SUPPLEMENTAL LIABILITY INSURANCE PROGRAM

Transcription

1 SUPPLEMENTAL LIABILITY INSURANCE PROGRAM Comprehensive Personal Liability Farm Comprehensive Personal Liability Premises and/or Farm Premises & Operations Includes copyrighted material with permission of American Association of Insurance Services

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3 WAYNE MUTUAL INSURANCE COMPANY SUPPLEMENTAL LIABILITY INSURANCE MANUAL OHIO INTRODUCTION This manual provides for Comprehensive Personal Liability, Farm Comprehensive Personal Liability and Premises and/or Farm Premises & Operations Liability Insurance. The rules, rates, forms and endorsements filed by or on behalf of the Company apply in all cases not provided for in this manual. INDEX UNDERWRITING GUIDELINES RULES Program Description Policywriting Instructions Premium Determination CPL Classifications FCPL Classifications Premises and/or Farm Premises & Operations Classifications POLLUTION LIABILITY EXPOSURE QUESTIONNAIRE RECREATIONAL VEHICLE QUESTIONNAIRE OIL & GAS WELL EXPOSURE QUESTIONNAIRE RATE PAGES CPL Personal Liability Rates CPL Homeowner Combo Liability Rates FCPL Initial Farm and Farm Combo Liability Rates Premises Liability Rates Farm Premises & Operations Liability Rates FORMS & ENDORSEMENTS LISTINGS Comprehensive Personal Liability Homeowner Combination Policy Farmowner Combo Policy and Owner-Occupied Farm Premises and/or Farm Premises & Operations TOC Wayne Mutual Insurance Company 1/2014

4 SUPPLEMENTAL LIABILITY INSURANCE MANUAL OHIO INDEX Rule Page Additional Insureds - CPL Rules-4 Additional Insureds - FCPL Rules-7 Additional Interests - CPL Rules-4 Additional Interests - FCPL Rules-6 Additional Interests Premises Rules-10 Additional Interests Farm Premises & Operations Rules-10 Business Activities - CPL Rules-5 Business Activities - FCPL Rules-7 Calculation of Premium Rules-3 Corporate Farms Rules-1 Classifications - CPL... 3 Rules-4 Classifications - FCPL... 4 Rules-6 Classifications - Premises and/or Farm Premises & Operations... 5 Rules-10 Custom Farming Rules-7 Eligibility - Supplemental Liability Program... UG-1 Exposure Basis Rules-3 Farm Employers Liability Rules-8 Farm Pollution Limited Liability (Farm Premises & Operations) Rules-10 Farms - Personal Liability Rules-6 Farms - Premises & Operations Rules-10 Fire Legal Liability Rules-7 Fruit Picking - By Public Rules-7 Horse & Buggy Medical Expense Coverage Rules-9 Horse Boarding Rules-8 Incidental Business Pursuits - CPL Rules-5 Incidental Business Pursuits FCPL Rules-8 Incidental Farming CPL Rules-5 Increased Exposure Adjustment... UG-2 Limits Basic CPL and FCPL Rules-2 Limits Basic Premises and Farm Premises & Operations Rules-2 Limits - Increased Rules-2 Multiple Dwellings Rules-1 Optional Pollution Liability - FCPL Rules-9 Personal Injury - CPL Rules-5 Personal Injury FCPL Rules-8 Personal Liability Coverage - Premises and/or Farm Premises & Operations Rules-10 Policy Terms - Annual Rules-2 Policywriting Instructions Rules-2 Premium Determination... 2 Rules-3 Program Description... 1 Rules-1 Recreational Motor Vehicle Coverage Off Premises CPL... 6 Rules-14 Recreational Motor Vehicle Coverage Off Premises FCPL... 6 Rules-14 Required Coverages Rules-3 Residences Rules-4 Vacancy Rules-10 Vegetable Picking - By Public Rules-7 Watercraft - CPL... 7 Rules-15 Watercraft FCPL... 7 Rules-15 Index Wayne Mutual Insurance Company 5/2015

5 SUPPLEMENTAL LIABILITY INSURANCE UNDERWRITING GUIDELINES 1. This program is intended to provide liability coverage for those insureds who have a property insurance policy with one of our mutual protective association partners. This program may not be used to provide stand-alone liability coverage. 2. Risks must be neat, well maintained, free of debris or accumulations of property, unusual hazards, and show pride of ownership. 3. Porches and stairs must be in good repair and free of hazards or defects. Make certain any stairs or porches are clearly visible in the front and rear photos of the dwelling. 4. THE FOLLOWING MAY NOT BE BOUND WITHOUT PRIOR COMPANY APPROVAL: A. Applicants with any liability or medical payments loss in the last five years B. Applicants that have been canceled or rejected by another company C. Risks with commercial or business activities D. Risks with 6 or more horses for personal use or any animal boarding, instructional or show exposure E. Risks with tanning beds F. Politicians (except town assemblymen, city council members, or selectmen for towns < 10,000) G. Radio and TV broadcasters and telecasters H. Newspaper or magazine reporters, editors or publishers I. Labor leaders J. Prominent figures: actors, actresses, professional athletes, or others in the public limelight K. Persons who represent a moral hazard or anyone who has been sued for libel or slander L. Law enforcement officials (except judges, bailiffs, correction officers, probation officers, fire personnel, or state/town inspectors) M. Vacant properties N. In-ground swimming pools with diving boards or slides O. In-ground swimming pools without fences P. Stairs with no handrail and a rise of 24 or more Q. Open outside primary stairways to second floor apartments R. Risks with more than 6 recreational motor vehicles 5. RISKS WITH THESE EXPOSURES ARE INELIGIBLE FOR COVERAGE: A. Pit Bulls, Doberman Pinschers, Rottweilers, Malamutes, Akitas, Presa Canarios, Staffordshire Terriers, wolves, wolf hybrids or any animal considered dangerous", "vicious" or having a biting history. B. Vicious or aggressive animals including but not limited to bears, cougars, lions and large snakes C. Above-ground pools with diving boards or slides D. Above-ground pools without a locked gate, steps that fold up or a railing around the pool deck. E. Tenant-occupied risks with a pool F. Risks not having a stable record of financial responsibility G. Dwellings constructed for more than a four-family occupancy H. Mobile homes constructed for more than a two-family occupancy I. Commercial and public buildings J. An oil or gas well that is not considered an exempt Mississippian well or an exempt domestic well according to Ohio Revised Code Sec UG-1 Wayne Mutual Insurance Company 8/2013

6 6. Risks with Trampolines can be written if: a. the Trampoline Liability has been excluded by using the SMP 62 Restriction to Policy form; or b. the risk is owner occupied, the trampoline has a net, is tied down and a charge per trampoline is added to the policy premium 7. An Increased Exposure Adjustment may be applied to any policy that varies from the average risk. The company recognizes that standard rates may be inadequate depending on the individual risk conditions. The following areas will be considered when contemplating an adjustment: a. Care, condition and use of premises, buildings or equipment b. Condition of stairs, handrails, porches, decks, stair coverings and fences c. Risk location or unusual exposures d. Insured s cooperation with company/agent loss control recommendations e. Insured s vocation or career f. Storage practices and hazardous operation g. Loss history This premium adjustment will be applied after all other rating procedures have been used. Refer to the rate pages for adjustment factor. Examples where this adjustment would be applied include: a. Risks with diving boards or slides for an in-ground swimming pool b. Risks with stairs that have no handrail and a rise of 24 or more c. Risks with open outside primary stairways to a second floor apartment UG-2 Wayne Mutual Insurance Company 1/2014

7 RULE 1 - PROGRAM DESCRIPTION SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO 1.1 Comprehensive Personal Liability (CPL) A policy may be issued to a person maintaining a residence in a one to four family dwelling. Use GL-1 Personal Liability Coverage Policy or Broad Form HO-2, Special Form HO-3 or Tenant Form HO Farm Comprehensive Personal Liability Coverage (FCPL) A policy may be issued to a person maintaining a residence in a one to four family dwelling, set of buildings, or land used for farming. Farming means the growing of crops or the caring for livestock. Farming includes the operation of roadside stands and farm markets used mainly for the sale of the Insured's own farm products. Use GL Farmer's Personal Liability Coverage Policy The following must be referred to the Company for determination of eligibility: Roadside stands in excess of 250 sq. ft. Risks with oil or gas wells on the premises. When writing such risks, you must complete and submit the Oil & Gas Well Exposure Questionnaire. 1.3 Premises and/or Farm Premises & Operations (Incorporated Farms, Commercial Farms and Rental Dwellings) Incorporated farms or commercial farm exposures may need to use forms GL-600 or GL-610. GL-600 Commercial Liability Coverage (Premises Only) This form provides liability coverage arising out of the insured premises and operations necessary or incidental to the insured premises. Liability principal coverages include: bodily injury and property damage liability including the products and completed work hazard; medical payments; and fire legal liability. The GL-600 includes an insuring agreement, definitions, defense coverage, exclusions and conditions. GL-610 Commercial Liability Coverage (Farm Premises and Operations) This form provides commercial liability coverage for farm premises and operations. It includes an insuring agreement, definitions, principal and supplemental coverages, defense coverages, exclusions and conditions. GL-9 Personal Liability Coverage Farm premises and operations liability provided by Form GL-610 can be extended to include coverage for the personal liability exposures of individuals. 1.4 Owners Occupants of 2 4 Family Dwellings Liability coverage in connection with the Insured's private residence may be provided by a CPL or FCPL policy. The additional rental units must be identified on the policy and an additional premium charge made. Use GL-1 - Personal Liability Policy or GL Farm Personal Liability Policy or Broad Form HO-2, Special Form HO-3 or Tenant Form HO-4 Rules - 1 Wayne Mutual Insurance Company 1/2014

8 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO 1.5 Basic Limits - Comprehensive Personal Liability (CPL) and Farm Comprehensive Personal Liability (FCPL): Coverage L (Liability) - $ 100,000 combined single limit A Products Aggregate Limit applies separately to each year of the FCPL policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The Products Aggregate Limit will be two times the BI/PD Each Occurrence Limit Coverage M (Med Pay to Others) - $ 1,000 per person $ 25,000 per accident 1.6 Basic Limits - Premises Liability and Farm Premises & Operations Liability: Coverage L (Liability) - $ 100,000 combined single limit A General Aggregate Limit applies separately to each year of the policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The General Aggregate Limit applies separately to each location shown on the declarations and will be two times the BI/PD Each Occurrence Limit Coverage M (Med Pay to Others) - $ 1,000 per person Coverage N (Products/Completed Work) - $100,000 combined single limit A Products/Completed Work Hazard Aggregate Limit applies separately to each year of the policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The Products/Completed Work Hazard Aggregate Limit applies separately to each location shown on the declarations and will be two times the BI/PD Each Occurrence Limit. 1.7 Increased Limits Higher limits of liability for Coverages L, M and N are shown in the Rate Pages. The maximum limit for Med Pay to Others is $10, Policywriting Instructions All required and optional liability coverages must be written at the same limit except for optional coverages. 1.9 Annual Policy Term Annual premiums and rates are shown in this manual. 2.0 Pollution Liability Exposure Questionnaire When writing optional pollution liability coverage, you must complete and submit the pollution liability exposure questionnaire. Rules - 2 Wayne Mutual Insurance Company 5/2015

9 RULE 2 - PREMIUM DETERMINATION SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO 2.1 Exposure Basis The exposure basis is indicated within each classification. Receipts means $1,000 of receipts and refers to the gross amount of money charged by the Insured for the Insured s operations. 2.2 Required Coverages Coverage is required for the following exposures if they exist: All residence premises of the Named Insured. All farm premises of the Named Insured. 2.3 Calculation of Premium The premium is computed as follows: Determine the classifications for all required and optional coverages from Rules 3, 4 or 5 and calculate the number of exposure bases Obtain the rates at the appropriate limit for the classifications determined in from the Rate Pages If applicable, add the charges for higher limits of Medical Payments to the rates determined in Multiply the rates determined in by the respective number of exposure bases determined in 2.3.1(subject to special minimum premiums shown in Rules 3, 4 or 5). The total of these products is the policy premium All coverage premiums and endorsements attached to the policy shall be adjusted to the nearest dollar. For this purpose an amount of fifty cents ($.50) or more shall be rounded to the next highest whole dollar. Premium adjustments apply separately to individual coverages If insurance is cancelled or reduced at the request of the insured or Company, the earned premium shall be computed on a pro-rata basis. Unearned premium in an amount less than $5.00 will not be returned All changes requiring premium adjustments shall be computed on a pro-rata basis and adjusted to the nearest dollar. For this purpose an amount of fifty cents ($.50) or more shall be rounded to the next highest whole dollar. Rules - 3 Wayne Mutual Insurance Company 10/2010

10 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 3 COMPREHENSIVE PERSONAL LIABILITY (CPL) CLASSIFICATIONS 3.1 Residences Code No. Rating Basis Initial Residence - one family... each Additional Charge for a two family dwelling... each This charge is in addition to the premium for Code No Additional Charge for a three family dwelling... each This charge is in addition to the premium for Code No Additional Charge for a four family dwelling... each This charge is in addition to the premium for Code No Additional Residence maintained by the Named Insured... each Additional Resident Not Otherwise Covered... each Attach Endorsement GL-72 - Additional Insureds and Additional Residences Additional Charge for Incidental Office, Professional, Private School or Studio Occupancy by an Insured... each This applies to all of the above classifications. Attach Endorsement Private Residence for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence Two Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence Three Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence Four Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence If two or more persons co-own and occupy separate portions of a two to four family dwelling, a single policy may be issued to cover these persons as Named Insureds. Compute the premium for each portion using Code No Attach Endorsement - Additional Insureds 3.2 Additional Insureds Other residents of the Named Insured household... each Attach Endorsement - Additional Insured Partners or Co-Owners... each Attach Endorsement - Additional Insureds Additional Insureds and Additional Residences... each Attach Endorsement - Additional Insureds and Additional Residences Rules - 4 Wayne Mutual Insurance Company 8/2013

11 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 3 COMPREHENSIVE PERSONAL LIABILITY (CPL) CLASSIFICATIONS (Continued) 3.3 Business Activities Code No. Rating Basis Salespersons, Collectors or Messengers - installation, demonstration or servicing... each Teachers - athletic, laboratory, manual training, physical training and swimming instructors... per teacher Teachers - corporal punishment of pupils... per teacher Teachers - not otherwise classified... per teacher Teachers does not include principals or administrative supervisors Attach Endorsement - Business Activities Incidental Business Pursuits...per policy Coverage may be extended for the loss arising out of the insured s incidental business activities. This coverage is available only when the insured s annual gross receipts from these activities are 10% or less of the total farming and incidental business annual gross receipts. Following is a list of typical incidental business activities: application of liquid fertilizer (excluding anhydrous ammonia); bait shop; ceramic shop; Christmas tree raising and sales; crop dryers (no coverage for loss or damage to the grain being dried); drapery or dressmaking (excluding any manufacture or use of cleaning equipment); flower shop; fruit grading and packing store; greenhouse and/or nursery, flowers, evergreen or shrub raising on premises; pick your own fruit; salesperson for jewelry or kitchenware no inventory or sales on premises; salesperson for feed, fertilizer or seeds- no inventory or delivery of products; salesperson for cosmetics no inventory or sales on premises; seed sales; shearing of sheep off premises. Attach Endorsement -GL Incidental Business Pursuits Incidental Farming... per policy Coverage is available when farming on the residence premises or away from premises is only incidental, farming is not the business of the insured, there are no farm structures and the acreage does not exceed one hundred (100) acres. Over 100 acres must be written in the Farm Personal Liability Program. Extends coverages L and M to apply to farming operations specified in the endorsement or in the declarations. Attach Endorsement Incidental Farming 3.4 Personal Injury Personal Injury...per policy Attach Endorsement - Personal Injury Endorsement 3.5 Trampoline Charge Unless the liability is excluded via endorsement, owner-occupied dwellings with trampolines that have side netting and are tied down will be charged an additional fee per trampoline Trampoline Charge... per trampoline 3.6 Recreational Motor Vehicle Coverage (Off Premises) Refer to Rule Watercraft Refer to Rule 7 Rules - 5 Wayne Mutual Insurance Company 6/2014

12 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 4 - FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) CLASSIFICATIONS 4.1 Farms The initial farm premises means the principal farm premises and all additional farm land without buildings, maintained by the Insured in connection with the principal farm premises. An additional farm premises means other farm land with or without buildings, maintained by the Insured in connection with the initial farm premises Initial Farm Premises - not more than 160 acres... each Initial Farm Premises - over 160, but less than 500 acres... each Initial Farm Premises acres to 1,000 acres... each Initial Farm Premises more than 1,000 acres... each Additional Owned Farm Premises w/outbuildings or Pasture... each Farm Premises for Rental or Sale, Including Buildings, Not Occupied by an Insured w/outbuildings or Pasture... each Attach Endorsement GL-73 - Additional Residences or Farms Rented to Others Additional Charge for a two family dwelling... each This charge is in addition to the premium for Code No Additional Charge for a three family dwelling... each This charge is in addition to the premium for Code No Additional Charge for a four family dwelling... each This charge is in addition to the premium for Code No Additional Residence maintained by the Named Insured... each Additional Resident Not Otherwise Covered... each Incidental Office (not farm office), Professional, Private School or Studio Occupancy by an Insured... each Attach Endorsement GL-80 - Office, Professional, Private School or Studio Occupancy Private Residence for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence Two Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence Three Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence Rules - 6 Wayne Mutual Insurance Company 4/2014

13 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 4 - FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) CLASSIFICATIONS (continued) Code No. Rating Basis Four Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement - Additional Residence If the Insured resides at a location separate from the farm premises, that residence is rated as Code No If two or more persons co-own and operate a farm and maintain separate households on the farm premises, a single policy may be issued to cover these persons as Named Insureds. Compute the FCPL premium for one household using the accumulated acreage and compute the CPL premium for the other household. Attach Endorsement GL-71 - Additional Insureds 4.2 Custom Farming The policy provides coverage for Custom Farm Work only if receipts from custom farm work for the 12 months just before the date of the occurrence do not exceed $5, Custom Farming... receipts Attach Endorsement GL-75 - Custom Farming 4.3 Fire Legal Liability Farms Fire Legal Liability farms... per location Attach Endorsement GL-77 - Fire Legal Liability - Farms 4.4 Fruit or Vegetable Picking - By Public Fruit or Vegetable Picking - by public - no off-ground picking... receipts Fruit or Vegetable Picking - by public including off-ground picking... receipts Attach Endorsement GL-78 - Fruit or Vegetable Picking - By Public 4.5 Additional Insureds Persons or Organizations... each Attach Endorsement - Additional Insured Persons or Organizations Partners or Co-Owners... each Attach Endorsement - Additional Insureds Partners or Co-Owners Additional Insureds... each Attach Endorsement - Additional Insureds 4.6 Business Activities Salespersons, Collectors or Messengers - installation, demonstration or servicing... each Teachers - athletic, laboratory, manual training, physical training and swimming instructors... per teacher Teachers - corporal punishment of pupils... per teacher Teachers - not otherwise classified... per teacher Teachers does not include principals or administrative supervisors Attach Endorsement GL-74 - Business Activities Rules - 7 Wayne Mutual Insurance Company 4/2014

14 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 4 - FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) CLASSIFICATIONS (continued) Code No. Rating Basis Incidental Business Pursuits...per policy Coverage may be extended for the loss arising out of the insured s incidental business activities. This coverage is available only when the insured s annual gross receipts from these activities are 10% or less of the total farming and incidental business annual gross receipts. Following is a list of typical incidental business activities: application of liquid fertilizer (excluding anhydrous ammonia); bait shop; ceramic shop; Christmas tree raising and sales; crop dryers (no coverage for loss or damage to the grain being dried); drapery or dressmaking (excluding any manufacture or use of cleaning equipment); flower shop; fruit grading and packing store; greenhouse and/or nursery, flowers, evergreen or shrub raising on premises; pick your own fruit; salesperson for jewelry or kitchenware no inventory or sales on premises; salesperson for feed, fertilizer or seedsno inventory or delivery of products; salesperson for cosmetics no inventory or sales on premises; seed sales; shearing of sheep off premises. Attach Endorsement -GL Incidental Business Pursuits 4.7 Personal Injury Personal Injury Attach Endorsement -GL-81 - Personal Injury 4.8 Horse-Related Liability Horse Liability...per horse The policy automatically provides coverage for the insured s legal liability for ownership of horses. However, an additional premium charge is necessary for each horse in excess of two Horse Boarding...per stall The policy may be extended to provide coverage for liability arising out of the boarding of horses by the insured on the insured premises. Eligible operations are limited to insureds that are familiar with horses and involve no more than 10 stalls. Attach Endorsement GL-478 Horse Boarding Operations 4.9 Farm Employer s Liability Farm Employer s Liability...per policy In Ohio, the Workers Compensation Insurance Fund is the exclusive remedy for injured employees. However, the possibility of suit still exists in areas not covered by the fund, such as Loss of Consortium or a suit brought by an injured employee against a negligent party who, in turn, subrogates against the employer for recovery. This endorsement provides coverage for farm employers liability and farm employees medical payments. Designated employees may be excluded. The limits of insurance (liability each occurrence; medical payments each farm employee) must equal the limits of liability for all exposures covered under the policy. Workers Compensation is required. Requests for coverage must include a workers compensation certificate number and the effective date of the most recent certificate. Attach Endorsement GL-872 Farm Employers Liability Coverage Rules - 8 Wayne Mutual Insurance Company 4/2014

15 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 4 - FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) CLASSIFICATIONS (continued) 4.10 FCPL Increased Optional Pollution Liability for Farm Risks Pollution Liability Coverage is provided under the policy up to a limit of $25,000 for certain pollution incidents involving discharge, dispersal, release or escape of pollutants usual to agricultural operations. Incidents are covered only if they are sudden and accidental. Increased limits are available and must appear on the declaration page. (See page Rates 3) $500,000 is the maximum amount of coverage that can be purchased as an optional coverage. Code No. Rating Basis Optional Limited Pollution Liability... Per Policy The increased limit must be shown on the Declaration s Page Horse & Buggy Medical Expense Coverage The policy may be extended to provide coverage for medical expense liability arising out of the use and operation of a horse and buggy for transportation. The endorsement includes $5,000 in medical payments for the named insured, immediate family members or any person using or occupying the insured s horse and buggy with the insured s permission Horse & Buggy Medical Expense Coverage...per policy Attach Endorsement GL Trampoline Charge Unless the liability is excluded via endorsement, owner-occupied dwellings with trampolines that have side netting and are tied down will be charged an additional fee per trampoline Trampoline Charge... per trampoline 4.13 Recreational Motor Vehicle Coverage (Off Premises) - Refer to Rule Watercraft Refer to Rule 7 Rules - 9 Wayne Mutual Insurance Company 8/2013

16 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 5 - PREMISES AND/OR FARM PREMISES & OPERATIONS LIABILITY CLASSIFICATIONS 5.1 Premises The GL-600 form provides liability coverage arising out of the insured premises and operations necessary or incidental to the insured premises. Liability principal coverages include: bodily injury and property damage liability including the products and completed work hazard; medical payments; and fire legal liability. The GL-600 includes an insuring agreement, definitions, defense coverage, exclusions and conditions. Code No. Rating Basis Dwelling 1 Family... each Dwelling 2 Family... each Dwelling 3 Family... each Dwelling 4 Family... each If two or more persons co-own the insured premises, a single policy may be issued to cover these persons as Additional Insureds. Attach Endorsement GL Additional Insured Vacancy - Additional Charge...each Apply charge if a dwelling becomes vacant for more than 30 days during the policy period. 5.2 Farm Premises & Operations The GL-610 form provides commercial liability coverage for farm premises and operations. It includes an insuring agreement, definitions, principal and supplemental coverages, defense coverages, exclusions and conditions. Code No. Rating Basis Farms (160 acres or less)... each Farms (more than 160/less than 500 acres)... each Farms (500 to 1,000 acres)... each Farms (more than 1,000 acres)... each Add l Farm Premises w/ Buildings or Pasture... each Dwelling 1 Family... each Dwelling 2 Family... each Dwelling 3 Family... each Dwelling 4 Family... each If two or more persons co-own the insured premises, a single policy may be issued to cover these persons as Additional Insureds. Attach Endorsement GL Additional Insured Personal Liability Coverage... Per Policy Farm premises and operations liability provided by Form GL-610 can be extended to include coverage for the personal liability exposures of individuals. Attach Endorsement GL-9 Personal Liability Coverage Vacancy - Additional Charge... each Apply charge if a dwelling becomes vacant for more than 30 days during the policy period Limited Farm Pollution Liability... Per Policy The policy provides Limited Pollution Liability Coverage up to a limit of $25,000 for certain pollution incidents involving discharge, dispersal, release or escape of pollutants Rules - 10 Wayne Mutual Insurance Company 5/2015

17 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 5 - PREMISES AND/OR FARM PREMISES & OPERATIONS LIABILITY CLASSIFICATIONS (continued) usual to agricultural operations. Incidents are covered only if they are sudden and accidental. Increased limits are available and must appear on the declaration page. (See page Rates 8) $500,000 is the maximum amount of coverage that can be purchased as an optional coverage. Attach Endorsement GL Limited Farm Pollution Liability Coverage 5.2 Farm Premises & Operations (continued) If Endorsement GL-9 Personal Liability Coverage is used to cover the personal liability exposures of individuals, the following optional coverages and forms may also be used: Code No. Rating Basis Farm Premises for Rental or Sale, Including Buildings, Not Occupied by an Insured w/outbuildings or Pasture... each Attach Endorsement GL-73 - Additional Residences or Farms Rented to Others Custom Farming... receipts Attach Endorsement GL-75 - Custom Farming Additional Charge for a two family dwelling... each Additional Charge for a three family dwelling... each Additional Charge for a four family dwelling... each Additional Residence maintained by the Named Insured... each Attach Endorsement GL-72 - Additional Insureds and Additional Residences Additional Resident Not Otherwise Covered... each Attach Endorsement GL-72 - Additional Insureds Incidental Office (not farm office), Professional, Private School or Studio Occupancy by an Insured... each Attach Endorsement GL-80 - Office, Professional, Private School or Studio Occupancy Private Residence for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement GL-73 - Additional Residences or Farms Two Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement GL-73 - Additional Residences or Farms Three Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement GL-73 - Additional Residences or Farms Four Family Dwelling for rental or sale, not occupied by an Insured, with or without incidental office, professional, private school or studio occupancy... each Attach Endorsement GL-73 - Additional Residences or Farms Additional Insured - Persons or Organizations... each Attach Endorsement GL-70 - Additional Insured Persons or Organizations Additional Insureds... each Attach Endorsement GL-72 - Additional Insureds Rules - 11 Wayne Mutual Insurance Company 5/2015

18 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 5 - PREMISES AND/OR FARM PREMISES & OPERATIONS LIABILITY CLASSIFICATIONS (continued) 5.2 Farm Premises & Operations (continued) Code No. Rating Basis Salespersons, Collectors or Messengers - installation, demonstration or servicing... each Attach Endorsement GL-74 - Business Activities Teachers - athletic, laboratory, manual training, physical training and swimming instructors... per teacher Attach Endorsement GL-74 - Business Activities Teachers - corporal punishment of pupils... per teacher Attach Endorsement GL-74 - Business Activities Teachers - not otherwise classified... per teacher Teachers does not include principals or administrative supervisors Attach Endorsement GL-74 - Business Activities Incidental Business Pursuits...per policy Coverage may be extended for the loss arising out of the insured s incidental business activities. This coverage is available only when the insured s annual gross receipts from these activities are 10% or less of the total farming and incidental business annual gross receipts. Following is a list of typical incidental business activities: application of liquid fertilizer (excluding anhydrous ammonia); bait shop; ceramic shop; Christmas tree raising and sales; crop dryers (no coverage for loss or damage to the grain being dried); drapery or dressmaking (excluding any manufacture or use of cleaning equipment); flower shop; fruit grading and packing store; greenhouse and/or nursery, flowers, evergreen or shrub raising on premises; pick your own fruit; salesperson for jewelry or kitchenware no inventory or sales on premises; salesperson for feed, fertilizer or seeds- no inventory or delivery of products; salesperson for cosmetics no inventory or sales on premises; seed sales; shearing of sheep off premises. Attach Endorsement -GL Incidental Business Pursuits Personal Injury Attach Endorsement -GL-81 - Personal Injury Fire Legal Liability farms... per location Attach Endorsement GL-77 - Fire Legal Liability - Farms Fruit or Vegetable Picking - by public - no off-ground picking... receipts Attach Endorsement GL-78 - Fruit or Vegetable Picking - By Public Fruit or Vegetable Picking - by public including off-ground picking... receipts Attach Endorsement GL-78 - Fruit or Vegetable Picking - By Public Rules - 12 Wayne Mutual Insurance Company 4/2014

19 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 5 - PREMISES AND/OR FARM PREMISES & OPERATIONS LIABILITY CLASSIFICATIONS (continued) 5.2 Farm Premises & Operations (continued) Code No. Rating Basis Horse Liability...per horse The policy automatically provides coverage for the insured s legal liability for ownership of horses. However, an additional premium charge is necessary for each horse in excess of two Horse Boarding...per stall The policy may be extended to provide coverage for liability arising out of the boarding of horses by the insured on the insured premises. Eligible operations are limited to insureds that are familiar with horses and involve no more than 10 stalls. Attach Endorsement GL-478 Horse Boarding Operations Horse & Buggy Medical Expense Coverage...per policy The policy may be extended to provide coverage for medical expense liability arising out of the use and operation of a horse and buggy for transportation. The endorsement includes $5,000 in medical payments for the named insured, immediate family members or any person using or occupying the insured s horse and buggy with the insured s permission. Attach Endorsement GL Farm Employer s Liability...per policy In Ohio, the Workers Compensation Insurance Fund is the exclusive remedy for injured employees. However, the possibility of suit still exists in areas not covered by the fund, such as Loss of Consortium or a suit brought by an injured employee against a negligent party who, in turn, subrogates against the employer for recovery. This endorsement provides coverage for farm employers liability and farm employees medical payments. Designated employees may be excluded. The limits of insurance (liability each occurrence; medical payments each farm employee) must equal the limits of liability for all exposures covered under the policy. Workers Compensation is required. Requests for coverage must include a workers compensation certificate number and the effective date of the most recent certificate. Attach Endorsement GL-872 Farm Employers Liability Coverage Recreational Motor Vehicle Coverage Endorsement... per Unit Refer to Rule (2-7) Watercraft Liability... per Unit Refer to Rule 7 Rules - 13 Wayne Mutual Insurance Company 8/2013

20 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 6 RECREATIONAL MOTOR VEHICLE COVERAGE ENDORSEMENT The Recreational Motor Vehicle Coverage Endorsement extends bodily injury liability coverage, property damage liability coverage and medical payments for off-premise use of recreational motor vehicles. Home office approval is required for risks with more than 6 recreational motor vehicles. When writing this coverage, you must complete and submit the Recreational Vehicle Questionnaire. 6.1 Eligible Drivers a) The household driving record must not exceed six violations or more than one at-fault accident in the past three years. 6.2 Eligible Vehicles This endorsement applies only to motorized land vehicles designed for recreational use off public roads, including snowmobiles, all-terrain vehicles and similar motorized vehicles. 6.3 Ineligible Risks The following are not eligible for coverage: a) Risks in which the owner or any other operator has had a major violation in the last 5 years, whether in a boat or motor vehicle b) Risks where any operator has demonstrated a poor driving record or has shown a lack of concern for traffic laws and the safety of others c) Motorcycles, motorbikes, mopeds, minibikes, dirt bikes, or any ATV designed or able to be licensed for road use. d) Vehicles used in races or speed contests e) Any three-wheeled ATV f) Any ATV over 700cc s g) Any Racer/Competitor Class ATV s including, but not limited to, the following: i. Honda - TRX ii. Kawasaki - Lakota or Mojave iii. Yamaha Raptor, Banshee, Warrior, Wolverine or YFZ450 iv. Polaris - Scrambler v. Suzuki - Quad Racer h) Any snowmobile over 600cc s or racer/competition class snowmobiles (ie. Phaser, V-Max) i) Any recreational vehicle used for business purposes j) Any recreational vehicle leased or rented to others k) Golf carts being used on public streets or highways l) Go-carts (homemade or kit) 6.4 Recreational Motor Vehicle Liability Classification (CPL and FCPL) Code No. Rating Basis Recreational Motor Vehicle Coverage Endorsement...per Unit 6.5 Recreational Motor Vehicle Liability Classification (CPL Homeowner Combo) Code No. Rating Basis Recreational Motor Vehicle Coverage Endorsement...per Unit Rules - 14 Wayne Mutual Insurance Company 1/2014

21 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 7 Watercraft liability can be added to Comprehensive Personal Liability (CPL) and Farm Comprehensive Personal Liability (FCPL) policies. The policy includes coverage for a watercraft owned by or rented to an insured which is powered by inboard, outboard or inboard/outboard motors which total 50 horsepower or less, and sailboats owned by or rented to an insured that are less than 26 feet in length. 7.1 Eligible Property Watercraft liability may be used to cover boats that meet all the following requirements: a) Owned by individuals for personal pleasure use b) 30 feet or less in overall length c) Capable of maximum speeds not greater than 50 mph d) 20 years or less in age for new business. Use the manufacture year to determine the age of each boat. e) Valued at $50,000 or less Use the combined values of the boat and motor(s) to determine the eligibility status for boats powered by outboard motors. 7.2 Eligible Drivers a) The owner insured must be at least 21 years of age and have a valid Ohio drivers license with a good driving record (Home Office must approve owners under 21 years of age) b) A current motor vehicle report (MVR) will be ordered by the company to determine eligibility of all operators or residents in the household. 7.3 Ineligible Property The following are not eligible for coverage: a) 1-2 passenger personal watercraft exceeding 100 horsepower/ 900 cc b) 3-4 passenger personal watercraft exceeding 120 horsepower/ or 1000 cc c) Air propelled or air powered boats d) Amphibious vehicles e) Boats powered by converted automobile engines f) Boats used or developed for experimental purposes g) Converted military surplus vessels h) Home-built or kit-built boats i) House boats used as year-round or seasonal residences j) Hovercraft k) Hydrofoils or Hydroplanes l) Ice Boats m) Power boats owned for racing purposes n) Property used for business, charter or other commercial purposes o) Sailboards or windsurfers p) Submersible watercraft q) Any boat in poor condition or while under construction Rules - 15 Wayne Mutual Insurance Company 8/2013

22 SUPPLEMENTAL LIABILITY INSURANCE RULES OHIO RULE 7 (continued) 7.4 Ineligible Risks or Non-Bound Risks The following risks cannot be bound, but may be worthy of consideration. A completed application may be submitted to the company as a trial application on the following: a) Risks in which the owner or any other operator has had a major violation in the last 5 years, whether in a boat or motor vehicle; b) Risks where any operator has demonstrated a poor driving record or has shown a lack of concern for traffic laws and the safety of others; c) Risks previously cancelled or rejected by another company; d) Risks where the household driving record exceeds six violations or more than one at-fault accident in the past three years. e) Risks that have had more than one boat physical damage or theft loss in the last 3 years f) Individuals with an unfavorable personal, business or financial reputation; g) Individuals with an uncorrectable physical or mental impairment that could adversely affect their driving ability 6.5 Watercraft Liability Classifications Code No. Rating Basis Watercraft Endorsement ( HP O/B)... per Unit Watercraft Endorsement (101 to 151 HP O/B)... per Unit Watercraft Endorsement (151+ HP O/B)... per Unit Watercraft Endorsement (1-175 HP I/B or Inboard/Outboard)... per Unit Watercraft Endorsement (176+ HP I/B or Inboard/Outboard)... per Unit Watercraft Endorsement (Sailboats with or without aux power)... per Unit The Watercraft Endorsement provides coverage for bodily injury or property damage that results from the ownership, maintenance, use, loading or unloading of the watercraft listed on the endorsement, with certain exceptions. Attach Endorsement ML-75 Rules - 16 Wayne Mutual Insurance Company 8/2013

23 POLLUTION LIABILITY EXPOSURE QUESTIONNAIRE Complete this form when requesting optional limits or increased limits of pollution liability coverage. Policy Number: Inception Date: Agent Name / Number: Insured Name & Address: Property Location: How Long Have You Owned This Property? Select any items present on this property: Underground storage tanks. Size of each and details of use: Above ground storage tanks. Size of each and details of use: Livestock. How is manure stored and disposed of? Wells, streams, bodies of water, or wetlands on the premises or on adjoining properties within 500 ft. of a manure storage facility. Distance: Degreasing units or solvents. Type and distance between the units and streams, bodies of water, or wetlands. Advise how the waste solvents are disposed of. Oil or gas wells (Complete the Oil and Gas Well Questionnaire) Painting or sandblasting. Details: Commercial pesticides or chemical applicators for loading or rinsing application equipment or holding tanks. Details: Agricultural chemicals or fertilizers or their containers (drums, cans, jugs or bags). Provide location, volume, container conditions and approximate distances (in feet) to the nearest well or body of water: Buried pits, dumps, cisterns, landfills, or other disposal sites. Provide location, volume, container types, storage conditions and approximate distance (in feet) to the nearest well or body of water: PCBs. Details: Fuel oil tank in the basement. Is there an open sump nearby? Asbestos around pipes or ceiling tiles. Details and locations: Other pollution hazards that could contribute to contamination in any form at this or other locations owned by you. Details: 1. Have there been any professionally conducted inspections for environmental hazards? Y ( ) N ( ) If yes, attach a copy of the inspection or report. 2. Has the Ohio or Federal EPA ever notified you of any potential contamination or violations? Y ( ) N ( ) If yes, provide details: 3. Have any previous pollution liability claims ever been filed by anyone for this location or any location Y ( ) N ( ) owned by you? If yes, provide details: No coverage is provided by this form nor does it replace or add to any provisions of your policy. I declare that I have examined this questionnaire and to the best of my knowledge and belief it is true, correct and complete. "Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer or submits a false or deceptive statement could be guilty of insurance fraud. INSURED SIGNATURE: DATE: PLQ - 1 Wayne Mutual Insurance Company 1/2014

24 RECREATIONAL VEHICLE QUESTIONNAIRE Complete this form when requesting optional limits or increased limits for recreational vehicle coverage. Policy Number: Inception Date: Agent Name / Number: Insured Name & Address: Recreational Vehicle Information:* VEHICLE TYPE YEAR TRADE NAME MODEL NAME & NO. SERIAL NUMBER CC s MAX MPH COV. AMOUNT DEDUCTIBLE $ $ $ $ $ * Contact the home office for risks with more than 6 recreational vehicles. $ Family Information: Include all children. NAME (As shown on Drivers License) DATE OF BIRTH SEX MARITAL STATUS* RELATION TO NAMED INSURED DRIVERS LICENSE # SSN * S = Single M=Married D - Divorced W = Widowed P = Separated These questions apply to all operators. Please read and complete them carefully: 1. In the last 3 years, have you or any operator(s) had insurance canceled, declined or renewal refused due to: a. misrepresentation by the insured to the insurer? Y ( ) N ( ) b. loss of driving privileges through suspension, revocation, or expiration of the operator's license? Y ( ) N ( ) c. non-payment of premium? Y ( ) N ( ) If yes, explain: 2. Do you or any operator(s) have any mental or physical impairments, including but not limited to hypertension, heart problems, emotional problems, diabetes, epilepsy, etc.? Y ( ) N ( ) If yes, explain: 3. Have you or any operator(s) been convicted of any moving violations in the past three years? Y ( ) N ( ) If yes, list below. NAME CONVICTION DATE OFFENSE RVQ - 1 Wayne Mutual Insurance Company 1/2014

25 4. Have you or any operator(s) had driver's license suspended or revoked in the last 3 years? Y ( ) N ( ) If yes, explain: 5. Have you or any operator(s) been cited or convicted of any of the following violations in the last 5 years? Driving while intoxicated? If yes, date of conviction: Driving under the influence of drugs? If yes, date of conviction: Drag racing? If yes, date of conviction: Fleeing a police officer? If yes, date of conviction: Leaving the scene of an accident? If yes, date of conviction: Felonies? If yes, describe felony and date of conviction: 6. List all accidents/losses that have occurred in the last 3 years. If no accidents/losses, indicate None NAME ACC. DATE DESCRIBE ACCIDENT & WHO WAS CITED RESULT OF ACCIDENT Bodily Injury/ Death? Total Property Damage (including own)? Yes No $ Yes No $ Yes No $ 7. Do you have a Personal Auto Policy with Wayne Mutual Insurance Company? Y ( ) N ( ) If yes, list policy #: 8. Are any of the recreational vehicles listed above used away from the primary residence premises? Y ( ) N ( ) If yes, explain: 9. Are any of the recreational vehicles listed above used in racing or speed contests, for business purposes Y ( ) N ( ) (other than farming), or on public streets or highways? If yes, explain: Remarks: No coverage is provided by this form nor does it replace or add to any provisions of your policy. I declare that I have examined this questionnaire and to the best of my knowledge and belief it is true, correct and complete. "Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer or submits a false or deceptive statement could be guilty of insurance fraud. INSURED SIGNATURE: DATE: RVQ - 2 Wayne Mutual Insurance Company 1/2014

26 OIL & GAS WELL EXPOSURE QUESTIONNAIRE This form is necessary when requesting coverage for risks with an oil or gas well. Please complete this form and have the insured sign below. Policy Number: Agency Name and #: Insured Name & Address: Property Location: 1. How many oil or gas wells are on the insured property? 2. For how many of these wells does the insured own 100% of the oil & gas rights? 3. Is the gas or oil produced used primarily by the insured? Yes ( ) No ( ) 4. If the gas is used primarily by the insured, does the insured have to pump the oil from the well to maintain natural gas production? Yes ( ) No ( ) If yes, how many barrels of oil are sold per year to commercial oil refiners? If yes, how does the insured dispose of the salt brine? 5. Does the insured sell gas to others (ie. other property owners or gas companies)? Yes ( ) No ( ) 6. If any of the oil is sold commercially, does the insured haul the oil to the refiners? Yes ( ) No ( ) 7. Is a certificate of insurance required by the Ohio Dept. of Natural Resources? Yes ( ) No ( ) If yes, for how much? No coverage is provided by this form nor does it replace or add to any provisions of your policy. I declare that I have examined this questionnaire and to the best of my knowledge and belief it is true, correct and complete. "Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer or submits a false or deceptive statement could be guilty of insurance fraud. INSURED SIGNATURE DATE OGQ - 1 Wayne Mutual Insurance Company 8/2013

27 COMPREHENSIVE PERSONAL LIABILITY (CPL) FORMS & ENDORSEMENTS Form Edition Required Form GL Personal Liability Coverage X GL Additional Policy Conditions X GL Additional Insured - Persons or Organizations GL Additional Insureds - Partners or Co-owners GL Additional Insureds and Additional Residences GL Additional Residences or Farms Rented to Others GL Business Activities GL Office, Professional, Private School or Studio Occupancy GL Personal Injury Endorsement ML Watercraft WIG RTC Restriction to Coverages (Wayne Insurance Group) ML Incidental Farming ML Motorized Vehicle Liability X -GL Personal Liability Coverage Amendatory Endorsement X -GL Incidental Business Pursuits GL-RV Recreational Motor Vehicle Liability SMP Restriction to Policy Forms - 1 Wayne Mutual Insurance Company 3/2014

28 COMPREHENSIVE PERSONAL LIABILITY (CPL) HOMEOWNER COMBINATION POLICY FORMS & ENDORSEMENTS Form Edition Required Form HO Broad Form HO-2 X or HO Special Form HO-3 X or HO Tenant Form HO-4 X ML Additional Insured ML Office, Professional, Private School, or Studio Occupancy ML Personal Injury ML Additional Residential Premises Rented to Others Liability Coverage Only ML Watercraft ML Incidental Farming ML Motorized Vehicle Liability X ML Additional Insureds Residents of Household -ML Business Activities -GL Personal Liability Coverage Amendatory Endorsement X -GL Incidental Business Pursuits GL-RV Recreational Motor Vehicle Liability SMP Restriction to Policy Forms - 2 Wayne Mutual Insurance Company 8/2013

29 FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) FARMOWNER COMBINATION POLICY AND OWNER OCCUPIED FARM FORMS & ENDORSEMENTS Form Edition Required Form GL-2.0 Personal Liability Coverage (Farm) X GL Additional Policy Conditions - Ohio X GL Additional Insured Persons or Organizations GL Additional Insured Partners or Co-owners GL Additional Insureds and Additional Residences GL Additional Insureds GL Additional Residences or Farms Rented to Others GL Custom Farm Work GL Office, Professional, Private School, or Studio Occupancy ML Watercraft WIG RTC Restriction to Coverages (Wayne Insurance Group) ML Motorized Vehicle Liability X -GL Business Activities -GL Fire Legal Liability Farms -GL Fruit or Vegetable Picking By Public -GL Personal Injury -GL Personal Liability Coverage (Farm) Amendatory Endorsement X -GL Certified Terrorism Loss X -GL Incidental Business Pursuits -GL Products Aggregate Limit X GL Horse Boarding Operations GL Horse & Buggy Medical Expense Coverage GL Farm Employer s Liability Coverage GL-RV Recreational Motor Vehicle Liability SMP Restriction to Policy Forms - 3 Wayne Mutual Insurance Company 05/2015

30 PREMISES AND/OR FARM PREMISES & OPERATIONS FORMS & ENDORSEMENTS Form Edition Required Form GL Commercial Liability Coverage (Premises Only) X or GL Commercial Liability Coverage (Farm Premises & Operations) X GL Personal Liability Coverage (use with GL-610) CL Common Policy Conditions X CL Amendatory Endorsement - Ohio X GL Personal & Advertising Injury (use with GL-600) X GL Personal & Advertising Injury (use with GL-610) X GL Contractual Liability Coverage X GL Additional Insureds WIG RTC Restriction to Coverages (Wayne Insurance Group) -GL Amendatory Endorsement X -GL Certified Terrorism Loss X GL Limited Farm Pollution Liability Cov (use with GL-610) -GL Products/Completed Work (use with GL-600) X -GL Products/Completed Work (use with GL-610) X SMP Restriction to Policy The following forms may be used only if the GL-9 Personal Liability Coverage is included: GL Additional Insured Persons or Organizations GL Additional Insureds and Additional Residences GL Additional Insureds GL Additional Residences or Farms Rented to Others GL Custom Farm Work GL Office, Professional, Private School, or Studio Occupancy ML Watercraft -GL Business Activities -GL Fire Legal Liability Farms -GL Fruit or Vegetable Picking By Public -GL Personal Injury -GL Incidental Business Pursuits GL Horse Boarding Operations GL Horse & Buggy Medical Expense Coverage GL Farm Employer s Liability Coverage GL-RV Recreational Motor Vehicle Liability ML Motorized Vehicle Liability X Forms - 4 Wayne Mutual Insurance Company 05/2015

31 $100K $300K $500K $1,000K* INITIAL RESIDENCE 1 FAMILY FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE ADD L RES. OCC BY INSURED ADD L RESIDENT - NOC INCIDENTAL OFFICE FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING ADD L INSURED PERSON/ORG ADD L INSURED PERSON/ORG No Charge ADD L INSUREDS PARTNERS/CO-OWNERS ADD L INSUREDS & ADD L RESIDENCES SALESPERSON, COLLECTOR TEACHER TEACHER W/CORP PUNISHMENT TEACHERS NOC INCIDENTAL BUS PURSUITS GL PERSONAL INJURY COMPREHENSIVE PERSONAL LIABILITY (CPL) RATES (AFFILIATED) All rates are for 12 months and subject to rounding to the closest $1 MED PAY: Rates include $1,000 limit Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. CODE CLASSIFICATIONS INCIDENTAL FARMING *Contact home office for approval TERRITORY: OHIO GL END ML-320 ED (Continued) COMBINED SINGLE LIMIT ADD L $1,000 MED PAY Rates - 1 Wayne Mutual Insurance Company 6/2014

32 COMPREHENSIVE PERSONAL LIABILITY (CPL) RATES (AFFILIATED) - CONTINUED All rates are for 12 months and subject to rounding to the closest $1 MED PAY: Rates include $1,000 limit Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. CODE CLASSIFICATIONS TERRITORY: OHIO GL END COMBINED SINGLE LIMIT $100K $300K $500K $1,000K* ADD L $1,000 MED PAY TRAMPOLINE CHARGE REC. VEHICLE LIABILITY (first unit) GL-RV REC. VEHICLE LIABILITY (each additional unit) GL-RV (51 to 100 HP Outboard) ML (101 to 151 HP Outboard) ML (151+ HP Outboard) ML (1 to 175 HP I/B or Inboard/Outboard) ML (176+ HP I/B or Inboard/Outboard) ML (Sailboats with or without aux power) ML Increased Exposure Adjustment ED Factor to apply to the liability policy premium 1.75 *Contact home office for approval Rates - 2 Wayne Mutual Insurance Company 8/2013

33 CODE COMPREHENSIVE PERSONAL LIABILITY (CPL) RATES (AFFILIATED) HOMEOWNER COMBINATION LIABILITY All rates are for 12 months and subject to rounding to the closest $1 MED PAY: Rates include $1,000 limit Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. CLASSIFICATIONS ML END $100K $300K $500K $1,000K* INITIAL RESIDENCE 1 FAMILY FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE ADD L RES. OCC BY INSURED ADD L RESIDENT - NOC INCIDENTAL OFFICE FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING ADD L INSURED PERSON/ORG ADD L INSUREDS - RESIDENTS OF HOUSEHOLD SALESPERSON, COLLECTOR TEACHER TEACHER W/CORP PUNISHMENT TEACHERS NOC INCIDENTAL BUS PURSUITS GL PERSONAL INJURY INCIDENTAL FARMING ML *Contact home office for approval TERRITORY: OHIO ED (Continued) COMBINED SINGLE LIMIT ADD L $1,000 MED PAY Rates - 3 Wayne Mutual Insurance Company 6/2014

34 COMPREHENSIVE PERSONAL LIABILITY (CPL) RATES (AFFILIATED) - CONTINUED HOMEOWNER COMBINATION LIABILITY All rates are for 12 months and subject to rounding to the closest $1 MED PAY: Rates include $1,000 limit Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. CODE CLASSIFICATIONS $100K $300K $500K $1,000K* ADD L $1,000 MED PAY TRAMPOLINE CHARGE REC. VEHICLE LIABILITY (first unit) GL-RV REC. VEHICLE LIABILITY (each additional unit) GL-RV (51 to 100 HP Outboard) ML (101 to 151 HP Outboard) ML (151+ HP Outboard) ML (1 to 175 HP I/B or Inboard/Outboard) ML (176+ HP I/B or Inboard/Outboard) ML (Sailboats with or without aux power) ML Increased Exposure Adjustment TERRITORY: OHIO GL END ED COMBINED SINGLE LIMIT Factor to apply to the liability policy premium 1.75 *Contact home office for approval Rates - 4 Wayne Mutual Insurance Company 8/2013

35 FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) RATES (AFFILIATED) INITIAL FARM & FARM COMBINATION LIABILITY All rates are for 12 months and subject to rounding to the closest $1 MED PAY: Rates include $1,000 limit A Products Aggregate Limit applies separately to each year of the policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The Products Aggregate Limit will be two times the BI/PD Each Occurrence Limit. Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. CODE CLASSIFICATIONS ADD L GL COMBINED SINGLE LIMIT $1,000 ED END MED $100K $300K $500K $1,000K* PAY ACRES OR LESS OVER 160/LESS THAN 500 ACRES TO 1,000 ACRES MORE THAN 1,000 ACRES ADD'L OWNED PREMISES w/ BUILDINGS OR PASTURE RENTAL FARM PREMISES w/ BUILDINGS OR PASTURE CUSTOM FARMING (per $100 receipts) FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE ADD L RES. OCC BY INSURED ADD L RESIDENT - NOC INCIDENTAL OFFICE FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING ADD L INSURED PERSON/ORG ADD L INSURED PERSON/ORG No charge ADD L INSUREDS PARTNERS/CO-OWNERS NC2 ADD L INSUREDS PARTNERS/CO-OWNERS No charge ADD L INSUREDS SALESPERSON, COLLECTOR TEACHER TEACHER W/CORP PUNISHMENT TEACHERS NOC INCIDENTAL BUS PURSUITS GL PERSONAL INJURY *Contact home office for approval TERRITORY: OHIO (Continued) Rates - 5 Wayne Mutual Insurance Company 4/2014

36 FARM COMPREHENSIVE PERSONAL LIABILITY (FCPL) RATES (AFFILIATED) INITIAL FARM & FARM COMBINATION LIABILITY - CONTINUED All rates are for 12 months and subject to rounding to the closest $1 MED PAY: Rates include $1,000 limit Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. CODE CLASSIFICATIONS TERRITORY: OHIO GL END $100K $300K $500K $1,000K* ADD L $1,000 MED PAY FIRE LEGAL LIABILITY - FARM FRUIT/VEG PICKING - NO OFF GROUND PICKING (Per $100 receipts) FRUIT/VEG PICKING - OFF GROUND (Per $100 receipts) HORSE LIABILITY (Per horse in excess of two) HORSE BOARDING (Per stall) GL HORSE & BUGGY (Per unit) GL INCL FARM EMPLOYER'S LIABILITY GL TRAMPOLINE CHARGE REC. VEHICLE LIABILITY (first unit) GL-RV REC. VEHICLE LIABILITY (each additional unit) GL-RV (51 to 100 HP Outboard) ML (101 to 151 HP Outboard) ML (151+ HP Outboard) ML (1 to 175 HP I/B or Inboard/Outboard) ML (176+ HP I/B or Inboard/Outboard) ML (Sailboats with or without aux power) ML COMBINED SINGLE LIMIT CODE CLASSIFICATIONS $50K $100K $300K $500K INCREASED POLLUTION COVERAGE Increased Exposure Adjustment ED COMBINED SINGLE LIMIT Factor to apply to the liability policy premium *Contact home office for approval 1.75 Rates - 6 Wayne Mutual Insurance Company 4/2014

37 PREMISES LIABILITY RATES (AFFILIATED) For use with Form GL-600 All rates are for 12 months and subject to rounding to the closest $1 MED PAY: Rates include $1,000 limit A General Aggregate Limit and a Products/Completed Work Hazard Aggregate Limit apply separately to each year of the policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The General Aggregate Limit and the Products/Completed Work Hazard Aggregate Limit apply separately to each location shown on the declarations and will be two times the BI/PD Each Occurrence Limit. Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. TERRITORY: OHIO CODE CLASSIFICATIONS DWELLING - 1 FAMILY DWELLING - 2 FAMILY DWELLING - 3 FAMILY DWELLING - 4 FAMILY END GL-600 GL-600 GL-600 GL-600 ED COMBINED SINGLE LIMIT $100K $300K $500K $1,000K* ADD L $1,000 MED PAY VACANCY - ADD'L CHARGE ADDITIONAL INSUREDS GL N ADDITIONAL INSUREDS GL No charge Increased Exposure Adjustment Factor to apply to the liability policy premium 1.75 *Contact home office for approval Rates - 7 Wayne Mutual Insurance Company 5/2015

38 ADD L COMBINED SINGLE LIMIT $1,000 CODE CLASSIFICATIONS END ED MED $100K $300K $500K $1,000K* PAY ACRES OR LESS GL OVER 160/LESS THAN 500 ACRES GL TO 1,000 ACRES GL MORE THAN 1,000 ACRES GL-610 ADD'L FARM PREMISES w/ BUILDINGS OR PASTURE** GL DWELLING - 1 FAMILY GL DWELLING - 2 FAMILY GL DWELLING - 3 FAMILY GL DWELLING - 4 FAMILY GL VACANCY - ADD'L CHARGE PERSONAL LIAB COVERAGE GL ADDITIONAL INSUREDS GL N ADDITIONAL INSUREDS GL No charge FARM PREMISES & OPERATIONS LIABILITY RATES (AFFILIATED) MED PAY: Rates include $1,000 limit Increased Exposure Adjustment For use with Form GL-610 All rates are for 12 months and subject to rounding to the closest $1 A General Aggregate Limit and a Products/Completed Work Hazard Aggregate Limit apply separately to each year of the policy or any applicable policy period less than one year (other than an extension of less than one year after the policy is issued). The General Aggregate Limit and the Products/Completed Work Hazard Aggregate Limit apply separately to each location shown on the declarations and will be two times the BI/PD Each Occurrence Limit. Refer to Company for limits in excess of those shown. $1 million liability rates are shown for quote purposes only and must have prior home office approval. TERRITORY: OHIO CODE CLASSIFICATIONS END ED LIMITED FARM POLLUTION LIAB GL COMBINED SINGLE LIMIT $50K $100K $300K $500K Factor to apply to the liability policy premium 1.75 *Contact home office for approval Rates - 8 Wayne Mutual Insurance Company 5/2015

39 FARM PREMISES & OPERATIONS LIABILITY RATES (AFFILIATED) - CONTINUED The following forms may be used only if the GL-9 Personal Liability Coverage is included: CODE CLASSIFICATIONS $100K $300K $500K $1,000K* ADD L $1,000 MED PAY RENTAL FARM PREMISES w/ BUILDINGS OR PASTURE CUSTOM FARMING (per $100 receipts) FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE FAMILY- ADD L CHARGE ADD L RES. OCC BY INSURED ADD L RESIDENT - NOC INCIDENTAL OFFICE FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING FAMILY RENTAL DWELLING ADD L INSURED PERSON/ORG ADD L INSURED PERSON/ORG No charge ADD L INSUREDS SALESPERSON, COLLECTOR TEACHER TEACHER W/CORP PUNISHMENT TEACHERS NOC INCIDENTAL BUS PURSUITS GL PERSONAL INJURY FIRE LEGAL LIABILITY - FARM FRUIT/VEG PICKING - NO OFF GROUND PICKING (Per $100 receipts) FRUIT/VEG PICKING - OFF GROUND (Per $100 receipts) HORSE LIABILITY (Per horse in excess of two) HORSE BOARDING (Per stall) GL HORSE & BUGGY (Per unit) GL INCL FARM EMPLOYER'S LIABILITY GL TRAMPOLINE CHARGE REC. VEHICLE LIABILITY (first unit) GL-RV REC. VEHICLE LIABILITY (each additional unit) GL-RV *Contact home office for approval TERRITORY: OHIO GL END ED (Continued) COMBINED SINGLE LIMIT Rates - 9 Wayne Mutual Insurance Company 4/2014

40 FARM PREMISES & OPERATIONS LIABILITY RATES (AFFILIATED) - CONTINUED The following forms may be used only if the GL-9 Personal Liability Coverage is included: CODE CLASSIFICATIONS TERRITORY: OHIO GL END $100K $300K $500K $1,000K* (51 to 100 HP Outboard) ML (101 to 151 HP Outboard) ML (151+ HP Outboard) ML (1 to 175 HP I/B or Inboard/Outboard) ML (176+ HP I/B or Inboard/Outboard) ML (Sailboats with or without aux power) ML ED COMBINED SINGLE LIMIT ADD L $1,000 MED PAY *Contact home office for approval ** Charge for each farm location with buildings or pasture. Acreage for locations with land only may be combined for a single charge. Rates - 10 Wayne Mutual Insurance Company 1/2014