Quotation Prepared for: Timber Rock Construction August 21, 2015 CONTRACTORS BUSINESSOWNERS INSURANCE QUOTATION

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1 Quotation Prepared for: Timber Rock Construction August 21, 2015 CONTRACTORS BUSINESSOWNERS INSURANCE QUOTATION CLASSIFICATION: Carpentry of residential and light commercial buildings. New construction and remodeling, additions, renovations, window replacement. Interior and exterior. Cabinet installation and construction included. There is an exclusion on the policy that states if a separate roofing job is conducted, there is no coverage. Roofing work can be done in conjunction with other carpentry work and has to be a minor part of the total job. Roofing work should not exceed 5% of the total job. Skylight installation or vent pipe installation that includes a minor amount of roofing is acceptable. Construction of an addition to an existing structure which includes roof installation for the addition is acceptable; however if the entire roof is to be replaced, the exclusion would apply. No tear offs and replacement. NO coverage for New York. No bridge construction or similar. Errors & Omissions / professional liability coverage is not included. Snowplowing is not included (please call if you need this coverage). THIS QUOTATION IS NOT INTENDED FOR THE GENERAL CONTRACTOR WHO SUB CONTRACTS OUT MORE THAN 25% OF THE WORK. ITS IS MEANT FOR THE HANDS-ON CONTRACTOR WHERE MOST OF THE WORK IS DONE BY THE OWNER(S) OR EMPLOYEES. Exclusions: NO work in New York, snow and ice removal by hand, machine, snow blower or by plow. (Coverage can be purchased; separate policy); loss of electronic data, either physically or other than physical damage; errors and omissions; professional liability; lead; mold; fungi; bacteria; silica; war; asbestos; pollution; punitive damages; nuclear energy; employment related practices; exterior insulation & finishing systems (synthetic stucco or EIFS); liquor liability; pedestrian PIP; terrorism; nuclear energy; flood; mudslide; earthquake; violation of statutes that govern s, fax, phone calls or other methods of sending material or information. Policy includes a property damage deductible of $250. Included BLANKET ADDITIONAL INSURED - ONGOING OPERATIONS RATING There is a flat charge for each active owner, partner, LLC member or corporate officer. TWO (2) flat charges have been applied. Insured subcontractors are included as long as their cost does not exceed 25% of the total work. (25% of gross receipts / sales) If it does exceed the 25%, then additional charges apply. Cost of subcontractors include their labor and material. An insured subcontractor must have general liability policy limits equal or greater than your policy. If a subcontractor does not supply proof of liability insurance, then they will be considered employees. FIELD EMPLOYEE PAYROLL (or cost of UNINSURED SUBCONTRACTORS): NONE GENERAL LIABILITY QUOTE MILLION COVERAGE $1,000,000. bodily injury & property damage liability, each occurrence Premises & operations (while performing work) $3,000,000. general aggregate / total limits All other than products & completed operations. (after job is completed) $1,000,000. bodily injury & property damage liability, aggregate Products / completed operations $1,000,000. Personal injury / advertising injury supplemental coverage $100,000. Fire legal liability supplemental coverage $5,000. Medical payments (to other than employees and owner) LIABILITY COVERAGE ONLY: Annual premium -- $1,811. PACKAGE COVERAGE: Annual premium $2,041. Included: $15,000. blanket limit for your tools, equipment & supplies $500. deductible per claim, $250. maximum per item List individual items when the value of each is over $250. to receive full coverage Rate is $20. per $1,000. of value Provide us with a list including: year, make, model, description, s/n, value of item today's replacement cost. Coverage is provided at all locations including your vehicle. Remember, that personal or commercial auto policies do NOT provide protection for tools, equipment, supplies! Occurrence means the total money the insurance company will pay per claim. Aggregate means the total money the ins. co. will pay for the total of all claims in a policy year. All premiums quoted are subject to audit

2 The policy will also includes the following. Broad form property damage and extended bodily injury Medical payments $5,000. per person (other than owners & employees) Employees as insureds Host Liquor liability Fire legal liability $100,000. Mobile equipment Newly acquired contractor operations Non-owned watercraft Oral and written contracts Personal injury / advertising injury Spouse as insured XCU Hazards Worldwide coverage (modified) Property of others in your care, custody and control (CCC). This endorsement provides coverage up to $2,500. Example: Your customer purchased a fancy expensive fixture and wants you to install it. While installing it, your wrench slips and damages the fixture. Automatic additional insured extension Knowledge or notice of injury or occurrence extension Per project aggregate limit Accounts Receivable $25,000. basic limit Exterior Glass $2,000. basic limit Outdoor signs $3,000. basic limit ($250. deductible) Building code / law 10% of building limit Debris removal Fire department service $10,000. limit Fire extinguisher recharge $3,000. limit Lock replacement $500. limit Newly acquired property $5,000. Outdoor property $5,000. basic limit / $250. per item Property of others $25,000. basic limit Valuable papers $3,000. basic limit Money and securities $10,000. inside / $2,000. outside Pollution clean up $25,000. limit Water damage - sewer / drain backup $5,000. Computer coverage $5,000. Employee dishonesty $5,000. deductible / $500. deductible Arson award $5,000. INSTALLATION FLOATER- ADDITIONAL COST An installation floater provides coverage for materials that are located at the job site waiting to be installed. Please call. COMMERCIAL UMBRELLA (EXCESS LIABILITY) - ADDITIONAL COST If you need liability limits higher than 1 million dollars then you need to purchase a commercial umbrella policy. It provides coverage over and above the underlying policies which are typically the business liability and commercial automobile. Up to 10 million coverage is available. Cost for small contractors is typically $650. per million. Please call for an exact quote. COMMERCIAL PROPERTY - ADDITIONAL COST If you own or rent a building used as a shop or for storage, coverage is available for the building and / or contents. Please call. COMMERCIAL AUTO - ADDITIONAL COST - SEPARATE POLICY Commercial auto is a separate policy. We have great rates on commercial automobile (truck) insurance. We'd like to provide coverage for your van, pickup, trailer, dump truck, etc. Please call us if you would like a no-obligation quotation or complete the enclosed survey form and return for a no-obligation quotation. Remember, personal auto policies do not provide coverage for vehicles used for business purposes.

3 JAMES C. FRANCHINO AGENCY, INC. 132 Columbia Turnpike, Florham Park, NJ Phone: , Fax: , to: APPLICATION FOR COVERAGE Answer all questions on ALL pages. If questions are not answered truthfully coverage will be denied. PRINT NEATLY! Exact business name: Mailing address: Business phone #: Cell phone # address: Fax # website address: Business is: sole proprietorship, partnership, C Corp., S Corp., LLC Business Federal Tax ID # (FEIN# / EIN#) Number of years this business has been in operation: # Describe business operations: Physical address of your office, storage, or shop location: (cannot be PO Box): Business insurance and claims history Is owner #1 or #2 aware of any incidences, occurrences, situations, problems that may have happened in the last 1 year that may lead to a claim or lawsuit? Yes, No Ownership Information Owner / officer / member #1 Name: NJ Electrical license # Drivers license #: Social security #: NJ HVACR license # Date of birth: List type of other licenses and certifications held: Is this owner active in the business doing physical work? Yes, No Describe your business background, education, work experience, training, employment, number of years, etc.

4 Owner / officer / member #2 Name: NJ HVACR license # NJ Master Plumbers license # NJ Electrical license # Drivers license #: Date of birth: Social security #: List type of other licenses and certifications held: Is this owner active in the business doing physical work? Yes, No Describe your business background, education, work experience, training, employment, number of years, etc. Additional Ownership Information Is owner #1 or owner #2 now involved or ever involved in another business in the last 5 years? Yes, No If yes, list the exact business name, owners names and details: During the last 5 years has owner #1, or #2 been indicted, convicted of the crime of fraud, bribery, arson or any other arson related crime? Yes, No Are there any personal or business bankruptcies, tax or credit liens against owner #1 or #2 in the past five (5) years? Yes, No If yes, describe personal or business and why: Has either owner performed during the past 5 years and / or will you perform in the NEXT 12 MONTHS any work involving the following: Airports and / or Hospital, Asbestos, mold, fungi, silica, radon abatement, blasting, bridge work, chemical plant work, chemical spraying, water / gas mains, government entity work, dams or levees, work converted by wrap ups / OCIP, drilling work, earthquake retrofit work, EIFS work, Equipment rental to others, building fire sprinkler systems, welding, retaining walls, flood control work, oil or gas production work, railroad work refinery work, extermination work, scaffolding erection, ship repair / pier work, tract home work, traffic signal work, tunneling work, demolition work? Yes, No

5 APPLICATION PAGE #3 WORK TO BE DONE BY OWNERS, EMPLOYEES and SUB-CONTRACTORS in the upcoming year for THIS BUSINESS, not your full time job! Please check Yes No Any snow removal by hand, snow blower, snow plow, or any machine? Any total roofing jobs where the old is torn off and replaced? Any work in New York? Any construction with steel girders? Any exterior work above 3 stories? Any real estate clean outs? Any yard clean up, outside digging, landscaping or lawn cutting? Any work aboard ships, boats, aircraft? Any Exterior Insulation & Finishing System, (EIFS), synthetic stucco, asbestos, lead, mold/ fungi, silica remediation or abatement? Any rental or leasing of equipment to others? Any work on life support systems or medical gases in hospitals, surgery centers, etc.? Any work on safety controls? Any work on swimming pools? Will any real estate properties be purchased, renovated, then sold for profit? Are any real estate properties owned or managed by you, the applicant? What percentage of the total work that you do, or will do is ROOFING WORK? none; less than 10%; greater than 10% Percentage of work in NJ, PA, NY, Other Split of work #1: residential: %, commercial: %, industrial: % Split of work #2: service work: %, new work: % Spit of work #3: interior work: %, exterior work: % Annual Field Employee payroll (other than owners) (estimate) in the upcoming year: $ Average annujal payroll for day laborers, helpers, and friends: $ Approximate annual receipts / sales from this business in the upcoming year: $ Percentage of work subcontracted to others % List any heavy equipment owned: Lifts, Backhoes, trench diggers, tractors, etc. Describe fully: Remember: You must collect certificates of insurance from all sub-contractors you hire and their general liability limits must equal or exceed you policy limits. If not they will be considered employees and you will be charged for them. You must also have a written contract between your business and all sub-contractors containing hold harmless and indemnification agreements. Effective date coverage is desired:

6 Sign all sections By signing below, I certify that this business will not subcontract to others more than 25% of the total work done. It does not matter whether subcontractors are insured or not insured. I understand that the general liability policy being purchased does NOT provide coverage for the following: Installation, service and repair of fire sprinklers or fire suppression systems, (except for low pressure heads over residential boilers), Traffic signals, Snowplowing, snow removal, by plow, truck, blower, machine or by hand, salting or sanding unless specifically described. The policy does not allow this type of work. By signing below I certify that my business will not do nor sub-contract out this type of work. X Date signature A policy will be issued based on the information supplied on this application. The applicant warrants that the above statements and particulars, together with any attached or appended documents or materials ( this application ), are true and complete and do not misrepresent, misstate or omit any material facts. Any misrepresentation or omission shall constitute grounds to rescind coverage and denial of claims, or, at the option of the company, the assessment of additional premium charges. The applicant understands the company, agent or broker is not obligated nor under any duty to issue a policy of insurance based upon this application. The applicant further understands that, if a policy is issued, this application will be incorporated into and form a part of such policy. If the applicant becomes aware that any response on this application becomes inaccurate as a result of information or change of circumstances before the policy is issued or during the policy period, the applicant must inform the company of such changes, in writing, and any policy issued before such notification is subject to immediate cancellation. The applicant understands that business policies are issued and rated based on an estimation of payroll, receipts/sales, cost of work sublet (subcontractors), square foot area, admissions, building construction. It is understood that the insuring company will perform an audit / inspection for the policy period insured, and insured will cooperate with the company by providing the information requested. It is also agreed that if the audit determines an additional premium is due the company or agency, the applicant / insured will pay the additional premium in a timely manor (within 10 days). It is also understand that the policy issued by the company may be different than the quotation provided by the agency and it is the responsibility of the applicant / insured to read the policy when issued. If there are any questions, the insured will immediately contact the agency for an explanation. X Date signature FRAUD STATEMENT 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 concerning any fact material hereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties. All questions answered on this application have been answered truthfully. Applicant Signature Date

7 P O L I C Y H O L D E R D I S C L O S U R E NOTICE OF TERRORISM INSURANCE COVERAGE You are hereby notified that under the Terrorism Risk Insurance Act, as amended, you have a right to purchase insurance coverage for losses arising out of acts of terrorism, as defined in Section 102(1) of the Act. The term "act of terrorism" means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of an air carrier or vessel or the premises of a United States mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilia n population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. If you accept this coverage, any terrorism exclusions for acts of terrorism, as defined in the Act, already contained in your policy or included in an endorsement are nullified. You should know that coverage provided by this policy for losses caused by certified acts of terrorism is partially reimbursed by the United States under a formula established by federal law. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under this formula, the United States Government generally reimburses 85% through 2015; 84% beginning on January 1, 2016; 83% beginning on January 1, 2017; 82% beginning on January 1, 2018; 81% beginning on January 1, 2019 and 80% beginning on January 1, 2020 of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. The premium charged for this coverage is provided below and does not include any charges for the portion of loss covered by the federal government under the Act. You should also know that the Terrorism Risk Insurance Act, as amended, contains a $100 billion cap that limits U.S. Government reimbursement as well as insurers' liability for losses resulting from certified acts of terrorism when the amount of such losses in any one calendar year exceeds $100 billion. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. SELECTION OR REJECTION OF TERRORISM INSURANCE COVERAGE You may accept or reject this offer of coverage. If you elect to accept this coverage, the premium is payable according to your billing notice. You may reject this coverage by signing and returning the notice to us. If you decline the coverage, an exclusion for terrorism losses will be added to this policy. The portion of your annual premium that is for the coverage for terrorism, as defined in this Act, is: $35. Please mark an "X" in one of the boxes below: I hereby elect to purchase terrorism coverage. Sign and return this form to us. I hereby decline the terrorism coverage. I understand that I will have no coverage for losses arising from acts of terrorism. Sign and return this form to us. Policyholder / Applicant's Signature Starr Indemnity & Liability Company Print Name Policy number Date

8 All quotations are estimates calculated by this agency and are accurate to our greatest ability. (We do not quote low just to get your business!) Final premium is determined by issuing company Liability & workers compensation policies are subject to annual audit. The company will conduct an audit of the policy every year, to obtain payroll and subcontractor information, either by an auditor visiting you, or by completion of a self audit form. All quotations are non-binding. No coverage is provided by sending you this quotation or by you sending us your money. Coverage is ONLY provided by WRITTEN CONFIRMATION by this agency. Please choose the coverage desired, complete entire application, and return with premium Commercial Package / General Liability Policy $1,000,000. liability limits, no tool coverage $1,811, Down payment $755. $1,000,000. liability limits, with tool coverage $2,041. Down payment $846. Other policies - If you desire coverage for scheduled tools, installation floater please call. If you desire coverage for commercial auto, please see enclosed commercial survey or application and call If you desire coverage for workers compensation, please call. Please include a Copy of the corporation or LLC state filling including the ownership statement when remitting the application. Effective date of coverage: The insurance company provides a payment plan. The down payment is 40% with two remaining installments of 30% that will be billed 90 days apart. The insurance company charges a $8.00 fee per installment Down payment or full payment can be paid by check, credit card, or "check by fax" Make checks payable to James C. Franchino Agency Inc. Make payment online: Go to By mail Complete the application in full and mail it to us. Payment form below is not necessary when mailing a check. Enclose a check in full or for the down payment. By fax or scan-to- Complete the application in full. Fax it or scan-to- . to jim@franchinoinsurance.com Include the payment form (see next page) check-by-fax, debit or credit card. If you don t care to transmit your credit card by fax, then call us with it. Remaining installments (not down payment) can be withdrawn from your checking account or credit card, either by your direction or automatically. If you are interested in this, please let us know and we will tell you how to set this up.

9 Payment Form (when paying by credit card or check by fax) Business name: Date: Person completing form, Name: I authorize withdrawal from the checking account, or debit / credit card by the James C. Franchino Agency Inc., for the purpose of purchasing new coverage for: I understand that the check, and bank information will be entered into a computer program and a similar check will be generated and be used as a "regular" check for the payment of insurance as indicated. Use of this check by fax or debit / credit card is for a one-time purpose on or about this date of: I also certify that the funds are in my account, and if a "NSF" or any similar situation should occur where the check is not "good" I will pay the bank fee plus a $25. handling charge to the agency. I also understand that any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. I also understand that no coverage is bound or reinstated. Coverage only can be bound by a written binder produced by the agency. Name (print) Name of company Signature X Check by Fax Payment Section Make check payable to: James C. Franchino Agency, Inc. in the amount of $ 2. Compete the check fully including amount, payable to, signature, date, etc., then write VOID across the check. YES WRITE VOID! 3. Fax this form, application and VOIDED check to us at: Name and address of the account holder: Name of bank is: Address of bank: City: State: Zip: Print in LARGE LETTERS, clearly the account number and routing number. Sometimes the check doesn t fax clearly. Account number: Check # Routing # (9 digits): Amount of Check: $ Debit / Credit Card Payment Section Card # Card expiration date: Security code # Visa, Mastercard, American Express, Discover Cardholder s name Date: Signature X Cardholders billing address: A 3% service fee must be added to all debit or credit card payments. (not checks) Payment of $ plus 3% service fee (round) of $. Total = $

10 COMMERCIAL AUTO SURVEY FORM If you desire a commercial automobile quote please complete this form and return by fax or scan-to- or complete the online form at: Exact business name: Mailing address: Business phone #: Cell phone # VEHICLE #1 Yr Make Model GVW Cost new $ Today's value $ Body style: Dump Trailer hitch? yes, no VIN # (17 digits) Is your vehicle lettered? yes, no Is so, cost of lettering: $ Any racks or alterations to your vehicle? yes, no If so, describe and cost of alterations: Liability coverage: $500,000. $1,000,000. Comprehensive (OTC) No coverage $500. ded. Collision No coverage $500. ded., or $1,000. Is this vehicle? Leased financed owned, no loan Name and address of lease or finance company: VEHICLE #2 Yr Make Model GVW Cost new $ Today's value $ Body style: Dump Trailer hitch? yes, no VIN # (17 digits) Is your vehicle lettered? yes, no Is so, cost of lettering: $ Any racks or alterations to your vehicle? yes, no If so, describe and cost of alterations: Liability coverage: $500,000. $1,000,000. Comprehensive (OTC) No coverage $500. ded. Collision No coverage $500. ded., or $1,000. Is this vehicle? Leased financed owned, no loan Name and address of lease or finance company:

11 Driver #1 Name: Date of Birth: Social Security # License # State Licensed: Married Y / N Driver #2 Name: Date of Birth: Social Security # License # State Licensed: Married Y / N Driver #3 Name: Date of Birth: Social Security # License # State Licensed: Married Y / N Please provide to us the following: Clear photocopy of motor vehicle registration of vehicles. Please enlarge if possible. Clear photocopy of drivers. Please enlarge if possible. Copy of current auto policy. New Jersey Fraud Statement for Motor Vehicle Application: Any person who knowingly makes an application for motor vehicle insurance coverage containing any statement that the applicant resides or is domiciled in this state (NJ) when, in fact that applicant resides or is domiciled in a state other than this state (NJ), is subject to criminal and civil penalties X signature Date INSURANCE & CLAIMS HISTORY COMMERCIAL AUTOMOBILE Do you currently have a commercial auto policy? Yes, No If NO, when did you last have, Year Month If YES, Expiration date: Year Month Name of current or most recent insurance company (not agency) Did you have any claims under this policy? Yes, No If YES, describe claim(s) and amount of money the insurance company paid: Are you aware of any incidences, occurrences, situations, problems that may have happened in the last 5 years that may lead to a claim or lawsuit? Yes, No