TOTAL SERVICES: STATE & LOCAL TAX: $0.00

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1 1 US Adjusting Invoice 4090 South Regent Drive Wichita Falls, TX Insured: MARTINEZ ANTHONY Date: 3/1/2017 Ins. Policy: ENG (00) Loss Type: 2/18/ WEATHERDG Desk Adjuster: JONES, TOM (PSIC) Invoice No.: Adjuster: Jim Shelden 2/18/2017 Date of Loss: RCV Loss: $1, Loss Location: CA Net Claim: $1, Cat #: PROPERTY APPRAISAL SERVICE $ Administrative Fee $25.00 EXPENSES: TOTAL SERVICES: $ TOTAL EXPENSES: $0.00 STATE & LOCAL TAX: $0.00 TOTAL SERVICES AND EXPENSES: $ Please Remit to: US Adjusting Services 3109 Skyway Cir N. Irving, TX Tax ID #: EXPLANATION OF CHARGES: Daily California claim. T&E log sheet attached for reference.

2 2017 TIME AND EXPENSE DAILY WORKSHEET Please Remit to: US Adjusting Services 3109 Skyway Circle N Irving, TX Tax ID#: INSUREDS NAME: Anthony Martinez INSURANCE CO. Pacific Specialty Insurance, Co. ADJUSTER: Jim Shelden CLAIM NUMBER: DATE UPLOADED: DATE START 3/1/17 STOP 2/24/17 2/24/17 2/24/17 2/25/ :00AM 2:00 PM /25/17 2/27/17 2/27/17 2/27/17 2/28/ /1/ TOTAL HOURS ENG POLICY NUMBER: HOURS 9.05 MILES RATE TOTAL $26.25 $7.50 $18.75 $0.00 $ $0.00 $ $18.75 $52.50 $82.50 $15.00 $0.00 $82.50 $0.00 $0.00 $ TASKS Received claim and set up file Left Message on voice mail foranthony Spoke to Anthony set an appointment to inspect the property for 2/25/ :00 AM Traveled to the risk. Met Jim with McCuller Construction and Anthony Martinez. Inspected the interior, exterior and roof Traveled from risk Updated xactanalysis Downloaded and labeled 31 photos. Completed diagrams and estimates in xactimate Spoke to Jim with McCullar Const. Agreed on the scope of the damages. Completed Narrative and T&E Log and uploaded documents in xactanalysis

3 25650 Roundup Way, Apple Valley, CA to 204 S Forest Knoll St Drive 104 miles, 1 h 59 min Map data 2017 Google 10 mi via US-395 N Fastest route, the usual trafdc 1 h 59 min 104 miles via CA-58 W and US-395 N 2 h 2 min 118 miles

4 1 Pacific Specialty Insurance Company Pacific Specialty Insurance Company 2995 Prospect Park Dr. Suite 150 T: (800) F: (650) LOSS REPORT Status Reference: Report #: 0 Catastrophe Number: Policy Number: ENG (00) Claim Number: Date of Loss: 2/18/ S FOREST KNOLL ST Type of Loss: Weather Damage Ridgecrest, CA File Number: ENCLOSURES: Statement of Loss COVERAGE: Coverage A $141, Eff. Dates: From: 10/21/2016 To: 10/21/2017 Mortgagee: Deductible: $ Co-Ins. Policy: Yes No Forms: FIRST AND FINAL INSPECTION DATE: 2/25/2017 The IA completed the field inspection on 02/25/2017 with Jim with McCullar & Sons Construction and our insured Anthony Martinez. The loss is the result of a rain storm which happened on 02/19/2017. The inspection of the interior revealed water damage to the ceilings in the hallway and bathroom. No other rooms were affected. Inspection of the roof revealed no visible wind damage. The water appears to be coming in around the flashing by the swamp cooler located on the east slope above the bath and hall areas. CAUSE & ORGIN: The cause of the loss is the result of storm on 02//19/2017 RISK: The risk is a 1 story wood framed building with a slab on grade foundation, stucco and brick veneer exterior and a 20 -year 3tab roof. The risk was built in 1983 and has 1107 sf of living area. EXTERIOR DAMAGES : There was no damage to the exterior of the building from the storm INTERIOR DAMAGE: Hallway: Water damage to the drywall ceiling. The hallway continues into the living room. Hall Bath: Water damage to the ceiling. DEPRECATION: Was calculated on age and condition OVERHEAD AND PROFIT: O&P was added as there are 3 trades or more to complete the repairs SALVAGE: No salvage opportunities present, as the damaged materials have little or no value. SUBROGATION: There is no potential for subrogation on the loss.

5 2 FUTURE ACTIVITY: None at this time REMARKS: We advised the insured that we are adjusting the loss for their insurance company. We are giving out our opinion to the cause of the loss and the scope of the damages. The insured understands that the insurance company will make all of the final decisions on this loss. Thank you for allowing us to serve you on this loss. Should this file require additional work, please feel free to notify our office and we will gladly re open our file to assist you. Sincerely, Jim Shelden STATEMENT OF LOSS: Item RCV Dep ACV Limit $63.41 $1, $1, Coverage A $1, TOTALS $1, $63.41 $1, Deductible $ Less Prior Payments $0.00 Claim Payable $1, Due Insured $1, Recoverable Depreciation Totals: $63.41 Non-Recoverable Depreciation Totals: $0.00 Net Claim Without Rec. Depreciation: $1, RECOMMENDATIONS: I recommend payment to Insured in the RCV amount of $1, /1/2017 JONES, TOM (PSIC) Date

6 1 1-Front View Overview east 2-Front View Address Verification - 1-3/1/2017

7 2 3-Roof SE Taken By: Jim Shelden Roof southeast slope no visible wind damage 4-Roof S Roof south slope no visible wind damage - 2-3/1/2017

8 3 5-Roof S Roof south slope no visible wind damage 6-Roof NW No visible wind damage - 3-3/1/2017

9 4 7-Roof NE Taken By: Jim Shelden Roof north east slope no visible wind damage 8-Roof E Roof east slope no visible wind damage - 4-3/1/2017

10 5 9-Roof W Roof SW slope no visible wind damage 10-Roof E Taken By: Jim Shelden Roof East slope appears water is coming in around flashing - 5-3/1/2017

11 6 11-Roof E Roof East slope no vsible wind damage 12-Living Room Overview north - 6-3/1/2017

12 7 13-Living Room Taken By: Jim Shelden Overview Southwest no visible water damage to the ceiling 14-Living Room No water damage to the ceiling - 7-3/1/2017

13 8 15-Living Room Overvirew south 16-Living Room Overview Northeast into hallway - 8-3/1/2017

14 9 17-Hallway Overview east 18-Hallway Overview west - 9-3/1/2017

15 10 19-Hallway Water damage ceiling and wall 20-Hallway Water damage to ceiling and wall /1/2017

16 11 21-Hallway Overview west 22-Hallway Overview west /1/2017

17 12 23-Bathroom Overview east 24-Bathroom Water damaged ceiling /1/2017

18 13 25-Bathroom Water damage ceiling 26-Bathroom Overview east /1/2017

19 14 27-Bedroom 1 Overview NW 28-Bedroom 1 Taken By: Jim Shelden Overview noerth no water damage to the ceiling /1/2017

20 15 29-Bedroom 1 no visible water damage to the ceiling 30-Bedroom 2 No water damage to the ceiling /1/2017

21 16 31-Kitchen No visible water damage to the ceiling /1/2017

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