUNT IS THE ORIGINAL POLICY PREMIUM AND ALL PREMIUM BEARING ENDORSEMENTS PLUS INTERIM AUDIT ADJUSTMENTS, IF APPLICABLE. THIS AUDIT ADJUSTMENT DOES NOT REFLECT THE ACTUAL PREMIUM DUE FROM OR TO THE INSURED UNLESS ALL AMOUNTS PREVIOUSLY BILLED HAVE BEEN PAID. WC990614 Archive Copy (Ed. 4/97) EXHIBIT C CHARTIS Law Department 5 Wood Hollow Road 3rd Floor STA Insurance Company. Parsippany, NJ 07054 TEMENT OF ACCOUNT The Insurance Company of the State of Pennsylvania INSURED NAME: NAME OF BROKER: Aircraft Management Services, Inc. C S &A FRANKLIN TYPE OF COVERAGE (S): Workers Compensation and Employers Liability POLICY NUMBER (S): 1211671 DATE OF COVERAGE (S): 3/15/2008-3/15/2009 Annual Premium LESS PAYMENT (S): $13,045.00 ($19,166.00) Audit additional premium $7,871.00 BALANCE DUE CHARTIS: $1,750.00 PLACEMENT AGAINST INSURED -------- ------------ $1,750.00 EXHIBIT D _jm F"ITZPATRICK LENTZ & BUBBA ATTORNEYS AT LAW FITZPATRICK LENTZ & BUBBA, RC. • 4001 SCHOOLHOUSE LANE • PO BOX 219 • CENTER VALLEY, PA 18034-0219 STABLER CORPORATE CENTER • PHONE: 610.797.9000 - FAX: 610.797.6663 www.fiblaw.com Edward J. Lentz James G. Kel1w 1927 -2002 Joseph A. Fitzpatrkk Jr. bzicherman@flblaw.com John R. Mcndschein Joseph A. April 19, 2011 Bubbat Special Counsel Matrimonial Law Tmothy D. Charlesworth Aircraft Management Services, Inc. DouglasJ,Smitlie* 228 Airport Road Hangar 7 Ernil W. Kantra 11 New Cumberland, PA 17070-2467 Joseph S.DAmicojr* RE: The Insurance Company of the State of Pennsylvania Michael K Nesfeder Policy Nos. WC 1211671 and WC 18736121 CaUmNineE.NDurso Dear Sir or Madam: Jane P. Long Please be advised that this firm is counsel to The Insurance Company of the Erch) Scho& State of Pennsylvania. I am writing in connection with the above-referenced policies and the outstanding premiums which are due and owing in the amounts of $1,750 and Abe-Una D. Lombardi" $8,808, respectively. A copy of the invoices is enclosed. Kathleen M. Mills Our client has advised that these amounts are past due and has requested that we take action to assist in collection of the balances. If payment is being made, or has been JBryanTuk° made, you should advise me. Similarly, if you have questions concerning the balances, James ARarthoiomew or would like to discuss arrangements for payment, you should also contact me. in either event, I would request a response within two weeks from the date of this letter. Deidre I Kambert Please note that the purpose of this letter is the collection of a debt and any BabaraZichermant information obtained in response to this letter will be used for that purpose. Edward Hoffman, Ice Thank you for your prompt attention to this matter. Anthony S, Rachuba, IV* Very truly yours, Steven'[ Boell Susan A Royster CLE) CL? D..I 6- l C JoshwaA.Gildea Barbara Zicherman BSZJkbg Lisa ADough"' Enclosure Marie K McConneP Thomas J. Schlegel* John P. Rice 'Aho admitted in New Jersey 1Aho adwdted in Ne Wk EXHIBIT E $8,808.00 EXHIBIT E - -- -------------- - -- --- Law Department C H A RT I S 5 Wood Hollow Road 3rd Floor Parsippany, NJ 07054 STATEMENT OF ACCOUNT Insurance Company: The Insurance Company of the State of Pennsylvania INSURED NAME: Aircraft Management Services, Inc. ----- NAME OF BROKER: C S & A FRANKLIN I TYPE OF COVERAGE (S): Workers Compensation and Employers Liability POLICY NUMBER (S): 1211671 DATE OF COVERAGE (S): 311512008-3/15/2009 Annual Premium $13,045.00 ------ -- ----- --- - LESS PAYMENT S) ($19,166.00) Audit additional premium $7,871.00 BALANCE DUE CHARTIST $1,750.00 --------- - PLACEMENT AGAINST INSURED $1,750.00 EXHIBIT E POLICYHOLDER NOTICE Thank you for purchasing insurance from a member company of American International Group, Inc. (AIG). The AIG member companies generally pay compensation to brokers and independent agents, and may have paid compensation in connection with your policy. You can review and obtain information about the nature and range of compensation paid by AIG member companies to brokers and independent agents in the United States by visiting our website at www.aigproducercompensation.com or by calling AIG at 1-800-706-3102. 91222 (7106Archive Copy EXHIBIT F THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA 13889 AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 0088687-00 WC 018-73-6121 014-17-0309-00 Member Companies of American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 l nft nninr,7R4Q PA 111:9. L I N A 12 WORKERS COMPENSATION AND EMPLOYERS PO BOX 209 681 LIABILITY POLICY INFORMATION PAGE FRANKLIN, TN 37068-1209 INSURED IS CORPORATION PREVIOUS POLICY NUMBER RENEWAL 001211671 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M. standard time at the insured's mailing address FROM 03/15/09 TO 03/15/10 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: PA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100, 000 each accident Bodily Injury by Disease $ 500.000 policy limit Bodily Injury by Disease $ 100.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR RI SC SD TN TX UT VA VT WI WV D. This policy includes these SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans . All information required below is subject to verification and change by audit. aassifications Cade Number Estimated Total Remuneration Rate Per S100 OF Re- Estimated Premium Annual ? 3 Year muneration 0 Annual ? 3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $309 EXPENSE CONSTANT (EXCEPT WHERE APPLICABLE BY STATE) MINIMUM PREMIUM 4i /US NA TOTAL ESTIMATED PREMIUM $13,656 If indicated below, interim adjustments of premium shall be made: ? Semi-Annually ? Quarterly ? Monthly DEPOSIT PREMIUM $13,656 01/09/09 AIG AVIATION WORKERS COMP 17 Issue Date Issuing Office 39967 (Wd 04/08) Archive Copy Authorized Representative WC 00 00 01 EXHIBIT F EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE Policy Number: WC 018-73-6121 Effective Date: 03/15/2009 TRSMPOLNOT FOREIGN TERRORISM POLHOLDR NOT-PREM DTMN W0000308 PARTNERS, OFFICERS, AND OTHERS EXCLUSION W0000406 PREMIUM DISCOUNT ENDORSEMENT W0000421C CATASTROPHE PREMIUM ENDORSEMENT W0000422A TRIPRA DISCLOSURE ENDORSEMENT WCOFAC NOTICE REG OFFICE OF FOREIGN ASSET CTRL 78052D PRIVACY POLICY W0000419 PREMIUM DUE DATE ENDORSEMENT WC370601 PA INSPECTION OF MANUALS WC370602 PA NOTICE WC370603A PA ACT 86-1986 ENDORSEMENT WC993703A PA NOTIFICATION OF AVAILABILITY LWNMANU001 MANUSCRIPT ENDORSEMENT WC990610 NAMED INSUREDS/ADDRESSES WC 99 06 12 (Ed. 1/97) (Rev'd 04/08)4/'0/%ve Copy EXHIBIT F WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY National Union Fire Insurance Company of Pittsburgh, Pa. American Home Assurance Company The Insurance Company of The State of Pennsylvania AIG Casualty Company Commerce and Industry Insurance Company Granite State Insurance Company Illinois National Insurance Company New Hampshire Insurance Company AIG National Insurance Company AIU Insurance Company $4M Member Companies of American International Group, Inc. EXECUTIVE OFFICES 70 PINE STREET NEW YORK, N.Y. 10270 Coverage is provided by the Company designated on the Information Page A Stock Insurance Company WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY QUICK REFERENCE BEGINNING ON PAGE Information Page ...................................................................................................................................................................................... .................i GENERAL SECTION ....................................................................................................................................................................................... .........1 A. The Policy ......................................................................................................................................................................................... ................................ .1 B. Who Is Insured ..................................................................................................................................................................................... ........................... 1 C. Workers Compensation Law ........................................................................................................................................................................... .......... 1 D. State .............................................................................................................................................................................................. ....................................... .1 E. Locations .......................................................................................................................................................................................... .................................. .1 PART ONE-WORKERS COMPENSATION INSURANCE ................................................................................................................................... 1 A. How This Insurance Applies ......................................................................................................................................................................... ............ 1 B. We Will Pay ........................................................................................................................................................................................ .............................. .1 C. We Will Defend ..................................................................................................................................................................................... ............................ 1 D. We Will Also Pay ................................................................................................................................................................................... ......................... 1 E. Other Insurance .................................................................................................................................................................................... .......................... 2 F. Payments You Must Make ............................................................................................................................................................................. .............. 2 G. Recovery From Others ............................................................................................................................................................................... .................. 2 H. Statutory Provisions ............................................................................................................................................................................... ....................... 2 THE ABOVE REFERENCED POLICY PROVISIONS WITH THE INFORMATION PAGE AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETE THIS POLICY. "INCLUDES COPYRIGHT MATERIAL OF THE NATIONAL COUNCIL ON COMPENSATION INSURANCE, USED WITH ITS PERMISSION. COPYRIGHT 1983 NATIONAL COUNCIL ON COMPENSATION INSURANCE" 39638C(04/92) (Rev'd 04Afthive Copy EXHIBIT F WC 00 00 00 A (STANDARD) ED 4 92 ATTACH FORM AND ENDORSEMENTS (IF ANY) HERE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows. GENERAL SECTION A. The Policy This policy includes at its effective date the Infor- mation Page and all endorsements and schedules listed there. It is a contract of insurance between you (the employer named in Item 1 of the Informa- tion Page) and us (the insurer named on the Infor- mation Page). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by endorsement issued by us to be part of this policy. B. Who Is Insured C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any fed- eral occupational disease law or the provisions of any law that provide nonoccupational disability benefits. D. State State means any state of the United States of America, and the District of Columbia. E. Locations You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership, and if you are one of its partners, you are insured, but only in your capacity as an em- ployer of the partnership's employees. This policy covers all of your workplaces listed in Items 1 or 4 of the Information Page; and it covers all other workplaces in Item 3.A states unless you have other insurance or are self-insured for such workplaces. PART ONE - WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This workers compensation insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury includes resulting death. 1. Bodily injury by accident must occur during the policy period. 2. Bodily injury by disease must be caused or aggravated by the conditions of your employ- ment. The employee's last day of last expo- sure to the conditions causing or aggravating such bodily injury by disease must occur dur- ing the policy period. C. We Will Defend We have the right and duty to defend at our ex- pense any claim, proceeding or suit against you for benefits payable by this insurance. We have the right to investigate and settle these claims, pro- ceedings or suits. We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. D. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim, proceeding or suit we defend: B. We Will Pay We will pay promptly when due the benefits re- quired of you by the workers compensation law. 1. reasonable expenses incurred at our request, but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the amount payable under this insurance; WC 00 00 00 A Archive Copy 1 of 7 EXHIBIT F 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and H 5. expenses we incur. E. Other Insurance We will not pay more than our share of benefits and costs covered by this insurance and other insur- ance or self-insurance. Subject to any limits of li- ability that may apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance will be equal until the loss is paid. F. Payments You Must Make You are responsible for any payments in excess of the benefits regularly provided by the workers compensation law including those required be- cause: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation of law; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discrimi- nate against any employee in violation of the workers compensation law. If we make any payments in excess of the benefits regularly provided by the workers compensation law on your behalf, you will reimburse us promptly. G. Recovery From Others We have your rights, and the rights of persons en- titled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. Statutory Provisions These statements apply where they are required by law. 1. As between an injured worker and us, we have notice of the injury when you have notice. 2. Your default or the bankruptcy or insolvency of you or your estate will not relieve us of our duties under this insurance after an injury oc- curs. 3. We are directly and primarily liable to any person entitled to the benefits payable by this insurance. Those persons may enforce our duties; so may an agency authorized by law. Enforcement may be against us or against you and us. 4. Jurisdiction over you is jurisdiction over us for purposes of the workers compensation law. We are bound by decisions against you under that law, subject to the provisions of this policy that are not in conflict with that law. 5. This insurance conforms to the parts of the workers compensation law that apply to: a. benefits payable by this insurance or; b. special taxes, payments into security or other special funds, and assessments payable by us under that law. 6. Terms of this insurance that conflict with the workers compensation law are changed by this statement to conform to that law. Nothing in these paragraphs relieves you of your duties under this policy. PART TWO - EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies 3. Bodily injury by accident must occur during the This employers liability insurance applies to bodily policy period. injury by accident or bodily injury by disease. 4. Bodily injury by disease must be caused or Bodily injury includes resulting death. aggravated by the conditions of your employ- ment. The employee's last day of last expo- 1. The bodily injury must arise out of and in the sure to the conditions causing or aggravating course of the injured employee's employment by you such bodily injury by disease must occur dur- . ing the policy period. 2. The employment must be necessary or inci- dental to your work in a state or territory listed 5. If you are sued, the original suit and any re- in Item 3.A. of the Information Page. lated legal actions for damages for bodily injury WC 00 00 00 A Archive Copy 2 of 7 EXHIBIT F by accident or by disease must be brought in the United States of America, its territories or possessions, or Canada. B. We Will Pay We will pay all sums you legally must pay as dam- ages because of bodily injury to your employees, provided the bodily injury is covered by this Em- ployers Liability Insurance. The damages we will pay, where recovery is per- mitted by law, include damages: for which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2. for care and loss of services; and 3. for consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct conse- quence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. C. Exclusions This insurance does not cover: 1. liability assumed under a contract. This ex- clusion does not apply to a warranty that your work will be done in a workmanlike manner; 2. punitive or exemplary damages because of bodily injury to an employee employed in vio- lation of law; 3. bodily injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your execu- tive officers; bodily injury occurring outside the United States of America, its territories or pos- sessions, and Canada. This exclusion does not apply to bodily injury to a citizen or resi- dent of the United States of America or Canada who is temporarily outside these countries; damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimi- nation against or termination of any employee, or any personnel practices, policies, acts or omissions. bodily injury to any person in work subject to the Longshore and Harbor Workers' Compen- sation Act (33 USC Sections 901-950), the Nonappropriated Fund Instrumentalities Act (5 USC Sections 8171-8173), the Outer Conti- nental Shelf Lands Act (43 USC Sections 1331-1356), the Defense Base Act (42 USC Sections 1651-1654), the Federal Coal Mine Health and Safety Act of 1969 (30 USC Sections 901-942), any other federal workers or workmen's compensation law or other fed- eral occupational disease law, or any amend- ments to these laws. bodily injury to any person in work subject to the Federal Employers' Liability Act (45 USC Sections 51-60), any other federal laws obli- gating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amend- ments to those laws. 10. bodily injury to a master or member of the crew of any vessel. 11. fines or penalties imposed for violation of fed- eral or state law. 12. damages payable under the Migrant and Sea- sonal Agricultural Worker Protection Act (29 USC Sections 1801-1872) and under any other federal law awarding damages for vio- lation of those laws or regulations issued thereunder, and any amendments to those laws. 4. any obligation imposed by a workers compen- D. We Will Defend sation, occupational disease, unemployment compensation, or disability benefits law, or any We have the right and duty to defend, at our ex- similar law; pense, any claim, proceeding or suit against you for damages payable by this insurance. We have the 5. bodily injury intentionally caused or aggravated right to investigate and settle these claims, pro- by you; ceedings and suits. WC 00 00 00 A Archive Copy 3 of 7 EXHIBIT F We have no duty to defend a claim, proceeding or suit that is not covered by this insurance. We have no duty to defend or continue defending after we have paid our applicable limit of liability under this insurance. E. We Will Also Pay We will also pay these costs, in addition to other amounts payable under this insurance, as part of any claim proceeding, or suit we defend; 1. reasonable expenses incurred at our request; but not loss of earnings; 2. premiums for bonds to release attachments and for appeal bonds in bond amounts up to the limit of our liability under this insurance; 3. litigation costs taxed against you; 4. interest on a judgment as required by law until we offer the amount due under this insurance; and 5. expenses we incur. F. Other Insurance We will not pay more than our share of damages and costs covered by this insurance and other in- surance or self-insurance. Subject to any limits of liability that apply, all shares will be equal until the loss is paid. If any insurance or self-insurance is exhausted, the shares of all remaining insurance and self-insurance will be equal until the loss is paid. G. Limits of Liability Our liability to pay for damages is limited. Our limits of liability are shown in Item 3.6. of the Information Page. They apply as explained below. Bodily Injury by Accident. The limit shown for " bodily injury by accident-each accident" is the most we will pay for all damages covered by this insurance because of bodily injury to one or more employees in any one accident. A disease is not bodily injury by accident un- less it results directly from bodily injury by ac- cident. Bodily Injury by Disease. The limit shown for "bodily injury by disease-policy limit" is the most we will pay for all damages covered by this insurance and arising out of bodily injury by disease, regardless of the number of em- ployees who sustain bodily injury by disease. The limit shown for "bodily injury by disease- each employee" is the most we will pay for all damages because of bodily injury by disease to any one employee. Bodily injury by disease does not include dis- ease that results directly from a bodily injury by accident. 3. We will not pay any claims for damages after we have paid the applicable limit of our liability under this insurance. H. Recovery From Others We have your rights to recover our payment from anyone liable for an injury covered by this insur- ance. You will do everything necessary to protect those rights for us and to help us enforce them. Actions Against Us There will be no right of action against us under this insurance unless: You have complied with all the terms of this policy; and The amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. The bankruptcy or insolvency of you or your estate will not relieve us of our obligations under this Part. PART THREE - OTHER STATES INSURANCE A. How This Insurance Applies though that state were listed in Item 3.A. of the Information Page. 1. This other states insurance applies only if one or more states are shown in Item 3.C. of the 3. We will reimburse you for the benefits required Information Page. by the workers compensation law of that state if we are not permitted to pay the benefits di- g. If you begin work in any one of those states rectly to persons entitled to them. after the effective date of this policy and are not insured or are not self-insured for such 4. If you have work on the effective date of this work, all provisions of the policy will apply as policy in any state not listed in Item 3.A. of the WC 00 00 00 A Archive Copy 4 of 7 EXHIBIT F Information Page, coverage will not be af- forded for that state unless we are notified within thirty days. B. Notice Tell us at once if you begin work in any state listed in Item 3.C. of the Information Page. PART FOUR - YOUR DUTIES IF INJURY OCCURS Tell us at once if injury occurs that may be covered by this policy. Your other duties are listed here. 1. Provide for immediate medical and other ser- vices required by the workers compensation law. 2. Give us or our agent the names and ad- dresses of the injured persons and of wit- nesses, and other information we may need. 3. Promptly give us all notices, demands and le- gal papers related to the injury, claim, pro- ceeding or suit. 4. Cooperate with us and assist us, as we may request, in the investigation, settlement or de- fense of any claim, proceeding or suit. 5. Do nothing after an injury occurs that would interfere with our right to recover from others. 6. Do not voluntarily make payments, assume obligations or incur expenses, except at your own cost. PART FIVE - PREMIUM A. Our Manuals All premium for this policy will be determined by our manuals of rules, rates, rating plans and classifica- tions. We may change our manuals and apply the changes to this policy if authorized by law or a governmental agency regulating this insurance. B. Classifications Item 4 of the Information Page shows the rate and premium basis for certain business or work classi- fications. These classifications were assigned based on an estimate of the exposures you would have during the policy period. If your actual expo- sures are not properly described by those classi- fications, we will assign proper classifications, rates and premium basis by endorsement to this policy. C. Remuneration Premium for each work classification is determined by multiplying a rate times a premium basis. Remuneration is the most common premium basis. This premium basis includes payroll and all other remuneration paid or payable during the policy pe- riod for the services of: 1. All your officers and employees engaged in work covered by this policy; and 2. All other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and mate- rials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obli- gations. D. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers com- pensation law is not valid. E. Final Premium The premium shown on the Information Page, schedules, and endorsements is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, pre- mium basis and the proper classifications and rates that lawfully apply to the business and work cov- ered by this policy. If the final premium is more than the premium you paid to us, you must pay us the balance. If it is less, we will refund the balance to you. The final premium will not be less than the highest minimum premium for the classifications covered by this policy. If this policy is canceled, final premium will be de- termined in the following way unless our manuals provide otherwise. 1. If we cancel, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share of the minimum premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short rate WC 00 00 00 A Archive Copy 5 of 7 EXHIBIT F cancellation table and procedure. Final pre- mium will not be less than the minimum pre- mium. F. Records You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. G. Audit You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. In- surance rate service organizations have the same rights we have under this provision. PART SIX - CONDITIONS A. Inspection If you die and we receive notice within thirty days after your death, we will cover your legal represen- tative as insured. We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the con- ditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with laws, regulations, codes or standards. Insur- ance rate service organizations have the same rights we have under this provision. B. Long Term Policy If the policy period is longer than one year and six- teen days, all provisions of this policy will apply as though a new policy were issued on each annual anniversary that this policy is in force. C Transfer of Your Rights and Duties Your rights or duties under this policy may not be transferred without our written consent. D. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. We must mail or deliver to you not less than ten days advance written notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancellation notice. 4. Any of these provisions that conflicts with a law that controls the cancellation of the insur- ance in this policy is changed by this state- ment to comply with that law. E. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to change this policy, receive return premium, and give or receive notice of cancellation. WC OOOOOOA Archive Copy 6 of 7 EXHIBIT F In Witness Whereof, the company has caused this policy to be executed and attested, but this policy shall not be valid unless countersigned by a duly authorized representative of the company. President National Union Fire Insurance Company of Pittsburgh, PA President The Insurance Company of The State of Pennsylvania at4 & szPresident Commerce and Industry Insurance Company President Illinois National Insurance Company President AIG National Insurance Company WC 00 00 00 A 7of7 (?;' 161-44 President American Home Assurance Company e-O?- President AIG Casualty Company A President Granite State Insurance Company e-cx?- President New Hampshire Insurance Company 4.- President AIU Insurance Company • )k . Ifs Secretary National Union Fire Insurance Company of Pittsburgh, PA American Home Assurance Company The Insurance Company of The State of Pennsylvania AIG Casualty Company Commerce and Industry Insurance Company Granite State Insurance Company Illinois National Insurance Company New Hampshire Insurance Company AIG National Insurance Company AIU Insurance Company Archive Copy EXHIBIT F Page 1 of EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC 018-73-6121 Policy Prefix & No. 014-17-0309-00 PENNSYLVANIA Schedule 003057899 INTRA/Independent State Risk ID AIRCRAFT MANAGEMENT SERVICES, INC Item 4. Classification of Operations Premium Basis Rates Code Estimated Total Per $100 of Estimated No. Annual Remuneratio Remuneration Annual Premiums RATING GROUP: 0001-01 CLERICAL OFFICE EMPLOYEES 953 84,11 0.49 412 AIRCRAFT OPERATION, N.O.C.-INCLUDING 7424 2,00 6.20 124 BUT NOT NECESSARYILY LIMITED TO: AIR TAXI, PATROL, PHOTOGRAPHY, MAPPING, SKYWRITING, ADVERTISING, SURVEY WORK, SIGHTSEEING, STUDENT INSTRUCTION, CROP DUSTING OR SPRAYING, OR FLIGHT TESTING-ALL MEMBERS OF THEFLYING CREW. AIRPORT OPERATION - GROUND EMPLOYEES 7428 212,521 7.03 14,940 STATE OF PENNSYLVANIA TOTALS TOTAL CLASSIFICATION PREMIUM 15,476 TOTAL UNMODIFIED PREMIUM 15,476 EXPERIENCE PREMIUM (ACTUAL) 0.913 9898 -1,346 MODIFIED STANDARD PREMIUM 14,130 UNDISCOUNTED PREMIUM 14,130 PREMIUM DISCOUNT -7.00 0063 -989 DISCOUNTED PREMIUM 13,141 TERRORISM 3.00% 9740 464 CATASTROPHE (SEE WC 00 04 21C) 0.01 9741 51 TOTAL ESTIMATED PREMIUM 13,656 EMPLOYER ASSESSMENT (NON-COAL) 2.26% 0938 309 TOTAL DUE 13,965 EXPERIENCE RATING MODIFICATION = 0.91 TOTAL FOREIGN TERRORISM (TRIA) PREMIUM INCLUDED IN TOTAL ESTIMATED PREMIUM $48 WC 7754 (Ed. 4-81) (Rev'd 04/08) Archive Copy EXHIBIT F TERRORISM (TRIPRA) POLICYHOLDER NOTICE - PREMIUM DETERMINATION As indicated in the Foreign Terrorism Premium and Domestic Terrorism, Earthquake and Catastrophic Industrial Accidents Premium endorsement(s) included in this Policy, the premium you have been charged for coverage under the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007 (collectively "TRIX) is shown in Item 4 of the Information Page and State Schedule Pages form WC 7754. The schedule below shows how the premium for Terrorism under TRIA is determined. Schedule FOREIGN TERRORISM: State Arizona ............................................................................... Colorado, Connecticut, Idaho, New Jersey, and Wisconsin ........................................................................... Premium Determination Method Rate per $100 of Remuneration in addition to rate included in Arizona premium as set forth below`. Rate per $100 of Remuneration. New York ............................................................................... Kansas, Maine and New Hampshire ...................................... Rate per $100 of Remuneration and rate applied to Total Classification Premium. Included in Rates applied to Premium Basis (Remuneration) for calculation of annual premium for each applicable classification of operations. Alabama, Arkansas, Iowa, Montana, Nevada, Tennessee Rate per $100 of Remuneration in addition to charge and Texas ............................................................................... included in rates applied to Premium Basis (Remuneration) for calculation of annual premium for each applicable classification of operations. All Other States * .................................................................... Rate applied to Total Classification Premium. This policyholder notice is not applicable in Alaska, Florida, Missouri, New Mexico or Virginia. ** For policies issued by Commerce and Industry Insurance Company or New Hampshire Insurance Company the total premium for Arizona also includes a charge for this coverage in the rates applied to Premium Basis (Remuneration) for each applicable classification of operations. For policies issued by American Home Assurance Company, American International South Insurance Company, AIG Casualty Company, Granite State Insurance Company, Illinois National Insurance Co., National Union Fire Insurance Company of Pittsburgh, Pa. or The Insurance Company of the State of Pennsylvania the total premium for Arizona also includes a charge for this coverage determined by applying a rate against the Schedule Modification factor. DOMESTIC TERRORISM: State Premium Determination Method Rate per $100 of Remuneration Alabama, Arizona, Arkansas, Colorado, Connecticut, Delaware, District of Columbia, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Mississippi, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Utah and Wisconsin .......................................................................... TRSMPOLNOT (Ed. 01/08) Archive Copy EXHIBIT F PARTNERS, OFFICERS AND OTHERS EXCLUSION ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2009 forms a part of Policy No. WC o18-73-6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA The policy does not cover bodily injury to any person described in the Schedule. The premium basis for the policy does not include the remuneration of such persons. You will reimburse us for any payment we must make because of bodily injury to such persons. Schedule Partners Officers Others MICHAEL J. HARTLE WC 00 03 08 Countersigned by - - - - - - - - - - _ _ ------------------ (Ed. 484) Archive Copy EXHIBIT F Authorized Representative PREMIUM DISCOUNT ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03 / 15 / 2009 forms a part of Policy No. WC 018 - 73 -6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA The premium for this policy and the policies, if any, listed in Item 3 of the Schedule may be eligible for a discount. This endorsement shows your estimated discount in Items 1 or 2 of the Schedule. The final calculation of premium discount will be determined by our manuals and your premium basis as determined by audit. Premium subject to retrospective rating is not subject to premium discount. Schedule Estimated Eligible Premium 1. State First Next Next $5,000 $95,000 $400,000 Balance Pennsylvania 10.90 12.60 14.40 2. Average percentage discount: 3. Other policies: 7.00 % 4. If there are no entries in Items 1, 2 and 3 of the Schedule, see Premium Discount Endorsement attached to your policy number: WC 00 04 06 Countersigned by _ _ _ _ _ _ _ _ (Ed. 4-84) Archive Copy Authorized Representative EXHIBIT F CATASTROPHE (OTHER THAN CERTIFIED ACTS OF TERRORISM) PREMIUM ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2009 forms a part of Policy No. WC 018-73-6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (other than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 A), attached to this policy. For purposes of this endorsement, the following definitions apply: • Catastrophe (other than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million. • Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. • Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a, It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of an effort to influence the policy or affect the conduct of the United States Government by coercion. • Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (other than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium WC 00 04 21C Countersigned by (Ed. 09/08) (> Copyright 2008 National Coun hWftp?nce Inc. All rights reserved. JJ EXHIBIT F Authorized Representative TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT DISCLOSURE ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2009 forms a part of Policy No. WC 018-73-6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "Act" means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2007. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. "Insurer Deductible" means, for the period beginning on January 1, 2008, and ending on December 31, 2014, an amount equal to 20% of our direct earned premiums, over the calendar year immediately preceding the applicable Program Year. "Program Year" refers to each calendar year between January 1, 2008 and December 31, 2014, as applicable. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program Year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. WC 00 04 22A (Ed. 09/08) 0 Copyright 2008 National CounaNco.ll?rtlpAps Cb yi?nce, Inc. All Rights Reserved. /'1I (i???YC vvf??r Raffik 1 Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses exceeds $100,000,000 in a Program Year, the United States Government would pay 85% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceeds $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amounts shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium WC 00 04 22A Countersigned by (Ed. 09108) 0 Copyright 2008 National Counj@r•fpjVLwajgjj Wce, Inc. All Rights Reserved. aagnf 2 EFRNI IT Authorized Representative IMPORTANT NOTICE TO OUR CUSTOMERS REGARDING THE OFFICE OF FOREIGN ASSETS CONTROL Your rights as a policyholder and payments to you, any insured, additional insured, loss payee, mortgagee, or claimant, for loss under this policy may be affected by the administration and enforcement of U.S. economic embargoes and trade sanctions by the OFFICE OF FOREIGN ASSETS CONTROL (" OFAC" ). WHAT IS OFAC? OFAC is an office of the Department of the Treasury and acts under presidential wartime and national emergency powers, as well as authority granted by specific legislation, to impose controls on transactions and freeze foreign assets under U.S. jurisdiction. OFAC administers and enforces economic embargoes and trade sanctions primarily against: • Targeted foreign countries and their agents • Terrorism sponsoring agencies and organizations • International narcotics traffickers PROHIBITED ACTIVITY OFAC enforces certain embargoes and sanctions against certain designated countries. No U.S. business or person may enter into certain transactions in or connected to such designated "sanctioned" countries. OFAC maintains a directory known as the "Specially Designated Nationals and Blocked Persons" ("SDNBP") list. No U.S. business or person may transact business with any person or entity named on the SDNBP list. Additional and more in-depth information on OFAC is available at the following website: http://www.ustreas.gov/offices/eotffc/ofac. OBLIGATIONS PLACED ON US BY OFAC If we determine that you or any insured, additional insured, loss payee, mortgagee, or claimant are on the SDNBP list or are connected to a sanctioned country as described in the regulations enforced by OFAC, we must block or "freeze" property and payment of any funds transfers or transactions and report all blocks to OFAC within ten (10) days. POTENTIAL ACTIONS BY US 1. We may immediately cancel your coverage effective on the day that we determine that we have transacted business with an individual or entity associated with your policy on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. 2. If we cancel your coverage, you will not receive a return premium unless approved by OFAC. All funds will be placed in an interest bearing blocked account established on the books of a U.S. financial institution. 3. We will not pay a claim, accept premium or exchange monies or assets of any kind to or with individuals, entities or companies (including a bank) on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. And, we will not defend or provide any other benefits under your policy to individuals, entities or companies on the SDNBP list or connected to a sanctioned country as described in the regulations enforced by OFAC. YOUR RIGHTS AS A POLICYHOLDER If funds are blocked or frozen by us in conjunction with the OFFICE OF FOREIGN ASSETS CONTROL, you may complete an "APPLICATION FOR THE RELEASE OF BLOCKED FUNDS" and apply for a specific license to request their release. Forms are available for download at the OFAC website. See http://www.ustreas.gov/offices/eotffc/ofac/legal/forms/license. pdf WCOFAC (Ed. 07/05) Archive Copy EXHIBIT F PRIVACY POLICY Our Commitment to Privacy: The AIG Companies (AIG) believe one of our most important assets is the trust consumers place in us to respect and properly handle nonpublic personal information received by us in connection with providing our products and services. To continue earning your trust and enhance the products and services offered to you, the companies listed below have adopted the following privacy policy to govern how we treat your nonpublic personal information including such information about our former customers. It's important for you to know that this privacy policy applies only to the product or service you have just obtained or the insurance policy under which you are seeking or receiving benefits. This policy does not preclude any AIG Company from using the information you provided in order to offer you other products or services in which you may be interested. This policy also does not preclude us from sharing your information with a non-AIG affiliated company so long as the sharing is necessary to administer and process the product or service you have just obtained or the insurance policy under which you are seeking or receiving benefits. As a large worldwide leader in the delivery of financial products and services, we offer numerous products and services to many types of consumers and clients in many different states and countries around the world. Therefore, any one of our companies may have different privacy policies to fit the specific products and services it offers. Information We Collect: We collect information about you that is necessary to tailor our products and services to meet your individual needs, provide effective customer service, and comply with legal requirements. We may collect nonpublic personal information about you, from one or more of the following sources: • Information we receive from you on applications or other forms; ¦ Information about your transactions with us, our affiliates or others; • Information we receive from a consumer-reporting agency; and • Information received in handling claims. Sharing Information Within Our Family of Companies: We may share some or all of the nonpublic personal information we collect with our affiliates - the members of the AIG family of companies, unless such sharing of information is prohibited by law. In many cases, the information that is shared may be at your request or is necessary to administer, process or otherwise handle your transactions with us or settle a claim on your behalf. In addition, we may provide this information to our affiliates in order to offer you products and services in which you may be interested. Our family of companies includes many insurance companies (e.g., auto, home, and life insurance), insurance claims handling companies, other financial institutions (e.g., savings bank), and non-financial institutions. Sharing Information Outside the AIG Family: Sometimes, we use companies or businesses outside the AIG family to administer, process, or otherwise handle your transactions with us, such as for claims handling or customer service. Other times, we may enter into contracts with nonaffiliated companies to perform services on our behalf, such as marketing our products and services, or we may enter into joint marketing agreements with other financial institutions. In these and other circumstances permitted by law, we may share some or all of the information we collect above with these nonaffiliated third parties. However, whenever we utilize a nonaffiliated third party to provide these services, they are required to follow federal privacy laws governing this notice. We also may share information to combat fraud, in response to a court order, or at the request of government regulators. Nonpublic Personal Health Information: We will not disclose nonpublic personal health information about you without obtaining prior written authorization from you, except as permitted by applicable law or regulation. 78052D (Ed. 11/06) Archive Copy Protecting and Safeguarding Your Information: To help prevent unwarranted disclosure of your nonpublic information and secure it from theft, we utilize secure computer networks and restrict access to nonpublic personal information about you to those employees who need to know that information to provide products or services to you. In addition, we maintain physical, electronic, and procedural safeguards that comply with applicable laws and regulations to guard our customers' nonpublic personal information. Maintaining Accurate Information: We also maintain procedures to ensure that the information we collect is accurate, up-to-date, and as complete as possible. If you believe the information we have about you in our records or files is incomplete or inaccurate, you may request that we make additions or corrections, or if it is feasible, that we delete this information from our files. You may make this request in writing to (include your name, address and policy number): Chief Privacy Officer AIG - Domestic Brokerage Group 175 Water Street, 3rd Floor New York, NY 10038 FAX: 212-785-9495 e-mail: DBG.Privacy@,AIG.com Special notice for policyholders who reside in any of the following states: Arizona, California, Connecticut, Georgia, Illinois, Kansas, Maine, Massachusetts, Minnesota, Montana, Nevada, New Jersey, North Carolina, Ohio, Oregon, Virginia or Wisconsin: You can obtain access to any nonpublic personal information we have about you if you properly identify yourself and submit a written request to us at the address above describing the information you want to review (include your name, address and policy number). Once we have received your request, and if the information is reasonably locatable and retrievable, we will, within 30 business days, take the following actions: ¦ Inform you of the nature and substance of the recorded information; • Allow you to see and copy, in person, such recorded personal information; or ¦ Send you a copy of the recorded personal information by mail (we may charge you a reasonable fee to cover the cost of this service). We will also tell you at this time the identity, if recorded, of persons to whom we have disclosed the nonpublic personal information within the preceding two years. If you ask us to correct, amend or delete any information about you, we will, within 30 business days, either correct, amend or delete the nonpublic personal information in dispute or notify you of our refusal to take such action along with the reasons for our decision. If we make the correction, amendment or deletion you've requested, we will also notify you along with any person you designate who has received the information about you within the preceding two years, together with any insurance support organization(s) which provided us with the disputed information. If we refuse to make the requested correction, amendment or deletion, you are permitted to file a concise statement setting forth what you think is the correct, relevant or fair information along with a statement of the reasons why you disagree with our refusal to correct, amend or delete the information subject to dispute. We will file your statement with the disputed personal information and make any person who reviews your file aware of your statement. We will also furnish your statement to any person who has received personal information from us within the two preceding years and any insurance support organization whose primary source of personal information is an insurer. 78052D (Ed. 11/06) Archive Copy `?p?,2 ?XFilt3ff ? Important Information Concerning the Applicability and Future Changes to this Privacy Policy: This privacy policy applies, with respect to nonpublic personal financial information, to the particular products or services you have just obtained, which provide primarily for personal, family, or household purposes in the United States by the AIG Companies listed below, and it applies to all nonpublic personal health information these Companies may have. Although we may change this policy at any time, as it relates to the particular product or service, please rest assured that you will be notified of any changes as required by law. AIG Companies Covered by this Policy: AIG Hawaii Insurance Company AIG Casualty Company AIU Insurance Company American Home Assurance Company American International Pacific Insurance Company American International South Insurance Company Commerce and Industry Insurance Company Granite State Insurance Company Illinois National Insurance Co. National Union Fire Insurance Company of Louisiana National Union Fire Insurance Company of Pittsburgh, Pa. New Hampshire Insurance Company The Insurance Company of the State of Pennsylvania American International Specialty Lines Insurance Company American Pacific Insurance Company, Inc. Landmark Insurance Company Lexington Insurance Company Agency Management Corporation A. I. Risk Specialists Insurance, Inc. A. I. Risk Specialists of Missouri, Inc. American International Entertainment, Inc. Eastern Risk Specialists, Inc. Florida Risk Specialists, Inc. The Gulf Agency, Inc. Louisiana Risk Specialists, Inc. Medical Excess Insurance Services, Inc. Michigan Risk Specialists, Inc. Midwestern Risk Specialists, Inc. Nevada Risk Specialists, Inc. New England Risk Specialists, Inc. Northwestern Risk Specialists, Inc. Risk Specialists Companies, Inc. Risk Specialists Company (Bermuda), Ltd. Risk Specialists Company of Colorado, Inc. Risk Specialists Company of Kentucky, Inc. Risk Specialists Company of Minnesota, Inc. Risk Specialists Company of New Jersey, Inc. Risk Specialists Company of New York, Inc. Risk Specialists Company of Ohio, Inc. Risk Specialists of the Carolinas, Inc. Southeastern Risk Specialists, Inc. Southern Risk Specialists, Inc. Western Risk Specialists, Inc. American International Surplus Lines Agency, Inc. AIG Warranty Services and Insurance Agency, Inc. and other member companies of the AIG family who sent you this privacy policy statement. 78052D (Ed. 11/06) Archive Copy p`?pFi"3 tXlt36 ? PREMIUM DUE DATE ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2009 forms a part of Policy No. WC 018-73-6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA PART FIVE PREMIUM D. Premium is amended to read: You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. The due date for audit and retrospective premiums is the date of the billing. WC 00 04 19 Countersigned by (Ed. 01/01) Archive Copy EXHIBIT F Authorized Representative SPECIAL PENNSYLVANIA ENDORSEMENT-INSPECTION OF MANUALS This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2009 forms a part of Policy No. WC 018-73-6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA The manuals of rules, rating plans, and classifications are approved pursuant to the provisions of Section 654 of the In- surance Company Law of May 17, 1921, P.L. 682, as amended, and are on file with the Insurance Commissioner of the Commonwealth of Pennsylvania. WC 370601 Countersigned by----------__-----_ (Ed.4-84) ------------- Archive Copy Authorized Representative EXHIBIT F PENNSYLVANIA NOTICE This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2009 forms a part of Policy No. WC 018-73-6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA An Insurance Company, its agents, employees, or service contractors acting on its behalf, may provide services to reduce the likelihood of injury, death or loss. These services may include any of the following or related services incident to the application for, issuance, renewal or continuation of, a policy of insurance: 1. surveys; 2. consultation or advice; or 3. inspections. The " Insurance Consultation Services Exemption Act' of Pennsylvania provides that the Insurance Company, its agents, employees or service contractors acting on its behalf, is not liable for damages from injury, death or loss occurring as a result of any act or omission by any person in the furnishing of or the failure to furnish these services. The Act does not apply: 1. if the injury, death or loss occurred during the actual performance of the services and was caused by the negligence of the Insurance Company, its agents, employees or service contractors; 2. to consultation services required to be performed under a written service contract not related to a policy of insur- ance; or; 3. if any acts or omissions of the Insurance Company, its agents, employees or service contractors are judicially de- termined to constitute a crime, actual malice, or gross negligence. WC 37 06 02 Countersigned by - - - - - - - - _ - - (Ed.484) ------------------ Archive Copy EXHIBIT F Authorized Representative PENNSYLVANIA ACT 86-1986 ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 03/15/2009 forms a part of Policy No. WC 018-73-6121 Issued to AIRCRAFT MANAGEMENT SERVICES, INC By THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA NONRENEWAL, NOTICE OF INCREASE OF PREMIUM, and RETURN OF UNEARNED PREMIUM This endorsement applies only to the insurance provided by the policy because Pennsylvania is shown in Item 3.A. of the Information Page. The policy conditions are amended by adding the following regarding nonrenewal, notice of increase in premium, and return of unearned premium. Nonrenewal 1. We may elect not to renew the policy. We will mail to each named insured, by first class mail, not less than 60 days advance notice stating when the nonrenewal will take effect. Mailing that notice to you at your mailing address last known to us will be sufficient to prove notice. 2. Our notice of nonrenewal will state our specific reasons for not renewing. 3. If we have indicated our willingness to renew, we will not send you a notice of nonrenewal. However, the policy will still terminate on its expiration date if: a. you notify us or the agent or broker who procured this policy that you do not want the policy renewed; or b. you fail to pay all premiums when due; or c. you obtain other insurance as a replacement of the policy. "Notice of Increase in Premium 1. We will provide you with not less than 30 days advance notice of an increase in renewal premium of this policy, if it is our intent to offer such renewal. 2. The above notification requirement will be satisfied if we have issued a renewal policy more than 30 days prior to its effective date. 3. If a policy has been written or is to be written on a retrospective rating plan basis, the notice of increase in premium provision of this endorsement does not apply. Return of Unearned Premium 1. If this policy is canceled and there is unearned premium due you: a. If the Company cancels, the unearned premium will be returned to you within 10 business days after the effective date of cancellation. WC 37 06 03 A (Ed. 08-95) Archive COPY Page 1 of 2 EXHIBIT F b. If you cancel, the unearned premium will be returned within 30 days after the effective date of cancellation Because this policy was written on the basis of an estimated premium and is subject to a premium audit, the unearned premium specified in 1a. and 1b. above, if any, shall be returned on an estimated basis. Upon our completion of computation of the exact premium, an additional return premium or charge will be made to you within 15 days of the final computation. 3. These return of unearned premium provisions shall not apply if this policy is written on a retrospective rating plan basis. WC 37 06 03 A Countersigned by - - - - - - - - _ - __ _ (Ed. 08-95) Archive Copy Page 2 of 2 Authorized Representative EXHIBIT F NOTIFICATION OF AVAILABILITY OF ACCIDENT AND ILLNESS PREVENTION SERVICES IN THE STATE OF PENNSYLVANIA AIG Consultants, Inc., a member company of American International Group, Inc. (AIG), maintains and provides accident and illness prevention services as required by the nature of the policyholder's business or its operation, in accordance with the Pennsylvania Workers' Compensation Act. A 5% premium discount is available to employers who form a certified workplace safety committee. Services include: Surveys Recommendations Training Programs Consultations Analysis of Accident Causes Industrial Hygiene Services Industrial Health Services For more information about these services, contact AIG Consultants at 212-770-5038, e-mail us at aig-consultants@aig.com or write to: AIG Consultants, Inc. 1700 Market Street-Suite 1800 Philadelphia, Pa. 19103 Fax # 215-255-6561 WC 99 37 03A (Ed. 08/02) Archive Copy EXHIBIT F ENDORSEMENT 001 This endorsement, effective 12:01 AM 03/15/2009 Forms a part of policy no.: WC 018-73-6121 Issued to: AIRCRAFT MANAGEMENT SERVICES, INC By:THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA DESIGNATED WORKPLACE EXCLUSION THE POLICY DOES NOT COVER WORK CONDUCTED AT OR FROM: 1. ANY EMPLOYEE COVERED UNDER OR EXCLUDED FROM COVERAGE UNDER ANY OTHER WORKERS' COMPENSATION POLICY. 2. ANY ACTIVITIES OTHER THAN THOSE RELATED TO CLASS CODES: 953, 7428, AND 7424 ONLY. Issue Date: O 1 / 09 / 09 Iw0014 Archive Copy Authorized Representative EXHIBIT F PAGE 1 EXTENSION OF ITEM 1. OF THE INFORMATION PAGE This endorsement, effective 12:01 AM 03/15/2009 Forms a part of policy no.: WC 018-73-6121 Issued to: AIRCRAFT MANAGEMENT SERVICES, INC By:THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA LOC NO. NAME AND ADDRESS SCHEDULE FEIN 0001 AIRCRAFT MANAGEMENT SERVICES 003057899 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 170 0-0000 BUSINESS TYPE: CORPORATION Issue Date: O 1 / 09 / 09 W C990610 (Ed. 1-Ar(ON@090PY UI # Authorized Representative EXHIBIT F BINDER CONFIRMATION 4070 M EM BER COM PAN IES OF AMERICAN INTERNATIONAL GROUP FOR INSURANCE IN FAVOR OF: AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 PRODUCER: C S & A FRANKLIN PO BOX 681208 FRANKLIN, TN 37068-1208 ISSUING COMPANY: THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA THIS IS NOT A BILL Division 014 Producer No. 0088687-00 Endt No. 000 Branch 17 Transaction Eff Date 03/15/08 POLICY N UMBER POLICY PERIOD COMMISSION RATE WC 018-73-6121 03/15/09 TO 03/15/10 7.5 PREMIUM SURCHARGE TOTAL DUE Transaction Total $13,656 $309 $13,965 Policy Total $13,656 $308 $13,965 DEPOSIT PREMIUM: SURCHARGES: WC99PS03 (Ed. 1/97) $13,656 $309 TOTAL DEPOSIT DUE: $13,865 Installment Schedule Installment Effective Date No. Amount Due Archive Copy EXHIBIT F Audit Billing Ticket Case Name: 018736121-000-A-6 001 Company Code: Ins Co of the State of Penn Policy Status: Completed - final Division: 014 Auditor's Name: Auditor Number: CAPXKCR Vendor Co. Name: Audit Method: Physical Audit Date Range: 05/27/2010 - 05/2712010 Risk ID: All other Completion Date: 05/27/2010 Audit Type: Final - annual Insured Name: AIRCRAFT MANAGEMEN T SERVICES, Due Date: Audit Period: 03/15/2009 - 03/15/2010 Technician Rejecting Audit: Policy Period: 03/15/2009 - 03/15/2010 Prior Policy Number: 1211671 Policy Prefix: WC Policy #: 018736121 LOB: WC - AIWCS Policy ID: 014017030900 Name of Program/Wrap-Up: Contract/Acct #: All Audits Completed: Yes Shelled: No Auditor # I Auditor #2 Auditor #3 Travel Time: 0.50 0.00 0.00 Audit Time: 2.50 0.00 0.00 Write-Up Time: 1.00 0.00 0.00 Other (Explain): 0.00 0.00 0.00 Billing Hours: 4.00 0.00 0.00 Total Hours: 4.00 Audit States: PA Policy Numbe r COMPANION POLICIES Status BILLING TICKET NOTES DALC 5= Finish Minutes. A ction Total Minutes: PROCESSING INFORMATION Date Received: 04/18/2011 Due Date: 04/28/2011 PAPC #: Technician Minutes: Technician #: Deposit Premium: Date Completed: Additional/Return Premium: Tracking Completion Done By: EXHIBIT G American International Companies" AIRCRAFT MANAGEMENT SERVICES, Attn: Melanie Green 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 Workers' Compensation Audit Prepared for: Ins Co of the State of Penn Report prepared by: AIG Premium Audit Division Policy Number: 018736121 Policy Term: 03/15/2009 - 03/15/2010 Audit Period: 03/15/2009 - 03/15/2010 Audit Date: 05/27/2010 EZ-Audit software by InsuraTek Corp. www.insuratek.com Date Printed: 04/18/2011 9:44:07AM EXHIBIT G Workers Compensation Audit Date: 05/27/2010 Legal Entity: Corporation Auditor ID: CAPXKCR Agent ID: 0088687 Auditor Name: Account Number: 018736121-000-A-6 05/29/2010 001 Audit Period: 03/15/2009 03/15/2010 Policy Number: 018736121 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT MANAGEMENT SERVICES. Exposure Summary S1Rk Clae___, LOAk Description fluasum From TQ Entity: 0001 AIRCRAFT MANAGEMENT SERVICES, Location: 0001 PA PA BLNC BALANCE CLASS 0 03/15/09 03115110 PA 7424 AIRCRAFT OPERATION, N.O.C.-INCLUDING 45,978 03/15/09 03115110 PA 7428 AIRPORT OPERATION - GROUND EMPLOYEE 331,822 03/15/09 03/15/10 PA 953 CLERICAL OFFICE EMPLOYEES 24,002 03/15/09 03/15/10 INSURED INFORMATION Contact: Melanie Green Phone: Title: Phone 2: Company Name: AIRCRAFT MANAGEMENT SERVICES, Mobile: Address: 228 AIRPORT ROAD HANGAR 7 Fax: NEW CUMBERLAND, PA 170702467 E-Mail: Entities Number Entity Name Federal ID State ID Date Added Date Deleted 0001 AIRCRAFT MANAGEMENT SERVICES, 3057899 Locations Location: 0001 PA Added: Deleted: Contact Name: Melanie Green Phone: Contact Title: Phone 2• Company Name: AIRCRAFT MANAGEMENT SERVICES, Mobile: Address: 228 AIRPORT ROAD HANGAR 7 Fax: NEW CUMBERLAND, PA 17070-2467 Email: Location of Records Entity: Location: Sequence: I Territory: Description: Same as insured address. Description of Operations The insured operates an aircraft maintenance service company in New Cumberland, PA. They will complete the following services: Annual Inspections -100 Hour Inspections -Phase Inspections -Major & Minor Repair -Major & Minor Troubleshooting -Major & Minor Alterations -Airworthiness Directives -Service Bulletins -Insurance Repair -STC's & Field Approvals -All Aircraft Makes & Models The employees that complete the maintenance activities have been classified under code 7428: Aircraft operation - ground employees. American International Group Page 3 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAF F MANAGEMENT SERVICES, There are pilots that will take the aircrafts up to test that the repairs are complete. These employees have been classified under code 7424: Aircraft operation - NOC. There is one employee that reviews financial records from her home office. This employee has been classified under code 953: Clerical Office Employees. There are other employees that will complete bookkeeping, accounting and other financial duties. However, the area that this work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the mechanical operations take place on the airplanes. Therefore these employees have been classified under code 7428. General Notes Does the insured subcontract any operations? NO Are cash payments made to any employees, subcontractors or "casual laborers"? NO Does the insured lease any employees from employee leasing companies? If yes, has the insured obtained proof of WC coverage for all leased employees? NO Does the insured use any temporary labor? If yes, has the insured obtained proof of WC coverage for all leased employees? NO Is the insured related to any other business by common ownership? NO Has the ownership of the company changed within the last 5 years through merger, consolidation, sale, transfer, or conveyance of ownership interest of physical assets? NO Has the insured changed names in the last 5 years? NO Have any of the insured's employees conducted new construction or alterations to the business premises during this policy period ? NO Do any employees own, rent or operate aircraft when conducting company business? YES Do any employees engage in stevedoring operations (loading and unloading of ships, railroad cars or airplanes) including tallying and checking? NO Do any employees engage in sawmill operations? NO Does the insured operate a daycare service for the employees' children? NO Does the insured employ clerical workers who work exclusively in an office engaged in record keeping, correspondence or phone work? Yes - but there is no physical separation for these employees. Does the insured employ clerical workers who work exclusively in a residence office engaged in record keeping, correspondence or phone work? YES Does the insured employ outside salesmen, messengers, or collectors who do not engage in delivery operations? NO Does the insured employ drivers? NO Does the risk have Florida exposure? If yes, are copies of Federal and State tax forms and other documentation used for verification attached to the audit? NO Date Printed: 04/18/2011 9.44:07AM American International Group Page 4 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT MANAGEMENT SERVICES Did the insured perform any construction operations covered by a separate wrap up policy? NO Is there a waiver of subrogation for any jobs the insured performed? NO Is code 0930 on the policy schedule or endorsement page? NO Is the insured entitled to a Contracting Classification Adjustment Program (CCAP)? NO Is statistical code 9046 on the policy schedule or endorsement page? NO Were there any exceptional exposure variances that require explanation? YES Did the audit period deviate from the policy period more than 16 days? NO Did the insured have any overtime payroll during the policy period that is excludable for states covered by the policy? NO Were the records properly segregated to allow for the overtime deduction? Have you shown an analysis in the worksheets? N/A Was this policy renewed? YES Were summary records used? NO Was an exit interview conducted with the insured and was the results of the audit discussed with a responsible party? YES Have all signature pages been completed? YES Has the insured signed the portion of the signature form allowing the broker/agent to receive copies of the worksheets? NO Is there a secondary business ? NO Has the description of operations included all aspects and detail of the operations as described in the HOB? YES Has a Standard Exception analysis been completed with details showing job duties and responsibilities? YES Does the records requested and audited section show proof that first and second sources were used to complete the audit? YES Was a Notice to Underwriter necessary? YES Were claims properly documented in the worksheets and the proper person notified of discrepancies? YES ADDITIONAL PA/DE WORKERS COMPENSATION PROCEDURE NOTES Have you documented the mandatory walk through of the insured's premises and determined the proper classification of the insured? YES - The walk through took place at the time of the audit. For each entity insured on the policy have you documented a complete and thorough Description of Operations from raw material to completion of product or service? YES Have you addressed the footnotes in the PA manual? YES If referred to an insured's accountant, have you advised the insured that in order to have a complete audit a tour of his premises is required and request that the records be brought to his place of business to conduct the audit. If the insured could not have his records available at his place of business, have you visited with the insured after you met with the accountant and documented same? A physical tour of the premises and discussion regarding the description of operations and employees duties is required to take place with the insured. - N/A, audit was completed with insured at their office. Have you audited by the exact policy period with no more than a 16 day deviation from policy period if it was absolutely necessary? YES American International Group Page 5 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Have you audited on a date paid basis and documented the start check date and the end check date in your audit? YES - The first pay date included is 3/12/2009, last pay date included is 3/11/2010. Have you completed a mandatory verification of PA & DE Unemployment reports? YES For smaller audits (insured's with 20 employees or less) have you recorded payroll by employee. Using the left side "note" key in the payroll section of the audit given a full description of daily duties for each employee, not just a job title? YES For larger audits (insured's with more than 20 employees) have you excluded from the main classification of the business all clerical and sale employees. Have you listed names of standard exception employees whenever possible? N/A For large audits with over 20 exceptions, have you used departmental payroll and given a full analysis of departmental duties using the left side "note" key in the payroll section of the audit? N/A Have you classified Executive Officers the same as any other employee and given full descriptions of their daily duties - assigning a class code based on their regular and frequent exposure to the business. Have you applied the proper minimum and maximum remuneration? The officer is excluded per endorsement. Have you listed key employees separately? YES Have you identified all miscellaneous employees separately and given a full description of their responsibilities? N/A - No miscellaneous employees determined during audit. Have you verified in the PA manual all inclusions/exclusions to remuneration and adjusted any tips to minimum wage requirements, as well as, shown a reasonable analysis? N/A - There were no inclusions/exclusions or tips determined during audit. There is no allowance for Overtime in the states of Pennsylvania/Delaware. Have you checked Q-Mod, called the Bureau or checked the website for authorized codes for this policy period and documented it in your audit work sheets with the Bureau file number? YES - Bureau File # 3057899 - Authorized codes are 7424, 7428, 951 and 953. Have you also documented whether or not the approved codes seem to be appropriate for the business operations? YES Class codes apply to the business of the insured. Have you shown monthly gross payroll totals for the business or provided an explanation as to why monthly payroll are not issued? Not available due to time constraints. Does your audit have a zero balance class showing that you accounted for all payroll? YES Have you documented whether you physically reviewed the Charter of the Corporation or the Minutes of the Board Meeting, etc. for confirmation of the corporate officers DURING THE POLICY PERIOD you are auditing? YES - 2008 Tax returns were reviewed. Operations based in PA. Insured does not travel outside PA for work. Officers: Michael Hartle - President Standard Exceptions: One employee completes clerical activities from her home office Records Reviewed: Payroll Reports, general ledger, 2008 Tax returns, quarterly returns. Anniversary Rating Date - None indicated. Subcontractors/Contract Labor: There were no subcontractors, contract labor, temporary labor, casual labor or leased employees. Exposure Variance: I'll 11111-U. "», 0-1 I 7:44:v 1AfVl American International Group Page 6 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT' MANAGEMENT SERVICES. Class Code Estimated Exposure Audited Exposure 953 84,110 24,002 7424 2,000 45,978 7428 212,521 331,822 Increase in exposure due to the hiring of additional employees to complete the work. Also, due to no physical separation the clerical employees (with the exception of one home based employee) have been classified under the governing class code of 7428. These exposure are in line with last years exposures. The insured stated that they tried to get their policy increased but due to miscommunication it did not happen. Clerical Analysis: There is one employee that reviews financial records from her home office. This employee has been classified under code 953: Clerical Office Employees. There are other employees that will complete bookkeeping, accounting and other financial duties. However, the area that this work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the mechanical operations take place on the airplanes. Therefore these employees have been classified under code 7428. Zero exposure codes: none Classes/locations added: none Claims Analysis: There was one claim made during the policy period. The claim has been verified to be in the correct classification code. The employee was listed on the payroll records and was active at the time of the accident. The claims information has been verified by the AIG claims report. Key Employees: Michael Hartle is the operations manager and is essential to the operations of the business. Exit Interview: Audit and Exit interview was conducted with the Insured's Office Manager, Melanie Green at the insured's address. We reviewed operations, exposures and classifications. The insured had no questions or objections to the audit figures. All FEIN Numbers correct as listed and endorsed on policy schedule. Audit Reconciliation state Clacc Code Desetiotion fauum From U Entity: 0001 AIRCRAFT MANAGEMENT SERVICES, Location: 0001 PA PA Gross Payroll 450,341 03/15/09 03115110 PA <Classified> -401,802 03/15/09 03/15/10 PA <Principals> -48,539 03/15/09 03115110 PA BLNC Balance BALANCE CLASS 0 03/15/09 03/15/10 PA 7424 AIRCRAFT OPERATION, N.O.C.-INCLUDING 45,978 03/15/09 03115110 PA 7424 Total AIRCRAFT OPERATION, N.O.C.-INCLU 45,978 03/15/09 03/15/10 PA 7428 AIRPORT OPERATION - GROUND EMPLOYEE 331,822 03/15/09 03/15/10 PA 7428 Total AIRPORT OPERATION - GROUND EMPLO 331,822 03/15/09 03115110 PA 953 CLERICAL OFFICE EMPLOYEES 24,002 03/15/09 03/15/10 PA 953 Total CLERICAL OFFICE EMPLOYEES 24,002 03/15/09 03115110 Date Printed: 04/18/2011 9:44:07AM American International Group Page 7 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Insured Name: AIRCRAFT MANA(7FMFNT 4ZFRV11`F4 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Principals Slak Class Code LName. Title Dates Entity: 0001 Location: 0001 PA EXCL Michael Hartle President 03/15/09 03/15/10 1.000 Min: 20,800 Max: 101,400 Payroll: 48,539 Amount Incl: 0 Payroll Verification Entity: 0001 Location: 0001 Verification Type: Ot St ti Federa1941 r ar ne Adjustment Amount Adjustment Otr Total Description 0 0 0 1st Qtr 2009 120,006 -99,131 20,875 Less: 1/1/2009 through 3/15/2009 2nd Qtr 2009 125,350 0 125,350 3rd Qtr 2009 108,510 0 108,510 4th Qtr 2009 113,488 82,116 195,604 Add: 1/1/2010 through 3/15/2010 1 st Qtr 2010 0 0 0 Adjustment 0 2 2 Rounding adjustment Gross Total: $450,341 Verification Total: 450,341 Deviation: so Audit Worksheet State Class Code Name Order Dept Empl. Dates Total Entity: 0001 Location: L=1.1 Gross Payroll PA Gross Payroll 180 03/15/09 03115110 450,341 Lump Sum: 368,224 Adjustment: 82,117 Total Gross Payroll 450,341 Classified PA 7424 Doersom, Keith 20 03/15/09 03115110 40,000 Duties: Pilot Lump Sum: 32,308 Adjustment: 7,692 PA 7428 Green, Melanie 30 03/15/09 03/15/10 31,877 Duties: Bookkeeping Notes: This employee completes clerical activities. However, the area that the work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the machanical operations take place on the airplanes. Therefore this employee has been classified under class code 7428. Lump Sum: 25,723 Adjustment: 6,154 PA 7428 Steinmiller, Rick 40 03/15/09 03115110 55,000 Duties: General manager Notes: This employee completes clerical activities. However, the area that the work is completed is in an open section of the shop warehouse. There is no physical barrier between where the desks are and where the machanical operations take place on the airplanes. Therefore this employee has been classified under class code 7428. Lump Sum: 44,423 Adjustment: 10,577 PA 7428 Plouse, Daryl 50 03/15/09 03115110 58,000 Duties: Director of Maintenenace Lump Sum: 46,846 Adjustment: 11,154 PA 7428 Beddow, Don 60 03/15/09 03/15/10 19,385 Duties: Inventory Manager Lump Sum: 19,385 Adjustment: 0 PA 7428 Black, Carl 70 03/15/09 03115110 10,449 Duties: Tech Date Printed: 04/18/2011 9:44:07AM American International Group Page 8 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Lump Sum: 10,449 Adjustment: 0 PA 7428 Schwende, Peter 80 03/15/09 03115110 3,369 Duties: Tech Lump Sum: 3,369 Adjustment: 0 PA 953 Hartle, A'Lynn 90 03/15/09 03/15/10 24,002 Duties: Administrative Notes: Works out of her home reviewing financial records. Lump Sum: 19,386 Adjustment: 4,616 PA 7428 Rishell, Kyle 100 03/15/09 03/15/10 26,529 Duties: Tech Lump Sum: 21,668 Adjustment: 4,861 PA 7428 Worley, Roger 110 03/15/09 03/15/10 37,816 Duties: Tech Lump Sum: 31,032 Adjustment: 6,784 PA 7428 Haag, Kristopher 130 03/15/09 03115110 537 Duties: Tech Lump Sum: 537 Adjustment: 0 PA 7428 Worley, Adam 140 03/15/09 03/15/10 1,836 Duties: Tech Lump Sum: 1,836 Adjustment: 0 PA 7428 Krampitz, Carl Michael 160 03/15/09 03/15/10 5,015 Duties: Tech Lump Sum: 5,015 Adjustment: 0 PA 7428 Davy, Johnathon 170 03/15/09 03/15/10 8,620 Duties: Tech Lump Sum: 7,162 Adjustment: 1,458 PA 7428 Mohler, Brett 230 03/15/09 03115110 22,573 Duties: Tech Lump Sum: 22,573 Adjustment: 0 PA 7428 Fishel, Meagan 240 03/15/09 03/15/10 3,381 Duties: Parts manager Lump Sum: 1,363 Adjustment: 2,018 PA 7424 Smith, Justin 250 03/15/09 03/15/10 1,765 Duties: Pilot Lump Sum: 0 Adjustment: 1,765 PA 7428 Stouffer, Richard 260 03/15/09 03/15/10 6,203 Duties: Tech Lump Sum: 396 Adjustment: 5,807 PA 7428 Wallen, Scott 270 03/15/09 03115110 27,692 Duties: Tech Lump Sum: 19,038 Adjustment: 8,654 PA 7428 Garton, Jacob 280 03/15/09 03/15/10 560 Duties: Tech Lump Sum: 560 Adjustment: 0 PA 7428 Rauch, Joshua 290 03/15/09 03/15/10 12,980 Duties: Tech Lump Sum: 12,980 Adjustment: 0 PA 7424 Wingert, Jason 300 03/15/09 03/15/10 4,213 Duties: Pilot Lump Sum: 4,213 Adjustment: 0 Total Classified 401,802 Principals Date Pnnted: 04/18/2011 9:44:07AM American International Group Page 9 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT' MANAGEMENT SERVICES. PA EXCL Michael Hartle 10 03/15/09 03115110 48,539 Duties: Pilot Lump Sum: 37,962 Adjustment: 10,577 Total Principals 48,539 Class Codes Slat Class Code ,M Bal ance Description Entity: 0001 Location: 0001 PA 7424 0 AIRCRAFT OPERATION, N.O.C.-INCLUDING BUT NOT NECE PA 7428 0 AIRPORT OPERATION - GROUND EMPLOYEES PA 953 0 CLERICAL OFFICE EMPLOYEES PA BLNC 0 Balance BALANCE CLASS Records Requested/Audited Entity: 0001 Location: 0001 R A Description R A Description R A Description Entity: 0001 Location: 0001 ?x ? Social Security (Fed 941's) ? ? Sales Journal ?p ?K 2008 Tax return ? ? Sales Tax Reports ? ? Cash Disbursements ?O ?x State Unemployment Reports ? ? Checkbook ? ? Individual Payroll Cards ? ? Job Costs Sheet ] 91 Payroll Book (Listings) ? ? Receipts Journal O x? General Ledger ? ? Summaries ? ? Certificates of Insurance ? ? Financial Statement Date Printed: 04/19/2011 9:44:07AM American International Group Page 10 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Policy Number: 018736121 Audit Period: 03/15/2009 03/15/2010 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT MANAGEMENT SERVICES. Status/Non-Productive Report Auditor Name: Auditor Number: CAPXKCR Insured: AIRCRAFT MANAGEMENT SERVICES, Policy #: 018736121 Company: 0130 Audit Period: 03/15/2009-03/15/2010 Division/Region: 014 Policy Period: 03/15/2009-03/15/2010 Location of Audit: VisitDate: Estimate %: Contact Type Contact Name Telephone # Date Contact Results Date Printed: 04/18/2011 9:44:07AM American International Group Page 11 of 12 EXHIBIT G Account Number: 018736121-000-A-6 05/29/2010 001 Audit Period: 03/15/2009 03/15/2010 Policy Number: 018736121 Policy Period: 03/15/2009 03/15/2010 Insured Name: AIRCRAFT MANAGEMENT SERVICES, Policies Policy Number Policy Dates 018736121 03/15/2009 03/15/2010 INSURED'S VERIFICATION OF AUDIT PERFORMANCE On 05/27/2010, Auditor visited our offices and reviewed those records necessary to complete a Premium Audit of the above listed policy(ies). The audit was reviewed with me and I fully understand what records were used and how the exposures were derived. I/We hereby certify that the foregoing truly and correctly includes all information required under the terms of the policy(ies) specified above for premium calculation. A copy of completed audit worksheets will be forwarded to you in the mail. Melanie Greene Office Manager 05/27/2010 (Signature of Insured or Authorized Representative) (Printed Name) (Title) (Date) SIGNATURE OF PREMIUM AUDIT REPRESENTATIVE Kelly Christy Auditor 05/27/2010 (Signature of Premium Audit Representative) (Printed Name) (Title) (Date) Date Printed: 04/18/2011 9.44:07AM American International Group Page 12 of 12 EXHIBIT G Page 1 of 2 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA WORKERS' COMPENSATION INSURANCE 175 WATER STREET - EXECUTIVE OFFICES, NEW YORK, NY 10038 INSURED AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 PRODUCER C S & A FRANKLIN PO BOX 681209 FRANKLIN, TN 37068-1209 FOR STATE OF: Pennsylvania AUDIT ADVICE POLICY PERIOD FROM: 03/15/09 TO: 03/15/10 AUDIT PERIOD FROM: 03/15/09 TO: 03/15/10 CANCELLED: [ ] PRO-RATA [ ] SHORT RATE BUREAU ID: 003057899 AUDIT TYPE: PHYSICAL ISSUE DATE: 06/02/10 DIVISION: BRANCH: 014 AIG AVIATION WORKERS COMP POLICY NO: WC---018_73_6121--------- 014-17-0309-00 TYPE OF ADJUSTMENT: FINAL DESCRIPTION CODE EXPOSURE RATE PREMIUM PERIOD: 03/15/09 - 03/15/10 RATING GROUP: 0001-01 LOC NO 0001 AIRCRAFT MANAGEMENT SERVICES 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-0000 CLERICAL OFFICE EMPLOYEES 953 24,002 0.49 118 AIRCRAFT OPERATION, N.O.C.-INCLUDING 7424 45,978 6.20 2,851 BUT NOT NECESSARYILY LIMITED TO: AIR TAXI, PATROL, PHOTOGRAPHY, MAPPING, SKYWRITING, ADVERTISING, SURVEY WORK, SIGHTSEEING, STUDENT INSTRUCTION, CROP DUSTING OR SPRAYING, OR FLIGHT TESTING-ALL MEMBERS OF THEFLYING CREW. AIRPORT OPERATION - GROUND EMPLOYEES 7428 331,822 7.03 23,327 TOTAL CLASSIFICATION PREMIUM 26,296 TOTAL FOR SPLIT PERIOD: 03/15/09 - 03/15/10 TOTAL CLASSIFICATION PREMIUM 26,296 TOTAL UNMODIFIED PREMIUM 26,296 EXPERIENCE PREMIUM (ACTUAL) 0.899 9898 -2,656 MODIFIED STANDARD PREMIUM 23,640 THIS IS NOT A BILL WC990613 (Ed. 4-97) (Rev' goive Copy EXHIBIT H Page 2 of 2 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA WORKERS' COMPENSATION INSURANCE 175 WATER STREET - EXECUTIVE OFFICES, NEW YORK, NY 10038 INSURED AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 PRODUCER C S 8 A FRANKLIN PO BOX 681209 FRANKLIN, TN 37068-1209 FOR STATE OF: Pennsylvania AUDIT ADVICE POLICY PERIOD FROM: 03/15/09 TO: 03/15/10 AUDIT PERIOD FROM: 03/15/09 TO: 03/15/10 CANCELLED: [ ] PRO-RATA [ ] SHORT RATE BUREAU ID: 003057899 AUDIT TYPE: PHYSICAL ISSUE DATE: 06/02/10 DIVISION: BRANCH: 014 AIG AVIATION WORKERS COMP POLICY NO: WC 018-73-6121 --------- 014-17-0309-00 TYPE OF ADJUSTMENT: FINAL DESCRIPTION CODE EXPOSURE RATE PREMIUM TOTAL FOR STATE Pennsylvania MODIFIED STANDARD PREMIUM 23,640 UNDISCOUNTED PREMIUM 23,640 PREMIUM DISCOUNT -8.60% 0063 -2,033 DISCOUNTED PREMIUM 21,607 TERRORISM 3.00% 9740 789 CATASTROPHE (SEE WC 00 04 21C) 0.017 9741 68 TOTAL PREMIUM 22,464 EMPLOYER ASSESSMENT (NON-COAL) 2.26% 0938 508 STATE FINAL TOTAL 22,872 TOTAL PA REMUNERATION: 401,802 TOTAL PREMIUM FOR TERRORISM COVERAGE INCLUDED IN TOTAL ESTIMATED PREMIUM $789 THIS IS NOT A BILL WC990613 (Ed. 4-97) (Rev' goive Copy EXHIBIT H Page 1 of 1 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA WORKERS' COMPENSATION INSURANCE 175 WATER STREET - EXECUTIVE OFFICES, NEW YORK, NY 10038 INSURED AIRCRAFT MANAGEMENT SERVICES, INC 228 AIRPORT ROAD HANGAR 7 NEW CUMBERLAND, PA 17070-2467 PRODUCER C S & A FRANKLIN PO BOX 681209 FRANKLIN, TN 37068-1209 AUDIT ADVICE SUMMARY POLICY PERIOD FROM: 03/15/09 TO: 03/15/10 AUDIT PERIOD FROM: 03/15/09 TO: 03/15/10 CANCELLED: l PRO-RATA ] SHORT RATE AUDIT TYPE: PHYSICAL ISSUE DATE: 06/02/10 DIVISION: BRANCH: 014 AIG AVIATION WORKERS COMP POLICY NO: WC 018-73-6121 ------------------------- 014-17-0309-00 TYPE OF ADJUSTMENT: FINAL DESCRIPTION TAXES/ASSESSMENTS/ PREMIUM SURCHARGES TOTAL POLICY REMUNERATION: 401,802 AUDIT EARNED PREMIUM AMOUNT 508 22,46 PRIOR ESTIMATED EARNED AMOUNT 309 13,65 TOTAL AP/RP AMOUNT 199 8,80 TOTAL AUDIT ADJUSTMENT 9 007 THIS IS NOT A BILL PRIOR ESTIMATED EARNED AMOUNT IS THE ORIGINAL POLICY PREMIUM AND ALL PREMIUM BEARING ENDORSEMENTS PLUS INTERIM AUDIT ADJUSTMENTS, IF APPLICABLE. THIS AUDIT ADJUSTMENT DOES NOT REFLECT THE ACTUAL PREMIUM DUE FROM OR TO THE INSURED UNLESS ALL AMOUNTS PREVIOUSLY BILLED HAVE BEEN PAID. WC990614 Archive Copy (Ed. 4/97) (Rev's 12/09) EXHIBIT H - r Law Department CHARTIS W 5 ood Hollow Road 3rd Floor Parsippany, NJ 07054 STA TEMENT OF ACCOUNT Insurance Company The Insurance Company of the State of Pennsylvania INSURED NAME: Aircraft Management Services, Inc. NAME OF BROKER: __CS & A FRANKLIN TYPE OF COVERAGE (S): - Workers Compensation and Employers Liability POLICY NUMBER (S): -----...--------- 18736121 DATE OF COVERAGE (S): 3/15/2009-3/15/2010 Annual Premium $13,965.00 LESS PAYMENT (S): ($131965.00) Audit additional premium $8,808.00 BALANCE DUE CHARTIS: $8 808.00 , PLACEMENT AGAINST INSURED - $8,808.00 EXHIBIT I SHERIFF'S OFFICE OF CUMBERLAND COUNTY Ronny R Anderson Sheriff ?y x1' of i-rclub"rt444 OFK;sE c ??cHir? FILED-OFFICE CIF THE PROTHONOTARY Jody S Smith Chief Deputy Richard W Stewart Solicitor 2011 AUG 30 AM $: 37 CUMBERLAND COUNTY PENNSYLVANIA The Insurance Company of The State of Pennsylvania Case Number vs. Aircraft Management Services, Inc. 2011-5824 SHERIFF'S RETURN OF SERVICE 08/02/2011 Ronny R. Anderson, Sheriff who being duly sworn according to law states that he made a diligent search and inquiry for the within named defendant, to wit: Aircraft Management Services, Inc., but was unable to locate them in his bailiwick. He therefore deputized the Sheriff of York County, Pennsylvania to serve the within Complaint and Notice according to law. 08/08/2011 09:29 AM - York County Return: And now August 8, 2011 at 0929 hours I, Richard P. Keuerleber, Sheriff of York County, Pennsylvania, do hereby certify and return that I served a true copy of the within Complaint and Notice, upon the within named defendant, to wit: Aircraft Management Services, Inc. by making known unto Greg Stansberry, adult in charge for Aircraft Management Services, Inc. at 228 Airport Road, Hangar #7, New Cumberland, Pennsylvania 17070 its contents and at the same time handing to him personally the said true and correct copy of the same. SHERIFF COST: $37.00 August 25, 2011 SO ANSWERS, RbNWY- R ANDERSON, SHERIFF ;Cj GcuntySuHe Sherff. Telec7s,at. In;. David D. Overt Trothonotag ��^ /�)'�f�-��()fnY^V Office ofthe _ - ' _ '- -/ �� County, - --- _ __/_ __ ~--o`-~Q Solicitor —Seg2,171 CIVIL TERM ORDER OF TERMINATION OF COURT CASES AND NOW THIS 28TH DAY OF OCTOBER, 2014, AFTER MAILING NOTICE OF INTENTION TO PROCEED AND RECEIVING NO RESPONSE—THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PARI.P.Z3O.Z BY THE COURT, DAVID D. BUELL PROTHONOTARY One Courthouse Square G Juite100 e ��TA 0 (Phone 717%40-6195 0 ��717240-6573