WIXLIB

----------- - --- - -------------I hsued by The Stock Insurance Company IPolicy NumberSI!SELECTIVE INSURANCE COMPANY OF AMERICA40 WANTAGE AVE, BRANCHVILLE1 NJ 07890COMMERCIAL POLICY COMMON DECLARATIONNamed Insured and AddressPolicy Periodli'rom:To:A FAKE COMPANY12:01 A.M. Standard Time AtLocaUon of Designated Premises.Producer Number:00-13103-00000!Named Insured 1s:CORPORATI ONProducer;DEHAYES GROUPINDIANA!I§.IISchedule of CoverageICOMMERCIAL PROPERTY COVERAGECOMMERCIAL GENERAL LIABILITY COVERAGECOMMERCIAL AUTOMOBILE COVERAGECOMMERCIAL INLAND MARINE COVERAGECOMMERCIAL UMBRELLA COVERAGECOMMERCIAL ABUSE OR MOLESTATION COVGCOMMERCIAL CRIME COVERAGESOCIAL SERVICESIIIIIIIiPREMIUM INCLUDESPREMIUM INCLUDESPAYMENT METHODDl'B - 10Date Issued: 2.,630,00 739.00Total Policy Premium ---*1 '""'"(This premium may be subject to adjustment.)Issuing Office:HEARTLAND REGIONI L-702S (11/89)TERRORISM - CERTIFIED ACTSTERRORISM - AUTOAuthorb;ed RepresentativeINSURID'S COPY

SELECTIVE INSURANCEBRANCHVILLE, NEH JERSEY 07890DIRECT BILL 1 PAYMENT HILL BE BILLED AS FOLLOWS1SCHEDULED BILL DATESCHEDULED DUE DATEIIPOLICYSCHEDULEISSUE DATEBILL ACCOUNT1 380 023 773PREMIUM AMOUNTS03.04,05.06.07,08,li!!!!!i.TOTAL!1111!THIS IS NOT A BILL,Your bill will be sent under separate cover. This is a Payment Schedule of your policypremium due based on your selected installment plan. Changes made to the policy premiumafter the issue date listed above, will be reflected on future bills,An installment fee of 8.00 may be added to each installment bill. Policies not paidby the installment due date may be subject to a late fee of 20.00 for each latepayment. An insufficient fund fee of 20.00 will be charged for payments returned byyour financial institution.A reinstatement fee may be incurred when a policy is reinstated after anon-pay cancellation is processed, Fee amounts are generally 35 forcommercial line policies and will appear on the next bill,MIS(:.tSlll (02/te)INSURED'S COPY

sSCHEDULE OF LOCATIONSI Schedule Effective Date;Policy Effective Date:Prem.No.lPolicy El'2 GARAGES131VACANT LAND!I- 14lOFFICE 15lHOME161VACANT LAND17lOFFICE181VACANT LAND19lVACANT LAND201HOME211OFFICE221HOME231HOME241HOMEI-.;;a; - IL-7036 (01/93)INSURED'S COPY"'I';Ii;§IiI'I

sPolicy Number" I'SCHEDULE OF LOCATIONSJ Schedule Effective Date:Policy Effective RENTAL28l291OFFICEREC 1REC 2REC 36 (01/93)J:NSURED'S COPY--'-III

SPolicy NumberCOMMERCIAL POLICY FORMS AND ENDORSEMENT SCHEDULEPolicy Elfective Date:I Schedule Effective Date;THE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMON COVERAGE PART IL 70 25 1189 COMMERCIAL POLICY COMMON DECLARATIONIL 70 36 0193 SCHEDULE OF LOCATIONSIL 00 03 0908 CALCULATION OF PREMIUMIL 00 17 1198 COMMON POLICY CONDITIONSIL 00 21 0908 NUCLEAR ENERGY LIABILITY EXCLUSIONIL 79 15 0117 IDENTITY RECOVERY COVERAGEIL 89 48 0818 EXCLUSION-LEAD HAZARDIL 89 56 0818 ASBESTOS EXCLUSIONIii!- !!!- siiiTHE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL PROPERTY COVERAGE PART:CP 70 26 0617 COMMERCIAL PROP DECCP 00 10 1012 BUILDING & PERSONAL PROPERTY COVERAGE FMCP 00 30 1012 BUSINESS INCOME COVERAGE CWEX EXP)CP 00 90 0788 COMMERCIAL PROPERTY CONDITIONSCP 01 40 0706 EXCL OF LOSS DUE TO VIRUS OR BACTERIACP 01 52 0796 INDIANA CHANGES-RIGHTS OF RECOVERYCP 04 ll 0917 PROTECTIVE SAFEGUARDSCP 10 30 0917 CAUSES OF LOSS-SPECIAL FORMCP 12 18 1012 LOSS PAYABLE PROVISIONSCP 15 32 0607 CIVIL AUTHORITY CHANGECS)CP 75 51 0511 SYSTEMS POWER PACCP 76 11 1011 GREENPAC ENHANCEMENT ENDORSEMENTCP 76 13 0513 CRISIS RESPONSE COVERAGECP 76 23 1011 COMMERCIAL PROP MORTOAOE HOLDERS SCHEDCP 76 30 0116 ELITEPAC PROPERTY EXT ENDCP 76 50 0116 SOCIAL SERVICE ELITEPAC PROP EXT ENDCP 76 51 0116 ELITEPAC SCHEDULE - SOCIAL SERVICECP 76 60 0116 BI ACTUAL LOSS SUST - 12 MONTH LIMIT ENDCP 76 64 0116 ACCOUNTS RECEIVABLE COVERAGE ENDORSEMENTCP 76 67 0116 ELECTRONIC INFORMATION SYSTEMS COVER ENDCP 76 68 0116 FINE ARTS COVERAGE ENDORSEMENTCP 76 69 0116 INSTALLATION PROPERTY COVERAGE ENDCP 76 70 0116 MOBILE EQUIPMENT COVERAGE ENDCP 76 71 0116 PERSONAL EFFECTS COVERAGE ENDCP 76 72 0116 PROPERTY IN TRANSIT COVERAGE ENDCP 76 73 0116 SALESPERSONS SAMPLES COVERAGE ENDCP 76 74 0116 TOOLS AND EQUIPMENT COVERAGE ENDCP 76 75 0116 VALUABLE PAPERS COVERAGE ENDIL 01 56 1117 INDIANA CHANGES-CONCEALMENT,MISREPRESENTIL 01 92 0702 INDIANA CHANGES-POLLUTIONIL 02 72 0907 INDIANA CHANGES-CANC AND NONRENEWALIL 09 52 0115 CAP ON LOSS FROM CERT ACTS OF TERRORISMIL 09 85A 0115 DISCL PURSUANT TO TERR RISK INS ACTTHE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL GENERAL LIABILITY COVERAGE PART1CG 70 35 0690 COMMERCIAL LIABILITY COVG DECLARATIONCG 00 01 0413 CGL COV FORM (OCCURRENCE)CG 04 35 1207 EMPLOYEE BENEFITS LIAB COVERAGECG 21 06 0514 EXCL ACCESS DISCL CONF PERS INF-WILIM BICG 21 47 1207 EMPLOYMENT-RELATED PRACTICES EXCLCG 21 57 0413 EXCLUSION - COUNSELING SERVICESCO Zl 67 1204 FUNGI OR BACTERIA EXCLUSIONCG 21 70 0115 CAP ON LOSSES FROM CERT ACTS OF TERRORAU the forms and endorsements contalned in this policy as of the "Schedule EffectiveNOTICE TO POLICYHOLDER:Date" are listed above. Forms and endorsements added to the pollcy after this date wtll appear on a "Policy Changes" endorse ment. Please read your potiey and all "Polley Changes" carefully.NOTE; All appllcable "IL" endorsements will be attached in the Common Section of the policy.IL-703S (08/93)INSURED'S COPYI,· II, III

SPolicy NumberCOMMERCIAL POLICY FORMS AND ENDORSEMENT SCHEDULEI Schedule Elfective Date:Date:THE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL GENERAL LIABILITY COVERAGE PART1CG 22 30 0798 EXCLUSION-CORPORAL PUNISHMENTCG 22 40 0196 EXCL-MED PAY TO CHILDREN CDAY CARE CTRS CO 22 44A 0413 EXCLUSION-HEALTH OR COSMETICS SVS.CG 22 52 1093 EXCL-MEDICAL PAYMENTS-INMATESCO 22 71 0413 COLLEGES OR SCHOOLS (LIMITED FORM)CO 24 28A 0208 IN CHANGES-AMEND OF DEF OF POLLUTANTSCO 25 04 0509 DESIGNATED LOCATIONCS) GENERAL AGO LIMITCG 73 00 0119 ELITEPAC OL EXT ENDCO 73 10 0116 SOCIAL SERVICES ELITEPAC OL EXT ENDCO 79 35A 0708 PRODUCT RECALL EXPENSE COV ENDTCO 79 88 0119 CONT INSTALL SERV REPAIR ELITEPAC OL EXTCO 79 95 0418 DATA COMPROMISE COVERAGECO 79 97 1116 GENERAL AGGREGATE LIMIT PER PROJECTCO 80 29 0610 ABUSE OR MOLESTATION LIAB COV EXCLIL 01 17 1210 INDIANA CHANGES-WORKERS COMP EXCLUSIONIL 01 58 0908 INDIANA CHANGESIL 02 72 0907 INDIANA CHANOES-CANC AND NONRENEWALIL 09 85A 0115 DISCL PURSUANT TO TERR RISK INS ACTIN 05 81 0216 ERISK HUB IMPORTANT NOTICEPolicy EffectiveIi iiiTHE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THEBUSINESS AUTOMOBILE COVERAGE PART1CA 70 57 0292 AUTO DEC -LOSS PAYEECA 70 58 0292 BUSINESS AUTO COVERAGE DECLARATION PAOE2CA 00 01 1013 BUSINESS AUTO COVERAGE FORMCA 01 19 1013 INDIANA CHANGESCA 04 33 1013 IN CHGS- POLLUTION EXCLCA 04 34 1013 IN CHANGES-AMEND DEF OF POLLUTANTSCA 04 42 1013 EXCL FED EMPLOYEES USING AUTO IN GOV BUSCA 20 01 1013 ADDL INSURED LESSORCA 20 18 1013 PROFESSIONAL SERVICES NOT COVEREDCA 20 54 1013 EMPLOYEE HIRED AUTOSCA 24 02 1013 PUBLIC TRANSPORTATION AUTOSCA 70 38 0818 PHYSICAL DAMAGE COVERAGECA 77 74 0706 LIMITED MOBILE EQUIPMENT COVERAGECA 78 09 1117 ELITEPAC COMMERCIAL AUTO EXT ENDCA 78 13 0116 SOCIAL SERVICES ELITEPAC AUTO EXT ENDCA 78 22 0116 COMM AUTO ELITEPAC SCH - SOCIAL SERVICESCA 80 23 0610 ABUSE OR MOLESTATION LIAB COV EXCLCA 89 14A 0818 NAMED DRIVER EXCLUSION - INDIANACA 99 03 1013 AUTO MEDICAL PAYMENTS COVERAGECA 99 44 1013 LOSS PAYABLE CLAUSEIL 01 17 1210 INDIANA CHANGES-WORKERS COMP EXCLUSIONIL 01 56 1117 INDIANA CHANOES-CONCEALMENT,MISREPRESENTIL 01 58 0908 INDIANA CHANGESIL 02 72 0907 INDIANA CHANGES-CANC AND NONRENEWALSA 21 44 0818 INDIANA UNINSURED MOTORISTS COVERAGESA 31 16 0818 INDIANA UNDERINSURED MOTORISTS COVERAGETHE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL INLAND MARINE COVERAGE PART CM 70 71 0794 COMMERCIAL INLAND MARINE DECLARATIONSCM 71 00 0310 ELECTRONIC INFORMATION SYSTEMS SUPPL DECCM 00 01 0904 COMMERCIAL IM CONDITIONSCM 01 39 0900 INDIANA CHANGES - RIGHT OF RECOVERYNOTICE TO POLICYHOLDER:All the forms and endorsements contained in this policy as of the "Schedule EffectiveDate" are listed above. Forms and endorsements added to the policy af\er this date will appear on a "Policy Changes" endorse ment. Please read your policy and all "Policy Changes" caret\Jlly.NOTE: All applicable "IL" endonements will be attached in the Common Section of the policy.IL-703S (08/93)JNSURED'S COPY

Policy NumberCOMMERCIAL POLICY FORMS AND ENDORSEMENT SCHEDULEPolicy Eft'ective Date:I Schedule Effective Date:THE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL INLAND MARINE COVERAOE PART1CM 71 01 0310 ELECTRONIC INFO SYS COVERAGE FORMCM 72 00 0112 LIBERALIZATIONIL 01 56 1117 INDIANA CHANOES-CONCEALMENT,MISREPRESENTIL 02 72 0907 INDIANA CHANGES-CANC AND NONRENEWALIL 09 52 0115 CAP ON LOSS FROM CERT ACTS OF TERRORISMIL 09 85A 0115 DISCL PURSUANT TO TERR RISK INS ACTIi-!!!!!!!!!I!!!!!! .-- !!!!!!!!!!!! THE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL UMBRELLA COVERAGE PART:ex oo 03A 0199 COMMERCIAL EXCESS/UMBRELLA DECCXL 40403 COMMERCIAL UMBRELLA LIAB COVGCXL 171099 ASBESTOS EXCLUSIONCXL 280403 CORPORAL PUNISHMENT EXCLUSIONCXL 63A 0199 PROPERTY OF OTHERS EXCLUSIONCXL 1190403 WATERCRAFT LIABILITY LIMITATIONCXL 1320403 PERSONAL & ADVERTISING INJURY LIABCXL 2110403 EMPLOYEE BENEFITS LIABILITY LIMITATIONCXL 3180403 EXCLUSION - LEAD HAZARDCXL 3260403 INUIANA CHANGES-CANC AND NONRENEWALCXL 338B 0804 SCHEDULED POLICY FOLLOWING FORM-LIAB COVCXL 3830702 FUNGI OR BACTERIA EXCLUSIONCXL 3880115 CAP ON LOSSES FROM CERT ACTS OF TERRCXL 4000403 NUCLEAR ENERGY LIABILITY EXCLUSION ENDCXL 4520612 ABUSE OR MOLESTATION FOLLOWING-FORM LIABCXL 4530413 EXCL-EMPLOYMENT PRACTICES LIABILITYCXL 459A 1014 IN CHANGES-AMEND OF DEF OF POLLUTANTSCXL 460IN 1114 NAMED DRIVER EXCLUSIONCXL 4621115 COMMERCIAL UMBRELLA LIABILITYIL 09 85A 0115 DISCL PURSUANT TO TERR RISK INS ACTTHE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THEABUSE OR MOLESTATION COVERAGE PART,AM 00 07 0610 ABUSE OR MOLESTATION OCCUR LIAB COV DECAM 00 01 0610 ABUSE OR MOLESTATION LIAB COV PARTAM 00 02 0610 INNOCENT EMPLOYEE VOLUNTEERAM 00 31 0115 CAP ON LOSSES FROM CERT ACTS OF TRSMAM 00 37 0519 ADDL INSURED - AUTOMATIC STATUSIL 09 85A 0115 DISCL PURSUANT TO TERR RISK INS ACTIL 70 76 0115 IN CHANGES - CANC AND NONRENEMALTHE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL CRIME FIDELITY COVERAGE PART1CR 70 26 0292 COMMERCIAL CRIME COVERAGE DECLARATIONCR 00 21 0506 COMMERCIAL CRIME COVERAGE FORMCR 01 54 0702 INDIANA CHANGES-RIGHTS OF RECOVERYCR 02 36 0702 INDIANA CHANGESCR 70 36 0116 ERISA INFLATION GUARD ENDORSEMENTCR 79 13 0109 COMPUTER FRAUD ADDITIONAL EXCLCR 79 31 0116 SOCIAL SERVICE CRIME ELITEPAC ENDIL 02 72 0907 INDIANA CHANGES-CANC AND NONRENEWALIL 09 35 0702 EXCL OF CERTAIN COMPUTER-RELATED LOSSESSCR 25 47 0917 U,S,DEPT OF LABOR-ERISA PLAN COVERAGETHE FOLLOWING FORMS AND ENDORSEMENTS ARE APPLICABLE TO THECOMMERCIAL SOCIAL SERVICE COVERAGE PART1SS 00 01 0312 PROFESSIONAL LIABILITY DECNOTICE TO POLICYHOLDER:All the forms and endorsements contained in this policy as or the "Schedule EffectiveDate" are listed above. Forms and endorsements added to the policy after this date wilt appear on a "Policy Changes" endorse·ment. Please read your policy and all "Policy Changes" carefully.NOTE; All applicable "IL" endorsements will be attached in the Common Section of'the policy.IL-7035 (08/93)INSURED'S COPYI1,IIIIII