I N315-TCT

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1 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT Named Insured: SODA SPRINGS RANCH CONDOMINIUM Policy Number: Policy Effective Date: Policy Expiration Date: Issue Date: I N315-TCT ADDITIONAL Premium $ CHANGE ENDORSEMENT Effective from at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: UNDER THE BUSINESSOWNERS COVERAGE PART, THE LIMIT OF INSURANCE FOR EMPLOYEE DISHONESTY AND FORGERY OR ALTERATION IS CHANGED FROM $25,000 TO $150,000 THE FOLLOWING FORMS AND/OR ENDORSEMENTS IS/ARE INCLUDED WITH THIS CHANGE. THESE FORMS ARE ADDED TO THE POLICY OR REPLACE FORMS ALREADY EXISTING ON THE POLICY: MP T RATES AND/OR PREMIUMS HAVE BEEN CHANGED TO REFLECT A CHANGE IN EXPOSURE AND/OR RATING PROCEDURE. NAME AND ADDRESS OF AGENT OR BROKER Countersigned by INS ASSOC INC-ESTES PO BOX 4190 ESTES PARK CO DATE: Authorized Representative IL T (Page 01 of 01) Office: DENVER

2 POLICY NUMBER: EFFECTIVE DATE: ISSUE DATE: I N315-TCT LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS. IL T IL T CHANGE ENDORSEMENT FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS BUSINESSOWNERS MP T AMEND EMPLOYEE DISHONESTY LIMIT IL T PAGE: 1 OF 1

3 BUSINESSOWNERS POLICY NUMBER: I N315-TCT-12 ISSUE D ATE: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EMPLOYEE DISHONESTY AND FORGERY OR ALTERATION INCREASED LIMIT This endorsement modifies insurance provided under the following: BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM A. The BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM is changed as follows: 1. The limit applicable to the Additional Coverage Employee Dishonesty is increased fro m $25,000 to $ 150, The limit applicable to the Additional Coverage Forgery or Alteration is increased fro m $25,000 to $ 150,000. MP T Copyright, The Travelers Indemnity Company, 2004 Page 1 of 1

4 CHANGE OVERPRINT /CHANGE SLIP POLICY NUMBER: I N315-TCT-12 ISSUE DATE: RATER: A5 CHANGE EFFECTIVE DATE: EFFECTIVE DATE: EXPIRATION DATE: INSURED S NAME: SODA SPRINGS RANCH CONDOMINIUM New/Renewal: R Special Code: Watch File: 0 Solicitor Code: Program Code: 10D Survey Code: 2 SAI: 8866A7142 Paymode: B Reinsurance: N MSI: I Audit Frequency: N DOWNSTREAM Rating Mode: G Responsibility: I Pro Rata Factor: PREMIUM SUMMARY S.B. ACCT. EFF. PREMIUM MO. DATE.1500 TOTAL D N/A OFFICE: DENVER 052 PRODUCER NAME: INS ASSOC INC-ESTES Page 1 of 1

5 M A S T E R CHANGE PROFILE P A C NAMED INSURED AND MAILING ADDRESS POLICY NO. 8483N315 SODA SPRINGS RANCH CONDOMINIUM POLICY PERIOD 10/01/12-10/01/ US HWY 34 #20 RATE EFF. DATE: 10/01/12 GRAND LAKE, CO CHANGE DATE: 10/25/12 PRO RATA FACTOR:.934 CONDOMINIUM PAC DELUXE PLAN PREMIUM CHANGE SUMMARY COVERAGE NEW OLD DIFFERENCE PRO-RATED ANNUAL ANNUAL IN ANNUAL AMOUNT CONDO DIRECTOR/OFFICERS AUTO HIRED AUTO NON-OWNED POWER PAC EMPLOYEE DISHONESTY POLICY COVERAGE TOTALS TOTAL POLICY PREMIUM

6 M A S T E R CHANGE PROFILE P A C NAMED INSURED AND MAILING ADDRESS POLICY NO. 8483N315 SODA SPRINGS RANCH CONDOMINIUM POLICY PERIOD 10/01/12-10/01/ US HWY 34 #20 RATE EFF. DATE: 10/01/12 GRAND LAKE, CO CHANGE DATE: 10/25/12 PRO RATA FACTOR:.934 CONDOMINIUM PAC LOCATION 01 BUILDING 01 ADDRESS 9921 U S HWY 34 # 20 GRAND LAKE, CO COVERAGE NEW OLD DIFFERENCE PRO-RATED ANNUAL ANNUAL IN ANNUAL AMOUNT BUILDING - DELUXE CONTENTS - DELUXE EQUIPMENT BREAKDOWN SEWER AND DRAIN BUILDING OWNERS ENDT LOC/BLD TOTALS

7 M A S T E R P A C PREMIUM SUMMARY NAMED INSURED AND MAILING ADDRESS POLICY NO. 8483N315 SODA SPRINGS RANCH CONDOMINIUM POLICY PERIOD 10/01/12-10/01/ US HWY 34 #20 RATE EFF. DATE: 10/01/12 GRAND LAKE, CO CONDOMINIUM PAC DELUXE PLAN PREMIUM SUMMARY COVERAGE PREMIUM BUILDING 31,400 BUSINESS PERSONAL PROPERTY 189 GENERAL LIABILITY INCLUDED AUTO HIRED 62 AUTO NON-OWNED 58 POWER PAC 84 EMPLOYEE DISHONESTY 203 ** INFLATION GUARD ANNUAL INCREASE APPLIED EQUIPMENT BREAKDOWN 3,437 CONDO DIR. & OFF. ( 120) 652 SEWER AND DRAIN BACKUP 528 MOLD/FUNGUS INCLUDED BUILDING OWNERS ENDT 140 TOTAL ANNUAL POLICY PREMIUM 36,753

8 PAGE 01 MASTERPAC PRICING FACTORS SODA SPRINGS RANCH CONDOMINIUM POLICY NUM: 8483N315 VER: 01 RATE EFFECTIVE DATE: 10/01/12 EFFECTIVE DATE: 10/01/12 PLAN: DELUXE GL LIMIT: 1,000,000 FUNCTION: CHANGE MODIFICATION FACTORS EXPERIENCE SCHEDULE EXPENSE COMPANY OTHER AGENCY TOTAL N/A.960 X X X X = EXPERIENCE SCHEDULE EXPENSE COMPANY OTHER AGENCY W/O COMP N/A.960 X X N/A X X =.960 COVERAGE LOC/BLDG NUMBER OF RATING FLAT TOT GARAGEKEEPERS LIMIT X LOC/BLDGS = LIMIT CHARGE X MOD COMPREHENSIVE ( 0 X 0 ) = COLLISION ( 0 X 0 ) = TOTAL GARAGEKEEPERS COMPREHENSIVE PREMIUM = 0 TOTAL GARAGEKEEPERS COLLISION PREMIUM = 0 TOT CHARGE x MOD = PREMIUM PROJECT AGGREGATE(PAYROLL (000)): LOCATION AGGREGATE(#OF LOCATIONS):

9 PAGE 02 MASTERPAC PRICING FACTORS SODA SPRINGS RANCH CONDOMINIUM POLICY NUM: 8483N315 VER: 01 RATE EFFECTIVE DATE: 10/01/12 EFFECTIVE DATE: 10/01/12 PLAN: DELUXE GL LIMIT: 1,000,000 FUNCTION: CHANGE MODIFICATION FACTORS EXPERIENCE SCHEDULE EXPENSE COMPANY OTHER AGENCY TOTAL N/A.960 X X X X = EXPERIENCE SCHEDULE EXPENSE COMPANY OTHER AGENCY W/O COMP N/A.960 X X N/A X X =.960 RATING TOT COVERAGE EXPOSURE X RATE FLAT CHG MOD EMPLOYEE DISHONESTY N/A EMPL DIS - NONCOMP OFF N/A.000 EMPL DIS - VOLUNTEERS N/A.000 EMPL DIS - PROP MGRS N/A.000 ERISA WELFARE/PENSION BUSINESS INCOME & EXTRA EXPENSE N/A.000 BI/EE DEPENDENT PROPERTY BUSINESS INC INTERRUPT-COMPUTER OPS N/A.000 CONDO-DIRECTORS/OFFICERS N/A TYPE OF ASSOCIATION MOD: 1.00 CONDO OCCUPANCY FACTOR: PRINTERS E & O N/A N/A MOLD/FUNGUS N/A INCL.000 POWER PAC N/A N/A EATING ESTABLISHMENTS N/A N/A LAWYERS PROPERTY ENDT N/A N/A ACCOUNTANTS PROPERTY ENDT N/A N/A MEDICAL/DENTAL OFFICE ENDT N/A N/A AUTO HIRED CHARGE N/A N/A AUTO NON-OWNED CHARGE N/A N/A EMPLOYEE BENEFITS LIABILITY N/A N/A EMPLOYERS OVERHEAD LIABILITY N/A.000 N/A.000 SEXUAL ABUSE COVERAGE 0 N/A NURSERY-KINDERGARTEN SURCHARGE N/A.000 PASTORS PROFESSIONAL LIABILITY N/A.000 MED PAY-ATHLETIC PARTICIPANTS 0 N/A PREMISES LEASED TO OTHERS N/A.000 SPECIAL EVENTS 0 N/A OPTOMETRIST PROF: NUMB/OPTOMETRISTS FINE ARTS RATE/FLAT CHARGE INCLUDES PROPERTY DEDUCTIBLE CREDIT

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