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S-1-(6-J4 fM/7'N6►"2/ f�1W 6 6: 3 R'1o� 4. -7 oE�e.l-rte �N�.� ��vE � u � at Iat4N s. T U ,�y ?NAB- -P4�6 S-*rG#►-F^f7S ,YVO E,W 7)4X AFrfiOA4101' -AA E- l wbo STS 4 7)4A r 64IT E S' *TEo-t "J /YE9CiVJ ICF i Su$ cf 7u i7f E P6.AIA ES Oe l cal P�', C,cS . -f 5F6 I� �Eli�T1.r� 7b u�JuJo,'4.! I-VF 7t� /4c, FvR S . i a y; C�� RODGER T. ATWOOD, II, Plaintiff V. IN THE COURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT STATE FARM FIRE AND CASUALTY COMPANY, Defendant 2013-01154 CIVIL TERM IN RE: PRISONER'S MOTION AND AFFIDAVIT FOR LEAVE TO PROCEED IN FORMA PAUPERIS PURSUANT TO 28 U.S.C. § 1915 ORDER OF COURT AND NOW, this 7th day of March 2013, upon consideration of Prisoner's Motion and Affidavit for Leave to Proceed In Forma Pauperis Pursuant to 28 U.S.C. § 1915, which is an inapplicable Federal statutory provision, and Plaintiffs failure to follow either the technical requirements or spirit and intent of the controlling Pennsylvania Rules of Civil Procedure, specifically Rule 240, the motion is DENIED. BY THE COURT, Thomas A. Placey, C.P.J. Distribution: Rodger T. Atwood, II _ rnw rn`T State Farm Fire and Casualty Insurance v 11 State Avenue Carlisle, PA 17013 r —'° w/copy of motion v c� _mac`, c� A N CD rT,. 'V Commonwealth of Pennsylvania Court of Common Pleas Rodger T. Atwood, II, of Cumberland County Plaintiff Civil Action Law VS. 115 � Term, State Farm Fire and -13^ � -��.� Casualty Company, (Year) Defendant No: r. r- cam ' r-z -a c1 PRISONER'S MOTION AND AFFIDAVIT =cP FOR LEAVE TO PROCEED IN FORMA PAUPERIS PURSUANT TO 28 U.S.C. §1915 r= I respectfully request leave to commence this civil action without prepayment of fees or security therefor pursuant to 28 U.S.C. §1915. In support of my request, I declare that: 1 ) I am unable to pay such fees or give security therefor. 2) I am entitled to redress. 3) The nature of this action is: Civil Action Law, wherein Plaintiff seeks to recover from State Farm Fire and Casualty Company damages resulting from a fire and/or thefts covered under a homeowner's policy. 4) My assets and their value are $-0- (everything was lost in the fire) . DECLARATION UNDER PENALTY OF PERJURY I declare under penalty of perjury that the information in this Motion and Affidavit is true and correct pursuant to 18 Pa. Cons. Stat. Ann. §4904. See also 28 U.S.C. §1746; 18 U.S.C. §1621 . Date:-'3 -I --,10l3 Rodcj%r T. Atwood, II ACP No: 12-MO845 45 Major Bell Lane Gettysburg, PA 17325 A.C.A.C.C. a " 4 t t _ - -- ----- ------------ — -- - i l -- .__�. .c�env_e�--1���v e._�c� cor►r��c.-�_�t•. s .,c� ,_v t_�c��a�_�,'�-1�I,.c3��l-�.--P Re P a�;.r-`�'=�'_ _ s aR s ecuA J 4--� .. 8c. �41_ ,� ".5 4j a,, ---- - -- --- -- -- - - -- 1.�_ SOCJ—, �e----- . Vin_ 3 . �ne- to A.�q e- o V4,. 5 AGk_',o+u'-�S -.� � j - -I�ect,��.��-��,� u►�dza Peti;r�l�-�r o� PeR..��Y _. A%A.e_ LN_t _R _QenrAl t�¢ -t"�c�-��►o� H�c4 A�'�ac�.r�v�� +5.. ��s�. ,ar�c.� --CaRR�,G-� .__ __-_--- --._ _ _ _ _ RODGER T. ATWOOD, II, IN THE COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA V. LORI JAYNE ATWOOD, Defendant 0009 CIVIL 2013 1 i CIVIL ACTION - LAW ORDER OF COURT AND NOW, this 181 day of JANUARY, 2013, Defendant's request to proceed In Forma Pauperis is hereby GRANTED. By the Court, 44ie Edward E. Guido, J. District Attorney =, Public Defender Paul Walters U, __4c' Cumberland County Prison .x =13 1101 Claremont Road � �= , Carlisle, Pa. 17013 .t Cn CCP :sld 49) Defendant continues to act in bad faith toward Plaintiff when Defendant persists in its investigation nearly a year after the loss with nothing more than wild speculations. It appears as if Defendant is taking advantage of the facts that Plaintiff is incarcerated and that he is indigent. WHEREFORE, Plaintiff prays this Honorable Court will afford him a broad and liberal reading of his pleadings, holding them to a less stringent standard than those drafted by lawyers. Plaintiff relies on the ruling in Haines V. Kerner, asking this Honorable Court to excuse any errors in form or substance or ignorance of pleading rules. Plaintiff likens his cause to that of the story of David and Goliath found in 1Samuel, Chapter 17. Further, Plaintiff, Rodger T. Atwood, II, requests that this Court take the following actions pursuant to 42 Pa. Cons. Stat. Ann. §8371 : 1 ) Award interest on the amount of Plaintiff's claim against Defendant, State Farm Fire and Casualty Company from the date the claim was made at a rate equal to the prime rate plus 02%. 2) Award punitive damages against the Defendant; and/or 3) assess court costs and fees against the Defendant. FURTHER, Plaintiff prays this Honorable Court would grant him all to which he may be entitled and any other relief this Court may deem just and proper. Respectfully Submitted, Dated: 3 -- 1 -x013 "� , ---r " Rod er T. Atwood, II ACP No: 12-MO845 45 Major Bell Lane Gettysburg, PA 17325 A.C.A.C.C. 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Ed, a�, «3l �S;EIIE �, GArnI So Z, Cc/ P`EASC MAC SSE p`AcEJ,, a4RE ©F `n4c UAPrtbsiA 6grclJ'uA f 1114V) -7)4 C6,jTcvTj' &-,rM a-MAY /b rL5 w ,r) E S ,�e,l- , ,wTv_-,,m o WE rrA 11 u� P�,,j,�� ,� Er d"': �R-dC�uRE. 7N� ON� U, T�►rCT 8E,c1EC� 7NE Mo7iuAj �Nc1(�rcb Ak4 ?74�F on/6 � y ,ma y 446y C C5Ah&AwW ,%,h 6 4 A C gab ?E- PWy A#A6CAAT%E-b Is AojtrJy G�S;aw iy, WAY4 ��3�s RODGER T. ATWOOD, 11, Plaintiff V. IN THE COURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT STATE FARM FIRE AND CASUALTY COMPANY, Defendant 2013-01154 CIVIL TERM IN RE: PRISONER'S MOTION AND AFFIDAVIT FOR LEAVE TO PROCEED IN FORMA PAUPERIS PURSUANT TO PENNSYLVANIA RULES OF CIVIL PROCEDURE, RULE 240 ORDER OF COUR t AND NOW, this 26th day of March 2013, upon consideration of properly filed Motion and Affidavit and review of the proposed civil action, �e motion is DENIED, as a prima facie reading of the Complaint shows that the matter is not ripe. Plaintiffs claim i for insurance coverage has not been denied by the insurance carrier leaving no justiciable issue as the basis for a suit before this court. Pa.R.C.P. 240 (J)(1). BY THE COURT, c Thomas laaey C.P.J.- , Distribution: , c� ✓ Rodger T. Atwood, II �Cn , State Farm Fire and Casualty Insurance j�,Pteg � =) co 11 State Avenue Carlisle, PA 17013 p wl copy of motion Commonwealth of Pennsylvania Rodger T. Atwood, II, Court of Common Pleas Plaintiff of Cumberland County VS. Civil Action Law State Farm Fire and 2013-01154 Civil -Term, Casualty Company, Defendant 2103 (Year) • C-) No: 2013-00154 C: -az zz; rn PLAINTIFF'S MOTION FOR LEAVE TO TRANSFER VENUE PURSUANT To Pa. R.C.P. 402 1 . COMES NOW, Plaintiff, and motions this Honorable Court to transfer venue in the above captioned Action from the Court of Common Pleas of the Ninth Judicial District of Cumberland County to the Court Of Common Pleas of the 41st Judicial District of Perry County. 2. According to Rule 2179(b) , Plaintiff may have inadvert- antly filed his complaint against Defendant in the wrong county. Venue in Actions involving a Corporation lies in the county where it' s registered office or principal place of business is located, where it regularly conducts business, or where the cause of action, transaction or occurrence giving rise to the cause of action arose. Proper venue in actions involving insurance companies lies in any county where there is venue for a Corporation, where the property is located (in the case of property insurance) , or where the plaintiff lives (in the case of personal insurance) . ( 1 ) 3. The determination of proper venue is made after service has been effectuated and not when the suit is filed. Service has been effectuated in the instant cause. 4. The relevant portion of Rule 2179 of Pa. R. Civ. P. states as follows : " (b) An action upon a policy of insurance against an insurance company, association or exchange, either incorporated or organized in Pennsylvania or doing business in this Commonwealth, may be brought ( 1 ) in a county designated in subdivision (a) of this rule; or (2) in the county where the insured property is located; or ( 3) in the county where the plaintiff resides, in actions upon policies of life, accident, health, disability, and livestock insurance or fraternal benefit certificates." 5. Plaintiff purchased his insurance policy from Defendant at their office in Cumberland County (Carlisle, PA) . The insured property is located in Perry County at 740 Pine Hill Road, Duncannon, PA. 17020. The fire loss occurred at this Perry County property where Plaintiff resided. WHEREFORE, Plaintiff, being a layman at law and unfamiliar with the complicated rules of pleading, prays this Honorable Court will afford his pleadings a broad and liberal reading that is usually afforded pro-se pleadings. Further, Plaintiff prays this Honorable Court would grant him the venue transfer he seeks and any other relief this Court deems just and proper. Respectfully Submitted, Dated. March 26, 2013 lefJp, Rod —r T. Atwood, II (2) Commonwealth of Pennsylvania Rodger T. Atwood, II, Court of Common Pleas Plaintiff of Cumberland County VS. • Civil Action Law State Farm Fire and 2013-01154 Civil Term, Casualty Company, 2013 (Year) Defendant No: 2013-00154 CERTIFICATE OF SERVICE I, Rodger T. Atwood, II, hereby certify that I, on the date of this Proof of Service, did serve one ( 1 ) copy of each of the attached Pleadings and Attachments upon those listed below by depositing same in the United States Mail, properly addressed, certified with return receipt requested, with all required postage and charges prepaid. State Farm Fire and Casualty Company State Farm Fire and Pennsylvania Fire Claims Casualty Company P.O. Box 106110 1 S Greg Lunde, 1 Agent Atlanta, GA 30348-6110 11 State Ave. Carlisle, PA 17013 Date: 3 A 070 w Rodg r T. Atood, II 9 ALAI RODGER T. ATWOOD, II, 00WIT' Plaintiff P V. IN THE COURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT STATE FARM FIRE AND CASUALTY COMPANY, Defendant 2013-01154 CIVIL TERM IN RE: PLAINTIFF'S MOTION FOR LEAVE TO TRANSFER VENUE PURSUANT TO PA. R.C.P. 402 ORDER OF COURT AND NOW, this 15th day of April 2013, upon consideration of Plaintiff's Motion for Leave to Transfer Venue Pursuant to Pa. R.C.P. 402, the motion is DENIED. BY THE COURT, Thomas Viacey C.P.J. `Distribution: ✓ Rodger T. Atwood, II State Farm Fire and Casualty Insurance ,red 11 State Avenue 13 15 Carlisle, PA 17013 41 0�9 L=, w/copy of motion MM M Tai r __. cry CO �:i LEE E. ULLMAN, ESQUIRE Attorneys for Defendant State Farm BARBARA E BROCKMAN, ESQUIRE Attorney ID Nos. 42428159147 FORRY ULLMAN 540 Court Street PO Box 542 Reading, PA 19603 610.777.5700 / FAX 610.777.2499 RODGER T. ATWOOD, II, IN THE COURT OF COMMON PLEAS Plaintiff OF CUMBERLAND COUNTY, P6 G �a VS . CIVIL ACTION - LAW 2 MF STATE FARM FIRE AND CASUALTY No. 13-1154 �� Cjl COMPANY, p , Defendant zc ' TO: The Prothonotary of Cumberland County: < Pursuant to 28 U. S . C. § 1446 (e) , Defendant, State Farm Fire and Casualty Company, hereby files the attached copy of the Notice of Removal filed with the Clerk of Court for the Middle District of Pennsylvania, on April 17, 2013 and docketed on April 18 , 2013 , at Docket No. 1 : 13-cv-01000 . FORR U LMAN Dated: 04/23/13 By: LEE E. ULLMAN, ESQUIRE Attorneys for Defendant CMiad:aWka0M600C6H3bcfteut*74 1 Firfj"441M3 Pi M&Its 8 IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA RODGER T. ATWOOD, II, CIVIL ACTION Plaintiff NO. VS . ASSIGNED TO: I 13 "<.,V ^ 01ow STATE FARM FIRE AND CASUALTY COMPANY, Defendant JURY TRIAL DEMANDED NOTICE OF REMOVAL Defendant State Farm Fire and Casualty Company ("State Farm") , by and through its attorneys, Forry Ullman, files the following Notice of Removal: 1 . A Complaint in the above-captioned civil action was filed in the Court of Common Pleas of Cumberland County, Pennsylvania, on March 4, 2013, and mailed via certified mail to State Farm and received on March 18, 2013. 2 . The Complaint was docketed as Cumberland County Court of Common Pleas No. 2013-1154 . A true and correct copy of the Complaint is attached hereto as Exhibit "A". 3 . The Complaint alleges that Plaintiff, Rodger T. Atwood, II, is an adult individual and citizen of the Commonwealth of Pennsylvania, residing at the Adams County Adult Correctional Complex, ACP No. 12-M0845, 45 Major Bell Lane, Gettysburg, Adams County, PA 17325, as of the date of the filing of the Complaint. It is further believed that Plaintiff remains CMmd:3SZ-xaflID600EBH3bcOneut*741 FiFe"CUM3 P P-M 8 a citizen of the Commonwealth of Pennsylvania, as of the date of the filing of this Petition for Removal . 4 . This action involves breach of contract and bad faith claims under a homeowner' s policy of insurance. 5 . Plaintiff avers that on or about May 2, 2011, he purchased a homeowner' s insurance policy from State Farm, covering Plaintiff' s residence and personal property located at 740 Pine Hill Road, Duncannon, Perry County, Pennsylvania 17020- 9119 (the "premises") . See Complaint at Paragraph 6. 6. Plaintiff further avers that after February 7, 2012, there were "thefts from the house and the garage on an almost daily basis", while Plaintiff was "on the lam" to avoid arrest by federal authorities . He also alleges that on or about March 3, 2012, there was a fire at the premises . Plaintiff later avers that he just recently learned the actual date of the fire was March 29, 2012 . See Complaint at Paragraphs 10 - 15. 7 . The Complaint contends that " (b) y letter dated April 03, 2012, Plaintiff gave written notice of the fire and thefts to Defendant, together with an inventory of the personal property destroyed by the fire and some of the items stolen on forms taken from Defendant' s website, and made claim for his loss ." "After receipt of Plaintiff' s written notice, Defendant undertook to investigate Plaintiff' s claim. " See Complaint at Paragraphs 18 and 19. 2 CQzd 3aZZ aOM600(S H3bcfteufi*74 1 Fifetb84Y4XM3 PEN6 bfrg 8 8 . The Complaint further contends that "Federal Authorities in the Middle District of Pennsylvania at Harrisburg have initiated a forfeiture proceeding against Plaintiff' s residence" due to pending criminal charges . Also, " (s)hould this Honorable Court find that Defendant is obligated to indemnify Plaintiff under Coverage A - Dwelling, in all likelihood Mr. Edward Jones, the mortgagee, would first be paid the $168, 000. 00 due him and the United States Government would receive the balance owed under Coverage A - Dwelling and clear deed and title to the property. Should this Honorable Court find that Defendant is obligated to indemnify Plaintiff under Coverage B - Personal Property and under Coverage C - Loss of Use, the United States Government never forfeits a Defendant' s personal property. " See Complaint at Paragraph 34 . 9. Plaintiff alleges that "Defendant has not denied Plaintiff' s claim" and "Plaintiff has been unable to salvage any personal property from the residence premises nor recover any of the personal property stolen from him. Plaintiff has not filed a claim for any of the stolen items." See Complaint at Paragraphs 36 and 38 . 10. The Complaint contains two purported counts : Count I for Breach of Contract; and, Count II for Bad Faith pursuant to 42 Pa.C. S. §8371 . 3 Crm&:aMAafl0800f H10bc UepO*74 1 FiFb"441a!M3 P&A4 4M 8 11 . In Count I for Breach of Contract, Plaintiff alleges State Farm failed to indemnify him for his losses, and demands judgment against State Farm in an amount in excess of $548, 370. 00, together with costs, interest and attorneys fees. 12 . Plaintiff avers the total claim loss of approximately $548, 370 consists of the "value of the property destroyed in the fire and the value of the property stolen from him, including but not limited to: the residence premises, insured under Coverage A - Dwelling for $278, 000 . 00 plus an additional amount of $55, 600. 00 under option ID; personal property, insured under Coverage B - Personal Property in the amount of $208, 500 . 00; loss of use, insured under Coverage C - Loss of Use in the amount of "actual loss sustained" (approximately $10, 800. 00 to date. " A Personal Property Inventory Form is attached to the Complaint and "amounts to a claim of approximately $203, 970 . 00 and this figure represents the amount of the personal property claim after withdrawing the claim for the 200 Silver Dollars with a listed value of $5, 000 . 00 . " See Complaint at Paragraph 44 . 13. In Count II for Bad Faith pursuant to 42 Pa.C.S. §8371, Plaintiff alleges State Farm acted in bad faith because it "waited nearly ten (10) months before first informing Plaintiff why his claim has not been finalized" and "possesses no evidence that the fire was not accidental and/or was not an 4 CMasd:1aZ%0ID800ESH3bcftept*341 FiFetbe4Y41a/ A3 PEW6 Wds 8 act of vandalism or malicious mischief as claimed by Plaintiff, nor does Defendant possess any evidence that the thefts did not occur as reported by Plaintiff. " See Complaint at Paragraphs 46 and 48 . 14 . In Count II, Plaintiff demands interest on the amount of Plaintiff' s claim, punitive damages, court costs, fees and any other relief this Court may deem just and proper. 15. Defendant State Farm is an Illinois corporation in the business of insurance, with its principal place of business located at One State Farm Plaza, Bloomington, Illinois 61710, at the time of the commencement of this action as well as at the time of the filing of this Petition for Removal . 16. Thus, for purposes of diversity jurisdiction, State Farm is a citizen of the State of Illinois . 17 . State Farm is filing this Notice of Removal in that diversity of citizenship exists between Plaintiff, a citizen of Pennsylvania, and State Farm, a citizen of Illinois . 18 . The amount in controversy exceeds the jurisdictional amount of $75, 000. 00 because Plaintiff is requesting judgment in an amount in excess of $548, 370. 00 for his breach of contract claim, and interest, punitive damages, attorney fees and costs under the bad faith statute. 19. Pennsylvania' s bad faith insurance statute, 42 Pa.C.S. §8371 allows for punitive damages, attorney fees and interest. 5 CiTasd:1&2�aflID600EbF[Dbcfteat*74 1 FiMbbO '41aM3 PEN6 Ott 8 20. Although State Farm vigorously disputes punitive damages are warranted in this matter, punitive damages are properly considered in determining whether the amount in controversy has been satisfied. Bell v. Preferred Life Assur. Soc. Of Montgomery, Ala. , 64 S.Ct. 5 (U.S. Ala. 1943) ; Frederico v. Home Depot, 507 F. 3d 188, 199 (3d Cir. 2007) ; Henderson v. Nationwide Mutual Ins . Co. , 169 F.Supp. 2d 365, 368 (E. D.Pa. 2001) (attorneys fees, interest and "punitive damages are included in the amount in controversy if they are available to successful plaintiffs under a statutory cause of action") (citing Markowitz v. Northeast Land Co. , 906 F. 2d 100, 103 (3d Cir. 1990) ) . 21 . Removal is timely under 28 U.S.C. §1446 (b) , because less than thirty (30) days have elapsed since service of the Complaint on State Farm. 22 . State Farm will give written notice of the filing of this Notice to the Plaintiff, as required by 28 U.S .C. §1446 (d) . 6 C9DRsd:1Sba0M600E6 FRcUMeat*74 1 FiFetbe4YUM3 P G7 Mcl 8 23. A copy of this Notice will be filed with the Prothonotary of Cumberland County, as required by 28 U.S.C. §1446 (d) . WHEREFORE, Defendant, State Farm Fire and Casualty Company, requests that this action proceed in this Court as a Civil Action properly removed. Respectfully submitted, FORRY ULLMAN Dated: 04/17/13 By: s/ Lee E. Ullman LEE E. ULLMAN, ESQUIRE Attorney ID #42428 Attorneys for Defendant 540 Court Street, P 0 Box 542 Reading, Pennsylvania 19603 610. 777 . 5700 / FAX 610 . 777 .2499 lullman @forryullman. com 7 C9DRsd:3&2Aa0ID800E6F3bc6Meph*74 1 FiMW84YU/'dQ3 P&AS ffics 8 IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA RODGER T. ATWOOD, II, CIVIL ACTION Plaintiff NO. VS . ASSIGNED TO: STATE FARM FIRE AND CASUALTY COMPANY, Defendant JURY TRIAL DEMANDED CERTIFICATE OF SERVICE The undersigned hereby certifies that on the 17th day of April, 2013, a true and correct copy of State Farm' s Notice of Removal was served upon the Plaintiff, by mailing the same to Plaintiff' s last known address, by First Class United States Mail, postage pre-paid, addressed as follows : Rodger T. Atwood, II ACP No. 12-MO845 Adams County Adult Correctional Complex 45 Major Bell Lane Gettysburg, PA 17325 This statement is made subject to the penalties of 18 U.S.C. §1621, relating to perjury. FORRY ULLMAN Dated: 04/17/13 By: s/Lee E. Ullman LEE E. ULLMAN, ESQUIRE Attorney ID #42428 Attorneys for Defendant 540 Court Street, PO Box 542 Reading, Pennsylvania 19603 610. 777 . 5700 / FAX 610. 777 .2499 lullman @fuuflaw. com 8 EXHIBIT A Commonwealth of Pennsylvania Court- of Common Pleas Rodger T. Atwood, II, of Cumberland County Plaintiff Civil Action Law VS. (1 CAVA Term, State Farm Fire and (Year) Casualty Company, c Defendant No: 2-ri rnF? g M a� -n 2 (Notice to Defend) O 3 0 Zn COMPLAINT =' N D� -< W 1 ) Plaintiff, Rodger T. Atwood, II, is an individual, and citizen of the Commonwealth of Pennsylvania who maintained his last place of residence at 740 Pine Hill Road, Duncannon, Perry County, Pennsylvania, 17020 2) Plaintiff, Rodger T. Atwood, II, is currently a resident of Adams County, Pennsylvania, residing at ACP No: 12-M0845, Adams County Adult Correctional Complex, 45 Major Bell Lane, Gettysburg, Pennsylvania, 17325. Plaintiff is being held by Federal authorities on pending drug charges. 3) Defendant, State Farm Fire and Casualty .Company, is a corporation or- other legal entity incorporated under the laws of a state other than the Commonwealth of Pennsylvania, with a principal place of business, or home office in Bloomington, Illinois. (1 ) 4) Defendant, State Farm Fire and Casualty Company 15 a corporation which operates an office in Cumberland County, Carlisle, Pennsylvania. Greg Lunde is an individual employed by and acting as an authorized agent of Defendant State Farm Fire and Casualty Company at its place of business at 11 State Avenue, Carlisle, Cumberland County, Pennsylvania, 17013. 5) Defendant, State Farm Fire and Casualty Company, was at all times mentioned herein, and still is, qualified to transact business as an insurer within the Commonwealth of Pennsylvania and regularly engages in the sale of insurance in Pennsylvania at the present time. 6) On or about May 02, 2011 , Plaintiff purchased a home- owner's insurance policy from Defendant covering Plaintiff's residence and personal property located at 740 Pine Hill Road, Duncannon, Perry County, Pennsylvania, 17020-9119 and bearing the Policy No: 38-BY-F929-5 (!.'insurance contract") . A true and certified copy of the policy is attached hereto and marked as Exhibit "A" . 7) Gulf Stream Investments, LLC, 125 S. 2nd Street, Newport, Perry County, Pennsylvania, 17074-1407 is listed as additional insured and Edward Jones, 7048 Wertzville Road, Mechanicsburg, Cumberland County, Pennsylvania, 17050-1542 is listed as the Mortgagee. At the time of the loss, Mr. Jones held a mortgage with a balance of $168,000.00. Plaintiff believes that• Edward Jones, the Mortgagee, has filed a claim to recover the mortgage balance, but is not certain of that fact. (2) 8) The Insurance Contract provides in pertinent palt dS follows: "Coverage A- Dwelling. We insure for accidental direct physical loss to the property described in Coverage A, except as provided in Section I- Losses Not Insured." "Coverage B- Personal Property. We insure for accidental direct physical loss to property described in Coverage B caused by the following perils, except as provided in Section I- Losses Not Insured: 1 . Fire or Lightning. . . 8. Vandalism or Malicious Mis- chief, meaning only willful and malicious damage to or destruction of property. . . 9. Theft, including attempted theft and loss of property from a known location when it is probable that the property has been stolen." A copy of the standard "Homeowner's Policy" provided to customers is attached hereto- and marked as Exhibit "B". ; There is a notation on the cover which states: "This policy--.is one of the broadest forms available today, and provides you with outstanding value- for your insurance dollars. However, we want to point out that every policy contains limitations and exclusions. Please read your. policy carefully, especially 'Losses Not Insured' and all exclusions." - 9) The Insurance Contract defines dwelling As "The dwelling used principally- as a private residence on the residence .premises shown in the Declarations." (Which would be 740 Pine Hill Road, Duncannon, Pennsylvania, 17020) . The Insurance Contract defines dwelling extension as "other structures on-.the residence premises, separated from the dwelling by clear space. " The Insurance Contract defines personal property as "Personal property owned or used by an insured while it is anywhere in the world." The (3) ti:► .� cscui � Insurance Contract defines Loss of Use as "Additional Living Expense. When a loss insured causes the residence premises to become uninhabitable, we will cover the necessary increase in cost you incur to maintain your standard of living for up to 24 months." The Insurance�;Contract defines Option ID as "Increased dwelling limit. We will settle losses to damaged building structures covered under Coverage A- Dwelling according to the Section-' Z- Loss Settlement provision shown in the Declarations." 10) On February 07, 2012, Federal Authorities, headed by the DEA of Harrisburg, Pennsylvania, raided Plaintiff's residence at 740 Pine Hill Road, Duncannon, Pennsylvania, 17020. Plaintiff was not home at the time. Because Plaintiff's wife was in the tanning bed on the second floor listening to music through headphones, she did not hear the agents announce themselves. When the agents received no response, they demolished the front door to the house as well as a window to the left of the front door. The damage done by the agents rendered the house unsecure. 11 ) Plaintiff instructed his youngest brother, Tyrone A. Atwood, to have someone make temporary repairs in an effort to secure the premises. Those repairs were made. 12) Before temporarily leaving the area, Plaintiff granted his youngest brother, Tyrone A. Atwood, Power of Attorney and instructed him- to continue paying the mortgage and utilites and to try to check on the residence on a daily basis. (4) V �G1GL'31 � 13) To avoid arrest by Federal Authorities, Plaintiff left the area with his wife, Stevie Lynn Atwood, his mother, Donna L. Atwood, and his father, Rodger T. Atwood. It was never Plaintiff's intention to permanently leave his residence or his personal property. That is evidenced by Plaintiff continuing to pay the mortgage and the utilities. 14) While on the lam, Plaintiff was in almost daily contact with his youngest brother and his brother informed him that there had been thefts from the house and the garage on an almost daily basis. These thefts occurred in spite of the fact, that the house and garage were locked. Eventually, it was determined that unknown persons were gaining access to the house through a weak- ness in the temporary repairs to the front of the house. Plaintiff instructed his brother to contract someone to make more permanent repairs. These repairs did stop the thefts of articles from the house for a time. Later, it was also determined that unknown persons were gaining access to the garage by using a credit card on the side entry door. Plaintiff instructed his brother to move several pieces of heavy equipment from the property to prevent their theft. When moving the equipment, Plaintiff's brother made a decision to remove several items of his own personal property, including several saddles. 15) On or about March 03, 2012, there was a fire at the residence. , The date of the fire is a matter of debate. It turns out that the fire did not occur on March 03, 2012. That date appears in all of Defendant's correspondence with'Plaintiff , except for the last two exhibits, which list the date of loss as March 31 , 2012. (Please see Exhibits still and "V) . Plaintiff just recently learned that the actual date of the fire was March 29, 2012. 16) At the time that the fire occurred, Plaintiff was living in a house on Sixth Avenue in Glasgow, Montana that Plaintiff had rented along with his wife and mother and father. Plaintiff's youngest brother, Tyrone A. Atwood did not learn of the fire until 2 or 3 days after it had occurred. Therefore, Plaintiff did not learn of the fire until at least 3 days after the occurrence. 17) Plaintiff moved, along with his wife and parents, to a log house on Silver Street in Cripple Creek, Colorado. This house was also a rental. A great many telephone calls were made between Colorado and Pennsylvania in an attempt to learn the extent of damage to the residence and the cause of- the fire. 18) By letter dated April 03, 2012, Plaintiff gave written notice of the fire and thefts to Defendant, together. with an inventory of the personal property destroyed by the fire and some of the items stolen on forms taken fkom Defendant's website, and made claim for his loss. A true and correct copy of Plaintiff' s letter dated April 03, 2012, is attached hereto and marked as Exhibit "C". Also, a true and correct copy of the inventory forms is attached hereto and marked as Exhibit "D". (6) 19) After receipt of Plaintiff's written notice, Defendant undertook to investigate Plaintiff's claim. 20) During the month of April, 2012, Plaintiff spoke with Greg Lunde, an- authorized agent of Defendant and with Ted Marzani, claim representative and SIU Investigator, employed by Defendant. Plaintiff spoke with these individuals by phone. It was at this time that Plaintiff first learned of an investigation by Defendant. Plaintiff thought the investigation was just standard procedure. It was during these phone conversations that the above-referenced employees or representatives of Defendant first hinted that the cause of the fire might have been other than accidental. 21 ) On May. 10, 2012, Plaintiff, his wife, and parents were captured and arrested on Bear Trap Ranch, Florissant, Colorado, by DEA Agents from the office in Colorado Springs, .Colorado. 22) Plaintiff's wife was released on bail and returned to Pennsylvania. Plaintiff and his parents were extradicted to the Middle District of Pennsylvania on Federal warrants for violation of the Federal Marijuana Drug Laws. 23) Federal Agents with the DEA wanted Plaintiff to speculate as to whether the fire was accidental, an ,.act -of' vandalism or malicious mischief, or. a malicious act by a party or parties that Plaintiff might owe a large drug debt. Plaintiff necessarily had some thoughts on the matter, but refused to speculate. (7) 24) Plaintiff received various correspondence from Scott L. Grenoble, an attorney with the law offices of Buzgon Davis who advised Plaintiff that he had been retained by State Farm Fire and Casualty Company regarding a house fire which occurred on or about March 03, 2012. Mr. Grenoble informed Plaintiff that he would furnish him with sworn State Farm Fire and Causualty Company Personal Property Inventory forms, requesting that they be completed and returned. •Additionally, Mr. Grenoble advised Plaintiff that he had been asked by State Farm Fire and Casualty Company to conduct an examination under oath. A true and correct copy of one of Mr. Grenoble's letters dated June 04, 2012, is attached hereto and marked as Exhibit "E". 25) By letter dated October 09, 2012, Plaintiff informed Scott L. Grenoble that he had completed the sworn Inventory Forms and that they were enclosed. Plaintiff also reminded Mr. Grenoble that he was almost certain that the DEA made ari extended video while in Plaintiff's residence during the raid and would in all likelihood make it available to Mr. Grenoble. The submission of these forms marked the second time that Plaintiff had submitted a detailed listing of personal property. A true and correct copy of Plaintiff's letter dated October 09, 2012, is attached hereto and marked as Exhibit 'T". A true and correct copy of the completed sworn Personal Property Inventory Forms dated October 09, 2012, are attached hereto and marked as Exhibit "G". (8) 26) By letter dated November 01 , 2012, Scott L. Grenoble, attorney at law advised Plaintiff that he had scheduled an examination under oath with the authorities at Adams County Adult Correctional Complex to take place at 9:O0a.m. on December 04, 2012 at the prison. A true and correct copy of that notification dated December 04, 2012, is attached hereto and marked as Exhibit "H". 27) Plaintiff submitted to an examination under oath by Attorney Scott L. Grenoble on, or about, December 04, 2012. During the examination, Plaintiff informed Attorney Grenoble that the 200 Silver Dollars listed at item 4 on the form entitled- Hobbies and Electronics had in fact been seized by the Drug Task Force and have subsequently been forfeited by Plaintiff.' Also, during that examination under oath, Mr. Grenoble wanted Plaintiff to speculate as to whether the fire was accidental, an act of vandalism or malicious mischief, or a malicious act by a party or parties that Plaintiff might have owed a large drug debt to. Once again, Plaintiff refused to speculate. 28) Plaintiff cooperated with the investigation by Defendant and provided all relevant information requested by their representatives. Plaintiff did not have counsel to represent him during the examination under oath. Plaintiff cannot afford to retain counsel and his incarceration makes it all the more difficult—for Plaintiff to defend his claims. (9) L'J � GS Ll:lJ. � 29) Plaintiff was furnished a transcript of the examination under oath, along with forms to make necessary corrections. Plaintiff made the corrections and returned the transcript. Plaintiff was never given a copy of the transcript, therefore, he is unable to attach it hereto. 30) Plaintiff submitted an additional claim for additional living expense under Loss of Use on or about December 04, 2012. In a letter from Scott L. Grenoble, Attorney .at. Law, Mr. Grenoble thanked Plaintiff for his claim and asked that he complete and return enclosed affidavits. Those affidavits represented authorization for release of Sales Records Forms so that the claimed purchases of Plaintiff could be verified. A true and correct copy of Attorney Grenoble's letter dated December 10, 2012 and an example of the release forms are attached hereto and marked as Exhibit "I". 31 ) In a letter dated December 12, 2012, Plaintiff was informed of the following by Mr. Jeffrey McIntyre, Claim Team Manager of State Farm Fire and Casualty Company: "we have received your request regarding additional living expenses. There is a question as to whether this company is obligated to indemnify you or anyone claiming damages under the Homeowner's Policy applying to a loss which occurred on March 31 , 2012, at 740 Pine Hill Road, Duncannon, Pennsylvania, 17020-9919 because •*There. is a question as to whether an insured as defined in the policy, resided in the designated residence premises at the time of the ( 10) ll .3L 1 GCJ1 M loss. *There is a question as to whether there has been an :accidental direct physical loss to the property described in Coverage A- Dwelling, and Coverage B- Personal Property. - *There is a question whether you or any person under the policy caused or procured a loss to property under this policy for the purpose of obtaining insurance benefits. For this reason(s) and for other good and valid reasons, which may become known, you are hereby notified that any action taken by State Farm Fire and Casualty Company or its authorized representatives to investigate the cause of loss, determine the amount of loss or damage, or attempt to adjust any claim arising out of the alleged loss shall not waive any of the terms of conditions of the Policy of Insurance described ab6ve, nor shall such action waive any of your rights under the Policy." A true and correct copy of Mr. McIntyre's letter dated December 12, 2012, is attached hereto and marked as Exhibit "J". NOTE *This is the first correspondence that lists the date of loss as March 31 , 2012. 32) Plaintiff submitted to an interview by TFC ,Michael R. Rugh, Deputy Fire Marshal, Pennsylvania State Police at the Adams County Adult Correctional Complex in January, 2013. During that interview, Mr. Rugh wanted Plaintiff to speculate as to whether the fire was accidental, an act of vandalism or malicious mis- chief, or a malicious act by a party or parties that Plaintiff might have owed a large drug debt to. Once again, Plaintiff refused to speculate. Mr. Rugh also expressed an interest in (11 ) iJ � G 1 L1J � .a speaking with Plaintiff's youngest brother TyroneA. Atwood. Plaintiff informed Mr. Rugh that he would let his brother know and have him contact Mr. Rugh to set up a meeting. 33 ) Plaintiff's youngest brother, Tyrone A. Atwood, met with , TPC Michael R. Rugh, Deputy Fire Marshal, Pennsylvania State Police, on or about February 16, 2013, in Perry County. During that meeting, Mr. Rugh informed Plaintiff's brother that they thought a flameable might have been used in the fire, but that they couldn't prove that a flameable was used. Plaintiff's brother informed Plaintiff that Mr. Rugh's conversation consisted in majority part of speculation. . 34) Federal Authorities in the Middle District of Pennsyl- vania at Harrisburg have initiated-a forfeiture proceeding against Plaintiff's residence at 740 Pine Hill Road, Duncannon, Perry County, Pennsylvania, 17020. Assistant United States Attorney, Christy Fawcett is handling the forfieture. Should this Honorable Court find that Defendant is obligated to indemnify Plaintiff under Coverage A- Dwelling, in all likelihood Mr. Edward Jones, the mortgagee, would first be paid the $168,000-'000 due him and the United States Government would receive the balance owed under Coverage A- Dwelling and clear deed and title to the property. Should this Honorable Court find that Defendant is obligated to indemnify Plaintiff under Coverage B- Personal Property and under Coverage C- Loss of Use, the United States Government never forfeits a Defendant's personal property. 35) Underthe Pennsylvania Unfair Claims Practices Act, Defendant is required to inform Plaintiff within 30 days of receipt of his claim (and every 45 days thereafter) why his claim has not been finalized. Plaintiff received the first such notice dated January 22, 2013. Plaintiff first filed his claim on April 03, 2012, nearly 11 months ago. Plaintiff's wife informed him by phone on February 27, 2013, that she had received a second notice. Defendant has known the whereabouts of Plaintiff at all times. A true and correct copy of Defendant's notification dated January 22, 2013, is attached hereto and marked as Exhibit 36) To date Defendant has not denied Plaintiff's claim, nevertheless, Plaintiff faces a dilemma. In the Homeowners Policy, attached hereto as Exhibit "B", at page 14, paragraph 6, it states: "Suit against us. No action shall be brought unless there has been compliance with the policy provisions. The action must be started within one year after the date of loss or damage." The dilemma is this: will Defendant use or continue to use the date of loss of March 03, 2012; -or will Defendant use the date of loss of March 31 , 2012; or will Defendant use the actual date of loss, March 29, 2012? Should Defendant persist in claiming the date of loss as March 03, 2012, the Plaintiff's action must be commenced no later than March 02, 2013. Therefore, deciding to err on the side of caution, Plaintiff commences this action on this 2nd day of March by handing one ( 1 ) original and one (1 ) (13) copy of Petitioner' s Motions and all Attachments to the authorities here at Adams County Adult Correctional Complex for mailing to the Commonwealth of Pennsylvania's Court of Common Pleas of Cumberland County. Plaintiff relies on the "Mail Box" rule announced by the United States Supreme Court in Houston V. Lack. 37) Plaintiff avers that he has complied with all policy provisions. 38) Plaintiff has been unable to salvage any personal property from the residence premises nor recover any of the personal property stolen from him. Plaintiff has not filed a claim for any of the stolen items. COUNT I BREACH OF CONTRACT 39 ) Plaintiff •incorporates herein by reference the allegations set forth in paragraphs 1 -38. 40) Plaintiff has paid all premiums and otherwise satisfied all conditions and covenants and performed all things required of him under the insurance contract between Plaintiff and Defendant. Defendant claims that, "There is a question as to whether an insured as defined in the policy, resided in the designated residence premises at the time of the loss." (Please see Exhibit "J" ) . Plaintiff's place of residence at the time of loss was 740 Pine Hill Road, Duncannon, Perry County, Pennsylvania, 17020, although he was temporarily in the Western States of the United States until such time as he could retain (14) 1:l � G 1GV1 � counsel and broker the best possible deal for surrender to Federal Authorities. The policy contains no time limits on the period of time an owner is permitted to be- absent from his property. Plaintiff purchased the property from Edward Jones. Everyone, including the Federal Authorities knew Plaintiff resided at 740 Pine Hill Road, Duncannon, Pennsylvania, 17020. Plaintiff formed Gulf Stream Investments, LLC listed on the policy as additionally insured. Plaintiff purchased the policy in person from Greg Lunde, an individual employed by and acting as an authorized agent of Defendant, State Farm Fire and Casualty Company, at its place of business at 11 State Avenue, Carlisle, Cumberland County, Pennsylvania, 17013. While away from the premises, Plaintiff continued to pay the mortgage payments as well as the utility bills well past the date of loss. Further, Plaintiff had his youngest brother as caretaker in his absence. 41 ) As a result of direct physical loss to the property described in Coverage A- Dwelling and Coverage B- Personal Property and Coverage C- Loss of Use, caused by fire, and/or vandalism, and/or malicious mischief, and/or theft, Plaintiff has suffered a covered loss within the meaning of the Insurance Contract. 42) Defendant is obligated by the terms of the Insurance Contract to indemnify Plaintiff's loss. 43) Defendant's refusal to indemnify Plaintiff's loss constitutes a Breach of Insurance Contract. (15) +L'l � L1LlJ1 � 44) As a direct and proximate result of Defendant' s breach` i Plaintiff has been deprived the value of the property destroyer] in the fire and the value of the property stolen from him, 1 including but not limited to: the residence premises, insured under Coverage A- Dwelling for $278,000.00 plus an additional amount of $55,600.00 under option ID; personal property, insured under Coverage B- Personal Property in the amount of $208, 500. 00; loss of use, insured under Coverage C- Loss of Use in the amount of "actual loss sustained" (approximately $10,800.00 to date) . A detailed listing of inventory of personal property is attached hereto as Exhibit "G", and amounts to a claim of approximately $203,970.00 and this figure represents the amount of the personal property claim after withdrawing the claim for the 200 Silver Dollars with a listed value of $6,000.00. These figures represent a total claim loss of approximately $548,370.00. WHEREFORE, Plaintiff, Rodger T. Atwood, II, demands judgmenti- against Defendant in an amount in excess of $548, 370.00, together with costs, interest,.and attorneys fees. COUNT II BAD FAITH 45) Plaintiff incorporates herein by reference the allegations set forth- in paragraphs 1 -44. -46) Upon information and belief, Defendant possessess no evidence that the fire was not accidental and/or was not an act ( 16) of vandalism or malicious mischief as claimed by Plaintiff j10I does Defendant possess any evidence that the thefts did not occur as reported by Plaintiff. This is contrary to Defendant's claim that, "There is a question as to whether there has been an accidental direct physical loss to the property described in Coverage A- Dwelling, and Coverage B- Personal Property." (Please see Exhibit "J" attached. ) 47) Upon information and belief, Defendant has no reasonable and sufficient basis for its conclusion that, "There is a question whether you or any person under the policy caused or procured a loss to property under this policy for the purpose of obtaining insurance benefits." Such a conclusion is absurd. Even if Plaintiff were to be indemnified in the maximum amount of coverage, it is doubtful that the residence dwelling could be rebuilt to its former state for the amount of coverage reflected in Coverage A Dwelling of the policy, and it's a certainty that the amount of coverage reflected in Coverage B- Personal Property could never replace many items of personal property both claimed in the inventory lists and attached as Exhibit "G", and not claimed (such as family photos, etc. ) which are difficult to put a value on. 48) Defendant acted in bad faith toward Plaintiff when -it . waited nearly ten (10) months before first informing Plaintiff why his claim has not been finalized, in violation of the Pennsylvania Unfair Claims Practices Act. (77) 49) Defendant continues to act in bad faith ,toward Plaintiff. when Defendant persists in its investigation nearly a year after the loss with nothing more than wild speculations. It appears as if Defendant is taking advantage of the facts that Plaintiff is incarcerated and that he is indigent. WHEREFORE, Plaintiff prays this Honorable Court will afford him a broad and liberal reading of his pleadings, holding them to a less stringent' standard than those drafted by lawyers. Plaintiff relies on the ruling in Haines• V. Kerner, asking this Honorable Court to excuse any errors in form or substance or ignorance of pleading rules. Plaintiff likens his cause to that of the story of David and Goliath found in 1Samuel, Chapter 17 . Further, Plaintiff, Rodger T. Atwood, II, requests that this Court take the following actions pursuant to 42 Pa. Cons. Stat. Ann. §8371 : 1 ) Award interest on the amount of Plaintiff's claim against Defendant, State Farm Fire and Casualty Company from the date the claim was made at a rate equal to the prime rate plus 02%. 2) Award punitive damages against the Defendant; and/or 3) assess court costs and fees against the Defendant. FURTHER, Plaintiff prays this- Honorable Court would grant him all to which he may be entitled and any other relief this Court may deem just and proper. Respectfully Submitted, Dated: 3 -1 -0 613 A U� 7i` Rodgder T. Atwood, II ACP No: 12-M0B45 45 Major Bell Lane Gettysburg, PA 17325 A.C.A.C.C. (18) Commonwealth of Pennsylvania Rodger T. Atwood, II, Court of Common Pleas of Plaintiff Cumberland County VS. Civil Action Law State Farm Fire and y3.- t15`�. Civil Term, Casualty Company, (Year) Defendant No: NOTICE 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 is 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 claim or relief requested by the plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THESE PAPERS TO YOUR LAWYER AT ONCE! Date:_ 3- 1-403 Rodg r T. Atwood, II ACP No: 12-M0845 45 Major Bell Lane Gettysburg, PA 17325 A.C.A.C.C. +L'J � t1LIJ1 � Commonwealth of Pennsylvania Court of Common Pleas Rodger-IT. Atwood, II, of Cumberland County Plaintiff Civil Action Law VS. 13-11511 Coil Term, State Farm Fire and (Year) Casualty Company, Defendant No: AFFIDAVIT OF VERIFICATION I, Rodger T. Atwood, II, do hereby state that he is the Plaintiff in this action and that the statements of fact made in the foregoing motion and exhibits are true and correct upon I. personal knowledge, except as to matters alleged on information and belief, and, as to those, he believes them to be true. I certify under penalty of perjury pursuant to 18 Pa—Cons. Stat. Ann. 4$4904 relating to unsworn falsification to authorities that the foregoing is true and correct. Date• 3 -1-,;,013 Rodg T. Atwood, II. ACP No: 12-MOB45 45 Major Bell Lane Gettysburg, PA 17325 A.C.A.C.C. t 'l ON 7 Commonwealth of Pennsylvania Court of Common Pleas Rodger T. Atwood, II, of Cumberland County Plaintiff Civil Action Law VS. . 13- 1154 C I Term, State Farm Fire and - (year) Casualty Company, , Defendant No: CERTIFICATE OF SERVICE I, Rodger T. Atwood, II, hereby certify that I, on the date of this Proof of Service, did serve one (1 ) copy of each of the attached Pleadings and Attachments upon those listed below by depositing same in the United States Mail, properly addressed, certified with return receipt requested, with all required postage and charges prepaid. State Farm Fire and State Farm Fire and Casualty Company Casualty Company Pennsylvania Fire Claims Attn: Greg Lunde, Agent P.O. Box 106110 11 State Ave. Atlanta, GA 30348-6110 Carlisle, PA 17013 Date: RodgLyr T. Atwood, II V� G 1 GCJ1 � EXHIBIT A &StateFarm- Certifred Policy Record ` 1, the undersigned, do hereby certify that 1 am custodian of the records pertaining to the issuance of policies by State Farm Fire and Casualty Company. I certify that the attached documents represent a true and accurate record of the terms and conditions of Policy Number 38-BY-F929-5 including any endorsements and/or inserts, if applicable, for the policy term(s) 05/02/2011 - 03/31/2012 and insuring Atwood, Rodger T of 740 Pine Hill Rd, Duncannon PA 17020-9119 based on available records. The policy was in effect on the loss date of 03/31/2012. Kevin Carmichael Underwriting Support Svcs Supv State of New York County of Saratoga Subscribed and sworn to before me this(-75 day of , 201,2. SHARi E PENS Notary Public, State of New York Registration#01PE8246088 Quallfied In Saratoga county commission Expires August 8,2015 Notary Public My Commission Expires: Exhibit A 1004596 2000 143559 200 03-21-2012 State Farm Fire and Casualty Company A Stock Company With Home Offices in Bloomington, Ilfnois DECLARATIONS PAGE 100 State Farm Place Policy Number Ballston Spa, NY 12020-8000 cU 35•5Y•F919.5 Named Insured policy period Effective Date Expiration Date AT2 P-13-6271-F382 H F 12 Months MAY 2 2011 MAY 2 2012 0003M The policyy,period begins and ends at 12:01 am ATWOOD, RODGER T standard at the residence premises. 740 PINE HILL RD DUNCANNON PA 17020-4119 Addl Insured-Sections I&II CERTIFIED GULF STREAM INVESTMENTS, LLC 125 S 2ND ST = NEWPORT PA 17074-1407 �o HOMEOWNERS POLICY Automatic Renewal - if the policy period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgageetienholderwritten notice in compliance with the policy provisions or as required by law. Location of Residence Premises Same as Insured's Address Mortgagee EDWARD JONES 7048 WERTZVILLE RD MECHANICSBURG PA 17050-1542 Coverages&Property Limits of Liability inflation Coverage Index:224.2 SECTION 1 Deductibles-Section I A Dwelling 278,000 All Losses 12% $ 1,390 Dwelling Extension up to 27,800 B Personal Property 208 500 C Loss of Use Actual Loss SECTION II Sustained ' L Personal Liability $ 500,000 Each Occurrence) Damage to Property In case of loss under this policy,the deductibles will be applies of Others $ 500 per occurrence and will be deducted from the amount of the M Medical Payments to loss.Other deductibles may apply -refer to policy. Others(Each Person) $ 1,000 Loss Settlement Provision(See Policy) Policy Premium $ 1,199.00 Al Replacement Cost-Similar Construction Discounts Applied: B1 Limited Replacement Cost-Coverage B Home/Auto Claim Free Forms, Options,& Endorsements Homeowners Policy FP-7955 Homeowners Pol' y Endorsement FE-3518 Jewelry and Furs$1,500 Each Option JF Articte/$2,500 Agggregate Increase Dwig Up to$ '55 600 Option ID OrdinanceA.aw 10" 0,800 Option QQ Additional insured Option R Other limits and exclusions may apply-refer to your policy Your policy consists of this page, any endorsements and the policy form. Please keep these together. FP-7001.60 Continued on Reverse GREG LUNDE s � L 1 LtJi 3 0748 151 1 717-241-2341 CONTINUED FROM FRONT SIDE State Farm®works hard to offer you the best combination of price,service,and protection. The amount you pay for homeowners insurance is determined by many factors such as the coverages you have,the type of construction,the likelihood of future claims,and information from consumer reports. State Farm Fire and Casualty Company sr�n ru" A Stock Company With Home Offices in Bloomington, Illinois DECLARATIONS PAGE Ballston State NY 12020-8000 Policy Number Way-f17.1-i5 Mortgagee Policy Period Effective Date Ex 11ration Dab AT2 P-13-6271-F382 H F 12 Months MAY 2 2011 MAY 22012 006 The polic period begins and ends at 12:01 am EDWARD JONES standard time at the residence premises. 7048 WERTZVILLE RD MECHANICSBURG PA 17050-1542 Named Insured ATWOOD, RODGER T z � �IFIED 740 PINE HILL RD S DUNCANNON PA 17020-4119 A �o HOMEOWNERS POLICY Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the MortgageolLienholder written notice in compliance with the policy provisions or as required by law. Location of Residence Premises Same as Insured's Address Addl Insured-Sections I&If GULF STREAM INVESTMENTS,LLC 125 S 2ND ST NEWPORT PA 17074-1407 Coverages&Property Limits of Liability Inflation Coverage Index:224.2 SECTION I Deductibles-Section I A Dwelling 278,800 All Losses 1 f2% $ 1,390 Dwalling Extension up to 27, 00 8 Personal Property 208 500 C Loss of Use Actual loss Sustained SECTION It L Personal Liability $ 500,000 Each Occurrenae} o m�ageta Property $ 500 In case of loss under this policy,the deductibles will be appiie M Medical Payments to per occurrence and will be deducted from the amount of the ym loss.Other deductibles may apply-refer to policy. Others(Each Person) $ 1,000 Loss Settlement Provision(See Policy) Policy Premium $ 1,199.00 Al Replacement Cost-Similar Construction Discounts Applied: 131 Limited Replacement Cost-Coverage B Home/Auto Claim Free Forms,Options,&Endorsements Homeowners Policy FP-7955 Homeowners Poli y Endorsement FE-3518 Jewelry and Furs$1,500 Each Option JF Article/$2,500 Aggregate Increase Dwlg Up fa$ 55 600 Option ID Ordinance/Law I O*A$ 2Y,800 Option pp Additional insured Option A Other limits and exclusions may apply-refer to your policy Your polioy consists of this page, any endorsements and the policy form. Please keep these together. FP-7001.6C Continued on Reverse • GREG LUNI<3E r M-5 Z 12 e 3 � 0803 161 Al 717-241-2341 _. CONTINUED FROM FRONT SIDE iron uaa 38—BY—F929-5 t aeon o0ai5o ,atanaarcl , Fie 1 Of 6 !!! FE-3518 HOMEOWNERS POLICY ENDORSEMENT(Pennsylvania) DECLARATIONS CONTINUED c. a motorized golf cart while used for golfing pur- Loss History is replaced by the following: poses; 1, Loss History:you and the members of your house- d. a motorized vehicle or trailer designed to assist hold have not had any insured losses,whether paid the handicapped that is not designed for travel or not that to the best of your knowledge would on public roads or subject to motor vehicle reg- have been covered under the terms of this or a istration;or y similar policy,and e. a commercially manufactured 2,3 or 4 wheeled DEFINITIONS personal conveyance powered only by or as- sisted by an•unmodified motor or engine with a Definitions 6,and 7.are replaced by the following: manufacturer's power rating of no more than 1 6. 'motor vehicle,when used in Section.11 of this pot- horsepower and capable of a top speed of no icy,means: more than 20 miles per hour. & a land motor vehicle designed for travel on 7. 'occurrence,when used in Section II of this policy, public roads or subject to motor vehicle regis- means an accident, including exposure to condi- bation; lions,which first results in: b. a trailer or semi-trailer designed for travel on a. bodily injury;or public roads and subject to motor vehicle regis- b. property damage; tretion; during the policy period. All bodily injury and c. a'recreational vehicie'while off an insured to- property damage resulting from one accident, se- cation. 'Recreational vehicle' means a motor- ties of related accidents or from continuous and re- ized vehicle designed for recreation principally p+atad exposure to the same general conditions is off public roads that is owned or leased by an considered to be one occurrence. insured. This includes, but is not limited to, a• Definitions 11.and 12.are added: motorized all terrain vehicle, amphibious ve- hicle, dune buggy, go-cart, golf cart, snowmo- 11• 'fungus'means any type or form of fungus,includ- bile, trailbike, minibike and personal assis~tive ing mold, mildew,mycotoxins,spores,scents or by- mobility device, 'Leased" does not include products produced or released by fungi. temporary rental; 12. 'State Farm Companies" means one or more of d. a 'locomotive" while off an insured location. the following: ' "Locomotive"ineans a self-propelled vehide for a. State Farm Mutual Automobile Insurance pulling or pushing freight or passenger cars on tracks that is large enough to carry a person Company; and is owned or leased by an Insured. b. - State farm Fire and Casualty Company,and 'Leased'does not indude temporary rental; c. subsidiaries or afFifiates of either a.or b.above, e. a bui dozer, track loader, backhoe, high-hoe, SECTION I-COVERAGES trendier, grader; crane, self-propelled scraper, excavator, pipe-layer, cherry picker,telehandler, COVERAGE A-DWELLING logging vehicle, mining vehicle or road budding Item 2.,Dwelling Extension,is replaced by the following: vehicle that is owned or leased by an insured while off an insured location. `Leased' does 2. Dwelling Extension.We cover other structures on not irictude temporary rentEd,and the residence premises,separated from the dwell- f. any vehicle while being towed or pushed by or ing by clear space. Structures connected to the carried on a vehicle included in a.,b.,c.,d.or e. dwelling by only a fence, utility line, or similar con- The following are not motor vehicles: nection are considered to be other structures. a. a boat, camp, home or utility trailer not being We do not cover other structures: towed or pushed by or carried on a vehide in- a. not permanently attached to or otherwise form- cluded in a.,b.,c.,d.or e.-above, ing a part of the result, b. a motorized land vehicle in dead storage on an b, used in whole or in part for business purposes insured location; unless such use consists solely of use of office 0,Copyright.State Farm Mutvai Automobile insurance Company,2010 CONTINUED a w s VJZee_ VJ .LZ 0804 - - - FE-3518 Page 2 of 6 space for paperwork, computer work or use of j. $5,000 on any one article and $10,000 in the aggre- a telephone, and consists solely of activities gate for loss by theft of any rug,carpet(except wall- that are: tD-wall carpet),tapestry,wall-hanging or other simi- (1) duties of the insured's employment by lararticle;and another;and k. $500 on commercially manufactured 2, 3 or 4 (2) Performed solely by the insured;or wheeled personal conveyances powered only by or assisted by an unmodified motor or engine with a c. rented or held for rental to a person not a tenant manufacturer's power rating of no more than 1 of the dwelling,i"ess used solely as a private horsepower and capable of a top speed of no more gage, than 20 miles per hour. This does not include those The following item is added to item 3. Property Not Cov- not licensed for use on public highways which are eyed: designed for assisting the handicapped. d. lawns or artificial grass, except as provided in Item 2., Property Not Covered,is replaced by the following: SECTION I—ADDITIONAL COVERAGES. 2. Property Not Covered.We do not cover. COVERAGE B—PERSONAL PROPERTY a. articles separately described and specifically Special Limits of Liability is replaced by the following: insured in this or any other insurance; Special Limits of Liability.These limits do not increase b. animals,birds or fish; the Coverage B limit The special limit for each of the c. any engine or motor-propelled vehicle or ma- following categories is the total limit for each loss for all chine, including the parts, designed for move- In that category: ment on land, except as provided in Special Prof Limits of Liability,item k. We do cover those a. $200 on money,coins and medals,including any of not licensed for use on public highways which these that are a part of a collection,and bank notes; are: b. $1,500 on property used or intended for use in a (1) used solely to service the insured loca- business, including merchandise held as samples tion;or or for sale or for delivery after sale, while on the residence premises. This coverage is limited to � (2) designed for assisting the handicapped; $750 on such property away from the residence d. devices or instruments for the recording or re- premises. production of video or sound permanently at- Elactr+onic date processing system equipment or the tached to an engine or motior-propelled vehicle. recording or storage media used with that equip- We do not cover tapes, discs, wires, videos or ment is not included under this coverage; other media that may be used with these de- c. $1,000 on securities, checks, cashiers checks, vim or instruments while in the vehicle; travelers checks,money orders,gift certificates,gift e. aircraft and parts; cards, rechargeable debit cards, phone cards and f. property of roomers, boarders, tenants and other negotiable instruments,accounts,deeds,evi- other residents not related to an insured. We devices of debt, letters of credit, notes other than do covet property of roomers, boarders and bank notes,manuscripts,passports and tickets; other residents related to an insured; d. $1,500 on watercraft of all types and outboard mo- g. property regularly rented or held for rental to tors, including their trailers, furnishings and equip- others by an insured. This exclusion does not ment; apply to property of an insured in a sleeping e. $1,500 on trailers not used with watercraft; room rented to others by an insured; f. $2,500 on stamps, trading cants and comic books, h. property rented or held for rental to others .including any of these that are a part of a collection; away from the residence premises; g. $2,500 for loss by theft of firearms; i. any radio devices or transmitters, global posi- h. $2,500 for loss by theft of silverware and goldware; toning systems, radar or laser detectors, an- i. $5,000 on electronic data processing system equip- tenaas and all other similar equipment ment, including but root limited to mobile personal permanently attached to an engine or motor- communication equipment, global positioning sys- propelled vehicle; tems,mobile personal electronic devices used for the j. books or records of accounts receivable, ab- reproduction of sound, and standard media or non- stracts or other journals, architectural or tech- media equipment for use with the above devices; nical drawings, card index systems or other 0,Copyright,Stake Farm Mutual Automobile Insurance Company,2010 CONTINUED nna�a� 38—BY—F929-5 ( oew)000m uuurc� FE35t� Papo 3 of 6 records. This exclusion does not apply to any SECTION 1—ADDITIONAL COVERAGES recording or storage media for electronic data Items 1.,3.and 11.are replaced by the following: i processing. We will cover the cost of blank 01;4 books, cards or other blank material plus the 1. Debris Removal. We will pay the reasonable ex- cost of labor you incur for transcribing or copy- penes you incur in the removal of debris of rov- ing such records; ered property damaged by a Loss Insured. This k. recording or storage media for electronic data expense is included in the limit applying to the processing that cannot•be replaced with other damaged property. The following coverages and of like kind and quality on the current retail limits also apply: market a. When the amount payable for the property 'L purchased or created date, sound or video that damage plus the debris removal exceeds the cannot be replaced with like kind and quality on limit for damaged property, an additional 5116 of the current retail market which is transferred or that limit is available for debris removal ex- downloaded onto mobile communication equip- pense. This additional amount of insurance meat, global positioning system or electronic devices used for the reproduction of video or does not apply to Additional Coverage, item 3. sound; Trees,Shrubs and Landscaping. m. contraband,or any property used in the course b. We will also pay up to $500 in the aggregate of illegal consumption, possession, import, ex- for each loss to cover the reasonable expenses port or trade;or you incur in the removal of tree debris from the residence premises, unless otherwise ex- n. outdoor hardscape property used for aesthetic eluded. This coverage applies when: purposes except as provided in SECTION I — ADDITIONAL COVERAGES. (1) the tree has caused a Loss Insured to COVERAGE C—LOSS OF USE Coverage A property; or Item 3., Prohibited Use,is replaced b the following: (2) the tree debris felled by windstorm, hail,or Y weight of snow err`ice blocks: 3. Prohibited Use. We cover Additional Living Ex- (a) the driveway, on the residence prem- i pence and Fair Rental Value,for a continuous period Ises, and prevents land motor vehicle not to exceed two weeks,beginning when a civil au- access to or from the dwelling;or I thorny issues an order of evacuation or prohibits your use of the residence premises,provided that (b) a ramp designed to assist the handi- a. direct physical damage occurs to any property, capped, on the residence premises other than covered property located on the res- and prevents access to or from the idence premises, arising from a cause of loss dwelling. that would be a Loss Insured under this policy c. We will also pay up to$150 for reasonable ex- ' K the damage had occurred to property on the penses you incur in the removal from the resi- residence premises; deuce premises of tree, shrub, or plant debris jb. the residence premises is within one mile of If loss is caused by windstorm, hail or weight of property damaged by a cause of loss identified - •. ..: . ..ices snow or sleet _ T ' in 3.a.above;and We will pay no more than$500 in the aggregate for c. the action of the civil authority is taken in re- each loss insured under b.and c.above. I sponse to: 3. Trees, Shrubs and Landscaping. We cover out- ; (1) dangerous physical conditions resulting door: from the continuation of the cause of loss a. trees,shrubs,live or artificial plants,and lawns, identified in 3.a.above; • (Z) dangerous physical conditions resulting b. artificial grass;end from the damage caused by the cause of c. hardscape property used for aesthetic purposes loss identified in 3.a.above;or not permanently affixed to realty; (3) the need to gain free access to property on the residence premises, for direct loss caused damaged by the cause of loss identified in by the following:Fire or lightning,Explosion,Riot or 3.a.above. civil commotion, Aircraft, Vehicles (not owned or We do not cover loss or expense due to cancella-- operated by a resident of the residence premises), ton of a lease or agreement. Vandalism or malicious mischief or Then. m,CopyriUK State Farm Mutual Automobile Insurance Company,2010 CONTINUED 1:I �L 1 Ll:l1 � 0805 FE-3518 Page 4 of 6 The limit for this coverage, including the removal of 9. b. (3) (c) of securities,checks,cashiers checks, debris,shall not exceed 5%of the amount shown in travelers checks, money orders, gift De the clarations for COVERAGE A—DWELLING. certificates, gift cards, rechargeable We will not pay more than$750 for any one outdoor debit cards, phone cards and other tree, shrub, plant or hardscape item, including de- negotiable instruments, accounts, bris removal expense.This coverage may increase deeds evidences of debt, letters of the limit otherwise applicable. We do not cover credit, notes other than bank notes, property grown for business purposes. manuscripts,passports and tickets; 11. Collapse. We insure only for direct physical loss to 12, d. caused by or resulting from continuous or re- covered property involving the sudden, entire col- peated seepage or leakage of water or steam lapse of a building or any part of a building, which occurs over a period of time and results in Collapse means actually fallen down or fallen into deterioration,corrosion,rust,or wet or dry rot: pieces. It does not include settling,sacking,shrink- 13. b. caused by or resulting from continuous or re- mg,bulging,expansion,sagging or bowing. peated seepage or leakage of water or steam The collapse must be directly and immediately , which occurs over a pad of time and results in caused only by one or more of the following: deterioration,corrosion,rust,or wet or dry rot a. perils described in SECTION I— LOSSES IN- 15. Sudden and accidental damage to electrical ap- SURER, COVERAGE B — PERSONAL plianoes, devices, fiftres and wiring from an in- PROPERTY. These perils apply to covered crease or decrease of artificially generated electri- building and personal property for loss insured cal current.We will pay up to$1,500 under this peril by this Additional Coverage; for each damaged item described above. b. decay, deterioration, insect damage or vermin SECTION I—LOSSES NOT INSURED damage,all that are hidden from view,of a: Items 1.i.and 2.c.are replaced by the following: (1) connector;or 1. i. wet or dry rot; (2) structural member of a building; 2. c. Water,meaning: unless the presence of such damage is known (1) flood, surface water, waves(including tidal to an insured prior to collapse; wave, tsunami, and seiche), tides, tidal c, weight of contents, equipment, animals or water, overflow of any'body of water, or people; spray or surge from any of these, all d. weight of ice, snout sleet or rain which collects whether driven by wind or not on a roof,porch or deck;or (2) water or sewage from outside the resi- e. use of defective material or methods in the dence premises plumbing system that en- construction (includes remodeling or renova- ters through sewers or drains, or water tion)of the building,*if the collapse occurs dur- which enters into and overflows from witt- ing the course of the construction of the in a sump pump, sump pump well or any building. other system designed to remove subsur- Loss to an awning, fence, patio, pavement, swim- face water which is drained from the; foun- ming pool, underground pipe, flue, drain, cesspool, dation area septic tank, foundation, retaining wall, bulkhead, (3) water below the surface of the ground, in- pier,wharf, dock, trellis or antenna or its supporting cluding water which exerts pressure on, or structure is not included under items b.,c.,d.and e. seeps or leaks through a budding, side- unless the loss is the direct and immediate cause of walk, driveway, foundation, swimming pod the collapse of the building. or other structure;or This coverage does not increase the limit applying (4) material carried or otherwise moved by to the damaged property. any of the water, as described in para- SECTtON I—LOSSES INSURED graphs(1)through(3)above. COVERAGE B—PERSONAL PROPERTY However, we do insure for any direct loss by fire, explosion or theft resulting from water, Items 91.(3)(c), 12.d., 13.b. and 15. are replaced by the provided the resulting loss is itself a Loss In- toSb�aing� surgd. O,Copyright,State Farm Mutual Automobile Insurance Company,2010 CONTINUED 38—BY—F929-5 osoe�coo rr�rt� CCC Pape g orb The following item is added: the bodily injury or property damage first occurs, 2. g. Fungus.We also do not cover: regardless of the number of insureds,claims made or persons injured. No additional limits or coverage r,.:.,. (1) any loss of use or delay in rebuilding, re- will be available for the occurrence under any addi- pairing or replacing covered property, in- tonal policy periods while this policy remains in cludmg any associated cost or expense, force. due to interference at the residence prerrr- The Coverage M limit is shown in the Declarations. ises or location of the rebuilding,repair or a replacement,by fungus; This is our limit for all medical expense for bodily injury to one person as the result of one accident.cost(2) any�ediation of fungus, including the The following condition is added to item 4., Duties of an (a) remove the fungus from covered Injure d Person-Coverage M: - property or to repair, restore or re- d. the injured person, or, when appropriate, someone place that property,or acting on behalf of that person,shall: (b) tear out and replace any part of the (1) provide us with any required authorizations; building or other property as needed . to gain access to the fungus;or (2) submit to us all information we need to comply (3) the cost of any testing or monitoring of air with state or federal law or property to confirm the type, absence, SECTION I AND SECTION II-CONDITIONS presence or level of fungus, whether per- Cancellation. All references to r10 days" are changed to formed prior to, during or after removal, ' r3Q days". repair, restoration or replacement of cov- ered property. The following conditions are added: SECTION Il—LIABILITY COVERAGES 11. Premium. COVERAGE M-MEDICAL PAYMENTS TO OTHERS: The a. Unless as otherwise provided by an afternative three year limitation on medical expenses for funeral ser- payment plan in effect with the State Farm vices is deleted. Companies with respect to the premium for SECTION II-ADDITIONAL COVERAGES this policy, the premium is due and payable in full on or before the first day of the policy Items 1.a., 1.c,and 1.d.are replaced by the following: period shown in the most recently issued Dec- 1. Clair Expenses.We pay. larations. a. expenses we incur and costs taxed against an b. The renewal premium for this policy will be insured in suits we defend. Taxed costs do based upon the,rates in effect, the coverages not include attorney fees; carried, the applicable limits, deductibles and other elements that affect the premium appli- c. reasonable expenses an insured incurs at our cable at the erne of renewal. request This includes actual loss of earnings c. The premium for this policy may vary based (but not loss of other income) rip to $200 per upon: day for aiding us-in the investigation or defense of claims or suits; (1) the purchase of other products or services d. interest the insured is legally liable to pay on from the State Farm Companies; damages payable under Coverage L above be- (2) the purchase of products or services from fore a judgment, but only the interest on the an organization that has entered into an lesser of agreement or contract with the State Farm (1) that part of the damages we pay;or, Companies. The State Farm Compa- nies do not warrant.the merchantability, (2) the Coverage L limit~and fitness,or quality of any product or service SECTION II-CONDITIONS one ed or provided by that organization;or Item 1., Limit of Liability,is replaced by the following: (3) an agreement, conceming the insurance provided by this policy, that the State 1. Limit of Liability.The Coverage L limit is shown in Farm Companies has with an organiza- the Declarations. This is the limit for all damages ton of which you are a member, em- from each orxurnenee for the policy period in which ployee,subsaber,licensee, or franchisee, m,Copyright,State Farm Mutual Automobile insurance Company,2010 CONTINUED 0806 FE-3518 Page 6 of 6 d. Your purchase of this policy may allow. 14. Change of Policy Address. We may change the (1) you to purchase or obtain certain cover- named insured's policy address as shown in the ages, coverage options, coverage deduc- Declarations and in our records to the most recent tbles, coverage limits, or coverage terms address provided to us by: on other products from the State Farm a. you;or - Companies, subject to their applicable b. the United States Postal Service. eligibility rules;or (2) the premium or price for other products or OPTIONAL POLICY PROVISIONS services purchased by you, including non- Option BP- Business Property is replaced by the follow- insurance products or services, to vary, ing: Such other products or services must be provided by the State Farm Companies Option BP-Business Property.The COVERAGE B- or by an organization that has entered into PERSONAL PROPERTY, Special Li nits of Liability, an agreement or contract with the State item b., for property used or intended for use in a Farm Companies.The State Farm Com- business, including merchandise held as samples or for panies do not warrant the merchantability, sate or for delivery after sale,is changed as follows: fitness or quality of any product or service offered cx provided by that organization. The$1,500 limit is replaced with the amount shown in the Declarations far this option. 12. Right to Inspect. We have the right but are not ob- ligated to perform the following: Option HC-Home Computer is replaced by the following: a. make inspections and surveys of the Insured Option HC -Home Computer. The COVERAGE B- location at any time; PERSONAL PROPERTY, Special Limits of Liability, b. provide you with reports on conditions we find; item i.,is increased to be the amount shown in the Dec- or larations for this option. c. recommend changes. Option OL-Building Ordinance or Law. Any inspections, surveys, reports or recommenda- Item 3.c.is replaced by the following: tions relate only to insurability and the premiums to c. legally required changes to the undamaged portion be charged. of the dwelling caused by the enforcement of a We do not building,zoning or land use ordinance or taw,it a. make safety inspections; (1) the enforcement is directly caused by the some b.' undertake to perform the duty of any person or Loss Insured; organization to provide for the health or safety (2) the requirement is in effect at the time the Loss of workers or the public; Insured occurs;and c. warrant that conditions are safe or healthful;or (3) the legally required changes are made to the d. warrant that conditions comply with laws,regu- undamaged portions of specific dwelling lations,codes or standards, features, systems or components that have This condition applies not only to us but also to any been physically damaged by the Loss rating, advisory, rate service or similar organization Insured. Mich makes insurance inspections, surveys, re- We will not pay for legally required changes to spe- ports or recommendations on our behalf. cific dwelling features, systems or components that 13. Joint and Individual Interests. When there are have not been physically damaged by the Loss In- two or more named insureds, each ads for all to sured. cancel or change the policy. All other policy provisions apply. FE-3518 O,Copyright State Farm Mutual Automobile Insurance Company,2010 b TABLE OF CONTENTS w DECLARATIONS Your Name r■ Location of Your Residence s Policy Period m Coverages Limits of Liability Deductibles Begins on Page 67 0 DECLARATIONS CONTINUED . . . . . . . . . . . . . . . . . . . . . . 1 �' z DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 y,8 cr SECTION I-YOUR PROPERTY °s COVERAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 S Coverage A-Dwelling . . . . . . . . . . . . . . . . . . . . . .' . . . 3 Coverage B-Personal Property . . . . .. . . . . . . . . . . . . . . . . 3 ' Coverage C-Loss of Use . . . . . . . . . . . . . . . . . . . . . . 4 Additional Coverages . . . . . . . . . . . . . . . . . . . . . . . . . 5 8 Inflation Coverage . . . . . . . . . . I . I . . . . . . . . . . . . . . 7 . LOSSES INSURED . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 g LOSSES NOT INSURED . . . . . . . . . . . . . . . . . . . . . . . . . 9 - LOSS SETTLEMENT. . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . ' CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 SECTION 11-YOUR LIABILITY COVERAGES . . . . . . . . . . . . . . . . . . . . . 15 Coverage L-Personal Liability . . . . . . . . . . . . . . . . . . . . 15 n Coverage M-Medical Payments to Others . . . . . . . . . . . . . . 15 m Additional Coverages . . . . . . . . . . . . . . . . . . . . . . . 15 EXCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 CONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 SECTION I AND SECTION 11-CONDITIONS . . . . . . . . . . . . . . . 19 CD OPTIONAL POLICY PROVISIONS . . . . . . . . . . . . . . . . . . . . . 20 1 a CL EXHIBIT B C-) $ Includes copyrighted material of State Farm Flra and Casualty Company., U4 Copyright State Farts Fire and Casualty Company,1983.1992.• 5 Printed In I)A A. ; > n i � r tit HOMEOWNERS POLICY an DECLARATIONS CONTINUED We agree to provide the insurance described in this policy: 3.we insure you on the basis your statements are true;and tv 1.based on you rpayment of premium for the coverages you 4,this policy contains all of the agreements between you tD chose; and us and any of our agents. 2.'based on your compliance with all applicable provisions Unless otherwise indicated in the application,you state that of this policy; and during the three years preceding the time of your application 3.in reliance on your statements in these Declarations. for this insurance your toss History and Insurance History are as follows: You agree,by acceptance of this policy,that 1.toss History:you have not had any losses,insured or 1.you will.pay premiums when due and comply with the not and provisions of the policy; 2,Insurance History, you have not had any insurer or 2,the-statements in these Declarations are your state- agency cancel or refuse to issue or renew similar insur- . ments and are true; ance to you or any household member. DEFINITIONS `You"and"your' mean the`named insured'shown in the 2."business' means a trade, profession or occupation. Declarations.Your spouse is Included If a resident of your This includes farming. household.Ma','trs'and"our mean the Company shown in the Declarations. 3."Declarations" means the policy Declarations, any amended Declarations,the most recent renewal notice Certain words and phrases are defined as follows: or certificate, an Evidence of Insurance form or any endorsement changing any of these. 1."bodily Injury'means physical injury,sickness,or dis- ease to a person.This includes required care,loss of 4.Insure means you and,if residents of your household: services and death resulting therefrom. -Bodily injury does not include: a. your relatives;and a. iany of the following which are communicable: dis- b. any other person under the age of 21 who is in the ease,bacteria,parasite,virus,orother organism,any care of a person described above. of which are transmitted by any insured to any other Under Section ll,Irmsured'also means: ,person; b. -the exposure to any such disease,bacteria,parasite, c. with respect to animals or watercraft to which this virus,or other organism by any insured to any other policy applies, the person or organization legally person;or responsible for them.However,the animal or water- craft must be owned by you or a person included in ' c, emotional distress, mental anguish, humiliation, 4,a.or 4.b.A person or organization using or having mental distress, mental'injury, or any similar injury custody of these animals or,watercraft in the course unless it arises out of actual physical injury to some of a business,or without permission of the owner,is person• not an Insured;and 1 FP-7'965 d. with respect to any vehicle to which this policy-ap- or carried on a vehicle included in 6.a.is not errata plies,any person while engaged in your employment vehicle; or the empioymentof a person included in 4.a.or 4.b, c. a motorized golf cart,snowmobile,trrotorizedticp 5,"insured locatlon'means: motorized tricycle, all-terrain vehicle or any othe similar type equipment owned by an Insured any a. the residence premises; designed or used for recreational or utility pirpose .b, the art of any. remises,other structures and off public roads, while off an Insured loealfon. , I� y P motorized golf cart while used for golfing purposes i grounds used by you as a residence.This includes not a molar vehicle;and premises,structures and grounds you acquire while this policy is in effect for your use as a residence; d. any vehicle while being towed by or carved on " . vehicle Included in 6.a.,6.b.or 6.c. c. any premises used by you in conneccti�on with the " premises included in 5.a.or 5.b.; 7."occurrence", when used in Section 11 of this polio! means an accident, including exposure to condition: " d. any part of a premises not owned by an insured but which results in: where an insured is temporarily residing; a. bodily injury;or e. land owned by or rented to an Insured on which a one or two family dwelling is being ponstructed'as a b. property damage; residence for an Insured; during the policy period. Repeated or continuous expr f, individual or family cemetery plots or burial vaults sure to the same general conditions is considered to t one occurrence. owned by an Insured; % g, any part of a premises occasionally rented to an 6,Oproperty damage means physical damage to or d- Insured for olhet than business purposes; shucti�on of tangible property,including loss of use of th property.Theft or conversion of property,by any insure h. vacant land owned by or rented to an Insured.This is not property damage, does not include farm land;and 9.'residence employee"means an employee bf an li I. • fart land(without buildings),rented or held for rental sured who per arms duties,including household or d to others, but not to exceed a total of 5t}0 acres, mastic services,in connection with the maintenance regardless of the number of locations; use of the residence premises.This includes emplo ees who perform similar duties elsewhere for you.Tt 6."Motor vehicle*,when used in Section 11 of this policy, does not Include employees while performing duties means: connection with the business of an insured. a. a motorized land vehicle designed for travel on public 10.'residence premises'means: roads or subject to motor vehicle registration.A mo- a ft one, two, three or tour-family dwelfing, oth n torized land vehicle dead storage on an insured structures and grounds;or location is not a motor vehicle; - b, a trailer or semMmiler designed tot travel on public b. that part of any other building; roads and subject to motor vehicle registration. A where you reside and which is shown in the Qaclai boat,camp,home or utirdy trailer not being towed by dons. 2 FP-?S ' on SECTION 1-COVERAGES OVERAGE A- IWELLING otherwise forming a part of the realty,At.yourrequest,we c0 ' cile the 1.Dwelling. W�cover the dwelling used prinipally as a will cover personal property owned by others while residote on the residence premises shown in properly is on the part of the residence premises occu- ru the DeclardlAs pied exclusively by an Insured.At your request,we will �n also cover personal property owned by a guest or a �D Dwelling incltafes: residence employee,while the property is In any othe- a. :structures attached to the dwelling; . ' residence occupied by an Insured. We cover personal property usually situated at an I.� b. ;materials aid supplies located on or adjacent to the sured's residence,other than the residence premises, residence premises for use in the construction, for up to$1,000 or 10%of the Coverage B limit,which- .alteration u repair of the dwelling or other structures ever is greater.This limitation does not apply to personal ''on the.residence premises; property in a newly acquired principal residence for the c. -foundatiorn,floor slab and footings supporting the first 30 days after you start moving the property there.If ;dwelling;and the residence premises is a newly acquired principal residence, personal property in your immediate past d. .wall-to-wa0carpeting attached to the dwelling. principal residence is not subject to this limitation for the 2.Dwelling Extension. We cover other structures on the first 30 days after the inception of.this policy. residence premises, separated from the dwelling by Special Limits of Liability.These limits do not increase clear space.Structures connected to the dwelling by only the Coverage 8 limit. The special limit for each of the a fence,utility[no,or similar connection are considered following categories is the total limit for each loss for all to be.other strictures. property in that category: We do not cover other structures: a. $200 on money,coins and medals,including any of a. 'not permanently attached to or otherwise forming a these that are a part of a collection,and bank notes; part of the realty; b. $1,000 on property used or intended for use in a b. used in whole or in part for business purposes;or business,including merchandise held as samples or c. ,rented or held for rental to a person not a tenant of for sale or for delivery after sale,while on the resi- -the dwelling,untess used solely as a private garage. dence premises.This coverage is limited to$250 on such property away from the residence premises. 3.Property Not Covered.We do not cover. Electronic data processing system equipment or the . a. land, including the land necessary to support any recording or storage media used with that equipment Coverage A property; is not included under this coverage; b. any costs required to replace, rebuild, stabilize,or c. $1,000 on securities,checks,cashier's checks,tray- otherwise restore the land;or eler's checks, money orders and other negotiable c. -the costs of repair techniques designed to compen- instruments, accounts, deeds, evidences of debt, :.sate for or prevent land instability to any property, letters of credit,notes other than bank notes,manu- whether or not insured under Coverage A. scripts,passports and tickets; :OVERAGE 8-PERSONAL PROPERTY d. .$1,000 on watercraft of all types and outboard mo- 1.Property Covered.We cover personal property owned tors, including their trailers, furnishings and equip- or used by an insured while it is anywhere in the world. ment; This includes structures not permanently attached to or e. $1,000 on trailers not used with watercraft; 3 FP-7955 f. $2,500 on stamps,trading cards and comic books, property of an Insured in a sleeping room rented 1, Including any of these that are a part of a collection; others by an Insured; st,we g. $2,500 for loss by theft of rifeanns; h. property rented or held for rental to others away fror to the the residence premises; emu" h. $2,500 for loss by theft of silverware and goldware; �e will I. any citizens.band radios, radio telephones radi or a i. $5,000 on electronic data processing system equip- transceivers,radio transmitters,radar or laserdetec ment and the recording or storage media used with tors antennas and other similar equipment other that equipment.There is no coverage for said equip- nently attached to an engine or o proopelle, ment or media while located away from the rest- vehicle; n f,n- dance premises except when said equipment or ices; media are removed from the residence premises for j. books of account, abstracts, drawings, card Inde hich- the purpose of repair,servicing or temporary use.An systems and other records.This exclusion does nc anal insured students equipment and media are covered apply to any recording or storage media for electroni r the while at a residence away from home;and data processing. We will cover the cost of bran re.It books,cards or other blank material plus the cost c cipal j. $5,000 on any one article and$10,000 In the aggre- labor you incur for transcribing or copying such re past gate for loss by theft of any rug, carpet (except cords;br the wall4o-wall carpet),tapestry, wall-hanging or other similar article. k. recording or storage media for electronic data proc ease 2.Property Not Covered.We do not cover essing that cannot be replaced with other of like kin and quality on the current retail market. the a. articles separately described and specifically insured COVERAGE C-LOSS OF USE r all in this or any other Insurance; 1.Additional Living Expense. When a Loss Insurei b. animals,birds or fish;, causes the residence premises to become uninhabii V of c. any engine or motor propelled vehicle or machine, able,we will cover the necessary increase in cost yon tes; incur to maintain your standard of living for up.to 2, including the parts,designed for movement on land. months.Our payment is limited to incurred costs for IN i a We cover those not licensed far use on public shortest of:(a)the time required to repair or replace IN 1)or highways which are: premises; (b) the Ems required for your household It 's1- (1) usedsolely to service the insured location;or settle elsewhere;or(c)24 months.This coverage is no on reduced by the expiration of this policy. s. (2) designed for assisting the handicapped; or re roduc- 2.Fair Rental Value.When a Loss insured causes that pat he d. devices or instrumenis for the recording P of the residence premises rented to others or held fo ?nt tion of sound permanently attached to an engine or rental by you to become uninhabitable,we will cover it: motor propelled vehicle. We do not cover tapes, fair rental value. Payment shall be for the shortest timr wires, records or other mediums that may be used required to repair or replace the part of the premise: iv" with these devices or instruments while in the vehicle; le rented or held for rental,but not to exceed 12 months ! )le e: aircraft and parts; This period of time is not limited by expiration of thk u- policy.Fair rental value shag not include any expense tha I. property of roomers, boarders, tenants and other does not continue while that part of the residence proem residents not related to an insured. We do cover Ises rented or held for rental Is uninhabitable. �. property of roomers, boarders and other residents 3.Prohibited Use.When a civil authority prohibits your us( r related to an Insured; of the residence premises because of direct damage ti g. property regularly rented or held for rental to others a neighboring premises by a Loss insured,we will cove by an Insured. This exclusion does not apply to any resulting Additional living Expense and Fair Renta ' S q FP-795! Value.Covert$is for a period not exceeding two weeks 4.Firs Department Service Charge. We will pay r H while use is pahibited. $500 for your liability assumed by contract or agree �0 ry a l do not coPr loss or expense due to ca forfredepartmentcharges.This meanscharges inci cancellation of when the fire department is called to save or pr a lease or agaement. covered property from a Loss Insur6d. No'dedui ru SECTION I-ADVMONAL COVERAGES applies to this coverage.This coverage may increas err The following Ad3Uonal Coverages are subject to all the limb otherwise applicable. to terms,'provisions.exclusions and conditions of this policy. 5.Property Removed.Covered property,while bein moved from a premises endangered by a Loss Ins 1.Debris Remolal.We will pay the reasonable expenses is covered for any accidental direct physical loss. you incur in tine removal of debris of covered property coverage also applies to the property for up to 30 damaged by aloss Insured.This expense Is included in' while removed.We will also pay for reasonable expe the limit applying to the damaged property. Incurred by you for the removal and return of the cov When the payable for property damage plus properly This coverage does not increase the Gmi amount Plying to the property being removed. the debris remmval exceeds thQ limit for the damaged property, an additional 5%of that limit Is available for 6.Credit Card,Bank Fund Transfer Card,Forgery debris removalexpense.This additional amount of insur- Counterfeft Money. ante does not apply to Additional Coverage, item 3. Trees,Shrubs and Other Plants. a. We will pay up to$1,000 for. We will also pay up to$500 in the aggregate for each loss (1) the legal obligation of an insured to pay beG to*cover the reasonable expenses you incur in the re- of the theft or unauthorized use of.credit c moval of tree debris from the residence premises when and bank fund transfer cards issued to or r, the tree has caused a Loss Insured to Coverage A tered in an Insured's name. If an insured property not complied with all terms and conditions u which the cards are issued,we do not coves 2.Temporary Repairs.-if damage is caused by a Loss by an Insured or anyone else; Insured,we will pay the reasonable and necessary cost you incur for temporary repairs to�covered property to (2) losstoanlnsuredcausedbyforgery orafter protect the property from further immediate damage or of any check of negotiable instrument;and kiss.This coverage does not increase the limit applying (3) loss to an'Insured through acceptance In I to the property being repaired. faith of counterfeit United States or Cana 3.Trees,-Shrubs and Other Plants. We cover outdoor paper currency. trees,shrubs, plants or lawns,on the residence prem- No deductible applies to this coverage. Use, for direct loss caused by the following:' Fire or lightning,•Explosion, Riot or civil commotion, Aircraft, 'We will not pay more than the limit stated abov :Vehicles (not owned or,operated by a resident of th e forgery or alteration committed by any one pen residence premises),Vandalism or malicious mischief This limit applies when the forgery or afteratio or Theft. volves one or more instruments in the same los The limit for this coverage, including the removal of b. We do not cover loss arising out of business pur debris,shall not exceed 5%of the amount shown in the or d'mhonesty of an Insured. Declarations.for COVERAGE A-DWELLING.We will c. Defense: not pay more than$500 for any one outdoor tree,shrub or plant'including debris removal expense.This cover- (1).We may make any investigation and settle age may increase the limit otherwise applicable.We do claim or suit that we decide is appropriate. not cover property grown for business purposes. obligation to defend claims or suits ends v 5 FP to the amount we pay for the loss equals our Ilmit of a, volcanic blast or airborne shock waves; ant liability. Rd (2) If claim is made or a suit is brought against an b. ash,dust or particulate matter;or 'ct Insured for liability under Hi's Credit Card or Bank c. lava flow. 'le Fund Transfer Card coverage,we will provide a is defense.This defense is at our expense bycoun- We will also pay for the removal of that ash,dust e set of our choice. particulate matter which has caused direct physical los to a covered building or covered property contaired in e- (3) We have the option to defend at our expense an building.. rd, Insured or an Insured's bank against any suit One or more volcanic eruptions that occur within a 72 for the enforcement of payment under the For- fs gery coverage hour period shall be considered one volcanic eruption. . �s This coverage does not increase the limit applying to IN id 7.Power Interruption.We cover accidental direct physical damaged property, p- loss caused directly or indirectly by a change of tempera-. lure which results from power interruption that takes 11.Collapse. We insure only for direct physical bss tc place on the residence premises.The power interrup- covered property involving the sudden,entire collapse o tion must be caused by a Loss Insured occurring on the a building or any part of a building. residence premises.The power lines off the residence premises must remain energized.This coverage does Collapse means actually fallen down or fallen into pieces not increase the limit applying to the damaged property. It does not include settling,cracking,shrinking,bulging s expansion,sagging or bowing. Is S.Refrigerated Products: Coverage B is extended to cover the contents of deep freeze or refrigerated units on The collapse must be directly and immediately cau'sec s the residence premises for loss due to power-failure or only by one or more of the following: it mechanical failure.If mechanical failure or power failure a. perils described in SECTION I-LOSSES INSURED, e is known to you,all reasonable means must be used to COVERAGE B -PERSONAL PROPERTY. These protect the property insured from further damage or this perils apply to covered building and personalproperty coverage is void.Powerfailure or mechanical failure shall for loss insured by this Additional Coverage; n not include: b. hidden decay of a supporting or weight-bearing struc- a a. removal of a plug from an electrical outlet;or • tural member of the building; n b. turning off an electrical switch unless caused by a c. hidden insect or vermin damage to a structural mem- Loss Insured. bar of the building; This coverage does not increase the limit applying to the d. weight of contents,equipment,animals or people; or damaged property. e. weight of ice,snow,sleet or rain which collects on a A. 9.Arson Reward.We will pay$1;000 for information which roof;or leads to an arson conviction in connection with a fire loss to property covered by this policy. This coverage may f. use of defective material or methods in the construc- increase the limit otherwise applicable. However, the tion(includes remodeling or renovation)of the build- $1,000 limit shall not be increased regardless of the Ing, 9 the collapse occurs during the course of the number of persons providing information, construction of the building. 10,Volcanic Action. We cover direct physical loss to a Loss to an awning, fence,.patio, pavement, swimming covered building or covered-property contained in a pool,underground pipe,flue,drain,cesspool,septic tank, r building resulting from the eruption of a volcano when the foundation,retaining wall,bulkhead,pier,wharf or dock loss is directly and immediately caused by: is not included under items b.,c.,d.,e.and I.unless the i e FP-7955 a loss is the-di0011 and immediate cause of the collapse of increased at the same rate as the increase in the Inflation the building. Coverage Index shown in the Declarations. on r-1 , This coveragiioes not increase the limit applying to the To find the limits on a given date: N ` damaged prallirty. 1,divide the index:on that date'by the Index as of the r-r 12.Lock&we vW pay the reasonable expenses you incur effective date of this inflation Coverage provision;then (v tore-key loclWon exterior doors of the dwelling located 2.multiply the resulting factor by the limits of liability for t on the residierce premises,when the keys to those Coverage A,Coverage 8 and Option ID separately. locks are a pat of a covered theft toss. The limits of liability will not be reduced to-less than the No deductibleappties to this coverage. amounts shown in the Declarations. INFLATION COVERAGE it during the term of this policy the Coverage A limit of liability is changed at your request,the effective date of this Inflation The limits of liabily shown in the Declarations for Cover- Coverage provision is changed to coincide with the effective age A,.Coverage,It and,when'applicabfe,bptron JD will be date of such change. SECTi'ON'I-LOSSE$INSURED COVERAGE A-DWELLING 6.Vehicles,meaning impact by a vehicle. We insure for adWental direct physical loss to the property 7.Smoke,meaning sudden and accidentat.damage from described in Coveage A,.except as provided in SECTION I- smoke. f LOSSES NOT INSURED. This peril does not include loss caused by smoke from COVERAGE B-.PERSONAL PROPERTY agricultural smudging or industrial operations. ! We insure for accidental direct.physical loss to.property B.Vandallsm or malicious mischief,meaning only willful described in Coverage B..caused by the following perils, and malicious damage to or destruction of property.. except as provided in SECTION 1-LOSSES NOT INSURED: /9.Theft,including attempted theft and loss of property from j'1.Fire or lightnbg a known location when it is probablp that the property has been stolen. . 2.Windstorm or hail.This peril does not include loss to This pent does not include: property contained in.a building caused by rain,snow, sleet,sand.-or dust.This limitation does not apply when a. loss of a predous or semi-precious stone from its the direct force of-wind.or hail damages the building setting; causing an opening in a roof or wall and the rain,snow, b. foss caused by thaft: sleet,sand or dust enters through this opening. This peril includes lass to watercraft of all types and their (1)committed by an insured or by any other person '• a regularly residing on'the insured location.Prop- trailers, furnishings, equipment, outboard motors, Drily while inside a fully enclosed building. arty of a student who is an insured is covered while located at a residence•away from home,If } 3.Explosion. the theft is committed by a person who Is not an Insured; 14.Riot or civil commotion. i (2) in or to a dwelling under construction or of mate" _ 5.Aircraft, including self-propelled missiles and space- dais and supplies for use in the construction unto I craft. the dwelling is completed and occupied;or I 7 FP-7951 don (3) from the part of a residence premises rented to 12.Sudden and accidental discharge or overfpwoh others: or steam from within a plumbing;heating,airconditk a caused b a tenant,members of the tenant's or automatic fire protective sprinkler system. or ( ). Y within a household appliance. household,or-tha tenant's employees; the This peril does not include loss: • 3n (b) of money, bank notes, bullion, gold, gold- ware, silver, silverware, pawterware, plad- a. to the system or appliance from which the wat lot num,coins and medals; steam Escaped; (c) of securities,checks,cashier's checks,trav- b. caused by or resulting from freezing; the eler's checks,money orders and other nego- c, caused by or resulting from water or sewage' tiable instruments, accounts, deeds, outside the residence premises plumbhg sp ility evidences of debt, letters of credit, notes that enters through sewers or drains,or water ++ other than bank notes, manuscripts, pass- enters Into and overflows from within a sump pr 'on ports,tickets and stamps;or sump pump well-or any other system designe five (d) of jewelry, watches, fur garments and gat- remove subsurface water which is drained fron ments trimmed with fur,precious and semi- foundation area;or precious stones; d. caused by or resulting from continuous or ireps c. loss caused by theft that occurs away from the rest- seepage or leakage of water or steam which oc dance premises over a period of time and results in deteriora om p corrosion,rust,mold,or wet or dry mt. (1) property while at any other residence owned, 13.Sudden and accidental tearing asunder, cracb rented to, or occupied by.an Insured, except burning or bulging of a steam or trot water hei om while an Insured is temporarily residing there, system, an air conditioning or automatic fire prote Property of a student who is an insured is cov- sprinkler system,or an appliance for heating.water, Iful ered white at a residence away from home; This peril does not include loss: (2) watercraft of all types,including their furnishings, 3m equipment and outboard motors;or a. caused by or resulting from freezing;or ras (3) trailers and campers designed to be pulled by or b. caused by or resulting from continuous or repe. carried on a•vehicle. seepage or leakage of water or steam which oc over a period of time and results in deteriors It the residence premises is a newly acquired prin- corrosion,rust,mold,or wet or dry rot. its cipal residence,property in the immediate past prin- cipal residence shall not be Considered property 14.Freezing of a plumbing,heating,air conditioning or a away from the residence premises for the first 30 appli fire protective sprinkler system,or of a douse days after the inception of this policy. appliance. on This peril does not include loss on the residence pr )p-10.Failing objects.This peril does not include loss to prop- Ices while the dwelling.is vacant, unoccupied or b. ed erty contained in a building unless the.roof or an exterior constructed,unless you have used reasonable care wall of the building is first damaged by a falling object. ar Damage to the falling object itself is not included. a. maintain heat in the building;or 11.Welght of Ice,snow or sleet which causes damage to b. shut off the water supply and drain the system le• property contained in a building. appliances of water. 1d � a Fp.: 15.Sudden aw4 accidental damage to,electrical appli- 16..Breakage of glass,meaning damage to personal pr( ances,devic%, fixtures and wiring from an increase or erty caused by breakage of glass which is a part of r decrease of artificially generated electrical current.We building on the residence.ptetnises.There is no cov+ tO will pay up teE 1,000 under this peril for each damaged age for toss or damage to the glass. c,r `item descrb,0 above. fit on SECTION I-LOSSES NOT INSURED 1.We do not insure for any loss to the property described f. continuous or repeated seepage or leakage of war in Coverage Awhich consists of,or is directly and imme- or steam from a: diately mused by,one or more of the perils listed in items 1 heating, g p a throughn.below,regardless of whetherthe loss occurs { ) g, tilers system; or rotE suddenly or gadually, involves isolated or widespread five sprinkler system; .damage;arises from natural or external forces,or occurs (2) household appliance;or as a result of any combination of these: (3) plumbing system,'including from, within a: collapse, except as specifically provided in SEC- around any shower stall,shower bath,tub inst, TION I-ADDITIONAL COVERAGES,Collapse, lation, or other plumbing fixture, including thi b: freezing of a plumbing, heating, air conditioning or walls,ceilings or floors; automatic fire protective sprinkler system, or of a which occurs over a period of time.If loss to coven household appliance, or by discharge, leakage or property Is caused by water or steam not otherwi t overflow born within the system or appliance caused excluded,we will cover,the cost of tearing out ar by freezing. This exclusion only applies while the replacing any part of the building necessary to repi dwelling is vacant,unoccupied or being constructed. the system or appliance.We do not cover toss to ti This exclusion does not apply H you have used rea- system or appliance from which the water or stes sonable care to: escaped; (t) maintain heat in the building;or g. wear,tear,marring,scratching,deterioration,inhe ent vice,latent defect or mechanical breakdown; {2) shut off the water supply and drain the system and appliances of water, h. corrosion,electrolysis or rust; c. freezing,thawing,pressure or weight of water or ice, I. mold,fungus'or wet or dry rot; whether driven by wind or not,to a swimming pool, j, contamination; hot tub or spa,including their filtration and circulation systems,fence,pavement,patio,foundation,retain- k. smog,smoke from agricultural smudging or industri Ing wall,bulkhead,pier,wharf or dock; operations; d. theft in or to a dwelling under construction,,or of I. settling,cracking,shrinking;bulging,or expansions materials and supplies for use in the construction, pavements;patios,foundation,walls,floors,roofs until the dwelling is completed and occupied; ceilings; e. 'vandalism or malicious mischief or breakage of glass m. birds,vermin,rodents,insects,or domestic anima and safety glazing materials if the dwelling has been We do cover the breakage of glass or safety glazi vacant for more than 30 consecutive days immedi- material which is a part of a building,when cans ately before the loss.A dwelling being constructed is by birds, vermin, rodents, insects or domestic not considered vacant; mats;or 9 FP-79! prop n. pressure from or presence of tree, shrub or plant subsurface water which is drained from tl*fours I of r roots. dation area;or xrver However,we do insure for any resulting loss from items (3) water below the surface of the ground,indud1% a.through m.unless the resulting loss is itself a Loss Not waterwhich exerts pressure on,or seeps or leak! Insured by this Section. through a building,sidewalk, driveway;{ounda. ?.We do not insure under any coverage for any loss which Lion,swimming pool or other structure. would not have occurred in the absence of one or more However,we do insure for any direct loss by fire of the following excluded events.We do not insure for explosion or theft resulting from water damage,pro wale such loss regardless of:(a)the cause of the excluded vided the resulting loss is itself a Loss Insured event.,,or(b)other causesof the loss;or(c)whether other rotes causes acted concurrently or in any sequence with the d. Negiect,meaning neglect of the insured to use at excluded event to produce the loss;or(d)whether the reasonable means to save and preserve property a event occurs suddenly or gradually,involves isolated or and after the time.of a loss, or when property u widespread damage, arises from natural or external endangered. - forces,or occurs as a result of any combination of these: e. War,including any undeclared war;civil-war,Irisur- std a. Ordinance or Law, meaning enforcement of any racoon,rebellion,revolution,warlike act by a militarl the ordinance or law regulating the construction,repair' force or military personnel,destruction or seizure o or demolition of a building or other structure. use for a military purpose,and Including any copse sere b. Earth Movement,meaning the sinking,rising,shift- quence of any of these. Discharge of a nuclea In g, expanding-or contracting of earth,all whether weapon shall be deemed a warlike act even it acct rwis 9 g 9 dental. t is combined with water or not Earth movement in- t an dudes but is not limited to earthquake, landslide, f. Nuclear Hazard,meaning any nuclear reaction,to. vpa mudflow,mudslide,sinkhole,subsidence,erosion or Aiation,or radioactive contamination,all whethercon tear movement resulting from improper compaction,site trolled or uncontrolled or however caused, or ant selection or any other external forces.Earth move- consequence of any of the Loss caused by the ment also includes volcanic explosion or lava flow, nuclear hazard shall not be' considered loss caustic except as specifically provided In SEC7ION i-AD- by fire,explosion or smoke., the except COVERAGES,Volcanic Action. However, we do insure for any direct loss'by firr However, we do insure for any direct loss by fire resulting from the nuclear hazard,provided the resuli resulting from earth movement, provided the result- ing fire loss is itself a Loss Insured. ing fire lass is itself a Loss insured. 3.We do not insure under any coverage for any'loss con, c. Water Damage,meaning: listing of one or more of the items below.Further,we do ISM (1) flood,surface water,waves,tidal water,tsunami, not insure for loss described In paragraphs i. and 2 seiche,overflow of a body of water,or spray from immediately above regardless of whether one or more o any of these,all whether driven by wind or not; the following:(a)directly or indirectly cause,contribute Ic` ori• or aggravate the loss;or(b)occur before, at the samr nfs: (2) water or sewage from outside the residence time,or after the loss or any other cause of the loss: premises plumbing system that enters through sewers or drains,or water which enters into and a. conduct,act,failure to act,or decision of any person •nal overflows from within a sump pump,sump pump group, organization or governmental body whethe rzir. well or any other system designed to remove .'Intentional,wrongful,negligent,or without fault; US( ;aj 79. 10 FP-795! b. del0k weakness,Inadequacy,fault or unsoundness of any property (including land, structures, or nn ,in: provernents of any kind)whether on or off there t0 , •dence premises;or (1) planning,zoning,development,surveying,siting; (A C.. weather conditions. •1 -(2) disign, specifications, workmanship, construe- liowaver,we do insure for an resulting loss from ire rn tim,grading,compaction; Y g a.,b.and c.unless the resulting loss is itself a Loss 0 (3) reaterials used in eonsUuction or repair,or Insured by this Section. .(4) rseintenance; SECTION I-LOSS SETTLEMENT Only the Loss Settlement provisions shown in the Declare- (4) we will not pay for increased costs resulting f lions apply.We will settle covered property losses according enforcement of any ordinance or law regula to the following. the construction,repair or demolition of a bull COVERAGE A-DWELLING or other structure,except as provided under tion OL-Building-Ordinance or Law Co 1.All-Replacement Cost Loss Settlement - age. Similar Construction. b. Wood Fences:We will pay the actual cash valu a. We will pay the cost to repair or replace with similar the time.pf loss for loss or damage to wood fen construction and for the same use on the premises not to exceed the limit of liability shown in the De shown in the Declarations,the damaged part of the moons for COVERAGE A - DWEWNG EXTI ! SION. property covered under SECTION I-COVERAGES, ► . COVERAGE A - DWELLING, except for wood 2.A2 -Replacement Cost Loss Settlement .fences,subject to the following: Common Construction. (1) until actual repair or replacement is completed, a. We will pay the cost to repair or replace with com we will pay only the actual cash value at the time construction and for the same use on tfie premi of the loss of the damaged part of the property, shown in the Declarations,the damaged part of up to the applicable limit of liability shown in the property covered under SECTION I-COVERAG Declarations,not to exceed the cost to repair or COVERAGE A - DWELLING, 'except for w replace the damaged part of the property; fences,subject to the following: (2) when the repair or replacement is actually com- (1) we wilt pay only for repair or replacement of pleted,we will pay the covered additional amount damaged part of the property with common you actually-and necessarily spend to repair or struction techniques and materials comm replace the damaged part of the property,or an used by the building trades in standard amount up to the applicable limit of liability shown construction.We will not pay the cost to reps' in•the Declarations,whichever is less; replace obsolete,antique or custom construe with like kind and quality; (3) to receive any additional payments on a replace- I ment cost basis,you must complete the actual (2) until actual repair or replacement is comple it repair or replacement of the damaged part of the we will pay only the actual cash value at the property within two years after the date of loss, of the loss of the damaged part of the prop and notify us within 30 days after the work has up to the applicable limit of liability shown in been completed;and Declarations,not to exceed the cost,to reps' 71 Fp.i y or i replace the damaged part of the property as actually and necessarily spent torepairorrep) is re described in 8.(1)above; the property;and (3) when the repair or replacement Is actually com- (3) if property is not repaired or replaced within pleted as described in a.(1)above,we will pay years after the date of loss. we will pay only n he the covered additional amount you actually and cost to repair or replace less depreciation• 1ss necessarily spend to repair or replace the dam- b. We will pay market value at the time of loss for:• aged part of the property,or an amount up to the applicable limit of liability shown in the Declara- (1) antiques,fine arts,paintings,statuary and sim tions,whichever is less; articles which by their inherent nature cannot (4) to receive any additional payments on a replace- replaced with new articles; ment cost basis,you must complete the actual (2) articles whose age or history coiitributesubsl repair or replacement of the damaged part of the tially to their value Including,but not limited g fn property within two years after the date of loss, memorabilia,souvenirs and collectors items;i ulaii and notify us within.30 days after the work has uild been completed;and (3) property not useful for its intended purpose. _ er 0 ;oN (5) we will not pay for increased costs resulting from However, we will not pay an amount exceeding enforcement of any ordinance or-law regulating smallest of the following for items a. and b.above; the construction,repair or demolition of a building (1) our cost to replace at the time of toss;. due or other structure,except as provided under Op- tion OL-Building Ordinance or Law Cover- (2) the full cost of repair, fed age. (3) any special limit of liability described in the pore ;7E b. Wood Fences:We will pay the actual cash value at or the time of loss for loss or damage to wood fences,. (4) any applicable Coverage B limit of liability. not to exceed the limit of liability shown in the Decla- rations for COVERAGE A-DWELLING EXTEN- _ 2..82-_Depreclated-Loss Settlement.-.- ---- _____--- ------- - SIOIJ. T--- -- nm a. We will pay the cost to repair or.replace less dep nisCOVERAGE B-PERSONAL PROPERTY ciation at the time of loss for property covered unc 3f 1 1.Bt-Llmfted Replacement Cost Loss Settlement. SECTION I-COVERAGES,COVERAGE B-PE GE SONAL PROPERTY, except for property listed vol e. We will pay.the cost to repair or replace property item b.below. covered under SECTION I-COVERAGES,COVER- b. We will pay market value at.the time of loss for: 1f G AGE B-PERSONAL PROPERTY,except for prop- erty listed in item b.below,subject to the following: (1) antiques,fine arts,paintings,statuary and simi co articles which by their inherent nature cannot for (1) until repair or replacement is completed,we will replaced with new articles; nr - pay only the cost to repair or replace less depre- air ciation; (2) articles whose age or history contribute substr 00 tially to their value including, but not limited (2) after repair or replacement is completed,we will memorabilia,souvenirs and collectors items;a. pay the difference between the cost to repair or stE: (3)replace less depreciation and the cost you have property not useful for its intended purpose. tip ev id t 79 12 FP-79 however,we will not pay an amount exceeding the (3) any special limit of liability described in the polic smallest 4 the following for items a.and b.above: or ' t� (1) ou cost to ieplace at the time of loss; (4) any applicable Coverage B limit of liability. ry .y (2) tho full cost of repair, eq DPI SECTION 1-CONDITIONS 1.Insurable Interest and Llmit of Liability.Even if more (4) produce employees,members of the Insured than one person has an insurable interest in the property household or others for examination under oa covered,%se shall not be liable: to the extent it is within the Insured's power . do so;and. a. to the Insured for an amount greater than the In- sured's interest;or e. submit to us, within 60 days after the loss, yo signed,sworn proof of loss which sets forth,to tt b. for more than the applicable limit of liability. best of your knowledge and belief: 2.Your Duties After Loss. After a loss to which this (1) the time and cause of loss; insurance may apply, you shall see that the following duties are performed: (2) interest of the insured and all others In the pro erty Involved and all encumbrances on the pro a. give irryn6ate notice to us or our agent.Also notify erty; the police if the loss is caused by theft.Also notify the credit card company or bank if the loss involves a (3) other insurance which may cover the loss; credit card or bank fund transfer card; .(4) changes in title or occupancy of the proper b. protect the property from further damage or loss, during the term-of this policy; make reasonable and necessary temporary repairs (5) specifications of any damaged building and d- required to protect the property, keep an accurate tailed estimates for repair of the damage; .record of repair expenditures; (6) an inventory of damaged or stolen personal prol c. prepare an inventory of damaged or stolen personal arty described in 2.c.; .property. Show in detail the quantity, description, age,replacement cost and amount of loss.Attach to. (7) receipts for additional living expenses incurre the inventory all bills,receipts and related documents and records supporting the fair rental value los that substantiate the figures in the inventory; and d, as often as we reasonably require: (8) evidence or affidavit supporting a claim under tt Credit Card,Bank Fund Transfer Card,Forge (1) exhibit the damaged property; and Counterfeit Money coverage, stating tf amount and cause of loss. (2) provide us with records and documents we re- quest and permit us to make copies; 3.Loss to a Pair or Set.In case of loss to a pair or set,u ' (3) submit-to and subscribe, while not in the pres- may elect to: ence of any other insured: a. repair or replace any part to restore the pair or set i its value before the loss;or (a) statements;and b. pay the difference between the depreciated value; (b) examinations under oath;and the property before and after the loss. j 13 FP-79 ►obey.Appraisal.If you and we fail to agree on the amount of 1t}.Mortgage Clause.The word"mortgagee'Inches In loss,either one can demand that the amount of the loss tee. be set by appraisal.If either makes a written demand for a, If a mortgagee is named in this policy, any k appraisal, each shad select a competent, disinterested payable under Coverage A shalt be paid to be me appraiser.Each shall notify the other of the appraiser's gages and you,as interests appear.If morelhan o identity within 20 days of receipt of the written demand. mortgagee is named,the order of paymentshail The two appraisers shall then select a competent,impar- tial umpire.if the two appraisers are unable to agree upon the same as the order of precedence of to me rech an umpire within 15 days,you or we can ask a judge of gages. oat a court of record in the state where the residence prem- b. It we deny your claim,that denial shall not apply it rer k Ises is located to select an umpire.The appraisers shall valid claim of the mortgagee,if the mortgagee: then set the amount of the loss.if the appraisers submit a written report of an agreement to us,the amount agreed (1) notifies us of any change in ownership, oa you upon shall be the amount of the loss.If the appraisers fail pancy of substantial change in risk of Olch I IN to agree within a reasonable time,they shall submit their mortgagee is aware; differences to the umpire.Written agreement signed by 2 a on demand an premium due under t any two of these three shall sat the amount of the toss. ( ) pate n e have not aid the due u;and Each appraiser shall be paid by the party selecting that policy, Y P p )top appraiser.Other expenses of the appraisal and the com- (3) submits a signed,sworn statement of loss will )rop pensation of the umpire shall be paid equally by you and 60 days after receiving notice from us of yr US. failure to do so.Policy conditions retathv to t other Insurance.If a loss covered-by this policy is also pralsal,Suit Against Us and Loss Payment ap covered by other insurance,we will pay only our share of to the mortgagee. 3e4 the loss..Our share is the proportion of the loss that the c. if this policy is cancelled by us,the mortgagee at applicable limit under this policy bears to the total amount be notified at least 10 days before the date canoe I dr of insurance covering the loss. lion takes effect. Proof of mailing shall be proof 3.Suit Against Us.No action shall be brought unless there notice. � has been compliance with the policy provisions. The 'to? . If we pay the mortgagee for any Ions and df p action must be started within one year offer the date of payment to you: "loss or damage. trial Qui'0 tlon.We may re air or replace any part of the (1) we are subrogated to all the rights of the mort+ ost• P Y P gee granted under the mortgage on the prope = property damaged or stolen with similar property. Any or Property we pay for or replace becomes our property'. � .toss Payment.We will adjust all losses you.We will (2} at our option,to may pay to the mortgagee ym l Y whole principal on the mortgage plus any accrt th pay you unless some other person is named in the policy interest. In this event, we shall receive a or is legally entitled to receive payment. Loss wilt,be assignment and transfer of the mortgage and payable 60 days after we receive your proof of loss and: securities held as collateral to the mortgage de w a. reach agreement with you; e. Subrogation shall not Impair the right of the mort at I b. there is an entry of a final judgment;or gee to recover the full amount of the mortgage claim. c. there is a filing of an appraisal award with us. 11.No Benefit to Bailee.We will not recognize an assn Abandonment of Property:We need not accept any meat or grant coverage for the benefit of a person Property abandoned by an Insured. organization holding,storing or transporting property , 1 14 FP-7 i fee,;iThis applfes.regardless of any other,.pravlslan of under•Ihis;policy, lot the purpose•of obtainjng insurance �� this policy. benefits,,then th(s Policy,is yoid and,we,wtlf not pay you .or any.other Insured r.this loss.,_•i:,z s.• C7 12.,Intentlonel;Acts.If you or;any person insured under this " ' rU 4policy�cau ,`or;procures a loss,to..propery..covered r,• r ,tr;r,,,rf?. �•" 10;•'.. 1 Ctrl .._.4. r: :•, :t.. ti ' . ., �SECTtON II LIABILITY CPVERAGES,,:. COVERAGE L-'PERSONAL LIABILITY :` f. 'out t bl'or,16"t h e:c.o;ir se'.b f th'e r'¢sid•e;n'-cf e:e•;n:l� fpor yee'9 i 11 a cC#!Ris;irlade;or a.suft is.brought against an Insured for ,employment by an:insiiied: damages be UM.&bodi9y.injury or,properijr,damage to SECTtON'll--ADDITIONAL COVERAGES�­= i which this'coverage applies,caused by an occurrence,we : •cI : ;_:fit; l=: Vile cover thiilpllowi in addition to ttie fmits.gf liability: WIII:- :i3[r y'T1 i. Y:IaI� rid 1 r.S it itY. ......._,,.q.. } 1.. •�'-.,,'•ti:n ,::: ;•"q�Ff{;`-..b. ,-:r, ..-••('�.,•:f liti ;'!lit .. ^.:,r(.1:.'•:c •: , 1,pay up'to oilrilirrift of 6abiiiiy for(fie,damages for which 1:Clalm'Expenses We pay: the insured is legally liablearil�:,.�.,;�,,. •, -.;+;"••�i• a r,::! .,•, •-i;� s-' •,:. •.r•��;�;.;� tr:p!.;,. g 1y a:.: qxpaR;es;we;incur;and.costs taxed against:an in- ': .;sured in suits we,detend ,i•' } 2.provjde;a.Aiifense=at our'expenseby�counsel of our '�; choice.`We may any'Investigation, settle any b.-„prerriiuins'odborids�eguired in suits; a deferid,'but �_..• -:claim of suit thpt we decide is appropriate:Our ob ligation :' hot.'forbond amounts greater,tha 'the G69eraQe L 0,defend any claim ocsuft ends when the amount we pay Gm ,We'a�e not obligated to appiji oror-tuWlsh any for damagesi.,4o,effect.settlement.°or,satisfy,a judgment bond; .resulting irorrlthe:ocourrence,equals,99E1imitof liability. C.`reasonable'expense"s art'insuredrincuis{atjoii r e ' COVERAGE M=MEDICAL PAYME10S=TO O*ERS �'°quasiIT' his includes acival'toss'iit 8airi(n`�s'(tiut net 7'`- '-`loss'ofottieriiioomb)"upto`$100�pei8ayfo"raidifigus WetwilUpajl'ttie necessary-niedieai expenses.,incurred or :in't investigation&defense"ol1cWQ-1drsuits; rried'ibiilly as�er3,alrfdd within three years irom the date of an �,•,r �; f� ..,;_ sui , aixirdent causing b6ally Injury.Medical expenses:means d. prejudgment interest awarded.against the insured reasonable chaiges for medical,surgical,x-ray,<detital,am- on that part.of the judgment wg pay;and;%t ;•; bulance,t Qspital,;protessional,riursing, prasthefic,devices ah0un6al senrices.This covers e a flea on :: e. iritere`st on:ttie;entite;judgment w[�ich.ac rue 3after g •Pp entry ot�lhe judgment and befors.we'.pay of tender, 1;to a person on the insured location with.the permission or deposit in court that part of die judgment which .r...,,, does not exceed the;limft,of liability that•applies.7-, 2.to a person_oft the insured location;if the bodily injury; ''2:`FlrM,Ald Expenses"We wilfQay expenses foi,firstaid to a,:arises out of a;condition qn the insured location or bthers'incurred by'an insured fdr bodily irildiicovered .;;;;the;we tfimediate ad'oinin ;under this policy.,We;wi11 not pay for first aid to-you or any t Ys.t hr. 1 g;. : ,. other,Insured.; >is;'cra,•s.a=.d by. e a• = „o..a,.n.insur.e.d.; ' 1c• 3.Damage,'to,1 operty of Oers; I l .;;,m.gis;caused by a residence.employee in the course of e " pay ' p t. thetresiderice employee's employment by an In- a. We will pay for property damage to property of .,� others caused by an insured. `i' erred;or; :.:-. .t . :..•. .�,.:�• b. We will not paymoie than the smallest of the fo Mowing d. is caused by an animal owned by or in the care of an f amounts: Insured;or (1) replacement cost at the time of loss; 3:.to,a:residence;employee if-the;occurrence;causIng _•, y=;.;�,:xt.; Ir. ;;_,�;,.<,�t :,, .. bodily,lnwr occuis off the.Insurgd location and arises (2) full cost of:rePair,ors ; ,,:;;�,; r: 15 FP-7955 I h out of:` :::^f.+ c. We will not pay for property darnege%f- (a) fiuslnesspursub -j,-;,.:,,.- .-,,r4'1(b);a6y aclxors omission i In,:conndotion with a (1) If Insurance Is otherwWA*OfWdM 16 ihis policy, promises an Inturedowns;rents or controls, (2) who Is 13 other than thi Insured location;or• pr :;,E. use of a mo- P Ownifthipt tf, 0 1 A I i,:'Ll,1 (3) to property,other than a rented g'off can,owned tbt4*,vdhriiiiiiii6fAft-'.(6pwht*drcraft,including an In- airboat difc watercraft,sail pmaterc ft. to I,;.#uriW:1oia'tbsId9Afirf.your hbusefi011d;or tj ,,,bqafd o�,similar.typ .Ira VZ .9 'i:S_ECT10N11-1 MONS 1,Coverage L and Coverage Wild no aooly'16- Vpy.,qq�p�l.and..'to t hold the other It::Qy %Jrlie 11!1!! 1 or Kid' for 0. bodily'Injury or property asmage: o ;10 k *A:B*J5,,1%1?t-,-,,O Isellf" (6)"0 P64V 1hg§)jOntid 6i held �(j) it.,'vWttA* rentkIAOoIhdMftbtA'hot tofexceed a4otal of 500 sured;or tp 9!,!Me dW by the In acres jqgar.41ess•of the number of locations; hichIls isuft-of-wiNI and maljcioo acts of ,,,,cepbot ly.1n1pr pertAsmage arising,out of the yp�pro y 6�i t" - es; rendering or aj Ing to render protessio , ervic b. bodily lnjuq'dr'jki*tfiV*dam*#e i'ft g out of &,t,bodily Injury-or,pr6petty daMAgbArlsirIg out of any tibuslnm-4pursu.kstof�i*dnsuledior,the.-,renW or premisies-curnint #Aed,or-,rBnted;lo,any Insured .?,>,fioftlirrfayian#aI *6artof,ih *p any, tomises by any of which is not an insured lo"Oon. This,exclusion 7." (13.4plured,This:excluslon'dai nohap - . !, ,­ 16' a This; _p ly,"t 'f "* - E;, MRY.11)�.ry,,, Z, 1%,jhi'86d 4 of the of non- jutihossfiq realde 15"r-A.LAIi-Im M415"il.-Gn 8*� z . 1,;iPP'upjiW#f(eOe9'tb&j&aU6'ft t6��16c&onal or tiidI1y.Inj it. 6jfpr6pert of the ....y dqmag�,afisjng out part-time buslhess pursuits of an Ihsored who .Itlf-,I "­­I. unloading oWnership,,mainten -MN.Iola is under 19 ye" (3) to the rental or holding for rental qf.-Afesid,ence "(1) an Mrcrafti of yours: 0 s.-ol ur-; rented qtq�r(yqp I a M ed q r,o p qT teq�yAr vf,*q•jIq basis forpo.906ive use as a residence; -!-IN If.,ilb)!,inpao,,,,vnless�intended)!for;use W a resi. a watercraft: ,v, ino Pi I dance-by more thantwo toomers or boarders, Owned,bytq,rentedtq.any Inaired,if ft has InIvatIv inboarkikdv"e mOlDi,power of studio q private garage; (b) owned''byy"oir rented to any Insured'9 ft is a 'Vi_ -tsai•in h-9,q(4))fWh6h%'dw#HIn§arMooldmbs'premlses is iling i@stel:wffi br without iuxllimy power, 26 lost or mare in overall length; FP-7955 (c) powered by one ormore.,outboarl,motors (l)'ahy wbG*J1is':in:th&cire�:olzAhyinsured- with more than 26 total horsepower owned by because of child care service's provided by or at 0 any Insured,u^410" Pr­, i...t .:.,(d)-dislinated asan alrboat,air.cuthion,or sirnim c6 of,��y,insured;pm plo tt ,'IpI C) (b),dWned- y a6 y,Caurd M is a personal (c) any other Nits&AciffellYrofla0parently act- "All _#tflEjgt p ymppoweredby ing on behalf of any Insured;or Jqtqmqtcon,1§u4t1op ngineastheprimary fle"d lo(;!", ,an :e, f;r. (2).,.,any,' P,nu*pq a claim 6ecause of bodily source o} N pervowh This exClusio"WhoRTI AU apply td'66dily Injury to a lo APjvy,.to any.,pomoriw hc,is-in- the jeare of any Insured because of child care services provided residence employee arising out of and in,thppurse :'�by,qT at Ifid•ti Vi:9 of the residence employee's em�16Ai,61- of.- Insured. Exclusion e.13 does.not•apply while the (p) any.iniured•: • ,premtses; I V;F,1.1 C.;1(Jr~M iv t 1 (4) any employee of any Insured;•or 1. ,bodlly.��jtq or Fropert ge afiii�g qut of: _y,dama (c) any other person actually or apparently act- kid ) 't? "r 11*1 •(1)•the entrustment-PyArlyAnsuredit o any person; -1ing Wbe '(2)"ttis#siipeivisiion by AjIHOiW6f person; This exclusion does not apply to the occasional child lh"We'd,f6r' to the --!,!'!'(3),'iny;Iiibili�'stiiff6'ritylimp.o.sedon.dny-insured; care ". .. I-— part-tiffie child care services providedVjIny insured wtig s s J d,3 1 ppf age;or < :•ci f'.,l.�tr[: iSr:r;ISsixU;l3+l{ V. 44 or. 1 v:�i •&mage,arisift4ut of an !(4};any lioility�4skomqd through;an unwritten '.written- a,-a,greement,,bya6yinsuredi�i!l�,4,ct nJury.lor*rOpeity . I � . 14 f ;,_ ; woqv Ins�tedo ganicipatioriiin,,:or;b repagitioif�-6r,'Pracfice :i , , V.�wz 4',qjith regq'rd.'tq'Uo.-v­e4ip,:.O#,�,haKb6'6r use of for any4prearrang6d.roizdrganiied.igcw,�sooed or �M Un I—. .1, k" ,"ltl any aircfpfi YO demolition cont qs�or si�ilar competition inyotving a worcra%or,motbi �qloWhlchisnot U. 1 ..-il'. _r '�IVIIV.-I rbik This or qw(oto e a i rb !jJ,)!F'J- than "W motapo 0 6eillhov,vessel lass ,,.,oxcIusipndoe1 g. bodily,Injury or property d directly uxiliary 0 eau -Ilhab,86g, u"I'6866i9d war,d'any use for a'military purpose,,or'any-consequenbe,'61 these. '2Xbv@ige7Ldoe*'s_'n* Dischaig6bf a nuclear weapon,,shall be deemed a i..., .1 H�;t w,liebilit I I i.-I ICA PRi warlike act even if accidental, Mhrn ifi e'mean- P .for -any loss assessment charged ) ,yourshare of: any ing of pan a.-*,BT6T.tfiie*d6firiiiiAZI-I�red. owners;-or This ejcluiibh also app ies tAng.elakh made or suit a(Z)-ai!isumidlundet'iny;uhwriheh-,cohtiict of agree- brought igainst you of any lnsurOlo`ihie dam- -il:,..�,ir,;)";ment-er,,by.contract-,oriagreeme`nt.in connection lieges with'bi:re)Sdj�sdmeorieielae who may be obli• with a business of the*Iniured;-: suitea the bodily Injury 'itp , ',y6u!br:an'y'IfisH(O'd-Whhin ihi"In' eaning da%agdAo'p!qperty cuqqqIly qwned by any i'nitdoby _exty.. of pan a.of b.of the definition of l6i6red'; 14sured; bVi,,,v­N*,":z 11 1",t!L! ".:� Y.Cla.rn.in�djq qr!�qlt pro4gb�.,�gainst any Insured portyirer ijoccupled or P I -Ate& q O,pf� y, u ' 'exclusion his Y: q.,.4qe1 b or,.In.ih 6aj n Jpp re ..J e ter FP-7955 ,+.l-',i9oes'riot'apply:lo•p'raPerty.dainege°causeii 6jrfire 3:CoVerage�TV1 tibes�not'aPPly+:to 6odily`Injtery:<<`- `�s Ku smoke'orezptbsion;a,:, :;W f -;•r« !: i:�{; ;..... :. viz a.. to a residence employee g it gccurs,off the Insured f d. bodily Injury.lo a persori•eligible to receive any location and does not arise out o!or in the course of c,. benefUs:required:6;'be;provided,orvoluntaniy-,pro- 1,,,;,.the.reaidence employees,erpployment,by an,in- idedbyenlnsuredunder_amorkers,comper"tion, cured' i•,fnon ccupational,dlsability,oroccipational disease •�law;ai,:,7<<:,::, =•., •: .><� .'' c. .:•i:,::� b. to a Person,eligible.to receive.any benefits required r'.. , ;'• " : =•r..a:�a .11f-r to Cie'proWded`or,voluntiinl 'provided:urider-any e. bodily n u Cdr, ib "'dairia e'for wEitcli an , '-'t i .r. .,,L rr - :'• is y j rl► P �� 9 workers comperi§atiori; rioitificcUpa�tional•tllsability i insured,under this:policy,iss also,aminsured,under a ,. , , . ,LO ,,�, ,;,,,,.. or occupational disease law, nuclear,ener�yiilitii�ey.poiicywouidbe.an.msured or ..;,:e:�;..: .' ::r ,:.�tt;n: = ! but'lo"fiis termination upon a austiori-dits Jimlt of t:,l.from nuclear reaction;:radiation or radioactide con- i liability.A nuclear energy'liabililyr policyi'is ai policy lamination;all whether controlled or uncontrolled or x.issue.d,by:'Nuolear.Energy Liabildy;Insumnee;Asso, however caused, or any consequence of any of .._l�3;, ,:ciation,Mutual'Atomie&ergy�Liability-Underwriters, :these;:; f r•'•r .` '.;- ' `�. � +v'Auclear•Insurance Association of,Canada,-or,any of _ �, •- a :; ! - :' i their successors ;•-a3;r:!!:=,'; +:f:,�,i r:i! u. to a person other than a±iesiderice employee of an Insured,regularly residing on any part of the Insured .SECTION_ II CONDITIONS,..,,,. f,f. ti:,i_. an=?.: Sll .•'.t: �...9 'J•. -il.. _ .. ."J �f.41 . . .. ..,.alt!_ ..�dc•:I ., t:• -:a:•. ., . fi(�f (i I�IIJ;irt•r %A& '!�.'jll5•>: ..i,';{i) .l �:f:�i`i$'.i•�li%t.(;,,;';.-1.•,la .•b.�.. .. 11?:'a: 1c� �fp �o!i Lla lli�y'r oveta�e L��imit is shown in the t;: .(ajc names an�addresses of any claimants and avail Decl ratlona ifs our,llm ,tor all damages from each able witnesses, ,z �,(,J Iu V ♦ - 1 jc�eurrnc;e�Ie�arl @ss,of�.�ijeumber of (nsjureds, b. ��edi I forward to us eve notice, dem d, ifalms made,or ke, r a?lurgd;, l t, r�:; ^�; I:f�6'J « ,� ': . ry ' .� f;..°i_ -;,�mmops or other piocess reiafing;lo,the i coident or .t ,„ ,.. �... The„Ot}Yerage.M.litnit is shAinm)n.the.Declar�lons,This ,occurrence;; F' ,. ,.7:,':• ;;l t 1: i i,_ i. i:.ra7 t�ii1Jl' rri's_orir�lmit`fo� II `= a erisexfoJ ily I u to r�; ,�. -. .”•• ►� rY `c ati7arregriestassisl'ir. "� s;c, , ,f,,. r.,: ,,, . :r, ore p Fson,�sthk fesuft,of.one,accldenL` a �, .1.. a rr:4 '(1)-making settlement;, v. 'q!)­! "it's ljmj; �c,i`' °i+atG_ 4,fi' i,r 1 „•,' v..,;`t •rir ++V:; ;,-.. " 2,&egera it ty 61 In urarice::This lhiidfalce a lies sea o= ``' irately i ea fi'tnsuu'red:finis cdnd'itloli.stiallnbt increase •''i !(?)+�?ecenbrcemeni of any fight of_conlribWtign or ; ;;,,;,,_ri indernn ty,against a•pgrson•or organization who our limit of liability for any one`occurrence. .�sl;r, i,, may!be liable.to an Insured; 3"`Drifle81 Ait6r`�'gss to case o't ail ai'dnt or'dccurrence, (3) the conduct of sulfa'and attend'hearings'!and ' t e'tnsu'red'shall`pi 66 the foltowin�VdRes'that apply. trials'9nd,. r .,r $,. ,.• in l t r s e f' 1' i44::, !, °,.w1 r.,s.:' , 1. !Y iYou'shall¢Sddla�Ate.Wvith 64 Ih seeiJig that these duties Is + , +' ? :�e,:1F.+rr ;; ,':' ; ( i`a`ocUring'.' d'giving ,evidenl e'alhd obfaihing_ihe re`pi3rformed: - 1' ` 'aNeniiilnce of witiiasses; ` '' a. „give_written notice to us o our agent as soon as 'e g e ` • p`r 1 , d. under the coverage Damage to Property of Oth- ('.praciieabl!s',+ktiich'ssls`fof is �''° '•. ers, exhibit the damaged property`if-witfiin'tfie`in- l"•.::1,:,E.2.1. q.,..il vtf_ :{. r .t„F 1{ (1) tho identity of this palicyaiid irisliied SUM.',!control;arid} ,:.. �:.n.: Insa4d4&Udt4bx6e01-of llWiriiWW's own 2 reasonab available 16formAn oil the lime, r' cost,volantari make PAM ents assume boll ations br,ii;'^ �.place=and citcumstifflas of�he'accident or oc• j,,;;: or'ineuf`eXperis�s'.�1�Si5�d�es'ridt'a�p1 Ito expense tcf cuti'encd;-end for first aid to others at the time of ttie16dily Injury. FP-7955 4•Duties of,arr•Injured Person-Covera eRThe inured 6.-Sult A pinstUs;.(do;a*p shaftbe.brou ht•a ainst us f tn l j g .... g g �-r person,or,when appropriate,someone acting on behalf unless there has'tieen complia�ce:witli,the:porcy provi- :�"of th at paisiin,shah: ,�' '..�'' stone. t ► il, ,-6W f i i i. Ei�'tt ;`(t +!i f:Ta(.: "Yl:rii.i:": 1:7. zai,i.b Y!:it l;{!is";it::°:=• t\) giv$6d,vjritten proof ofelairii;under oatii if required, Nn'.ons'16hgll haveith$'right.to join us as'atparty to an .< t:�acliori sigainstan Insured Furthsr,no actlori Wi(h'respect `r as soon as practicable; 9 rrr Iti•:Coverage-L shall be��broughtragainst�%us'until the i t� °;t, -.rj ,,. ,:• r; obligation of the Insured has been determined;by final b .exec to aut o6;q ion 0 alldw us to,0 tam coples of ;judgment or agreement signediby us t.J ritedlCal fP.po -anCl,recordS;,agq cs�... 3>au r i:ir,+ri x {,;•-•er. ,;E. • 7.8iu viipt y`o1 ati'lrisutbd:Bghkruptcy or insoi+rerr y c. submit to physical examina8on ti}+a physician se- :an l'nsiirrad shah'riot'reliedelus df°olir'abli$aii66 under i lectedlby us when'and we reasonably this " t" :': „'' C•'' :h t :•; t5 :•require:. �� ...:ii: .'tI #y :::� .•f'•, t 1� ,�,+.<5'.;:`!;`• 4f'.` ..`:fix, •::3t:�� '::"..-i i`. ;•7.4..`•.,. ":; ' J]fl !(:'.FS,tt, n',' ,'r •';�a:1t:: 4E., ..;t; t1:0herinauranca;,—t @Tagef»,'Thisinsurance'is$xcess 5.Payment of Claim-Coverage M.Paymenvunder this .)?ver'3any'•otfier-,.valid acrd coll$ctibla insurarice,except I coverage is not an admission of liak�% by an insured or 'r'insurance written specifically to ooveras excess ov$r the t us fimfts of liability that apply In th1$P olicy:;'x:':'; li..f�.r .1..:?i,.:� -•t• ., ., SECTION'1'AND SECTION 11= CONDITIONS t.Policyr Period. This paGcy applies only to Hiss'tinder ,r ° ' 'b: `We Ina}i canoet this policy only for r$asons stated 4 Section I or bodily Injury or property damage under in,this,condhlpn.We•will.notlfy you,ip wrWng of the eiition'tl wfiic66666is duniig the"p$riod't l#licylsin ''14!'#date c;eiceifagori take ,et#ect This canceffatiori no- effect. " '�` ,,+';hca may be d$inrre to'yoU pfmailed to yo at your 'proof of Y •, - ,• ! - �. t:+F l-. 1i . <mallirig tiff dress si?Qwti•In°the;Declaraffona.', ; 2''COiceatniiit or`Fiaud ibis 1lcyisvotd`as tip you and «„ , ._ � ..X :maiiirtg shall b$:sufflent prt�af af.notice'':'4 ' anyoiherinsured;`i#ydii°ararryottierInsured'urr'derthis policy has intentionally concealed or iriisFepie"sanied any r ' °`: rm ° en�y�u�liaire'not'paid�'ttie piemipni,'we may material fact or circumstance relating to.this_,insuranc$, 'r-:���" celat.gn 11ir ' 4�`iii3`t' n '+otrat iei3st`10 whether before or after a loss. '` " ' °; 'y' 'g y '`' a i 116W r-;the''date'cancellatkin M es•effect 1 3.Liberalization Clause. If we'adopt any rev�ion which This condition,appties whether thp,premium is PC'''`'�``payatile'lO'4s our P1. ui;der any finance uvonidi'0a dell coverage under th�3paliay`itiitlioat addi i : . ' �.s,v 2 or cr$d�#plan. .._ ... � •,w, tionatp'reniiiiin,within50day`spriortoorduMgth,per#od :. _ ,• . _,:i+;i;v u:;,.,' ? this policy is in effect;the 6rdadeneit coverage will frame diately apply to,this policy:, ,. 4 Whan this poll has.been in g## ctfor Jess,ihan .. . 6U.dayyss and,rs not e.ienewai,wrth.us,we may 4.Waiver or Change.of Policy Pro�iisfonii lA waiver or "'' en caricef for Qny reason,`We:may.cancelby noti change f vislon.of this ti must4be i writin ' `;`"' in``oil at 1'east''ttl1da''`6e#ore'•tne da s,rai c$t- s. g,>.R.. y!pC�• ... ,:+.. +P,o,.eY.:,:�. pE. g g Y i.:t. by us to to valid.Our,'.re. ues};iatan a ffptopa#or exama laUon takes effect ' nation shall not waive any of our rights. i t .5�Canceil tl~: :F_" . :i" c :, •, .. - -(3)-Wfien`ttiis•policy tia�,^bserr;in effect for 60 days y' or diore,or it any time if•it`is a renewal with us, a. You may cancel this policy al aty`time by notifying us wmay cancel ' Y,•,;,i;' „ 't i in writing of,the date cancellation is to,take effect.:We ,waive;the:requirg(qent that,the notice be in ;fi (a) ii.-O re;has been,a material.misreprgsenta- r.,-,,writing bye f onfirming$q date andtime of cancellation ;t Iron of fact,w oii it known to�s„would have yu.;;to,you'in,wnling: :,:-• caused us not to'issue;61S policy;or t 19 FP-7955 (b) Htlfe rL*fuiS-chAqbdsub§tantiaHy since the '-Waived,we,milty requ re an assignment bf,iiihif6i r0v- Lpolfcyl Wjiddtl­:'. cry for a loss to the eifent'Mif paymarit is Widi6jus. t,­0 Inguridi sh'all:4, We may cancOlMls Oblicy by 6f"g you at least 30 days before the date cancellation takes effect. a..,sign qnd,deiyer all related papers;, (4 M ici.is wdaikr a period longer Man .--1 ­7 .1 .1, imif6n66i 16r any reason at anni- b. cooperate witlf its'ln a're ikriablerisnin4r;hn­01'5 one,yqar,,w...,,,...... �Vsk'soy"Wi may camel by notifying you at least his. 1. 1,dd h oktiliij-41fir prelu tce su qg QA the date cancellation lakes effect. ays `6: :Wh.iri this -"I!`yJ§qmQK,M4 premium Subrogation does not apply under Section 11 to Medical .pq c for the P'e"A'irro 16'66:qfcanWlakk h rs, gifyoftt 8 6 to the expiration M, el. daWW"111"be-reNrided.0hen you,,request cancella- Death.It any person rotes for rson shown in the Declarations or the '�drown cane, "'.—-, tion,the return pWfiiAwfll bi 61 sk on our r f a rd less '"spouse,.1a riisideii%f thetime houstbold,'dies: ;such cantellafiowThe retum!piemiu may be I a. we insure the legal-repieserftatI4 df:the deceased. than aJ4II proratalrefund.Wherimi cancel,the e return :;,premium will be:pro rata.,-y This condition applies.only with respect to the prem- 'underthis e dbdeas, cov6o' 4.1JhqreturR,pre lqrO,,may,n4l:,ba.returvdedwW-the j .m notice of concellatio-n..or;whba.th.e:policyls!tetumed policy at the time of death; to us.In such cases,we will refund A within a reason• b. Insured ifibluile's': Wet dftg(MiNdieWdWRtk _ - , ­R/ ii,js an In- icy..It we .:(i).iAy,,mqmbdr of,,.yoqr,h6useholdj4•pol. to i-aWid it, e* only while a S.Noiiiiie"w' s'l.Wernoyelectnot,lorenew,this 4,J elect not to renew,a wiifii'�n;t6'iifh'6_ '� %, th,itime of,yourdeA,, ut res 1�­btihi`risldin yj� and you,ormafled,io-yob!alyoo*r*mhiiihjiddtd ' 6*nin the Declarsitions.3he,notice will be mailed or.delivered ) will ;.­­ "", tilts,V I ad-toyo roperty, ;J(2)j),vfthjesp your p iffie,person having "WhAsteof policy. er. `at least 30 ays before a expir, `.�Vlqop temporary 6uitq.'0y of,the,property until 0' `16fiil Ming ifiall bi idtficlifit 0§bf P�q 'of,a legal repre- roo 7.Assignment.Assignment of.this policy, valid ;Y,shag not be tr, I.—,Assignment" . . r.-11 1.*�1.11.i; -.01 1 o ; a..� 'g` Wme ess*wo No o Itteribdilon. 10.Conformity to State L��. polk*'Orovision is in S.Subrogation.An Insured may waive in writing before a inqrvonflict.wfth the.,applicable.law.of.the:State in which this loss all rights of recovery aOUW��y$Qn.11 not poHpyJs`is&ued,,Me.law-6f Me Staterwill apply. OPTIONAL POLICY PROVISIONS - *.-%.­"Jil't: :% ' A' Each Optional Policy Provision applies only as ih6wn in the 2.S6ctlon 11-Coverages C iCnd!M but only with respect to Declarations and is subject to,all,,the terms,provisions, the,.resIdqqce,.premIsesJh1s coverage,does not apply ..tq exclusions anift�dftiors of 66 policy. t�6igW Wu'lr y_116 an 661 p*ildlylellel aniirig out of or in the 1 the,employeWstemplbotint,by.the person or Option At-Addftiohdl'ln'sire'd-'f66diri�*�6'n 6firsuied is Y: orgqnlzatio6. ,,extqnWedJoInclude the nization shown in the person g grgai as an Addftlonal.Irfsured-.orA ii�n"a'm'e'is on :ThI4 optlonlaflpfltliorilj.Witfi respect id the'lo6ago6,shown in til'e'Aft'us.c6veirageiils-with respect i _-, ; . "..,- `'';r:::: p the Declaiatloiis:- 1,Section 1 A;or Option BP ss'Prdpeyle"66VERAGE B - -PERSONALPR0PFtl7Y-,­S0;i 'm lUiM W of Liability,Rem b,, for popery used or intended tot.u,—s e in a business, FP-7955 including.merchandise,held;as sam les,or for•sale•,or for :-; .,:(a) draft,or;saddle animals including vehi- rn P ._ � _ g ,a hive 1 a'. saI is.olian"ed as io(f,A: Iles for use;,with them;or r-r The 0 limit is laced with the amount shown in the N $�, Q0: „ rep :„•. (b} aircraft,:motor•vehicles, recreational CD Declarations for this option. .•. .,motor.vehicles or watercraft,airboats,air �a ' _ cushions or personal watercraft which Option BU - Business Pursuits: SIECT1ON It EXCLU- ;. ,. -• rn `” use'a wate�''jet'pump'powered by an SIONS,ftem 1:b_is modified as:foltows: a ,a; - C internal oor»bustiori'engsie as the pri- J.Section II Coverage applies;to the_business pursuits rn"soutcoiof gpulsio'ri;; of an insured who is a: ,>, ;, : : :ir.c, :' `r:, :'.n"° :• -z :_ ::f'' owned or operated, or hired by or for the ..;a. ciQrleal,offic _employee,•salesperson,collector, ,.''o Insured or,employer of fhi:Insured or used 'messenger,or by th(e,insured fpt the instruction t i ,_ , In the use �eiof;;o'r'. :. b. ;(ezceptr cglleg.g,;unjve city.and,l?fotes- siorial atfr�eiic coaches); 'school principal or (2)'under Coverage M for bodily Injury to a pupil _ .;',:.school adminjstrator;•,,;;',;�' : ',:;;�; �:ti , arising'outrof•corporal punishment Adminis- tered by or at the direction of the insured. 'whila acting`witf n'ihe�''kOp2'of.the.'abbve listed i Occupations.`'""'`~ f;, ''" Option FA-16arins:Firearms are'insured for accidental direct physical loss`br damage: :n•': 2.However,no coverage is provided:. .s,.,:.,. :•;•� ::,,•. '• :.: -:�: ' • ;: :::•• ; The limlis,for-this option•are shown in,the Declarations.The a. -for bodily injury or damage arising out first amount is the limit for any one article;the second amount of`a Uslness owned o�financially controlled by is the`aggregate limit for`each loss:' o ilia fnsuied'ortby a'paitilierstiip,'of which the = : �; ;, { j The.followin additional rovisions ap ' lris�iied is a`partner or member' g.• P PIY } Ib:''•fbf tiodlsytnju'ry'oipropeity da'm'age arising out 1:'we do,not insure,for:any loss to the property described in iei(de'ring o!�'br failure to'render profes- this option erttier;consisling,of,or directly aril immedi , sional'services of any natufd;@thg4an teaching ately caused by,one or more bi`the foflowirtg ! or school administration).This exclusion includes " ' % °'' " but is not limited to: a: mechanical tireakdown;;wear and pdr,'giadual date *ri >r;,�.• i rioration; • '(1).'computer•programming,-architectuial,-angi- b. insects ar vermin• iieering or 16dustrialAbsign services; " C.,any process of refinishing,renovating,or repairing; (2) medical,surgical,dental.or other services or treatment i treatment conducive to the health of persons d. dampness of atmosphere or extremes of tempera- oranimals;.and- .,•: :..tares; ; ;, '. :,,..;,, ... 1.:,.•, � (3) Beauty or bartier services iri treatment e. inheienf defect qr•t city manufacture;; '.c•., for,,bodily.,,,iInjury:.to,-,a,follow�err ployse.of the J. _ rust.fouling ovexplosion of firearms;. Insured injured in the course of,einployment;or g. breaKage;'marning;;scratching,'tearing or "denting en.,the,insured;is;a•member;of,the faculty-Or unlesscausedbyfire;thievesoraccidentstoconvey ' teaching staff of a school or college::• .��•.- ;•<, ances;or - •(t) for,bodilyinjury,or•propgrtydamage arising h. infidelity of an Insured' `employee's or persons to out.of the.ii4tena_nce;,u. -load_.h or:un whom the insured property may be entrusted or load rented; .2} FP-7955 2.our limititot,lossV Iny 000409-8 peril 6cept theft is ,-,-!Iitveidentgl*to-this-businesi)ioctupanty, This Optional tht,limit shown in the Declarations for Coverage 8,plus Policy Provision does not include:elocttonic data proc- to" 9:11, vir ..:; tWe"afir,i,ja�,j Wit, esping systein, equipment pfeth?arlacording or storage ( -1 W1 ffipffl•)ge &` 1h'l'b­'�$Meqt qt.ffierthWddlse held as v- 3..o,i limits for loss by theft are those shown-in the Oftla- a!hV foFW'br .pr e q,iori for "jrf,lieu o the limb app� Coverage B theft emit;and The Option 10 limits are shovff in the.Declarations.The first limit applies to prppert 66, in y on the residence premises. A es The second limit a6p'lie'j'to-p r tMits by ky,�o6red-pehl ei 011hose -.:.dence,lpremises.eThese�..ruT�ds,aTo iniaddition to the 9 .s R_ jrj;-j;OVERAGE PERSONAL.-..PROPERTY,,.Special Option HC-Home ComputeniThe:COVERAGE B-PER- --I�.,,Umlts;ottUabliftyon,ptop.erty.,Vp0,,prJnte ded for use SONAL PROPERTY,Sl;;c]Rl Limits of Liability,hem i.,for r! IR f, s e", used ui e I s e 3.Under Section 11,the residence premises�i s' Q coneid- .I S Y t4i -64n, s - ifitthi�deddr­I 416T igbowiP losillb lo' '," :1T, !.*:-a r,!'ered.busiAess p[operty because an ldsurod-odcupies a Option 10-Increased Dwelling LI It, e' 11 settle loss part of it 8,amincidental builnesi.1b, V as to damaged building structures covered under COVER- - 4,SECTION 11-EXCLUSIONS,item 11.of Cov6ra'ga L and A&M-:1DWEW5NG'd666(dln`§iW' 'JSECtIOA,l1*_'LOS S:- Qj4taga-M is replaced.with the-fol[bviingj`�: n tEM EMENT 0iMldhhbWh-In 04 Decliritfdhg!+1'�'- I I". ­-, • -,%; �'. ", dnt5 v'".-ol 6-- * .'. , *,-,l�ju�"gr'�roorty,dimagoiadsing'out of If the amount you actually and necessarily spiM t6 fepair or 10 b. bodily ­ _­, i* *iA�&,@ anhitii;46r.ji6Tental or replace damaged boildifigIttildtoidd exceeds the.dpolibabli .­ pj_� b if .y,prejnises y n in the Declarations,j�w �pA holding f0jental pj,any,parl o aq Day :,gl,lnkt!ro.�'i�is,exclusior�d6ii,gqt-apply: id IF,of 16T U"o 2141 6*6rdin hly Itt ent to ness Outwits' ' or t6 buslAess pur- l.the Option0libitl0liability shown.in'the'Declatations ) W .".1 1 t.1, n.1, si to repair or rep eve the Dwelling;or -efebtav'Is�1P r ': t "lael fir I"e,*,",,r.mr�'-i,...-"Ij,:. jnsyred Wfoh,are,n1cpssary or 2. 10%of the Option ID limit of liability to repair.or replace incidenfal to the use of the residence prern- building structures covered•under,COVERAGE A - Ises as an Incidental business;• DWELLING,Dwelling 1':xtdni%.'3. -u als�) G-111 ..i �; !.,lik '(2,r,wilh respect tmCdvbragekto the occasional Report Increased Values.Youmusf�6$Vtuiwffi�go Bays or part-time buslfiessi)ursbiis of an Insured .o.the,plart of.apy,neV whd is under 19. ears of age;. . bpildiqg struplule costog.$5,000 or more;or any a"ddifidn"s"to or remodeling 6!Sui)866itru6fures which increase their values by$5,000 or mote I-N ou must pay (3),to the rental or holding for rental of a resi- Any--addifional"premium qAue,Io?,the-In.cmasid.viilud.We Wig derive of yours: wtp6Apnore,1hAn:-the_,apPIicabIe t1mift of liabllq.shoWn;in the -a an for exclusive use Declarations,I you fail to notify us,of�that increased-�,alue within•90 days. as; id6nde-,'L:;'I� -:0191"wona ;,fir Option 10-IneldentalBusiness;Thi�.ilcoverage provided by -tend ( I6t'dse as a .1n pajl,*,unIess,.jn p,5 tar' roomers or this option applies only to.that Incidental business occu- i.COVERAGE A-DWELLING,Dwelling Extepslon:litem (c) in part,as an incident.0bustness or pri- 2,b.is deleted. vate garage; 2.COVERAGE B-PERSONAL PROPERTY is extended (4) when the dwelling on the residence prern- to include equipment,supplies and furnishings usual and Ises is a two family dwelling and you occupy t22 PP-7955 oaa:par.t.,and:rent'or hold torontal.thsiother on 1 16 ;V ny parson actually or.Appientlyj act 6S)"*t8,nt& or Ing on behalf of any Ifilid '.�"Ii6*1'4-d elti fdr totif toothidj ot WA P a of,50 dcrej re a ess of'Me4number Covers fi De� 61 and(2),ituw on s child ional,c IN 'ihftC6-#j not Apo This exclusion does ript agcy to the provided. y,.an y Insq or,to the cam se�mqes n ng d 4' 16ailfinjuty- a oi-aif Ititured arising pan-lime child care services prWdid'by any Insure idental ui of the, sea,as,,-an inc V:•U V.:?• sIness other•thin tda'reald6n6e Wpldoe while iol c--i%h ;I�JF�Aewelry:qrid FursAev ,(dIry,-walchBS;14! engaged in.the employeS's employment lay In- 9011 'i6dgirm6�trhmq lb -iodsandsemi-p(q; dwith 'r,preq M­8,�;r•sured; •9oldware, sl qr. ­v- f-,", .b l:: , �Repl— e cipus"Stones gold'4thei&�` arising outok000-pun_ -Insured 16r iccidental direct ?ctyj-bodIly-1fiJdry2o�a pupil aris silverware and platinum are J' ishment admirfistirediby or4at,thridirection-ot the physical WW'damag6jl. Insured- Declaraflonsjlhq d ount a. liablIfty,'845irig outolany.aft-prrors or!omissions of first ampt it tqisthplirn for any pne,agicle;the seqop_qT an insured,or any other person for whose acts an is the:+`: aggregate limit for e8di loss. `fe&19410eepaiation or 1. 1 Lt'.7!111o,IIIP ;.resu ng. 15 -data,'0 ans, esignsiopirilons,r Ths)4il;wing.460Gonal prov.Wons;apply:';, ......reliI,r" sports, ns or 4: to . .. ... Wfis,specirlica, 'upervisory inspec n6'i 1n,S­Ui6,fbiPifiy 1 S to Me Pro 'Per , ty,d'escnb�d in T 'tMii8fidu6t6f'6InsuTed'9 �;(bngWiiifinj-sefv S,W I - this option e6er consisting of, oi difiky mmedi- ,n ta procissirig,com- -,lj.,1ateN!,caused by,one or more of the!fOIIOwinP irvideo, I t 11 . I "&�pyterproorqmming;or p,�tqrp�sy,l or t. -3-' -- '-I* 1ki %d,t�I­ r"34. - a. mechanical breakdd*n,wear an ear,g�aduiildete d.pzany:cIajm made or,9041rOughi 9gainst any Insured rio r6IjQn;c,1 141 ,by-A 41 ool Rfi any person AO is in the care of any Insured b." insects or veffnih- id ;,o,bbcautiF&,child carese rvic ai ptdv ad by or at inh -1y Aran ini' "ifi�ctio4,66der'.,4 "Ai a orcusorA &:delhid'ov 'des •any Ins6j6d; 'jb Ay biW016ybe Of lj4y Ir6rid;or iv.out Ibh for4oss by�any.Coverage!B-Pgrll ex06011110ft-is (c) any other pers&actually or apparently act- .the,jimft*6wn ih the Declatationsifdr COVeragp 01-plus o? ut.:I:* u- regale re ,or C-the agg Wi in the Decla- ) (2) any person wh6 makes a claim because of bodily 3.our limits for loss by theft are those shown `!AjUry tolany person Is 4hblil Othe care of any rifflons forlhWoptloh;and '*'a services provided V) Q�c limits for loss y any covered piiji epept)those.in ad bemse O'd b suf by or at the diclarations for hems 2.and 3.ate those shown in the tin (a ) nsdied;' 4o ado. 8 ­IT p. TM FP-7955 OpHon`Ol: BulfdIng-,OrdittanceorLaw- ,iand use requirements atthedescribedpremises; •�,,< and 1.;Coverso Prd'vided. total tltnik`'of`i 't.(4)Jhe`Wbiriaitse or I"is in forge i ttie tiirie of the nsutance'provided by`this'Building occurrence of the same"Loss l isurf#d;or Ordinance or Law provision will not exceed 61amourit 1•',.. . ` ' equal to the Option OL percentage shown in the Recta- c. the legally required changes to the undamaged par- , rations of the Coverage A limit shown in the Declare- bon of the dwelling caused by the enforcement of a Hans at the time of the loss,as adjusted by the inflation building,zoning or land use ordinance or law if the ,,,coverage pro4visions,ofi the polioy,This.,is.an,additional; ..,.>, „i; enforcement is directly caused.by, .same•f Loss , amount of insurance and applies only to th e dwe#i,no. Insured and file requirerneht is in effect afthe time the Loss insured occurs. 2.Damaged Portions of Dwelling. 4,Building Ordinance or Law Coverage Limitations. When the dwelling covered under COVERAGE A - DWELLING-is damaged by a;Loss Insured.we will pay a We will not pay for any increased cost of construction f under this coverage. ator the increased.cost'tb-ripair,or.rebuild the-phpskaily damaged portion of the dwelling caused by the enforce- (t) until the dwelling is actually repaired or replaced Mont of,a building;zoning or land use ordinance or law if:„ ;,.,,,at•the same or•another premises,in:the same the`enfbrcemeni is ditectfp raused"by`tfie s&ma�, -. . ,.- .r, ,general vicinity;and: :.. .. lnsured`and th'e requirer Wj is Iri`eflect at`the time the' Loss Insured occurs. (2) unless the repairs or replacement are made as soon as reasonably possible after the loss,not to 3.Undamaged Portlons of Damaged Dwelling, exceed two years. When the dwelling covered under COVERAGE A - b. We will not pay more for loss to the undamaged DWELLING is damaged by a Loss insured we will also portion of the dwelling caused by the enforcement of pay for. any ordinance or law than: a. the cost to demolish and clear the site of the undam• (1) the depreciated value of the undamaged portion aged portions of the dwelling caused by the enforce. of the dwelling,if the dwelling is not repaired or ment of a building,zoning or land use ordinance or replaced; law if the enforcement is directly caused by the same Loss insured and the requirement is in effect at the (2) the amount you actually spend to replace the time the Loss Insured occurs;and undamaged portion of the dwelling if the dwelling is repaired or replaced. b. loss to the undamaged portion of the dwelling caused by enforcement of any ordinance or law if, c. We will not pay more under this coverage than the amount you actually spend: (i) the enforcement is directly caused by the same Loss insured; (i) for the increased cost to repair or rebuild the dwelling at the same or another premises in the (2) the enforcement requires the demolition of par- same general vicinity if relocation is required by tons of the same dwelling not damaged by the ordinance or taw;and same Loss Insured; (2) to demolish and clear the site of the undamaged (3) the ordinance or law regulates the construction portions of the dwelling caused by enforcement or repair of the dwelling,or establishes zoning or of building,zoning or land use ordinance or law. -24 FP-7955 <: We wily never,pay for'more*than-a'dwelling of the Option SG-Silverware and Goldware Theft::The COVER; same height, floor area and We on'the same or AGE B-PERSONAL PROPERTY, Special Limb of Li- similar premises as the dwettiN,subject to the limit ability, item h., for theft of silverware,arid''goldware'is 0 proaided in paragraph•1.Covefage P(gylded of this increased to be.the,amount shown,in-the•Declarations for opt... this option. Cot- INMITNES5 WHEWt6P,'tfiis Company has caused this policy to tie''signed-b X;iWftsider►t and' at Bloomington, Illinois. ;• f tt►.f�i t11 Presi Secretary dent The Board of Directors;in as r`danae'with Aiticlb VI(c)of this Company's Aiticle.s bf corporation,may frorri ti ie to time distribute equitably to the holders of the'participatirig pplicces issued by said Campaiiji such sums aut of its earnings as iri its judgment are ` proper. r.. . .... .r. _, what ,, .y .• ;. •• .t. .'u :25 FP-1958 April 3,2012 To: Greg Lunde, Agent State Farm Insurance 11 State Avenue Carlisle,Pennsylvania 17013 From: Rodger T..Atwood, 11 125 S. 2nd Street Newport, Pennsylvania 17074 RE: Insurance Claim Regarding Policy Number-38-BY-F929.,S Dear Mr. Lunde, By this notice, I am formally.filing a claim for structure damage and loss of possessions at 740 Pine Hill Road, Duncannon, Pennsylvania 17020, that resulted from a fire.. Edward Jones holds a mortgage on the property of approximately$168,000.00. He is-listed on my policy. I am uncertain Of whether or not he has filed a'daim to date.. My current legal difficulties have necessitated my absence from'the area. On February 7, 2012, Federal Authorities conducted a raid of the property- During the raid, significant damage was done to the front entrance and a window,rendering the house unsecure. My, brother had to have someone board up the entrance and the window. On subsequent visits, my brother noted that there had been break-ins by unknown parties to the house and the garage and noted that a number of items were missing from the house as well as the garage. EXHIBIT C My brother made every effort to stem the thefts and ultimately made a decision to remove a number of items that were his own personal property. He also made a decision to move several pieces of heavy equipment from the property to prevent their theft Please find enclosed a home inventory of possessions accompanied by as many photographs as I am presently able to provide. Should there be any dispute regarding possessions present in the house at the time of the fire, I point out that you have only to enlist the aid of the members of the raiding party to attest to the fact that the claimed items were present. Additionally, my policy covers loss from fire and theft. Additionally, I assigned power of attorney to an individual prior to my departure. Respectfully Submitted, Rodger T. Atwood, H Cc: Attorney .. . .. ... , �. �-�r r -�-�*.r rrrrrr�rrrrrrrr r�� rE.�■irrrrrrrirrrr� rirE�r 1 � , f! r■srrrrrrrr ,1 1 11 �■Erre 1 r�.111 srrrr■rrrr ©rr� rr®rrrrrr .r�-**�� r�T�r■rrrrrrrrr■r� r�'r.�� ��r�irr�irrr�■■ ��rrrr rm . ' :: �rrrrrrrrr r■rrrrrrrrr rrrrrrrrrr M: 7717,rte r�rrrrrr�rrr■�■ PIN �rrrrrrrrr rrr�rrrrrrrrrrr Dining Roam aMxoh�er o!hems ttem Year Purchased Cost 1 Pairftq of Rocker 2020 $65.00 6 Yw*ee Candles 2023 S150.00 i Phorre 2011 $85.00 1 Covered paintirtIf 2010 560.00 Lonpbefyer Basket 2010 $90.00 m-nab rat Moms Item Year Pumbase'd Cost i Wine CaMnet 2011 $250.0 Bottles of Wine 2012. $36000 00-mm-b®re Ltmmm Mem Year Purdosed Cast 1 Dkft Rm.Set and6Chain 2012 $1,400.00 Number of Items ftem vemPurchased Cast 30 Place Mats 2011-2012 $240.00 hummed ByllicclowT.Atwood it Pollm Ngmd,er Office Numbs at ttsna (tan Yew Purchamd can 300 Books 1M-2011 $6 000.00 1 Bookcme_ 201.0 $600.00 l4tumberoHtems ftern YewPurdfased Cast i ue Eagle 2010 $250.00 4 Wooden Plaques 2010 $MW Number of items Item Year Purdumed Cost Prkrter Pa _ Past-8s Photo Paper stapks- Pawalps Pens. Pen Haider File F*Wm Push Plus 2010-2012 550100 Sdssors Ink CoUidges FaxCwbidges Tablets Sbqft ke nmw Letteropener Hangkw Flle F,okiers 3 Hole Punch Number of Itmrs Item Year N rclosed Cost 1 Fax Machine• 2010 5300-00 i. Wheiess Prhtter 2010 5150.00 1. Computer HP 1• Fiat Screen Monitor 2011 51,500A0 L Wheless Krlbpard 1 Wheless Mouse E shredder 2033 $15a 00 i. Trash Can 2011 530.00 1 stapler 2011 55 00 1 Calca at n 2011 $40.00 2 Me Cabbwt 2011 $250.00 Files in Cabinet I iffepla tx able NumbwofItons !sera Yew Aoduaed Cost 1 Mice Chair_ 2011 5200:00 1 Desk • 2011 $2.SWM Number of Kom ft m Year Puridueaed Bost 1 2011 5350.00 - b wmd Wf ftftmT-Atwood fl Poftr fill Rltdr�Vla Room Number of trams Item Year Purchased Cast 1 StairdessEkct&Stow 2010 5 i Standess O'tshwoher 2010 $1,100.00 1 Stainless Side bySide RefteraW 2010 52 00 1 standess Mkrawave 2010 $30D W 1111 HIM LH -1-11 1 11 Ill I .- N N4N P N N y1 N N Rill :z.tt 1111 gN �pNy M � O I I > H .i N 14 M Nf N N r1 .4 e 1 M N r4 II NIIIIIIII II ! 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"�w ,T�<.,e�j•. O'aaM T"MwOdr JMBcyilk�v3JWM'�s Closet t`.ORtelits uwm*y a C30W ftysoaft IDSI-2012 2=-2x12 Umm 1s taatt 20x9-21Y1x. 4 CAm cfsods armft cW 2M2 m 9 C...fwax, 2812 54.00 2 =Sam 2011. 9 Cordkas OMIW 2018-2012 nom 3 2=1 2012 Um o•oset conteft Ob-Am MonnCJ m 2 lfacumckwmm 2818-2012 1 WwkStmmc 2811 52Ji0.0i0 9 torumberm Bakes 2009-2012 3 CbKtI PWM 2011-200.2 lif8c. 2038-2M2 �`y�;�,;n,: .�ht"�Ti_vac' " a7•:'3:.•'l:dL':. ^iS�:;;a..3;:=• :'*r'fTH;='.�tskeS:i'ti rJt il;.� t:�ki4.:7,1::•ry`.,'s="^"✓; �`11-%m-w�...x;s�� s.�,�d 'TO�Id%,.n..� i^,�il::T.ht^�.?2=`�..+'�?,�rs.Fl•<.$•,:�.:.t .��.��,;cv°'.:•'':,!1f-S:.•�`L 7:.!4:'1g'. ,?w�w`--w m;Ei;:=1ia.:t~ '�. - _,r.+.. Jm4 �I� �I � Iltli illuw� IINnI�INNU� j�IINIIAAA�� ���I IIII I �IRII��IYldlll� I� I IIInORY I����II IANNI ��III IN N:r� ����i�� u al�6�q�a �a�� ����u�� i �� i ���� �ioia i� n ��I �� III Elal� �I �I� � I� n� n � u�N� �mac� �' - �:. wo■�w�www■ww� rr ' aaY .S .SCOTT L, IMUSLB b `LAW'OLFICES Direct Dial; (717)454.08QS June 4,2012." VIA•CERTIFIED MAIL/RETURN:RFCETP.T acid FIRST CLASS MAIL Rodgei T .Atwood 740-Pine:Hill Road. . : Duncannon,PA 17020-9919' ` And Rodger T:Atwood .• ; C/o-Rodger T.Atwood II ; 125"South 2d,Street Newport,PA 17074-1407• RE:' ~:Sfate Farm Claim Number:'38-OV66-6b2 - -. :' State Farm Insured: Rodgei;Atwood, Date of Loss:' : Maich 3,2012` :Deal lvif;Atiuood,::: - Please be advised that I'have been rtaiied"by•State Faun Mutual-=Fire and"�asiialty Coinpany';regarding a' house_fire which occurred.bn or'about.Ivtarch`3 -2012. 1.have bee4_asked.by"State'F rm:lvlutual Fit . Iusuiraike:Companly:t6conduct an Exam nation riclei Oath: V As-I:aip-sure y_oti'sie awaze; yotfr:ansuratire`pothp,iv�th State Farm'provides that=.you;musC appear for an: - �Xamination Under"Uatfi•apon_reguest. ` +iii Examii�atioii.[Jnder Oath will;require:you�toappear.:arid.ansvirer • . , under oatki ques(ioi,s.which I,p0se"to',you: You nay feel-free to bring-an'attoiney with you,'although-yoµ:are,: not iequirad to do sty. . . J : Upon receipfi`oftlu�corresporic3erice; please contact uiy office to"coordinate a'mutuaily:convenient:date:and tune"for your statement: VJe would-'�sk-yqutO','bring,v i#h you any dpcumtmts-or'matenals of-any l ind:V�ch you belitx c-11 Kei tci ' support your,clai�q in any way._:7n':adilition tcj any.docun eats you inlay,choose'tq.kjring in support of dour ,. cAsiih'_v!e:wQuld,ask that you specifically gather_togetlier anc`brmg urith•:you'th f"'llowing documents,"to the••_ extenf you are reasonably able: _ .'1. Any=pliotogiaphs slides;'.'videotapes. drawings:or, diagrams''of:the-subject matter.of dlis,Loss ' 49.525 Sb=EidHfx STET,lximiiok,PJli'i7o42'" Pxorrs(717)?74-14 /'Fi�i�7i7I 27.4-1752 - - bnigondavis.coai avis:cam • L+'3 L •• , LU.-L .2 i -• ' .Atwood Date:)ime'4,2012: _ Page:2 . To: Rodger A • . . . • • - Prepared either before,=during or atker the loss:. y .2. Any appraisals,repair estimates`or inventories of any property which you'claim was,damaged or .-desfroyed in-this loss. _ 3. :Any documents relating to'y-out•acquisition of the:claimed"'items including,reeeip. .invoices- credit card statements,warranty information,etc. Your cbrhplete.Federal Iricome,Tax Retuiiis with 41--4ccompanying schedules,W-2 forms and/or . 1099 forms for the'your tax:years prior fb the date of this,loss: : 5. Any and a documents•re*ding•a gift of inheritance received within the.past-ten(10) 3�ears. 6:..Copies of ali rn rtgpg., eaSe.to�ow.n documentation for'the pmpei Y- 7.. •Your most recent pay.'Stub shoy�irig year-to-date ear�gs. y 8.-.-Y6 courpleted Personal Property Tsiventor-y pr-ms. Co`ies of:an Banlrru tc' fil' ' docunieatation,-•Filed within the'past 7 years. " p Y p Y Following your Examinatipn Aden Oat .Staie_fiarm will'study the documents and information.,1 additiana State.Farris m ay gather `any .additional information cieemeil..nec ssry.to.•properly investigate this loss. Following`&i,,a decision vvili k�eir►ade: , y ' . . _ _ .: 16 the meaiidm,State-Faris Mutual iie arid-Gasualfy Company continues-to respectfully iesezve ny_and ail rig7its`or efcnses whicfi might now exist or which may arise:in the future rega ding tliis'clariri. -Nowl. iver or= estoppel of:any kind should.lip:•inferred,or intended•from the:insucarice.company's.clesiie.to_conduct this':, F�xainiixA#on ZJ�rder Qath. The company;fuit4er reserves the.right to have preseW tlie: assigned claims representative Or mother company aepresenta ye.:• _ _ _ I lookforwarcl.toBearing-from you . earY. 3'.your ,. . .. SCQTT GRENOBLE: . S ,G� ` Cc: 'ied.Ivlaizini�viae=mail onlX): _ . (0 91 ao r z -- _ PIP, -- S�S Soa* 6 Mlq 65" % - -- -- bAr- dA 5*r-RTE pOUauA! ,Swb 6Jclar4 We C D�E ST�r'i liaRte+ e�foMAl f'� faR,n1` �-uFJr. _:�!,i__'�`tE_•wT�EJ'T aF• C�A2.'fi��,-� e� 7NE��/�s�,w�--- • ---�i-�S',--.t_l,Me�_�ocur�o�r,�,.�,n/�.�usN�%�!E L�►r-6�P �R !'/bra , E4� — --- -- - ut ment l,o;,--,-k 6�sAvd-mss_. Lo car? _/W 04FkE hnr E auf E r�'►�f of 711E r 1T11�D -- -.�QEvi O uS�6�T�.-/1114i"�U��T�'!gf^L �. •� n�V��'_I(`�f '7���I -�7y1�_�Y4R!'l CAIJ 8E' -------�_.._. PAL S oalb Fug C//Jkj)� N_ neE�� 7�IEKEf S", _- -_.L./y'► ftr. Cl � L1 t EXHIBIT- F - — - - -- K ik J r `cam /41/ �}}KII � 49� � +S�E.Ii� Ano — A . 61- fEg-r "716A+_CT' i`,4,� 7t�dr�f C/A1aC f,4C7Z4 I CA,f(f V4114,6 `,,,b - - -- - J---- ---- .--. - - -°- - - __. -�� r��f f 6a ,-r,j teAcr 7 E _ Ac t <ITT-.,W�noxr- olsa Cvalb 7tt r9 13 +is6 �f,1D c� r,�f lr� 1`fac.�,l+� D ►� �"►Qe� lert.1b XAA6 F alb Do a �4x y r_r rE` �rtB�E?a_ r .ar,�. r`�! CA'Al. VAC- (yl W- 4jrJ'Gr 7P47- C-&-i zw f fE• E C3 rDc,ic ? 1�/�4hb �Z -xw►F ph-e 7)4 riy?-E ca)C- _R�E,+�17A*+ 1�7r°�4 f E 6 r.� SiX?t� S77re— .W �14?J!�al_ v_ `rzr,4 j �,_arE ►rD b '3csy2�q?L.�ta_�AXpAtg-?'lS_ _....FlofZ Cot0it abO. &Pf WG(A5 — rat-IN g9 �� �u 7?Vf bE�r►9 +fig` m CbU ¢ .spy �2 r, - , ? •�E rac (1�__ ,L,� -/�rD ?s/_,-r, .� A4LCb - ,CP--7b bion 1,R,yI 0,L ZT7 1 Claus Claim Ac in ,t$ ;r;: Cov B ,� i;,,.,. if'3 R Claim Room !`�y�9 /�ih Code ®ACV 01 RC Ded.F 41►� CIL �.r l rrit t ri +v ;r Rep. TO BE COMPLETED BY INSURED i�E'OdMPliE7Eb$YrCLAI_M R_EPRES PRA1I11,E " 1 2 3 4 5 6 7 8 9 10 J 11 12 13 14 Rem Replacement Today's Maxlmurn Actual RIC MIr/Brand Name iJp. Pttr�fiased Doan Pate of per a Vafuel 9b Adfustments RJC Benefits Description of Property and or manta- Purchase Restoration Actual Tax WC To RIC- Settlement Benefits Pald a Pry Seriat/Modef Number Obtained From ton or Age Cost Cash pr a wef Data Paid LE -r- Value u ov ( 5 Books n/fA a)AR�C-f d' *A ,toll �8 jE � MiWe+�f a r t( A 7b ifli.fCkl N/A URIX rdd An, 'a �� 3 ? CRockS ( DEn/ l4 .to/ ¢ °•• kE SrJ�,,.l Si1•ET WtA ,Za► �ro� �� t ,.Z ane f4ki Chore JdJ t o j fi 'A jot F' aac 44 444 4ds 1 v 14r SZm-w 7v PNASarrh. ao h et %1"'o, 4 ! TV SI-MA, UK w",r «bri; :: 30 34* b v b pAy� s � ,rE aorr .1 7S*- ' 47sP. t`? f1. S �or(tFf 0.11A 16 P I 3 rt .iorr Lem L0�'' - a37nt t E u iS 7 7"B IC Z `y3SRuf ! A-Appraisal B-Paid t3AI or Receipt C-Canceled Check t;9oad. 7�a" M��`,,� "� tf � f`�` Estimate P-Photo CR-Credit Card Reoelpt 0-Other. TOTALS ?;sh *de and w - 7f? 1}.Z9- 9'7�4— �Pro*No.: 1 DEDUCTIBLE " `f Person who knowingly and with intent to defraud any Insurance company or other person files an application for insurance ti Person of claim containing arty materially false iniormation, or conceals for the purpose of misleading, Information SETTLEMENT Pa "' ��� of ; ;} ring any fact material thereto,commits a fraudulent Insurance act,which is a crime and subjects such person to criminal ��� . I chill Pe"Itles• A `';• '.ice rt0above hfortation Is true ,{, Date completed Ae best of my knowledge. Insured's Signature `� r 44th.rF Date 10-1-I& BY :r: • Uaun CI . uatm 01 LOSS �G• V C A R "Xta s . ,.fir L t B y a-Rt I ' % , Cialm ii''11 .,t t a I Vii: Room V1� /`�Q�h Code ® CV ® C Dad. CIL it rL ' a pep r��,J,�. ,� v+ 3. ,t" TO BE COMPLETED BY INSURED CbWIWED�BY.;CLAI�VI�Fi�PIhE'SENTA 1 2 3 4 5 6 7 8 9 10 11 - 12 13` 14 Rem Replacement Today's Maxft m Actual Ric N0. Mfr/Brand tiame Purctiased Doan Date of PAPair or Value/ % Aclustments Ric Benefits Descrfptlon of Prop" and or merits- Purchase Restoration Actual Tax Ric To RrC— Settlement eanefRs Paid Qtmntlty S&WhAodel N� Obtained From tion or Age Cost Cash or eaok*�l Date Paid • LE -r Value U Ov P 4i''I A/`n �' +� Ulf i ¢f" laf d0 a I ( 11a,t : l 9 a F�q PR+�.rrd rJ In KIP So0'E- , ya FI►,rnr� P /o �RRrnE-0 p�� (r., ,JAR I/' da►I. ' /tfo /+m' �4; :;•:� t / CORD rJrr G WA[*v4W y' ,haw �;; /Ja /aa 9� ! ,-b CR + ,/ti/o /oat /dn� a : t "it r r SCA46J- WIA ,?alt: `:i (,0�' 'i �0� `+; F: .S W Wbv w (Wif- n/�f� nisi/ ,! go A It e ► a ; - �tlo IJ p Aut+ft� ' 14� Son ' A( A y v .1411 ' 3b S t�gniD�t=f II ;a Whob SNVE J4(l t", A-Appraisal B-Paid Bill or Receipt C-Canceled Check �� >� a` f t `t,<t. # r3.� �• 'r: ' i 4 .i E-Estimate P-Photo CR-Credit Card Receipt 0-Other TOTALS st°�, • ' :#n1#�•w, - n ty a"'t`;a� ••Depr./Dsc. Mauna and Worts Phone No.: ?X— 97/°4 1 DEDUCTIBLE Any person who knowingly and with Intent to defraud any Insurance company or other person files an application for insurance or statement of claim containing any materially false Information, or conceals for the purpose of misleading, Information SETTLEMENT s �. Page t; s conceming any tact material thereto,commits a fraudulent insurance act,which is a crime and subjects such person to criminal and civil penahies. Date completed The above Information Is true ,.��/ V. to the best of my knowledge. Insured's Signature CT""�°�`t Date BY Claim 1 W � RN, IftSUn3d O " :ate,..- r•.• {y r. a a s -th• 3 * -t Claim 1'1`11%'V.' 4 �t•r''S �; � GOV. Room +[,�VMrf Ct atif Code 93 ACV ®RC Dad. ' CIL r x , Unit Rep 4 To BE COMPLETED BY INSUREDh: �• Tt��E' Mf?L�'#ED BYtL`LAftV1R1�PRE5f!(1`A71.ti'E`, t ; T 8 9 10 11 12 13 14 t 2 3 4 5 8 Replaoernent Today's MaxinKan �RIC MfgBrend Name pub l�okxr Date of Repair a value/ % Adjustments RIC p m=r -- Purchase R Repair or Actual Tax WC To PJC Settlernern Benefits Pald Desorption of X Cash pf avp"b*l Date Paid 5aWmodel Number Obtained From lion or Age Cost ,� Value u ov L•.. ,� the �i r f ; ( sou pg..A ltolbst q Sri+ y ISO All 3 l<"'Io- O-wcA Zia Jot 3 b1A� �0 M� a.l•�- Y 3? l) r VA •¢ a Ott; pD 1±� .;c•� 3 3 rhpRR�E 13AS�o /, Yw40C G04 ' � /0 (r >au oft WIG 4 AIR, k r;x It ti. i c. V {{ , f••,� 'i i4p', =rsli: '� �a' `•ate MR,S: �A-Appraisal B-Paid Bi11 or Receipt C-Canceled Check TOTALS 9d � e` .(:Y. " �9 N i •, Estimate P-Photo CR-Credit Card Receipt 0-Other }I ,1� •• pepr Il7isc. r7 x.79—p7b¢ 1 i 0 and Work Phone No.:( - 3 DEDUCTIBLE ' :,a, ?iz• Z"t q�l person vYfto knowingly and with intent to defraud any Insurance company or other person files an application for Insurance ( };3Ilk,� a; �.,, tat me of claim containing any material) false information, or conceals for the purpose of misleading, information SETTLEMENT page 3 -_ of ming any tact material thereto,commits a fraudulent Insurance act,which is a crime and subjects such person to criminal ,..�,_r :' ••.�:, Date completed penalties. above information is true Date 10 -!d By tbAhG best of my knowledge. Insured's Signature °,- T. / SW413 PAA Rimes!IOUSA- Personal Property Inventory Form claim Claim FA= IF Nw1ber 7 Unit tnsurs& see~side for Insmx0am and example )Us& -7-: Date SG Insured jr Of LOSS HC= BP cov im Cis urri Room iW Coda IN ACV 10 RC Ded.aAA CJL mo- Rep. TO BE COMPLETED BY INSURED . -- . ,CLAIMF EV A - 3 4 5 6 7 8 9 10 11 12' 13 14 Today's MBXWM Actual FVC Item Repbowlent A4usurwts FVC Benefits NO, Mir/Brand Name ptrdmwd D=j- Date of nq3&or vow % Descipgon of Property and or maids- pudim Restoration Actud Tax RIC To Pc Settlement BeWds P8W SedWModeINMt)er Obtained From bon or Age cost cash U V1 appkabie) Date Paid -y- VWUe 0V LE JWRY oe P NW A, j op AocoaL WA A r, L r M ^0 - YA,4 l YAW" t jail CAhlbd .4 1AfAjE A1( 0 P j-� W&.* (�Ashqler 1 . hum 7"Xic 3WAf AWIF X.)e ftlA hit d 1A AIAWJ Jo PAICCMArT Af 4' Pit ........... IF 8-Paid Bill or Swelpt Ri fAQ C-Cerx�eledl Check LS J1.7*1 A-Appraisal TOTA E-Estimate P-Photo CR-Credit Card Receipt 0-Other Depr./Cisc. Ham and Work Ph"No.:(.20 $-.7?- 774f urence EDUCTIBLE Any person who knowingly and with Intent to defraud any Insdrence conVany or other person files an application for InS SETTLEMENT page RL of or statmnent of dalm'contelning any rnatedally false Informdo conceals for.the p�-"-- -of jv�sleadlng, Information ULP-MN I q Twif-v I or ro M- - ft- -1 r%-.- % 560•$13 PA.1 Printed In US.A. nal Property Inventory Form Gaim _a°,. ter: 4 L` -' claim- - erso op y rN ��. Y.. r .;,,,,. ,;. i' r. : ' Number ._',st.c T :s Unit a JF= 3 FA= isunxt See other side for Instrur ffons and example. te C>tdrnA �l9dl T [4plAfoo/!� - Da 3_3 ,= F: ,,F•^' s H '� „ t epee�t`tattfie ,Cn�tplete�a 'slt0tla �. Insured a' C= BP= E a � a _ Clalm Srs 1tik'' F:t. r•., 3.,.'. ., E'�.t� 37 8��t� c.:r•� CO'V. 8.��.L�k.�:,•.xF•.a y rs.,,,. .;.• �5.,` Room Code �tr5'. i ACV f IRC Ded. ; f' ;;s C!L s�.„f. +r�[s �t ;tdrt*s.l .+U. MO_ Rep ti;'�.'?_:<"t ?s.' c�;•+'' ,; TO BE COMPLETED BY INSURED 'Aft n,:�;t M,f�EOOMRI?LTl7' Y�fAillA 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Item AAfriBrand Name Reply Today's Maximum Actual R/C No. Purchased Docu• Date of Repair or Value/ % Adjustments FVC Benefits Description of Property and or menta- Puxd�ase Restoration Actual Tax wC To RIC" Settiemeni Benefits Paid SWWModel Nrmtier Obtained From tion or Age Cost Cash pf app!)Mblef Date Paid �Y LE •r• Value u_ ov p Books NIA �t,4I ' a 3 R 7, • 4 f tC,+J PG d Add Msc- 6+J Fr{E rto M rc aft' r ,Fit Z' ! X xfo N" jp w,1jLJVff 12" i.6 tc IoM' �W Aw all _9 f a k f, I S ifJ Jalr � a -� Uft✓ !+ � � n Lny 6- 1A 3. .>' CAkq AT�R.S rJ S`Tx lET JD�f � �� Olt, ! r, G4a,wr- liv- JAlr �.ix 5.5x, oii• y�'�r t' a fv•,.• .r� �+L:t:�L 1 .,�...,•.k f.'33 ` �JAppralSat B-Paid Bill or Receipt C'Canceled Credt $�a' �,- n�t`• r ' � .�-�-�vt ,�'u'-�tu�.�.f �-� - }�s�'� �.,-•�j:... •- it►VEstimate P-Photo CR-Credit Card Receipt 0-Other TOTALS rr( rl n� 76 pepr/Oisc. -Mold and Work Phone No.:(7 ► V-22— '774 l DEDUCTIBLE 440erson who knowingly and with intent to defraud any insurance company or other person files an application for insurance - sr�atement; 01 claim contalrtin arty rnateriall false information, or conceals for tha purpose of misleadin information SET'TlEMENTSr . g 91 ►....,. Ursa - - -1-- . . - - -� - - _ ,....�.�. ,.�. ,4 a /emTeritt C orriplete all:stiailmd.iue s�' Irisu of Loss SG= = HC= ___ -__._ BP= )OrTI d DICE co�rT'D) � ©ACV 2 RC Ded. CIL 'r ' Cmv.a Claim . Code `'�,�,,� _ Unit fvl0= Rep. TO BE COMPLETED BY INSURED —',',.'TO BE COMPLETED BY CLAIM REPRESENTATIVE 2 3 4 5 B 7 B 9 10 11 12 13 14 7i7o ment TTY's Maximum Act MfrlBmnd Name Purchased Doerr Date of Repair or Value/ % Adiustments FVC Benefits Description of Property mid or rnenta- Purchase Restoration Actual Tax R/C To RIC•• Settlement Benefits Paid any Serial/MDW Nurntw (btalned From tion or Age Cost Cash N eovgcsbb) Data LE `r- Value U ov 1 uK �,44 ,a, aari{ JSbo aco�� .t !s r 0 wise uK UA4,e c �k °y,i s .U8 ,Gb V /L I UK VA141 St, r 40, .' rote- 01Y ; •i f- i{: 1-Appraisal B-Paid Bill or Receipt C-Canceled Check -Estimate P-Photo CR-Credit Cana Receipt O-Other TOTALS a�$5o a$Sa {�:,.'•' r ? `+` t Depr./Disc. me and work Phone No.:( 7 n ) ?a?- 9764 1 DEDUCTIBLE person who knowingly y pe gty and with Intent to defraud any insurance company or other person fifes an application for insurance ; .:. �,; --•�. statement of claim containing any materially false information, or conceals for the purpose of misleading, information SETTLEMENT Page of . nceming any fact material thereto,commits a fraudulent Insurance act,which is a crime and subjects such person to criminal d civil penalties. Date oornpieted / I e above information Is true // the best of my knowledge. Insured's Signature ! !~ Ate,!L!L Date fO'9 I bZ By ---- � > --' --------- � N f 111%PJu&1& Of LOSS MIL;=W-131j� #Mom R*qjs1n"1vJ6h,W 'laff M Gov. Claim Room 'Rep. TO BE COMPLETED BY INSURED 03 A ual PX Description of Property arld or nv"- PUrdme Restoration Actual Tax Pic To RIC— Settlernent Benefits Paid WallModel Nufter Oblakied From lion or Age cost cash Pt appka") Date PaW Quantity V. dl YJ of Noe axcov cA 1311 j CAeO Sb WOW bi bob AJfAAve Ja A2�4 AA E-Estimate P Photo CR-Credit Card Receipt 0 Other A-Appraisal 8-Paid EM11 or Receipt C-Canceled Cl�� IpM and work PhonIe No.: 1 DEDUCTIBLE person who knovAngly and with Intent to defraud arry insurance company or other person files an application for Insurance &AState""t of clal g any materially false Information, or conceals for the purpose of misleading, Information SETTLEMENT of copcernIng any fact material thrio commits 8 froudulerd Insurance qF%which Is a crime and subjects such person t criminal N 500.213 PA.1 Primed/V.S A. �,.,�....,,.•, . ., ,. •, Claim: •�•�, ;��.•`• • '?•b - ,•��''�'�••!:' _F FA= N=bff Personal Property Inventory Form a :�,, :_Y; r: :�4, uiat =:. �. =° d ,F Q aas and ejwnWte Q �' Date rnsraeot see Goer awe for/►IrtrucN 'Casa T �,�; 'OD '�" of Lass '�v 3—l.Z SG�, '..ltt3 t;'.'. �_'x HC= :.C 3. BP- Claim _ ' :p° �_�y „at4ad�t1'4';„•`� Insured � [�.�."”" � - � •. :.t .tia; etapR' I.+ a Cay.B a*'i,' ;,''R; J l rnDPV J�vt C0D"�'i��Code 'AA' ®ACV ®RC Ded. a T C/L`' s�3 Unit t` • ...r� M0= +' Rep .:�•. "..�:..• ., : ,,' •� Room 'r+ TO BE COMPLETED BY INSURED a �., ( M�L�E7ED)BYwC4AINI�i- R�3EMTAIIYE;"a'r s1 3 4 5 8 7 8 9 10 11 12 13 14 g;'qA Maxinl�arl Actual RIC M WOrand Name Purchased Doer Date of Replacernent vaakw % Adjustments RIC Benefits Repair or R/C To RIC" Settlement Benefits Paid jobLT4 Property and ar mertta Base Restoration Actual Tax SenaltModel Number Obtained From lion or Age Cash pt avwcawal Date paid FE Cost Value U �/'�b�� l¢^ !4 11��a �/ !& uA 4 Cam l 6S yAN6cEE s c ► 3. { 1aa S is ,fo« `'a is 4(A SoJcav 1d6Y .1 rit oo t ,t lD S-mo-116 rct Act �/ a�oscod'I al 1 Sca�E rr1A 141A t"{b ` Y4 v sTwlrr EV NrT ��� BosGtyU'J Xw► . ajrstt a7S-o' ' r � a Ga,ro D, Qzd d( �. J R 3 $ Pcc ,9 J ip $oSco�f j AN ! i Scd "� .� G ft tpE N(A Eaw'S a f�`'ti Crl� Ui�Cw Is n11A 161coll 1 Ave all i zt WCb u 9C0 tgbo'' k P61f A,10 AA SO S"ItIE+�•aa4 ru(A aS p�l/ �Qb u�lr`:/(�i 'S �.• I'S��iSl 4�. tlr - i�r; {l.'i'�`` -i. C-Canceled Check A-Appraisal B-Paid Bill or Receipt TOTALS De?. ./ a Diss E-Estimate P-Photo CR-Credit Card Receipt O-Other �� "�, ;,� ••DeprJ DEDUCTIBLEr� , Ho and work Phone No.:( ) Bas'" Hum Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance yit.;;°> y �:;i,Page or statement of claim contains an material) false Information, or conceals for the purpose of misleading,.information SETTLEMENT .d I -A-t A- rat, SM-219 PA.1 P,Imed In U.S.A. ersonal Property Inventory Form claim +r:;,,:; , ' a m �,.:;`'• ;` ,,F= " � = FA= sunnt See other side ror instructions and example. Nur>>t .r, r 1 Data /�C e- %• of Loss SG ::;t. s:: _ HC= ' I'salimi,ReF ! .Cainplet"i '> L`wd Insured �,.., ► Cov. S'f; >:, .t'IE.. Claim X. C I. ?fl. n r MN y 'q Code psi EM ACV RC Dad. CIL a},t� Limit s :w' :ti; Rep loom,�,w*71f ICDa1►t +3=i . ►a. TO BE COMPLETED BY INSURED 777"'2 3 4 5 6 T 8 s 9 1 13 14 � Actual R!C Item Mfrll3rarxl Narrhe Purcrosed Doan Date of Va�lupJ % Pic Benefits Description of Property and or menta- Purchase Restoration Actual Tax lement Benefits Paid SaWModel Number Obtained From tion or Age Cost Cash u pr appkable) Data Paid ov ruawwy qtr �r Value Esc, s tars -M.�E= -Xra6 Ir` .2 x /QAJi3�wE s7t9f ' RAZO><J y+>► . �sp7e ,pD ` 3•. �t •t'�t ! s7ivT.�Qr '�7� 8acoVT Y�vf ai(01 •.� ��aE'�- $nun- L�r�y>7ae� � aQa =5� 1�'° �� /,so`� �;r. AEC ME &���fwv 3 ' r N Ilh� EryScd `f /fj lSbp '+k? /�0� '•i Irc Cif{r ai eL7• t4 rmto,+►f��°' uK R*Y6 RhD w° as�.s %db :#ir wwc r v. Nsrn- DA�ei. CW0- Rrt� > aalb 4a TiA. 4D . a • �p S1Iau,�6! CL.tR �AtvE S [oafl�d Y°"` .'L7f�.;°�'' � tyt�; 8D '7 .� aJ9t- CLtA;AJ�✓ l'A GOw6 f ao/.7 dft A ` j' , Rcrt 01W t!aM�j�'A4><fR y'`,lE J 14A At CARS r'#Jl6f ✓� l A�'f � ,lard /S"D�' ��z /�� ,i? ' 1 a' i2.•. ).•'y A ­wd 3 ,, ' �uwlbt ' d 0 �P Cod'I �tC dell /�dC N 40D ,.t3 r -08,10- aszW♦W A)/.A LdoFE f ?on t 47D- ' 'I /?A k :," ;. ='P:�"` • nyIf�i Y' '�' t. ^.,• r���7,:". t�` ;y„�.:ii:( -i ”j "j. p-Appraisal B-Paid BiA Or RaC2ipt C-Canceled Check TOTALS •;7Qo � : 'a't s ?r PFt i'i';b`y''�•: ;>:s c t; r;_..i +`' "i Estimate P-Photo CR-Credit Card Receipt 0 Other x:;, ,%�;�`5' peprvsc. vq ` 7�7 8.19—97 ¢ / DEDUCTIBLE Hor land w�Phone No.:( . ) .{' AWperson who knowingly and with Intent to defraud any insurance company or other person flies an application for nnce SETTLEMENT • ;<$.?::.'' page.'; of ad,41atement of claim containing any mated Ii y false information, or conceals for the purpose of misleading, . rttl fact met rfa hereto conutdts a raudule k. . 560.213 pAl Rfirt G srs4nal Property Inventory Form Claim aim ! Number Unit JF= FA= ured See other side for frrsinwitons and example. Q Date . . a J- 3 aiifl tpreEeettYe Insured 1O, SG- of NC= -- _._ BP ��Afif Ro4�f (Carsi�o� Cay. B Claim , Code 93 ACV R9 RC Ded. CIL Limit MO=, Rep. TO BE COMPLETED BY INSURED = ' TO BE COMPLIETED BY CLAIM REPRESENTATIVE 2 3 a 5 6 7 B 9 10 11 t2 13 14 717o Ad [Wand Name Purchased hoar Date of Replacement Valuels % ustments Maximum BBeer�as C Descxiption of Property and or manta- Purchase Restoration Actual Tax Pic �To RVC•• Settlement Berr*fits Paid Quality SerfetlModel Number Obtalned From lion or Age Cost Cash ill eppftabb) Date 1.6 •Y- Value u ov S r3 35M V 9L xf A /?Dfw`J V VE o10r!' aj'coV S �` .#off 4: �o� �6� JLAdL 4A 4W6 l kn�DpE AIIR aria?;x AW" aW rbNs w- Josef`' 45b°— 40 Wi k. 1-Appraisal B Paid Bill or Receipt C-Canceled Check TOTALS 910, //t? , `" Estimate P Photo CR-Credit Card Receipt Q-Other ``' Y , • Depr./Disc. me and work Phone No.: 1 ?t'7 994¢ I DEDUCTIBLE y person who knowingly and with Jntent to defraud any Insurance company or other person files an application for Insurance o pr^ia Infnrmorinn is fn n n , A . Q� . $60.213 PA.f Prinled I asonal Property Inventory Farm al t JF= r , FA- Number r i coed: See other aide for fnsinretrons and example. (� -. Data aim FteQreserstaflw+a: insured oDpe �rstwvo,11. of Loss 3 /.Z S()_ . ; HC= BP= Cow. B t Claim xsm // l/ E� �e 1 k; ; ACV ®RC Dec. r CrL ` Umit Mtn= Rep TO BE COMPLETED BY INSURED TO 8E COMPLETED BY CLAIM REPRESENTATIVE 2 3 4 5 6 7 8 8 10 11 12 13 A Replacement Today's Maximum Actual R!C b. Mirl6rand Name purchased Docu- Date of Repair or Value) �, A i�ustments R!C Pai Benefits d Description of Property and or ments- Purchase Restoration Actual Tax Ric To R!C" Settlement Benefits Paid SerialiModel Number Obtained From lion or Age cost Cash u ov ill npplkabie) Date I cluantity LE -y- Value �w4NA�Gk$Nt .Si�oArD A/lA 19 f i 171a PXI*l`i l•a '. /u t 4N� PA WYt,9 `." t E f jD6L A!� � *a ,�oa7 # /Sb� 154 ArAlf fc S ! (C8Wrtej1 8CA x4i Ar(A 4AWJ J607;t CA E Ca1)3 $WCH low e ='' .t i.• a � N jA t�"D �u jat0 AA.it t �. o g �a�i f q g ,f ,lit �fs A$ty6i 7;', L Jbo da 9 MttE� f�,t t (FC �ui�1t�J 1d'.r< 01044 11, A11p Cb . � d'�r ��" lira/1�� � � ��� tlfu;a ifs' .r •, +,. t-Appraisal 8-Paid Bill or Receipt C-Canceled Check 754:p' U,t TOTALS �2 . -Estimate P-Photo CR-Credit Card Receipt O-Other i, ii ? � �' Depr.iDisc. i}ED +'�aril work Phone No.•( '�t? � 8d` ; 974f 1 tsCrtl3LE ; � ti y person who knowingly and with Intent to defraud any Insurance company ar other person les an application for insurance IN) ft n hrwa Infirm ry lon l tow rt ..- rti'. .-. a cl� •• ,•• Personal Property Inventory For _ S80�'.3 p^t �tited pu.s.A nl Claim �f: .,. +• � Claim Number Unit > - - —— JF J` ' FA= tnstn%* see,.00ar side for l�n,�sftxffans and example. Date uI+ `M,,.!!�@QBf I�Sff BdtS'z�J Insured — !"V�9�. -T.-' rJJbBt!f of Loss 3 3 r all a -r t t,., i � HC= 7. - 5 BP= { / �' N doo � sk.::�r; + - <�,�;.7't x;�`•- `(�. -a.,'.1•R. A—A 40 r Code %' ACV ®RC Ded. ' I.rr. CIL _.t Umtt ; _ . " ,.. R TO BE COMPLETED BY INSURED '=y. .'RCECOMPL'.EiD'B1C, :AINI REP�iE�SEM`A`f 1 2 3 4 5 6 7 8 9 10 11 12' 13 14 Item Replacement Today's Maximum Actual RIC No. Name Purchased gocar Date of Repay or Vah�J % Adiustmerds RIC Benefits Description of Property and or rrerda- Purchase Restoration Actual Tax R/C To R/C" Settlernertt Benerds Paid fifty WaVMMW N urrber Obtained From tion or Age Cost Cash m avpokmabbt Date Paid !e -Y• Value u ov Iwo ct".11 tA1 Al rA Ar T, ,-c baK �(A Y Joe? 46 400 x 74A btC 4614 rU Aff Ally CMG a. 160' 16A✓ }- _ t Aw cW, 1140 rT",b N(A 46 lSf. �� kwER- �4 IJ IA /66 d „_` !bo ."? I Jt9�wMt�►•t•tt aE',nAa°$�E.( ,r11 Y"' ;x.; �,f`—° '' 7,f`� .d` � ' 7 I d.aK NO W(,4 375- �° 1 C'ot aAC� CRoC� C'awb SAP w"J6 �9 ;_ /COQi /dah.L il !t ,,4r1t ad lAf N� y ,40I"`i 1So� ' Ise ri: 3: y� r ►a 1tr,T -baste V t;,r •is :t�! OJT: •z._ X,-. i i.,r;: i iR ..; S }• :Y.,i f4 r.s:f'r +. •G.,!. I 1'F..•4- y i'.'. Its ! `.,���+.• h�, vi=�,� -. 1(•{I .';�'i A-Appraise B-Paid gill or Receipt C-Canceled Check TOTALS E-Estimate P-Photo CR-Credit Card Receipt O-Other N,• a� Hoe and Work Phone No.:( 7 i� ) 8�.q-' 97G¢ . t ..Depr'/Disc. rn Any person who knovAngly and with intent to defraud any insurance company or other person files an application for insurance ement-of claim containina any noterialIg false als for the ourpow of isleadin information SETTLEMEfV1 'ersonal Property Inventory Form claim :r': ' s=,--.°; , ,<: a claim y F: seo•213 Pk 1 P►erceo m us.& Number ; :i. :' }y,ie{;r.. ritki?/-':1��tia r?t.i\ r',S T\_ -'r'� `.,;t� :��; t.;k' fir, $ unit b JF `= ,' FA- Date !. ; Is~ See other side for Instructions end exem�le j ; Insured ,(;��A ~` of ces _ �N , , •:.. Clalmif�i41esei t `5.. e>s FS! ,Hf - _LXvL� 1 / kXn/ `��^��joZ q 't LL ki, '_t F BP=HC= /+9I� $EARaaM ,. l: A)i. Ty Cw. 13 t ,s'�3 Y Q;!S'$r•�L��i$1�T". Claim Room a t ;a:Y. v- 9 ;-1'= t Cade 't`t EN ®RC Ded. :-� CIL Ijmft ;'. ,_ M0= ?=�'; 4,-. t Rep. ' -.�,• t. _ •5. TO BE COMPLETED BY INSURED �,3t >r COIiApli D`t3Y(�:11MkFj fiSld1'A ;• 1 2 3 4 5 6 7 8 9 10 11, - 12 13 14 Item Mfr/Brand Name No Ruchased Dear Dale of R� t OdRY's Adjustments Maxim= ewe Actual Description of Property � or manta- R d�ase Restoration Actual Tax RIC To RIC"' Settlement Benefits Pail Quantity Se WNbdel Number Obt*,ed From tion or Age Cost Cash to appftble) QMe Pak) " LE 'V' Value ' U ov j 8' ,wS Ck�i•+� ,J w u� Y�c Ada r , !v0 a LO L �T;' o 1DaD . . 141rV 64< 3 8,4WXf X04- it � j4b 4 8 iR -rivet" AI(4 D / Nit AIX Ae',W( &4-j f ►,j fjA � � Ara , gf p' . 9f % E :,J; :? +' Yg�Aw J Mw6ley BOY IJ !4 olbf! ( 6(,6CrwC At14cF A11/4 ,parr yes 450 j 38 pAOtOW 7V P,,ffS7.^i ! Nr DM++t►� ��4 �/# (A v& ot0 fi tie o11a �a� '�i bw ,5 Chu T}W� -ME"TVAM $6b /463"7 Q �3 l A44 :., . QM.. » M ` y I+ W,a(K-1M a(Er N(A �wEJ Y C doll !.� rl"Ew"- i VA Pf9 Appraisal B Paid f3i11 or R pt C- fleck °¢ ;. �° y�' S �t c.,. iY 5 ecei CanCded C TOTALS l 3bo 133 t 4" "S `i ' ;at%v y 6f Estimate P-Photo CR-Credit Card Receipt O-Other i r, ,� y, t��Y+� %. r •.�r ha, :;yz 'ss, it0t , and W rtc Phone No.:( 7!7 � epPT9— 97b� ! DEDUCTIBLE �R Disc. kqjperson who knowingly and with Intent to defraud any Insurance company or other person files an application for Insurance ;' ement of claim containing a material) false Informatlo or conceals for the purpose of misleading, information SETTLEMENT :�,' , .;�} Pa ::. :�_;, SM213 PA.1 4114, 2- Personal Property Inventory Form Clain' Urdt JF— FA X, NLinter inswea see oO*side for ksftxdbm and examp(a. Date I- bob Of LOSS SG HC-,�t-i Insured 1UP 1A C-oV. B, it Code Lkr AGV RC Ded. CIL Claim-"I Roor"%42!"k$ mo=�= 0 Rep. A ............... TO BE COMPLETED BY INSURED .............. 3 4 5 6 7 8 9 10 11 12 13 14 papkowneM Todays MWm^ Actud PJC ttem Mdarand Nwm Pxdw-qed Doow OWe Of Reor or Vakjw AdjcsWWS PJC Berefits No. DworWon of Rop" and or ffwfta- Purdme Redoration Actud Tax Ric To RIC Settlernet Berents Paw SaWMoW Modw Oftned From bon or Age C46! cash T oppketft) we plod -r VEOLve U ov OUR" LE 71 live r 14. V--t .101(1. 5`1 CAN ;4�A?( jaw IN "g .304� A) 4a 4-A-A A"J PAh4 Splhr JA Q,0MAV(,,&rw -2�; N _A9140 4 t JOT-9 -- yaomy 140 /Is .2w 11 10A. 4A 56 ?At?J ofe'sox0v tJfA b,44,&&dy O� P9U—%4f tj(A &JC- MAO tj tj[A SOW yda 180 PAI,;4 o�r PAI-11--s AAA 44 ANVY. % 30 PW 0(- 574-09 �j 6l khfi(j AWE J6131 PL PA A f Me 9001T AX, OA-1" PTWIK W(A 0. 43� A-Appraisal 8-Paid Bill or Recelpt C-C-an0ded CheCk TOTALS4%50 figya lt�,,tm Mpr. E-WiMtO P-Photo CR-CrWft Card Reoelpt 0-Other Dsc- EDUCTIBLE Home and work Phom No.: Any person who knowingly and with intent to defraud any Insurance company or other person files an epplication for Insurance NT or siaternent 0 clalm-c"InIna any rnatedallyfalse I of Conceals for the puqme of rnisleadingi, Information SETTLEME -a. ,4 L a f 'i SW219PA.1 Printed, arsenal Property inventory Form aul _> : Claim : Unit JIF= / >=A ured See other side for instruedons and example, _ r' Bats aim Represefrtettve: Corrpateteteii'st>ade+d areas. insureds 1, yam, of Loss 3` +1� SG= HCa BP ,y, „4 Coy, B Chaim �OT*nr�l1 "n �grtp,_ Coda: '` ` 'tom' ACV Zj RC Ded. -iLLL CIL T Limit M0= Rep. TO BE COMPLETED BY INSURED ?� TO B COMPLETED'BY CLAIM REPRESENTATIVE 2 3 d 5 6 7 S 9 10 1i 12 13 14 Repiacerrwl may' Actual RIC t4. t�A r/Bran d Name Purchased Docu- Date of Repair or Value! % Adjustments RII C nth Benefits Description of Property and or rnents- Purchase Restoration Actual Tax RtC To R1C'• Settlement Benefits Pa&I caua„t;ty Serial/Model Number Obtained From than or Age Cost Cash III applkablel Date F LE Y Value u ov i r P,4>tL of c�1n wtbbd p GAS All J39w oin r M04'Ud L07�fO RAJ r ,?fit• .r WIA V-to APO 1751- 34 3 3,p-€cE JU�rr NSA s aarl : a a.4ix� ,3 � y� �dtis-'•�{ ,�q1' `°"fwd t r' . 4 Ate W Sub% j a N I iRNfl CA N1A r`itfi YMIX o?8M 4OD� Mir ii :l r.� t•:- �.i:. I i, tr) 1-Appraisal B-Paid BID or Receipt C-Canceled Check TOTALS Lid , Estimate P-Photo CA-Credit Card Receipt O-Other pr. sc. h+ me and work Phone No.:( Z7 ) 9-2?- 9764- 1 DEDUCTIBLE , ra y person who knowingly and with Intent to defraud any Insurance company or other person fifes an application for Insurance 2 +;; „. It abOrVA Information Is tnin n . r ,_ n r- • 594.413 f"A-t RYitW rU.S.A. Personal Property Inventory Form claim �F ( FA� Number :r . Unit lmuMct See d"ker side for Instnic0ow end example. _ Date J-,, 3_3 42 }}'� n " g -t tqt t�q Stivei;�+^,.T�vN 1mt. t ±T •~; Insured ! Qf I= - SCa° a.�iLr�t' ` tic= _ i 13P q�� +k• Cov.B 4'. -,-:'i':• .. ''"13w. .t. Claim ;..•J•.�-'•,.;�i X• i. ~•• ;:-/_'t I t lXrt'�t 1�.'' - •;�.--i;'.yt �E Code ACV ®RC tad. c , ;': .1i� MO= h :. Y• Rep- ROOM TO BE COMPLETED BY INSURED c ,� ' }COIiAFt:B7ED:BY OP,ll `iFiEPRf±S` KTA`rjyLf' _ 5 6 7 8 9 :`10 11 12 13.• ,....1Actual c 1 3 d RI Item Today's Maximum No. MMBrand Name purftsed Doaw- pate of � Vahre/ % Adjustments R!C Benefits Description of property and or mernta- %thase Restoration Actual Tax �C TO HtC" Benefits pfd SeriaYM4dd f�miber Obtained From ton or Age Cost Cash of�'b'0l pate pod DMAY LE -r• Value i u ov y,,A J ;94D u l G11: yo. .1011 § , J90Dr' op J JtU '_l s OO(J 1 71 �'r A f s ~ iA �?� �Rl. WooDE,rJ �•flHt.A y '` slsi ="_ ''� ,'.:� ", ¢ t pjgi g&W6 pi JA JAMAICA 414-4 01A wA AAW ku , `my&X a&cN A11A � bit a�� j 0 WATC2.E`6>:► r4+J S err:.� 3 uti` a" 7dq : 57>rr <far!^ ' gate r t• 1 40 Tcps ,ten kloccw AIA r E aou ` l 4- t F 4rV3"f A Sf r r ,1slt_ oa 1: � t 1~ r ♦Y^ lT. .t•.V•�'v i�4'1 4 ,t,t.t"N. > :':�:a1 •i Tj :J�j�'i\'�`'i.•` •�.ii lg:�.. -riF A-ApprSfsaf i3•Paid$IiC or Receipt C-Cartceied Check ., , '}U fli;•E'--• #�,s':y {., ,. , t� f TOTALS lltb =r' ,a; .. r.IDtsc. E Otimate P-Photo CR-Credit Card Receipt O-Other ;,,,�:,'.=,:•- p 7 $any t:¢ ( DEDUCTIBLE .� ' a•:<•.: Horne arid Work Phone No.:{ } , Any person who knowingly and with Intent to defraud any insurance company or other person files an application for insurance ?;,�;f.�.:s.claim containing any e ! inforrt�tton SETTLEMENT i,•..:� . :'..�' SW�13PXI Pr"wdinU,S.A. Claim )ersonal Property Inventory Form Clalm FA Number urit JF no~ S"oftw side for lnsmxfons and exan*& Date mlima insured Of LOSS HC— sp kth&= i SG 2L lif Claim I INN i; mo�V-111110 �-Ilii t i�, H GV CDv. Room Code A RC Dad,4011 CIL Limit Rep. W A - A00-J.", . TO BE COMPLETED BY INSURED 2 3 4 5 6 7 8 9 10 11 12 13 14 Item p4pWouffwd Today's maxirmem Actual RIC Mftfflmld NWM Purchased D=J- Date of Repair or Value/ % Adjustn-L"s RIC BenqMs DescriplJon 01 Property MA or nwvla- Puntase pestorallon Actual Tax RIC To FVC Setoemeal S&Wfts Paid SaWModel Mmtw Obtdned Frorn tion or Age cost Cash of amkobbi Date Paid LFI -y- Value I u ov A F ,,,j - 01 WIV i(AW .70,;L 86:4 114 Pol- IfIA 15V Of r PA3AMAf A 0 Xi PW AJ JA AOX OW41 . At- 45v- 45-0- W! a IAZ.SL 14A ot, I'll Forbr 416COL S�� A) 06;x 1"i Act A' 'fib -lujVC61, abit- .9 06TT Wt4 f;,,6).t& loo 10b�' 4.6. .. 4 Svo .17 5. t S—Abbk PA A1(4 All All t4A /40 tw� 910-wi k/mLcr- AdA 30b7� L60 A.Me 4A Appraisal B-Paid SRI or Receipt C-CwWed Check R-0 ne. b TOTALS f"7fw I�j4F4;tlmate p-Photo CR-Qedit Card Reoelpt 0-Other ./Dsc. H&Wid WOM Phone No.:1 72 -VE-27" DEDUCTIBLE PA 5, Wh knowingly end with Intent to delreud any Insurance company or other person files an application for Insurance 10 2" claim containina any mterially, false Information..or conceals for the Pumose of ffdslesdniL Intmnation SETTLEMENT M Pace LA-L�cf t IN A I SM-213 PAA Rued t usaW Property Inventory Form Cl :; r Claim JF = l FA= + ,,_; . . . urea Sea other stile for tnatrucdona and exampla. jr Date �,�_�� aim F110"sol tive Ccxrlpteterell arses insured �� � of Loss SG= - WC= BP= ,---- 30m ° ` t�Cb&q`A Code = 't'R ACV RC Dad., ., CIL Urnit f3 MO- — R - TO BE COMPLETED BY INSURED TOPE COMPLETED BY CLAIM REPRESENTATIVE 2 3 4 5 6 7 9 9 10 tt 12 13 14 7tem Mt?iornn' Today's Maxlrrurm ActualRJC MirtBrarxi T3arre Purdtased t?oar CJa1e u1 tlatuel 9b Ad`lustm sls Rtc Berreirs Desalptlon of Property and a menta- Ruse Actual Tax WC To RiC" Settlement Benefits Palo { the SeriallModet M m trey Obtakred Fmm Wn or Age Cost case � u (11° a�► Date I ��yo N�R ai i1 `E Fr c& f Atau�s" .feu .' 3 5 PE P(A ci-.l Al(A tfnr aerl` ' S'sb y. 5aa' M' bit Stye l ✓ t - '"� c�faR1Lr�' ,t>rttt xrwE 35 >M1f a f r sum � 1 / �E'a y "�, �L � , �Nu 2 r�lH QO n!�/� 7ay3 u � ii, 1� '' ro } 3� 4 $oAAA 6Aft6f llA �, sRut '; jDa` Ab .y . ;4CID�+ yr WIA ;Olt ; . � - W~ A WA/A-< + o1p/1::21` sue' `4 S?Dff sD lQttrmo A/14 3�t>b9 err =A"'> k-Appraisal B-Paid Bit or Receipt C-Canceled Check y 13960 134sa''' �{• 'y'rt{'` r � '':'<::t' i'`; >: y -Estimate P-Photo CR-Credit Card Receipt O-Other TOTALS • : ••Vepr.lDisc. rrle and wait Phone No.:( 7 f DEDUCTIBLE ``: Intent o defraud her Verson fill es art a Ilcatlon for insurance 1r , ersonal Property Inventory Form Claim `��_°,-; :std`' "s "'' Claim: 56-213 PA.1 a�in us.ti Number; ,.i s.:�. �' i- ' .'' Unit .: JF FA° rsureck See other side for Instructions and example. Date _ n Insured DSO- t. �jt4looD .� of Loss SG= :t,:<,: t�:; HC= BP= a�m:ta + 1 . a - ® rnDM C ov. B t:•�.;y� ,'-y ii "'`.��'i•,'itiv !J,*. Claim r<<r Y:•!: F: �.'.�-.ri.,, 1L:':_ l�Z :2`... ,�� ,-<• loom Code ti ®ACV ®RC Ded. �. GL ';,@�~<•► lJrrrt =�f'• PEI MO- ..,:.:;c :, R� ,; -,.' • 't�:; TO BE COMPLETED BY INSURED 1 2 3 4 5 6 7 6 9 10 11 12 13 *14 Item PteplBOement Today's Maximum R/C No Mfr/Brand Name Purchased Docu. Date of Repair or Value/ % Adjustments R/C s Desaiptlon of Property and or manta- Purchase Restoration Actual Tex R/C To R/C'• Settlement Benefits Quantity SertatrModd Number Obtained From tion or Age Cast Cash or amemb,e► Date p -y- Value u ov T�+Nr�,w artD ""pu u udtr.01ft W.' Golf 08, gaao : . - N- / 10 7-trjrJW Lour �° S�n��EA" 7 ►w CA-[ aA �. .r Ito 4 l NI14 v� -0m aToN c,to ,S"a elk Es /� St�V',�•V ��•f' !^••�• � � Wr� �ti VVV n�h V ',1! ���i 4/r M� f3�aef r�(A I,V (E• �•� � 1���. � 's 1, fit. SO has. y, -;.;• /J .30 f�AN'cJ' AJ<►b IJ/A mR l� �.1! aj� ��'� �{,X''n °�� >l.',. (•+ �('(�, �I�d /IUtfl/lUr �j. �slr—i� /0y '� �d� i•srf'° t1� iP elf `{ 8 M S �t l� aocl'`. 13 0 Vi tjeRM S Ski V>�Airt 1 - o6il-'{ ��a= ' .7bli I¢ /►�Acyf Y �0j` � lao' ; last' ,i } IS F• SecK� �A E rd,s ' � •;}t) 'tl :.«: >>'t- �K..t. I•�7. � 'fi+'t.A`:',• .;,' • :l" H:.•. -..:ti. .•<, ..,. � j Appraisal S-Paid 810 or Recei C-Canceled Check /3 c ,, t?; �r-«. ,,:: ,, j?, :_ ?#• j fit,: 'i, -.- In V4 Estimate Estimate P-Photo CA-Credd Card Receipt O-Other TOTALS Sa I z,•ti ' �' Y��' i•t t *'>t, ., ::; - r _ t. >�';. fit:.7 is ;`,: ;1 t:. w ,...•,�. "per./f�sa- -igW and Work Phone No.:( 71-7 DEDUCTIBLE S,•,> Y-,4.. ,kNi Amon who knowingly and with Intent to detraud any Insurance company or other person(lies an application for Insurance mormati In SETTLEMENT , 'I``•-;::;'° pacm of 15W-2t9 PA i hti,t.d 1 nsffRal Property Inventory Form claim cam"t• �F FA .i Number :,'' Unit = ured: im ofher side for Insmrcdons and example. {� y Date aim lValeaetrtalire;. Oorrgsfete.ell:af deri:areas Insured ���- r 11j�+� of Loss SC= RC= BP= xxrt 1ED(�es�nn�s 3 Code =;,: Coy.f3 Claim ... ACV 99 RC Ded. CtL Unit Rep• 70 BE COMPLETED BY INSURED TO BE COMPLETED BY CLAIM REPRESEM AT111E 2 3 d 5 6 7 8 9 10 11 12 13 14 7em Today's Maxirnwn Actual R!C NltrO"Name Purchased Doan- Date of R e VakW % Adjustments r vc Benafls Dwaipfian of Property and or rnerrta- PtM#tase Restoration Actin Tars fUC To WG" Settlgrnent ft-efits Paid Quay rt + Serlavmodei Number Obtained From tion or Agee Cost VCash u Os nt�aote► Date I qV to 1� Sc�f 4 A nr+f~ I ad c ' to &Sot S Jon-t r•, ; ,tars— ;K a - ,� ;, • Cvfir S' Al Xn► Al `r,at rl 1A 116 ,xryt : Lcv 41r's�47 fin: Cods A v a /c7 n1 Stb Si 3pJceuj gar . + c,�'i I619 :•,,•t s iv 1-Appraisal B-Paid E91I or Receipt C-Canceled Check at ;;, ;; ; :: • ;; .ys:= -Esthnate P-FtVA0 CR-Credft Card Receipt 0-Other TOTALS •� i - me and Work Phone No.:{ 71 ) 7fa DEDUCTIBLE BrE y person who knowingly and with Intent to defraud any Insurance company or other person files an application for insurance A' e aoove Information is true 560Q13 PA./ PrMed In U.S.A. ersonal Property Inventory Form Nom;°';"%,,i': •ti: ;:at�f a Gaim .i; ` JF = FA= r:d. .z s =:,.'. Unit °,'... ;.., , oared: See other side for 1nSMXdans and example. ... ,L1 Date 3 /•2 _ �� HC- a•' fjP Insured aD 1 �Wo A f .,': ,,,,, :i:.1 = alrti;t@ pfesettiile3�Car!F�le[eap:sh!dedare o Loss •.. i� _ Claim Room- Cade b :' ®ACV ®RC [fed.�` ' �` ';" CIL ` ": Limit ,,:r.:i' < M0='+ _ Rep.TO-BE COMPLETED BY INSURED pgrx;'* TQ.� COFdP1EKEDBY.'CLAINII`RI�FiF.S1WNTA�;tV1:': t 2 3 4 5 6 7 8 9 10 11 12 13 Actual R/C hem Fieplacemarit Tay's Maxkm m Actual Her Purchased Dow- Date of R�or ustmertts RlC Bereffis ow of Ply and Name or manta- Purchase Restoration Actual Tax RIC T RIC" Settlement gig Paid Quantity SwWModel Number Obtained Fran tion or Age Cost Cash v u of amftw) Date Paid • u: - Value TitAW ;S n1,q 6R'�►A d 1 171 W AN Ga45 NX b ¢ l SAFE to` L4 TJ tj T,�r,9+r.rCfi' eto .� i 3'y 6t;o ;#: :•z IA �>,� � Berl ,. �o• �, �D _;., ,r Jbm IC (leots� 1 SbN Cof+-l�f tj �� 4 0'lov'' 4o yr 3 1 ,1 _4 i.rl ttstq s';r.;"+.s.:;r- 'a:fi•'E.iq. .,,.� r.. 1 pi:c`:F ^,) • � C-Canceled Check ' .�,,Appraisal Paid ill or Receipt TOTALS ° list Estimate P-Photo CR-Credit Card Receipt 0-Other peps/Disc. n) ' �a9- 97�¢ ! DEDUCTIBLE 'i'a"., .' r }ne and Wprk intone No.:(Z_ j =1 t + gtfp person who knowingly and with intent to defraud any Insurance company or other person files an application for Insurance or, Wemerwt of claim contalni any material) false informatio or conceals for the purpose of misleading, Information SETTLEMENT "t t ,a.;s.r f'a ^ r._ of '' :rsona! Property Inventory Form palm ' '=: :� •: ;• Claim Number •''�'� - Unit JF= FA 3 f ure& See other side for instructions and example. - it Date aim RBpreserlteti* ConvIett}:ali:al*ded am Insured 0 b / °A• of Loss 3 j-X47 SG= HC= , BP a nom i�81r5J C-,� arvItS Code 6 ACV @ RC Ded. CJL � Vmit B � MO-:' Rle�p. TO BE COMPLETED BY INSURED TO BE COMPLETED BY CLAIM REPRESENTATlvt 2 3 4 5 6 7 8 9 10 11 12 13 14 b. Mir/brand Name Replacement Today's Maximum Actual RJC Purdiased Docu- Date of Repair or Valuel % Adqustments WC Benefits Description of Property and or rnenta- Purchase Restoration Actual Tax R/C To R/C" Settlement B"tits Pald SerwModel Number Obtained From tlon or Age Cast Cash r'Wftab6) Date P. Quantity LE Velue U ov PA#SW �rSt• AFT •t�1 V /rGt/Ifihpfc Y" bra ado / Ch 0`1 4 Joo s,� Dcl�i1FJ pi[A Ila lap %x, Asp f J� (� rv_z WODAK CA'fA04 1 Q"IJ CAM 6M c ftar•! 'o1A't. I�S�' `i' 175' + Klb. >9(L�S10 ^Jl A �rult(C W�' oto11 's S�� : S1+p`z 10 ) %74 g '7 o Sig.`sA V�� 3L 1 ALOC J p0b (Lc KK"' dJ t•.N .20I0� 3L0°� :: JY,Or �` 4; 1•Appraisal B-Paid Bill or Receipt C-Canceled Check ALS :{ c-Estimate P-Photo CR-Credit Card Receipt O-Other TOT :, • Depr.JDisc. me and work Phone No.:( '�11 } Qd9- 916¢ / DEDUCTIBLE y person who knowingly and with Intent to defraud any Insurance company or other person flies an application for Insurance rf arwwA infnrrtmtinn is to w n A .. ... 580.213 PAA PrWed ?rsonal Property Inventory Form claim Claim Number ' unit JF= FA= ured See other side for lnstntedons and example. !� Date Insured r`W,Q�T of Loss SG= -` HC= BP— co,/RepresenmUve: Cuinptete.ali'stiadecf:areas; �� Tom J,15- 1rz/•V -0 OTKO- '' Eg ACV _ �•9" r Rep. � Code '°•{ `f �RC Dad. GL •�' lJmit M0= Rep. TO BE COMPLETED BY INSURED TO BE COMPLETED BY CLAIM REPRESENTATIVE 2 3 4 5 6 7 8 9 10 11 12 13 14 em Replacement Today's Maximum Actual R/C jo• M1rierand Name PurdmW Doan- Date of ROW or Value/ % Adjustments A/C Benetlts Description of Property and or manta- Purchase Restoration Actual Tax RIC To RIC.— Settlement Benefits Paid t]trantity SOWModef Number Obtained From tlon or Age COSt Cash 111 �) Date i L -r Value u oar / / t ��R S „� Knyf i!n► it tJ 6cid4ccIr 4im A� s $8 l! S EVATQW rl a4 �o (o dF�S M1 du rpoo¢_ 4 o± p.CH ;rJP1tdQ6 N{/4 �r��,+rfar rf �Sm'MK 7 ftocK GY�rt/p-f 1J to 60 REif :ft"t r • t-Appraisal B-Paid Bill or Receipt C-Canceled Check TOTALS //BSD 1 •� ':=:''i:: ' `'f::' `' Id!' ; -Estimate P-Photo CR-Credit Card Receipt O-Other 7/7 do3q— Q7L 1 '• - • •_�: _ fDepr./Disc. +rte and Work Phone No.: ( ) / DEDUCTIBLE ' 'Y Perean who knowingly and with intent to defraud any Insurance company or other person files an application for insurance ..nM•-� fit_"_........ .. 560.213 PA.1 rlhted ti '!rsonll Property Inventory Form Claim ,: ;. urali JF p • ' • FA- N11111581' ured "'N other side for fnshvcNons and example. j�, Date aim RAJAsetFft ye nt.cxriptetg ll�hgded ereAq; insured / 'ri 1- do A, OI L03S �'' -/'2 SG= HC= --__ BP= r `-"`„ / Cov. B *, Claire tom D•�f"`t ^1 C�vI Code�` ~" ' ®ACV RC Ded. GL Limit M0-. Rep. TO BE COMPLETED BY INSURED " ' TO BE COMPLETED BY CLAIM REPRESENTATIVE 2 3 4 5 6 7 8 9 10 11 12 13 14 em MlrlBrarxt Name Fteplaoernent Today's Adjustments MaxxiimLrm Benelb b. Purchased Doan Date of Repiair or V81ue/ 5'e Description of Property and or rnanta- Purchase Restoration Actual Tax RIC To RfC" Settlement Benefits Paid aent�Y SeriaVModel Number Obtained From lion or Age Cost Cash (11 Wftabfa) pate Pt LE -y- Value U oY S r�tt (!2MWT- lJ D GwD y uE aer1 r 0% �t( t 4 got 1 I�+AN 4116.r l�t IQ Gtr '°�►t-r: � 5., /f'N°rttlS�Atilt f ��9s`•i ►�als°`° V 1 t�l'<i s ^��� �+A.�w pa v[ �or3 '� T�,73�' •. 4¢rS SGbA a� , , iL Aj Iq jblatk, 53 CS �r` r!���A rwy►' R' _ /U�� �`3MMt' 6�r� go a S-k; (1 Snuff ' tj(4 0.6f rr•` 7 3 cwksS D4S r/� �jwE°.f ye'" E a l�� l�bd- }_ 3 RA�� �y�lnf N(A LOWED W Jort'4:1 E a;�. Gda I - SS-14APX' S7-,qq,4e- AJtl .j691Lr v elf a e- N�A 466W a :f... � •. E 4 3 ( a A 01 AWRT C W( a y.Y Jtta /n►Sc, P— µcl Rl l n 3a)� •+_ /d 00 1 Appraisal B-Paid Bill or Receipt C-Canceled Check '- r ;;• ': -Estimate P-Photo CR-Credit Card Receipt O-Other TOTALS •'. •Depr.lDisc. m r crf-2 9-974¢ ! DEDUCTIBLE e and Work Phone NO.: ( _ y person who knowingly and with intent to defraud any Insurance company or other person tiles an application for insurance v ehrn+n fnrnrmoHnn fe• n.o � .. trsonal Property Inventory Form Claim :;: Claim sec 213 P"., °`ti„° Number Unit JF FA t t tah3d Sae other side for Instructions and example. � Date film Ref»'e~latytative: Ccwmlgtwen.str� areas- irrsured I�� �- Ob� of Lass -!'� 5C= HC= BP_ Gov. B. Claim Code';'s=rte C'A ACV E RC Ded. - GL, ► Limit s M0= Rep TO BE COMPLETED BY INSURED ; 'TO BE COMPLETED BY CLAIM REPRESENTATIVE 2 3 d 5 6 7 8 9 10 11 12 13 14 Cn l R cement Today's mum Actual WC b. t�Brend Name Purchased pore- Date of Emir or Value/ % f Pic _ Description of Pt Ad'ustments 6eneras i qty and or manta- Purctaase Restoration Actual Tan PIC To R/C" Setifement Benefits Pak! Ouantity SerWMOW Number Obtained From t:on or Age Cost ti V� u pa appkaalet t�tfi P LEI�Y d 1 U Ea�Jurt tD lk' — a;1�� S"t �l ytal eta` : 42tfb°=' c ov MIX "j f f I� P aclt 130a� d � • _ t �s } t•APPraisal 8-Paid Bill or Receipt C-Canceled Check mss°` .� '• r t ski`- r,'' :';;; t.^.: * ; ltd : 'Estimate P Photo CR-Credit Card Receipt 0-Other TOTALS =�;''R' `:}• ,;:.._ , a•_::p' '. me and wont Phone No.:{ 717 } _c�1'e19� ?174 f . J DEDUCTIBLE ' ' Y PO men who knowitr and with intent to defraud an insurance co n1 � 9iY y company or other person files an application for Insurance statement of claim containing any materfail false Information or conceals for a I-,.r''r' 0 _ SCOTT L:•GRENOBLE, r L)a - LAW OFFICES. . . Oi7)a54086 Y sgiiriobli @Wu ori davis.c6m Noverlibei 1, 2012 . .,�: = • ,Y. r. '. VIA PiRST CLASS•and CERTIFIBD'MAIL; Ttodger'Atwood. : • �. _ - ;`' ,;. ; -Inmate No.'12-M0J W, Adams County'Prisan= '45 Major Bel: Lanz Gettysbilig,'PA•-17325 .- • f . `RE: Stafe Farm,Claim l�umber:49-OVb6-662. ' "State,Farm Insured:' Rodger Atwood 16ate of Loss:' ` Mauch 3;2012 :I)ear:Mr."Atwood:- .. , ': - ,. �; ' .. `. _ �t' •• - • .. • , ,amiiiation.Llilder.•• '. . By letter, 2b, 201..,'I advised that State Fait is requesting, you'appear for ari Ex . Qath. Our records confin-n Ahat you Ireceived that corre§pondence on or about June 27,2012 •As bf this date;'• we have;'not received ;a'response.< As such; I have proceeded .i o, coordinate'ae,.schedilling of yoii;:. Examination-Undei-0ath. 'It'will>take'place'ai,ihe;Adams County. Prison on December 4.2012; at 900 o'clock A.M:•:If you;would like,to have'your attorney present;plea§e•coordinate•same. I would also ask"that you•,have,your;counsel•,contact:hie regarding,•this.•issue:•'''Otherwise,, I look�forwai-d':to:seeing:you ;on ,December 4,2012,at 9i00tk A1VI: ' -State Fair&coritiilues tgxeseive-all of its rights.aiid defenses under.'th6 terms.of ttie policy aqd,applicable v ery,1T!dy yon, , •: t _... SCE GRE OBLI"s :, ''> ✓' .. . :.,' . . Ted Marzaru -via email " ' .1 •. , '� • �-;' • : -•�. ::•. . .• " ; ,• •, .•,�.: • ', , -B-, EXHIBIT< t. P.O.Box 49,525 SOUS[i 1;ICFITEfS'1 REE'C,L:FBANON,PA 17g4 r Pilo'NE{717)274�i42i-/Fnx(?i7}174-1752 . �• buzgondavis.com 1§grenoble @b uzgonclavis.coin r ' ;`� LA U _- : r ',�' . ,- 1 • -` • ,,1. ,. ', t.- - • r .. f - •.'. ^ '.• .1, , 1 •1'y':: •' .' 4.J., -scoTTL-GIt`ENOBLE. ... , . �v o�Fac s n�t�:.c��)454.6805: sgrenoble @buzgondivis_com' December.10,2412 Rodger-Atwood Inmate No,'12-M0845 - -Adams,Count3' Prison • . 45 Major Bell Lane , Gettysburg;PA 17325 .- RE: State Facni''Claim'Number.:'38=(3V66-662 State Farm insured:.. "Rodger-Atwood Date of L''oss: March 3;2012' Dear Mr.Atwooa-: < Tliank.you;for your correspondence ofbD cembq 4,2012 regaidm' ;the'clairn'for-ALE: I will•fOrvvard same • :_ ' to State.Farm: - ' In the.plearitimp, in-an effort:to,follow up witli respect to some of the personal property items,:enclosed" please find authorizations for-.your•review. and"signature. Please"return',these.'affidavits in the•.enclosed envelope;and:1 will,fgrwaid them to the various-retailtis. "I will-.provide'copies'-of'any.responses that^I - receive. . ' 1 'In the nipantime,if you have any questions,please feel free to contact nie. ' .' • .Ve ry trul ours•' - '. . .' �• •. r' .. `- . �• ' •' •, ', -' .Y•Y SC O L.'G LE ' - ' .�. SL•G lake • ' - . ". . - . •- . ,-�- .. ', ' - , •... . - • `• • . . Enclosure , A,• i.. • ` -' , •, ,.• • •- .• •+ � .'• ..•; -' •. '.'•:• -, ' •• - • • 1'r - •.'_. . • •' •, •- •• EXHIBIT 'I ; P.O:Box 49�5?5 SOV'cx EtGT�rH 51'x881',LEBANON,PA i7o42 ' _ +J PTAQNE(717)274-1421'/FAX(717)•274-1752 buzgondavis,coin•%sgrenoble @buzgondavis.coin ; S1' L 4 ,GLJ1 � AUTHORIZATION FOR RELEASE OF SALES RECORDS NAME OF OWNER: S.S. # NAME OF RETAILER: Value City Furniture . ADDRESS OF RETAILER: 5047 Jonestown Road Harrisburg,PA 17112 To Whom It May Concern: This will authorize you to release to the law firm of BUZGON DAVIS LAW OFFICES, any and all sales records from to ' including, but not limited to, all receipts, records of purchases, contracts, bookkeeping entries, account summaries or statements, bills, invoices, orders, purchase orders, bills of lading, accounting information, and/or all documents which reflect, refer or relate to any purchase made by the above named individual from Value City Furniture. I am the person referred to in this authorization, or, if not that person, my name, relationship to that person and authority to grant this authorization are as follows: A photostatic copy of this authorization shall be considered as effective and valid as the original. Date Printed Name Signature State faTIIne Providing Insurance artd Financial Services Home Office,Bloomington,lirmais 61710 December 12, 2012 Sbde Farrn RODGER ATWOOD- Prnn*mFrecieft INMATE NUMBER 43897 POBooc106110 DAUPHIN COUNTY PRISON AiantaGA300486110 501 MALL RD HARRISBURG PA 17111 CERTIFIED MAIL—RETURN RECEIPT REQUESTED PERSONAL AND CONFIDENTIAL RE: Claim Number: 38-OV66-662 Our Insured: Rodger Atwood Date of Loss: March 31,2012 Dear Mr. Atwood: We have received your request regarding Additional Living Expenses. There is a question as to whether this company is obligated to indemnify you'or anyone claiming damages under the Homeowners policy applying to a loss which occurred on March 31, 2012, at 740 Pine Hill Road, Duncannon, PA 17020-9919 because: • There is a question as to whether an insured as defined in the policy, resided in the designated residence premises at the time of the loss. • There is a question as to whether there has been an accidental direct physical loss to . the property described in Coverage A—Dwelling, and Coverage B- Personal Property. • There is a question whether you or any person under the policy caused or procured a loss to property under this policy for the purpose of obtaining insurance benefits. For this reason(s) and for other good and valid reasons, which may become known, you are hereby notified that any action taken by State Farm Fire and Casualty Company or its authorized representatives to investigate the cause of loss, determine the amount of loss or damage, or attempt to adjust any claim arising out of the alleged loss shall not waive any of the . terms or conditions of the policy of insurance described above, nor shall such action waive any of your rights under the policy. If we do not hear from you to the contrary,we will assume that it is acceptable for us to continue handling the case on these term. The Company does not intend, by#his letter,to vraive any policy defense in addition to those stated above, but specifically reserves its right to assert such additional policy defenses at any time. EXHIBIT J RODGER ATWOOD 3"V66-662 Page 2 If you do not understand any part of this letter, please let us know. Please contact Mr. Nagy or Mr. Marzani if you have any questions or concerns. Sincerely, eff M re Cam/ CI T Ma ager 800-406-8543 Extension 2 2408 CC: Claim Representative—Dan Nagy 800-406-8543 Extension 2002334 Claim Representative-Ted Marzani Scott Grenoble, Esquire 281756/1071833 Providing Insurance and Financial Services },�{,p Home Qlfioe,Bloomington,IL late w January 22, 2013 Rodger T Atwood State Farm Claims 740 Pine Hill Rd PO Box 106131 Duncannon PA 1 7020-91 1 9 Atlanta GA 30348-6131 RE: Claim Number. 38-OV66-662 Policy Number: 38BYF9295 Date of Loss: March 31, 2012 Dear Rodger T Atwood: The Pennsylvania Unfair Claims Practices Act requires we inform you within 30 days of receipt of your claim (and every 45 days thereafter)why your claim has not been finalized. Your claim is currently pending due to the following reason(s): -Claim investigation is continuing. If you have questions or need assistance, please call us at(610) 212-3338. Sincerely, Ted Marzani SIU Investigator (610)212-3338 Fax: . (888)713-4693 State Farm Fire and Casualty Company EXHIBIT R �_► � G t G1:l � � LEE E. ULLMAN, ESQUIRE Attorneys for Defendant State Farm BARBARA E BROCKMAN, ESQUIRE Attorney ID Nos. 42428159147 FORRY ULLMAN 540 Court Street PO Box 542 Reading, PA 19603 610.777.5700 / FAX 610.777.2499 RODGER T. ATWOOD, II, IN THE COURT OF COMMON PLEAS Plaintiff OF CUMBERLAND COUNTY, PA VS . CIVIL ACTION - LAW STATE FARM FIRE AND CASUALTY No. 13-1154 COMPANY, Defendant CERTIFICATION OF SERVICE I, LEE E. ULLMAN, ESQUIRE, the undersigned, hereby certify that on April 23, 2013, a true and correct copy of State Farm Fire and Casualty Company' s Praecipe to File Notice of Removal with the Cumberland County Prothonotary, was served upon the Pro Se Plaintiff, by mailing the same to Plaintiff, via United States First Class Mail, postage prepaid, addressed as follows: Rodger T. Atwood, II ACPN: 12-M0845 45 Major Bell Lane Gettysburg, PA 17325 A.C.A.C.C. I understand that the statements herein are made subject to the penalties of 18 Pa. C.S.A. §4904 , relating to unsworn falsification to authorities . FORRY---ULZMAN Dated: 04/23/13 By: - LEE E. ULLMAN, ESQUIRE Attorneys for Defendant