1. Insured Name: 2. Insured Address: 3. Insured Contact: Phone: A B C Location

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1 Chubb Group of Insurance Companies 202 Hall s Mill Road, Whitehouse Station, NJ SOLAR ENERGY APPLICATION SUPPLEMENT APPLICANT INFORMATION 1. Insured Name: 2. Insured Address: 3. Insured Contact: Phone: 4. Describe Operations to be Insured: A B C Location Rooftop Ground Rooftop Ground Rooftop Ground MW Capacity MFG/# of Panels MFG/# of Inverters Year Installed For additional projects please continue on another Solar Energy Application. Operational Construction Development Operator Name If rooftop, who does Structural Engineering Evaluation? COVERAGES Please check coverages and limits desired COVERAGE General Liability Property Auto* Workers Compensation* Umbrella Other LIMITS OF INSURANCE Submit Current Financial Statements *Complete ACCORD application or equivalent

2 LOSS HISTORY - List paid and pending losses over last 5 years for submitted coverages: DESCRIPTION DATE OF LOSS LOSS AMOUNT GENERAL LIABILITY 1. Please detail annual energy generation by location: A B C Annual KWH Sold to Utility Host Other 2. Project Access - Restricted Yes No If yes, describe: 3. Do you own or maintain any electric transmission distribution lines or substations? Yes No If yes, describe line length (miles) and number of substations: 4. If any work is subcontracted, please describe type of work contracted out & attach sample contract: Subcontractor coverage required: General Liability Yes No Limit Required: Automobile Yes No Limit Required: Workers Compensation Yes No Limit Required: Umbrella/Excess Liability Yes No Limit Required: Are you named as an additional insured? Yes No Do you waive your rights of subrogation? Yes No In contractual indemnifi cation? Mutual To You To Subcontractor Are certifi cates of insurance required for all subcontractors? Yes No 5. Describe Special Endorsements required by Host, Power Purchase Agreement, Interconnect Agreement, or Solar Incentive Program. 6. Are you developing any additional sites? Yes No If so, provide location(s) and describe what is being done.

3 7. Are any site(s) planned or in the process of construction? If so, complete the following questions. Submit a copy of the construction contract and design specifi cations. a. Insured is: Owner Developer General Contractor Subcontractor b. Project Name: c. Premises Location: d. Description: Type of project (PV, Thermal, etc.): Ground Mounted Rooftop MW Capacity: e. Total project cost: $ f. When does construction begin? Planned date of completion: g. Project general contractor: h. Access Restriction? Describe: 8. Do you provide any consulting services for others? Yes No If so, describe services provided. PROPERTY 1. Values Location A B C Panels Inverters Power Tower Operations Building Balance of Plant Spares Business Income (1) Total (1) Attach a completed Power Generation Business Income worksheet for each location. 2. Coverage Extensions Type Sublimit Type Sublimit Earthquake* Debris Removal Flood Pollution Clean Up Windstorm Building Ordinance Transit Valuable Papers Extra Expense Other *Limited capacity available in severe earthquake areas

4 3. Deductible Building and Personal Property Windstorm/Hail Flood Earthquake Lightning BI days 4. Please describe contingency plans in place for critical equipment failure (i.e. inverters). 5. Equipment under manufacturer s warranty? Yes No. Warranty ends (date)? UMBRELLA 1. Additional underlying insurance information Auto W.C. Other Limits Carrier Premium 2. Auto A. Number of Vehicles PP Light Med. Heavy Radius of Operations Less than 50 miles miles Greater than Other B. Driver Selection/Training Criteria Is a formal driver safety training program utilized for all drivers? Yes No Do all drivers maintain valid licenses for the class of vehicle operated? Yes No Are motor vehicle operating records reviewed for all drivers? Yes No (If no, attach a list of drivers including date of birth, license number and state) 3. International exposures: Describe operations and location: 4. Watercraft or aircraft exposure? Yes No If Yes, describe: PRODUCER INFORMATION Producer/Agency Mailing Address Phone Number Fax Number

5 DECLARATION and SIGNATURE I have read the above Application. I declare that to the best of my knowledge and belief the statements and information in this Application and any attachments thereto are true, accurate and complete. This information is given to the insurer for the specifi c purpose of obtaining insurance coverage. It is agreed that if any information given in this Application or in any attachments thereto is materially false, inaccurate or incomplete, the insurer may deny coverage or cancel the policy. Signature for First Named Insured Title Date (May not be signed by Producer) Submitted by Producer INFORMATION OR DATA CONTAINED IN OR SUBMITTED IN CONNECTION WITH THIS APPLICATION (OR OTHERWISE TO ANY OF THE MEMBER INSURERS OF CHUBB GROUP OF INSURANCE COMPANIES ( CHUBB ) IN CONNECTION WITH THE UNDERWRITING PROCESS) DOES NOT CONSTITUTE NOTICE OF AN OCCURRENCE, WRONGFUL ACT, CLAIM, SUIT OR OTHER CIRCUMSTANCE AND DOES NOT SATISFY ANY OF THE REPORTING NOTIFICATION OR OTHER PROVISIONS OF ANY POLICY. ALL SUCH NOTICES MUST BE GIVEN SEPARATELY IN ACCORDANCE WITH THE APPLICABLE POLICY CONDITIONS. For the purpose of this application, the above-signed offi cer of all person(s) and entity(ies) proposed for this insurance declares and acknowledges by their signature above, that he/she has reviewed this application and the statements contained therein with his/her Chief Executive Offi cer, Chief Financial Offi cer, Chief Operating Offi cer or their equivalents, and that to the best of their knowledge and belief, after reasonable inquiry, the statements in this application, and in any attachments, are true and complete. Chubb is authorized to make any inquiry in connection with this application. Signing this application shall not constitute a binder or obligate Chubb to complete this insurance, but it is agreed this application shall be the basis upon which a policy may be issued. If the statements in this application or in any attachment change materially before the effective date of any proposed policy, the applicant must notify Chubb, and Chubb may modify or withdraw any quotation. You understand that the limit of liability under any policy to be issued in response hereto shall include both indemnity payments for claims and payment of claim and defense expenses, as defi ned in the policy. NOTICE TO APPLICANT - PLEASE READ CAREFULLY Any person who knowingly and with intent to defraud any insurance company or other person, fi les 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 thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties, including but not limited to fi nes, denial of insurance benefi ts, civil damages, criminal prosecution and confi nement in state prison. Notice to Arkansas, Louisiana, New Mexico and West Virginia Applicants: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefi t, or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fi nes and confi nement in prison. Notice to California Applicants: For your protection California law requires the following to appear on this form: Any person who knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fi nes and confi nement in state prison.

6 Notice to Colorado Applicants: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fi nes, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. Notice to District of Columbia Applicants: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fi nes. In addition, an insurer may deny insurance benefi ts if false information materially related to a claim was provided by the applicant. Notice to Florida Applicants: Any person who knowingly and with intent to injure, defraud, or deceive any insurer fi les a statement of claim or an application containing any false, incomplete, or misleading information, is guilty of a felony of the third degree. Notice to Kentucky Applicants: Any person who knowingly and with intent to defraud any insurance company or other person fi les an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime. Notice to Maine Applicants: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fi nes or denial of insurance benefi ts. Notice to Nebraska Applicants: Any person who, knowingly and with intent to defraud any insurance company or other person, fi les an Application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime, where such person subsequently submits a claim. Notice to New Jersey Applicants: Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties. Notice to New York Applicants: Any person who knowingly and with intent to defraud any insurance company or other person fi les 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 thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to a civil penalty not to exceed fi ve thousand dollars and the stated value of the claim for each such violation. Notice to Ohio Applicants: Any person who, with the intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or fi les a claim containing a false or deceptive statement is guilty of insurance fraud.

7 Notice to Oklahoma Applicants: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Notice to Oregon Applicants: Any person, who knowingly and with intent to defraud any insurance company or other person, fi les an Application for insurance containing any false information, or conceals for the purpose of misleading information concerning any material fact thereto, may be guilty of an insurance fraud. Notice to Pennsylvania Applicants: Any person who knowingly and with intent to defraud any insurance company or other person fi les an application for insurance or statement of a claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Notice to Tennessee, Virginia and Washington Applicants: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fi nes and denial of insurance benefi ts.