(SAMPLE) SUMMARY OF INSURANCE

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                                                         SUMMARY OF INSURANCE                                                      Page 1 of 4

INSURED: OUR BEST CLIENT                                                                                            DATE: As of _____________
                                                                                                                  EFF./EXP.
 COMPANY & POLICY NO.                                         COVERAGE                                  AMOUNTS    DATE          PREMIUM


ABC Insurance Company      COMMERCIAL PACKAGE POLICY
Policy No. ABC123
                           Locations:
                           #1      1 Main Street, Anytown,
                           #2      10 Main Street, Anytown,
                           #3      35 Main Street, Anytown,

                           Buildings
                           Blanket Limit
                           Causes of Loss: Risks of Direct Physical Loss subject to Policy Conditions
                           and Exclusions
                           Coinsurance: 100%
                           Deductible: $5,000
                           Replacement Cost
                           Agreed Amount
                           Protective Safeguards Endorsement—Automatic Sprinkler System—Location 1
                           Building Ordinance or Law
                           Earthquake Sprinkler Leakage (10% coinsurance)

                           Business Personal Property
                           Blanket Limit
                           Causes of Loss: Risks of Direct Physical Loss subject to Policy Conditions
                           and Exclusions
                           Coinsurance: 100%
                           Deductible: $5,000
                           Replacement Cost
                           Protective Safeguards Endorsement—Automatic Sprinkler System
                           Molds Included For Coverage
                           Manufacturers Selling Price Endorsement Included
                           Earthquake Sprinkler Leakage (10% coinsurance)
                           Property in Transit
                           • Deductible: $1,000




      THIS IS A SUMMARY ONLY. FOR ACTUAL POLICY INFORMATION, REFER TO YOUR POLICY.
                                                               (SAMPLE)
                                                          SUMMARY OF INSURANCE                                                     Page 2 of 4

INSURED: OUR BEST CLIENT                                                                                            DATE: As of _____________
                                                                                                                  EFF./EXP.
 COMPANY & POLICY NO.                                         COVERAGE                                  AMOUNTS    DATE          PREMIUM


                           COMMERCIAL PACKAGE POLICY (CONT'D)

                           Business Income
                           Blanket Limit
                           Earthquake Sprinkler Leakage
                           Monthly Limitation — 25%

                           Crime
                           • Blanket Employee Dishonesty including ERISA
                           • Depositor’s Forgery
                           • Deductible: $1,000

                           Exhibition Floater
                           • Trade Booths - Including Transit
                           • Deductible: $1,000

                           Electronic Data Processing — 1 Main Street, Anytown
                           • Hardware
                           • Media
                           • Extra Expense
                           Causes of Loss: Risks of Direct Physical Loss subject to Policy Conditions
                           Exclusions
                           Coinsurance: 90%
                           Deductible: $1,000
                           Replacement Cost

                           EDP - In Transit
                           • Any Location
                           Property Covered: Lap Top Computers
                           Coinsurance: 80%
                           Deductible: $1,000




     THIS IS A SUMMARY ONLY. FOR ACTUAL POLICY INFORMATION, REFER TO YOUR POLICY.
                                                             (SAMPLE)
                                                        SUMMARY OF INSURANCE                                                    Page 3 of 4

INSURED: OUR BEST CLIENT                                                                                         DATE: As of _____________
                                                                                                               EFF./EXP.
 COMPANY & POLICY NO.                                        COVERAGE                                AMOUNTS    DATE          PREMIUM


                           COMMERCIAL PACKAGE POLICY (CONT'D)

                           Commercial General Liability
                           • General Aggregate
                           • Personal & Advertising Injury
                           • Each Occurrence
                           • Fire Damage (Any One Fire)
                           • Medical Payments (Any One Person)
                           • Employee Benefit Liability
                           • Deductible - Each Claim $1,000

                           Includes:
                                   Premises Operations
                                   Independent Contractors
                                   Limited Blanket Contractual
                                   Personal Injury
                                   Advertising Injury
                                   Host Liquor Law
                                   Broad Form Property Damage
                                   Incidental Medical Malpractice
                                   Non-Owned Watercraft under 26' in length
                                   Employees as Additional Insureds
                                   Extended Bodily Injury
                                   Automatic coverage for newly acquired organizations for 90 days

                           Important Exclusions:
                                  Absolute Pollution
                                  Absolute Asbestos
                                  Nuclear Energy
                                  Products & Completed Operations
                                  Employment Practices

                           Subject to Final Audit
                           Premium was based on $_____________ estimated Receipts


     THIS IS A SUMMARY ONLY. FOR ACTUAL POLICY INFORMATION, REFER TO YOUR POLICY.
                                                             (SAMPLE)
                                                        SUMMARY OF INSURANCE                                                 Page 4 of 4

INSURED: OUR BEST CLIENT                                                                                      DATE: As of _____________
                                                                                                            EFF./EXP.
 COMPANY & POLICY NO.                                       COVERAGE                              AMOUNTS    DATE          PREMIUM


ABC Insurance Company      COMMERCIAL AUTOMOBILE POLICY
Policy No. ABC 456         • Bodily Injury and Property Damage
                           • Combined Single Limit
                           • Medical Payments
                           • Uninsured Motorist
                           • Comprehensive, Actual Cash Value Less $1,000 Deductible
                           • Collision, Actual Cash Value Less $1,000 Deductible
                           • Employer's Non-Owned & Hired Automobile Liability Included
                           • See Vehicle Schedule
ABC Insurance Company      COMMERCIAL UMBRELLA EXCESS LIABILITY
Policy No. ABC 789         • Each Occurrence
                           • Aggregate Limit of Insurance
                           • Self Insured Retention
                           • Flat Rate — Not subject to final audit
CA WC Company              WORKERS' COMPENSATION POLICY
Policy No. CA123           California
                           Employers Liability - Bodily Injury by Accident - Each Accident
                                               - Each Employee by Disease - Each Employee
                                               - Bodily Injury by Disease - Policy Limit
                           Subject to Audit
All States WC Company      WORKERS' COMPENSATION POLICY
Policy No. ASWC123         States other than California and Monopolistic States
                           Employers Liability      - Bodily Injury by Accident - Each Accident
                                                    - Each Employee by Disease - Each Employee
                                                    - Bodily Injury by Disease - Policy Limit
                           Subject to Audit




      THIS IS A SUMMARY ONLY. FOR ACTUAL POLICY INFORMATION, REFER TO YOUR POLICY.

				
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