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1ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235Insured:Property:John Smith1234 Avenue DWapakoneta, OH 45895Claim Rep.:CSI Representative John SmithEstimator:CSI Representative John SmithReference:Company:Business:Price List:Estimate:(555) 123-4567Business:(456) 555-1234ABC Insurance789 Smith DriveDallas, TX 75231Claim Number: 012-0004792-2012Date Contacted:Date of Loss:Date Inspected:Home:Policy Number: 12345678907/10/20126/29/20127/16/2012OHPO7X --Date Received:Date Entered:Type of Loss: Wind Damage7/10/20127/19/2012

2ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235M&G-TRIPLETT-------Loc 1 Bldg 1 Roof9236.73 Surface Area558.64 Total Perimeter Length193.00 Total Hip LengthDESCRIPTIONQUANTITYUNIT COST92.37 Number of Squares110.64 Total Ridge LengthRCVDEPREC.ADDITIONAL LAYERS OF SHINGLES MUST BE VERIFIED TO BE CONSIDERED FOR A SUPPLEMENT,1. Remove Laminated - comp. shingle33.69 SQ42.651,436.88 0.00 rfg. - w/ felt2. Laminated - comp. shingle rfg. - w/39.00 SQ175.086,828.12 3,641.66 felt3. R&R Ridge cap - composition153.00 LF4.71720.63 272.54 shingles4. Remove 3 tab - 20 yr. - composition7.58 SQ41.59315.25 0.00 shingle roofing - incl. felt5. 3 tab - 20 yr. - composition shingle7.67 SQ150.301,152.80 806.96 roofing - incl. felt6. Aluminum coating - without fiber5,110.00 SF0.442,248.40 1,606.00 7. Drip edge281.00 LF1.32370.92 169.56 8. Remove Additional charge for high92.37 SQ4.15383.34(0.00)roof (2 stories or greater)9. Additional charge for high roof (292.37 SQ9.90914.46(0.00)stories or greater)10. Roof vent - turtle type - Metal11.00 EA34.58380.38 173.89 11. Flashing - pipe jack1.00 EA22.8522.85 10.45 12. Chimney flashing - average (32" x2.00 EA203.94407.88 186.46 36")The items actually being flashed are two large roof ornamental pieces.Totals: Loc 1 Bldg 1 ,314.39Loc 1 Front ElevationDESCRIPTION13. Soffit, fascia & gutter - MinimumchargeAllows for soffit and fascia.Totals: Loc 1 Front ElevationM&G-TRIPLETT--------QUANTITYUNIT COSTRCVDEPREC.ACV1.00 Page: 2

3ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235SKETCH2Main LevelLoc 2 Bldg 1 Roof3936.38 Surface Area250.96 Total Perimeter LengthDESCRIPTIONQUANTITY39.36 Number of Squares62.50 Total Ridge LengthUNIT COSTRCVDEPREC.ACV14. Remove 3 tab - 25 yr. 39.36 SQ41.59composition shingle roofing - incl. felt15. 3 tab - 25 yr. - composition shingle39.67 SQ161.89roofing - incl. felt16. Remove Additional charge for39.36 SQ4.15high roof (2 stories or greater)17. Additional charge for high roof (239.36 SQ9.90stories or greater)18. R&R Continuous ridge vent 50.00 LF6.17aluminum19. R&R Flashing - pipe jack3.00 EA28.3720. Temporary Repair1.00 EA10.00Mr. Triplett paid there maintenance man an hourly wage to repair the roof.1,636.98 0.00 1,636.986,422.18 4,110.20 2,311.98163.34(0.00)163.34389.66(0.00)389.66308.50 125.71 182.7985.1110.00 31.34 (0.00)53.7710.00Totals: Loc 2 Bldg 1 Roof9,015.774,267.254,748.52Loc 2 RightDESCRIPTIONQUANTITYUNIT COSTRCVDEPREC.ACV122.00 LF8.381,022.36 623.86 398.501,022.36623.86398.5021. R&R Gutter / downspout aluminum - 6"Totals: Loc 2 RightLoc 2 LeftDESCRIPTION22. R&R Gutter / downspout aluminum - 6"M&G-TRIPLETT--------QUANTITYUNIT COSTRCVDEPREC.ACV20.00 LF8.38167.60 102.27 65.334/2/2013Page: 3

4ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235CONTINUED - Loc 2 LeftDESCRIPTIONQUANTITYUNIT COSTTotals: Loc 2 LeftRCVDEPREC.ACV167.60102.2765.33Loc 2 BackDESCRIPTIONQUANTITYUNIT COSTRCVDEPREC.ACV1.00 EA119.76119.76(0.00)119.761.00 EA230.00230.00(0.00)230.00349.760.00349.76Total: Main Level10,555.494,993.385,562.11Total: SKETCH210,555.494,993.385,562.11Line Item Totals: M&G-TRIPLETT--------25,967.4011,860.9014,106.5023. Comb and straighten a/c condenserfins - with trip charge24. Siding - Minimum chargeTotals: Loc 2 BackGrand Total Areas:0.00 SF Walls0.00 SF Floor0.00 SF Long Wall0.00 Floor Area1,079.62 Exterior Wall Area13,173.11 Surface Area173.14 Total Ridge LengthM&G-TRIPLETT--------0.00 SF Ceiling0.00 SY Flooring0.00 SF Short Wall0.00 SF Walls and Ceiling0.00 LF Floor Perimeter0.00 LF Ceil. Perimeter0.00 Total Area0.00 Exterior Perimeter ofWalls0.00 Interior Wall Area131.73 Number of Squares193.00 Total Hip Length809.60 Total Perimeter Length4/2/2013Page: 4

5ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235CoverageItem Total%ACV Total%Loc 1 Bldg 115,411.9159.35%8,723.4460.58%Loc 2 Bldg 00.00%Other .13100.00%TotalM&G-TRIPLETT--------4/2/2013Page: 5

6ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235Summary for Loc 1 Bldg 1Line Item TotalMaterial Sales Tax15,411.91@7.000%417.15Replacement Cost ValueLess Non-recoverable Depreciation 15,829.06 7,105.62 Actual Cash ValueLess CoinsuranceLess Deductible 8,723.44(4,607.72)(1,000.00)Net Claim 3,115.72CSI Representative John SmithM&G-TRIPLETT--------4/2/2013Page: 6

7ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235Summary for Loc 2 Bldg 1Line Item TotalMaterial Sales Tax10,555.49@7.000%309.75Replacement Cost ValueLess Non-recoverable Depreciation 10,865.24 5,189.55 Actual Cash ValueLess CoinsuranceLess Deductible 5,675.69(993.81)(1,000.00)Net Claim 3,681.88CSI Representative John SmithM&G-TRIPLETT--------4/2/2013Page: 7

8ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235Recap by RoomEstimate: M&G-TRIPLETT-------Loc 1 Bldg 1 RoofCoverage: Loc 1 Bldg 1Loc 1 Front ElevationCoverage: Loc 1 Bldg 115,181.9115,181.91230.00230.0058.47%34.72%100.00% 349.7640.65%100.00% 10,555.4910,555.4940.65%100.00% 0%59.35% 40.65% 25,967.40100.00%100.00% 100.00% 0.89%Area: SKETCH2Area: Main LevelLoc 2 Bldg 1 RoofCoverage: Loc 2 Bldg 1Loc 2 RightCoverage: Loc 2 Bldg 1Loc 2 LeftCoverage: Loc 2 Bldg 1Loc 2 BackCoverage: Loc 2 Bldg 1100.00% 100.00% 100.00% Area Subtotal: Main LevelCoverage: Loc 2 Bldg 1Area Subtotal: SKETCH2Coverage: Loc 2 Bldg 1Subtotal of AreasCoverage: Loc 1 Bldg 1Coverage: Loc 2 Bldg age: 8

9ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.1235Recap by Category with DepreciationItemsGENERAL DEMOLITIONCoverage: Loc 1 Bldg 1Coverage: Loc 2 Bldg 1HEAT, VENT & AIR CONDITIONINGCoverage: Loc 2 Bldg 1ROOFINGCoverage: Loc 1 Bldg 1Coverage: Loc 2 Bldg 1SIDINGCoverage: Loc 2 Bldg 1SOFFIT, FASCIA, & GUTTERCoverage: Loc 1 Bldg 1Coverage: Loc 2 Bldg 1SubtotalMaterial Sales TaxCoverage: Loc 1 Bldg 1Coverage: Loc 2 Bldg 1TotalRCV@@55.17% 44.83% @100.00% @@64.18% 35.82% @100.00% @@16.86% 83.14% .000%57.39% 42.61% 714,106.50292.6326,694.3012,295.1714,399.13NOTICE: This is an estimate for repairs and a copy of this document does not constitute settlement of claim. The above figuresmay be subject to additional company review and approval. Your loss will be settled on an actual cash value basis and yourpolicy may contain a replacement cost provision. If it contains such a provision, full cost of replacement can be considered if theproperty is actually replaced. You have the right to make further claim under this provision within 180 days after the loss. Allpolicy terms and conditions apply to this claim.M&G-TRIPLETT--------4/2/2013Page: 9

M&G-TRIPLETT--------SKETCH1 - Main Level4/2/2013Page: 1

M&G-TRIPLETT--------SKETCH2 - Main Level4/2/2013Page: 2

1ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.12351Loc 1 RiskDate Taken: 7/15/2012Taken By: CSI RepresentativeRisk overview.2Loc 1 Pitch GuageDate Taken: 7/15/2012Taken By: CSI Representative6:12 pitch.M&G-TRIPLETT--------4/2/2013Page: 1

2ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.12353Loc 1 Shingle GuageDate Taken: 7/15/2012Taken By: CSI Representative4Loc 1 Front SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeSlope overview.M&G-TRIPLETT--------4/2/2013Page: 2

3ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.12355Loc 1 Front SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeOverview of hail damage.6Loc 1 Front SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of a hail impact mark.M&G-TRIPLETT--------4/2/2013Page: 3

4ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.12357Loc 1 Front SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of a hail impact mark.8Loc 1 Front SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of a hail impact mark.M&G-TRIPLETT--------4/2/2013Page: 4

5ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.12359Loc 1 Front SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of a hail impact mark.10Loc 1 Right SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeSlope overview.M&G-TRIPLETT--------4/2/2013Page: 5

6ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123511Loc 1 Right SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of hail damage to the roof coat.12Loc 1 Back SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeSlope overview.M&G-TRIPLETT--------4/2/2013Page: 6

7ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123513Loc 1 Back SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of hail damage to the roof coat.14Loc 1 Back SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of hail damage to the roof coat.M&G-TRIPLETT--------4/2/2013Page: 7

8ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123515Loc 1 Back SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of hail damage to the roof coat.16Loc 1 Back SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of hail damage to the roof coat.M&G-TRIPLETT--------4/2/2013Page: 8

9ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123517Loc 1 Left SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeSlope overview.18Loc 1 Left SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of hail damage to the roof coat.M&G-TRIPLETT--------4/2/2013Page: 9

10ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123519Loc 1 Left SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeView of hail damage to the roof coat.20Loc 1 Lower RoofDate Taken: 7/15/2012Taken By: CSI RepresentativeView of wind damage.M&G-TRIPLETT--------4/2/2013Page: 10

11ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123521Loc 1 Front ElevDate Taken: 7/15/2012Taken By: CSI RepresentativeElevation overview.22Loc 1 Front ElevDate Taken: 7/15/2012Taken By: CSI RepresentativeView of wind damage to the soffit.M&G-TRIPLETT--------4/2/2013Page: 11

12ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123523Loc 1 Front ElevDate Taken: 7/15/2012Taken By: CSI RepresentativeView of damage to the fascia.24Loc 1 Left ElevDate Taken: 7/15/2012Taken By: CSI RepresentativeElevation overview.M&G-TRIPLETT--------4/2/2013Page: 12

13ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123525Loc 1 Back ElevationDate Taken: 7/15/2012Taken By: CSI RepresentativeElevation overview.26Loc 1 Right ElevDate Taken: 7/15/2012Taken By: CSI RepresentativeElevation overview.M&G-TRIPLETT--------4/2/2013Page: 13

14ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123527Loc 2 RiskDate Taken: 7/15/2012Taken By: CSI RepresentativeRisk overview.28Loc 2 Shingle GuageDate Taken: 7/15/2012Taken By: CSI Representative25 year shingle.M&G-TRIPLETT--------4/2/2013Page: 14

15ABC Insurance789 Smith DriveDallas, TX 75231PH: 456.555.1234FX: 456.555.123529Loc 2 Pitch GuageDate Taken: 7/15/2012Taken By: CSI Representative3:12 pitch.30Loc 2 Left SlopeDate Taken: 7/15/2012Taken By: CSI RepresentativeSlope overview.M&G-TRIPLETT--------4/2/2013Page: 15