EVIDENCE OF COMMERCIAL PROPERTY INSURANCE

1 The ACORD name and logo are registered marks of ACORDDATE (MM/DD/YYYY) EVIDENCE OF COMMERCIAL PROPERTY INSURANCELOAN NUMBERPOLICY NUMBERPOLICY TYPENAIC NO:COMPANY NAME AND ADDRESSIF MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACHCONTINUED UNTILTERMINATED IF CHECKEDTHIS REPLACES PRIOR EVIDENCE DATED:EFFECTIVE DATEEXPIRATION DATECONTACT PERSON AND ADDRESSPRODUCER NAME,(A/C, No):FAXPHONE(A/C, No, Ext):ADDRESS:E-MAILSUB CODE:CUSTOMER ID #:AGENCYCODE:NAMED INSURED AND ADDRESSADDITIONAL NAMED INSURED(S)THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTSUPON THE ADDITIONAL INTEREST NAMED BELOW.

2 THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTERTHE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEENTHE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL PERSONAL PROPERTYBUILDING ORPROPERTY INFORMATION (Use REMARKS on page 2, if more space is required)THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONSOF SUCH POLICIES.

3 LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID / DESCRIPTIONLENDERS LOSS PAYABLEMORTGAGEECONTRACT OF SALELENDER SERVICING AGENT NAME AND ADDRESSNAME AND ADDRESSADDITIONAL INTERESTAUTHORIZED REPRESENTATIVEIf YES, LIMIT:Actual Loss Sustained; # of months:If YES, LIMIT:BUSINESS INCOMEIf YES, indicate value(s) reported on PROPERTY identified above: $DED:DED:DED:DED:DED: - Coverage for loss to undamaged portion of bldg - Incr. Cost of Construction - Demolition CostsSPECIALBROADBASICPERILS INSUREDDED: COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE :DED:%If YES,PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGEHOLDER PRIOR TO LOSSFLOOD (If Applicable)COVERAGE INFORMATIONNOYESBLANKET COVERAGETERRORISM COVERAGEA ttach Disclosure Notice / DECIS THERE A TERRORISM-SPECIFIC EXCLUSION?

4 IS DOMESTIC TERRORISM EXCLUDED?DED:REPLACEMENT COSTAGREED VALUECOINSURANCEEQUIPMENT BREAKDOWN (If Applicable)ORDINANCE OR LAWWIND / HAIL INCLEARTH MOVEMENT (If Applicable)$LIMITED FUNGUS COVERAGEFUNGUS EXCLUSION (If "YES", specify organization's form used)N/ARENTAL VALUEIf YES, LIMIT:If YES, LIMIT:If YES, LIMIT:If YES, LIMIT:If YES, LIMIT:If YES, LIMIT:If YES, LIMIT:DED:NAMED STORM INCLS ubject to Different Provisions:Subject to Different Provisions:DED:If YES, LIMIT:YESNOYESNO 2003-2014 ACORD CORPORATION. All rights 28 (2014/01)Page 1 of 2 CANCELLATIONSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEDELIVERED IN ACCORDANCE WITH THE POLICY OF COMMERCIAL PROPERTY INSURANCE REMARKS - Including Special Conditions (Use only if more space is required)Page 2 of 2 ACORD 28 (2014/01)