AMERICAN STATES INSURANCE COMPANY FIRST NATIONAL INSURANCE CO. OF AMERICA POLICY NUMBER 01-CH RENEWAL OF 01-CH AGENT NAME

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1 ~:_RI PKOS BA :.=:: ~ ::YNNE RD =~ 3~, KS AMERICAN STATES COMPANY FIRST NATIONAL CO. OF AMERICA COMMERCIAL PACKAGE rpo.;;..;l;;;.;;.ic.;;..;y_~=::::::~==:::::::::::::~==:=::=, MEMORI AL 1' R..;..E_N...;;;E W.;:..:A..:;:L.:::.D..:;:E...:;C..:;:L ' POLICY NUMBER 01CH RENEWAL OF 01CH E2 NAMED INSURED EXTENSION AGENT NAME._ t=?'::; Fr\OM TO AM SWJDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE. AND ADDRESS THE OSBORNE INS AGY INC W 73RD ST SHAWNEE, KS (913) HE TOTAL DUE FOR THE POLICY TERM IS 3, YOU WILL BE BILLED THROUGH YOUR CUSTOMER ACCOUNT # YOU NEED NOT PAY ANY AT THIS TIME. WE WILL SEND A BILLING STATEMENT IN A SEPA MAILING. IN RETURN FOR THE PAYMENT OF THE, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, THE COMPANIES INDICATED ON THE SPECIFIC COVERAGE PART DECLARATIONS AGREE WITH YOU TO PROVIDE THE AS STATED IN THIS POLICY. THIS RENEWAL SERVES THE SAME PURPOSE AS WRITING A NEW POLICY WITH THE SAME PROVISIONS, CONDITIONS AND INSURING AGREEMENTS. THE INDIVIDUAL COVERAGE PART DECLARATIONS WHICH FOLLOW, LIST ALL OF THE FORMS THAT APPLY TO YOUR RENEWAL AND THOSE, IF ANY, WHICH NO LONGER APPLY. ONLY NEW OR REVISED FORMS ARE ATTACHED TO THIS RENEWAL. YOU MUST ADD THEM TO YOUR PRIOR POLICY. COMMERCIAL PROPERTY COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL AUTO COVERAGE PART... 3, FOR TOTAL POLICY... 3, , =:!!' ii.., ĪE (DATE) BY COMPANY USE ONLY NU (STERAI)CB INSURED COPY Page 1 (AUTHORIZED REPRESENTATIVE) Safe co and the Safeeo loyo are reyistered trademarks of Safeco Corporation PREPARED

AMERICAN STATES COMPANY COMMERCIAL PROPERTY COVERAGE PART DECLARATIONS PAGE CP 1 NAMED INSURED: LINDENTRIPKOS MEMORIAL POLICY NUMBER: 01CH5844142 PREMISES 1 33723 W 84TH ST DE SOTO, KS 66018 1

2 AMERICAN STATES COMPANY COMMERCIAL PROPERTY COVERAGE PART DECLARATIONS PAGE CP 1 NAMED INSURED: LINDENTRIPKOS MEMORIAL POLICY NUMBER: 01CH PREMISES W 84TH ST DE SOTO, KS AMERICAN STATES COMPANY OCCUPANCY: STORAGE BROAD CAUSES OF LOSS 52, OTHER INTERESTS SUBJECT TO PROVISIONS OF CLAUSE(S) DESIGNATED BELOW: MORTGAGE HOLDER = =~ = 9CC (CP)(0207) NORTHEAST (STERA) PREPARED CMD40 SEQ.OOOI CIN12PRI NT00107S9OO231

C HHERCIAL PROPERTY COVERAGE PART DECLARATIONS PAGE CP 2 AMED INSURED: LINDENTRIPKOS MEMORIAL POLICY NUMBER: 01CH5844142 PREMISES 2 33725 W 84TH ST DE SOTO, KS 66018 1 AMERICAN STATES COMPANY

3 C HHERCIAL PROPERTY COVERAGE PART DECLARATIONS PAGE CP 2 AMED INSURED: LINDENTRIPKOS MEMORIAL POLICY NUMBER: 01CH PREMISES W 84TH ST DE SOTO, KS AMERICAN STATES COMPANY OCCUPANCY: VFW CLUB SPECIAL CAUSES OF LOSS PERSONAL PROPERTY OF INSURED SPECIAL CAUSES OF LOSS 2 AMERICAN STATES COMPANY OCCUPANCY: VFW CLUB 357, , CANOPY BROAD CAUSES OF LOSS 3, , OTHER INTERESTS SUBJECT TO PROVISIONS OF CLAUSE(S) DESIGNATED BELOW: MORTGAGE HOLDER LOSS PAYEE ******************** COMMERCIAL PROPERTY TOTAL 3, A OF TERRORISM IS INCLUDED IN THE TOTAL ABOVE FOR CERTIFIED ACTS OF 9CC (CP)(0207) NORTHEAST (STERA) PREPARED CMD40 SEQ.OOOI, CIN12PRINTOO1D789OO241 :=m:r2:pmfffixllu789:00z

4 FIRST NATIONAL CO. OF AMERICA COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PAGE CG 1 NAMED INSURED: LINDENTRIPKOS MEMORIAL POLICY NUMBER: 01CH FORM OF BUSINESS: ORGANIZATION OTHER THAN A PARTNERSHIP OR JOINT VENTURE L I M ITS 0 FIN SUR A N C E COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTSCOMPLETED OPERATIONS) PRODUCTSCOMPLETED OPERATIONS AGGREGATE LIMIT PERSONAL AND ADVERTISING INJURY LIMIT EACH OCCURRENCE LIMIT DAMAGE TO PREMISES RENTED TO YOU (ANY ONE PREMISES) MEDICAL EXPENSE LIMIT (ANY ONE PERSON) EMPLOYMENT PRACTICES LIABILITY AGGREGATE LIMIT EACH CLAIM LIMIT 600,000 ~ 600, ,000 ~ 300, ,000 RETROACTIVE DATE OF APPLIES TO SECTION I OF THE EMPLOYMENT PRACTICES LIABILITY FORM. THIS DOES NOT APPLY TO ANY 'EMPLOYMENT PRACTICES' WHICH OCCURRED BEFORE THE RETROACTIVE DATE. CODE CLASSIFICATION BASIS EXPOSURE COMMERCIAL GENERAL LIABILITY OTHER THAN PRODUCTSCOMPLETED OPERATIONS ~ PREMISES WAREHOUSES PRIVATE OTHER THAN NOTFORPROFIT PRODUCTSCOMPLETED OPERATIONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT AREA (PER 1000 SQUARE FEET) 1, PREMISES CLUBS CIVIC, SERVICE OR SOCIAL HAVING S OR PREMISES OWNED OR LEASED NOTFORPROFIT ONLY PRODUCTSCOMPLETED OPERATIONS ARE SUBJECT TO THE GENERAL AGGREGATE LIMIT AREA (PER 1000 SQUARE FEET) 4, CC(GL) (0207)NORTHEAST (STERA) PREPARED CMD40 SEQ.0001 ~~~ CIN12PRINTOO10789OO251

C XXERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PAGE CG 2 AMED INSURED: LINDENTRIPKOS MEMORIAL POLICY NUMBER: 01CH5844142 CODE CLASSIFICATION BASIS EXPOSURE EMPLOYMENT PRACTICES LIABILITY

5 C XXERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS PAGE CG 2 AMED INSURED: LINDENTRIPKOS MEMORIAL POLICY NUMBER: 01CH CODE CLASSIFICATION BASIS EXPOSURE EMPLOYMENT PRACTICES LIABILITY PREMISES NA EMPLOYMENT PRACTICES LIABILITY (PER UNIT) ******************** ADJUSTMENTS: COMMERCIAL GENERAL LIABILITY TOTAL CC(GL) (0207)NORTHEAST (STERA) PREPARED CMD40 SEQ.OOOI CIN12PRINTOO10789OO261

ESSEX INSURANCE COMPANY

ESSEX INSURANCE COMPANY COMMON POLICY DECLARATIONS POLICY NUMBER: 2CT864 RENEWAL OF POLICY: Named Insured d Mailing Address (, Street, Town or City, County, State, Zip Code) AUBURN VALLEY SERVICE CORP. & AUBURN VALLEY PROPERTY