COUNTRY Mutual Insurance Company

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1 Location Summary Policy Number: WA Location Summary Loc # Complex Name Street Address City State Zip Code 1 34 Amherst NH LOC-SUM Page 1 of 1

2 Billing Number: Businessowners Policy Declarations Policy Period Optional Coverages From: 01/01/2018 To: 01/01/ :01 A.M., Standard Time s of Insurance WORLDS APART Advantage Endorsement Equipment Breakdown Building Automatic Increase 3% CAPsure Community Coverage (All In) Employee Dishonesty $25,000 Property Management Agent As An Employee Covered For "Employee Dishonesty" Only Employee Dishonesty for Designated Community Officers And Directors Forgery and Alteration $25,000 Extended Business Income 90 Days Hired Non-Owned Auto Liability $1,000,000 Aggregate s of Insurance Per Location Policy Forms and Endorsements attached at issuance: See Schedule of Forms and Endorsements THIS POLICY DECLARATION TOGETHER WITH THE COVERAGE FORM(S), FORMS AND ENDORSEMENTS, IF ANY, COMPLETE THE ABOVE NUMBERED POLICY. To report a claim after hours, call AWA DS Page 2 of 2

3 Schedule of Forms and Endorsements Schedule of Forms and Endorsements Form Number Title IL N New Hampshire Fraud Statement PRIV Privacy Statement PNWA WORLDS APART Businessowners Program Notice To Policyowners AWA DS Worlds Apart Declarations AWA Mutual Conditions FORM-SCHED Schedule of Forms and Endorsements LOC-SUM Summary of Locations BLANKET Schedule of Building and Personal Property Blanket s LOC-BLDG AWA Worlds Apart Advantage Endorsement BP Businessowners Coverage Form BP IN Businessowners Coverage Form Index AIL Exclusion - Tanning Beds And Tanning Bed Operations AIL Punitive Damages Exclusion AIL Equipment Breakdown Coverage AWA Disclosure Pursuant To Terrorism Risk Insurance Act AWA Building(s) AWA CAPsure Community Coverage AWA Employee Dishonesty Coverage For Designated Community Officers And Directors AWA Ice Dam Deductible - Per Unit AWA ation Of Coverage To Designated Premises With Special Events Exception BP New Hampshire Changes BP New Hampshire Businessowners Standard Fire Policy BP Hired & Nonowned Auto BP Employment-Related Practices Exclusion BP Abuse or Molestation Exclusion BP Calculation of Premium BP Cap On Losses From Certified Acts Of Terrorism BP Conditional ation Of Coverage For Terrorism - Sub- On Annual Aggregate Basis (Relating To Disposition Of Federal Terrorism Risk Insurance Act) BP Fungi or Bacteria Exclusion (Liability) BP Exclusion - Year 2000 Computer-Related and other Electronic Problems BP New Hampshire Effective Time Changes - Replacement Of 12 Noon FORM-SCHED Page 1 of 1

4 Schedule of Named Insured(s) Policy Number: WA Schedule of Building and Business Personal Property s Location Blanket Buildings listed in the for this location Loc # Not included in Blanket 1 $5,179,432 All For locations and buildings not included in a blanket limit, see the for the specific limits. BLANKET Page 1 of 1

5 Location 1 Policy Number: WA Loc #1 Amherst, NH Bldg #1 Bldg #2 Bldg #3 Bldg #4 Bldg #5 LOC-BLDG Page 1 of 5

6 Bldg #6 Bldg #7 Bldg #8 Bldg #9 LOC-BLDG Page 2 of 5

7 Bldg #10 Bldg #11 Bldg #12 Bldg #13 Bldg #14 LOC-BLDG Page 3 of 5

8 Bldg #15 Bldg #16 Bldg #17 Bldg #18 LOC-BLDG Page 4 of 5

9 Bldg #19 LOC-BLDG Page 5 of 5

COMMERCIAL CONDOMINIUM PAC

COMMERCIAL CONDOMINIUM PAC Report Claims Immediately by Calling* 1-800-238-6225 Speak directly with a claim professional 24 hours a day, 365 days a year *Unless Your Policy Requires Written Notice or Reporting COMMERCIAL CONDOMINIUM