TOTAL ANNUAL PREMIUM:... DIRECT BILL: Insured Mort. Other New Business - 1 months premium required with application.

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Conrad Bradford
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1 Box 48 Cottonwood, Minnesota Farm application Farmowners New Business Farm Fire with Premises Liability (Attach CF-1944) Farm Fire without Premises Liability Renewal of Number EFFECTIVE DATE_ APPLICANT AND MAIL ADDRESS AGENCY AND MAIL ADDRESS AGT. NO. Phone No.: Soc Sec No.: Phone No.: Fax No.: DESCRIPTION OF PREMISES: List all property with buildings owned, leased, rented or maintained. List primary building location 1st. Loc No. of Sets of Qtr. Sec-Twp-Rge Interest Fire No. Dwlgs. Bldgs. Acres Sec. Numbers Township County State O/T Dist. # 911 Address Bare Land Total Additional acres - with no buildings - owned, leased, rented or maintained not listed above. TOTAL ACRES DEDUCTIBLE: Check Deductible desired for both the Residence and Farm Property listed below. RESIDENCE COV. A, C & D: $250 $500 $1,000 $1,500 $2,000 $2,500 $5,000 $10,000 FARM PROPERTY COV. E, F & G: $250 $500 $1,000 $1,500 $2,000 $2,500 $5,000 $10,000 DWELLING: Owner Occupied Tenant Occupied Construction_ Year Built No. of Smoke Detectors If Mobilehome construction, are tie-downs used? Yes No FIRE PROTECTION CLASS: Protected Partially Protected Unprotected DWELLING COV.: Repl Cost (R) ACV (A) FORM: Basic (1) Broad (2) Special (3) Tenant's (4) Farm Dwlg Plus (5) COVERAGES Coverage A - Residence Coverage C - Personal Property Coverage D - Additional Living Expense and Loss of Rent (Owner Occ. only - 60% Incl.) (Owner Occ. only - Actual Loss Sustained within 12 months) (Farm Dwlg. Plus - 75% Incl.) (Farm Dwelling Plus - Actual Loss Sustained within 12 months) LIMIT OF INS. ADDITIONAL DWELLINGS: For each additional dwelling to be insured, please complete a Seconday Dwelling Application (CF-1759). INFLATION GUARD - applies to Dwellings/Mobile Homes and Farm Buildings written on a Replacement Cost Basis only: (Limits of Insurance for Coverage A, Coverage C, and Farm Buildings will automatically be updated based on changing construction cost factors.) Mortgagee C/D Loss Payee on Mortgagee C/D Loss Payee on OPTIONAL PROPERTY COVERAGES Back Up of Sewers - FP-208 Amount $ Borrowed Farm Machinery Increase to $ (10,000 Included) Farm Extra Expense - NS-355 Amount $ Farm Operations Records Amount $_ Livestock Confinement - CF-660 (complete separate app.) Mod. Replace. Cost - Res. - FP % 60% 70% 80% Peak Season Item_ Amount $_From To Refrigerated Food Products - NS-305 Amount $ Replacement Value (Personal Property (HHG), etc.) Special Form - Personal Property, (HHG) Inland Marine (complete Inland Marine Application) Hay in the Open - Stack Increase to $20,000 Other CF-1941 (Ed. 8-17) 1 PROPERTY COVERED PREMIUM Basic Dwelling Premium Scheduled Farm Personal Property Unscheduled Farm Personal Property Farm Barns, Buildings and Structures Farm Liability and Medical Payments Inland Marine Scheduled Property Woodburning/Solid Fuel Surcharge Farm Fire Surcharge Companion Policy Discount (Farmowners Only) TOTAL ANNUAL PREMIUM:... DIRECT BILL: Insured Mort. Other_ New Business - 1 months premium required with application.

2 GENERAL underwriting Report - Furnish Photos of all Buildings (Application Returned If Not Completed) A. Date of last on site inspection?_ By whom? B. Is dwelling on primary premises occupied by: Owner Tenant Unoccupied C. Principal farm operation(s): Grain Dairy Livestock Occupation Other Than Farming: D. General housekeeping and condition of premises: Excellent Good Fair Poor E. Are any of the farm premises vacant or unoccupied? Yes No If Yes, explain F. Name of Previous Carrier Was policy cancelled or non-renewed? Yes No If Yes, why? G. How long have you known applicant? Do you recommend issuance of this policy? Yes No H. Do we carry other insurance for this applicant? Yes No If Yes, list policy number(s) DWELLING A. Year roof last shingled: B. Central Heating System: Yes No C. Age of Heating Plant: D. Fuel Used: E. Space Heaters: Yes No F. Solar Heating: Yes No G. Age of Wiring: H. Age of Plumbing: WOODBURNING/SOLID FUEL EQUIPMENT: Yes No If Yes, our Solid Fuel Questionnaire must be completed. OUTBUILDINGS (Outbuildings must be in use and have economic value to be insured) A. Condition of buildings: Excellent Good Fair Poor B. Do any outbuildings have exposed insulation? Yes No C. Describe any existing damage: D. Condition of wiring in buildings: Excellent Good Fair Poor E. Any fuel tanks inside buildings? Yes No LIABILITY A. Are premises used for any business or professional purposes other than farming? Yes No Describe: B. Does applicant do custom farming? Yes No Type: Receipts: C. Does applicant do custom spraying? Yes No Gross Receipts: D. Has any machinery had guards or shields removed? Yes No Explain: E. Are fences adequate to keep livestock confined? Yes No F. Does applicant own dog(s)? Yes No What breed: _ Has dog ever bitten anyone? Yes No G. Are there horses on premises? Yes No # Owned: # Boarded: Explain if used in any events (i.e parades, rodeos, shows): Explain if any training, stud service or other business use:_ H. Trampoline? Yes No; Swimming Pool? Yes No; Above Ground? or Below Ground?; Diving Board/Slide? Yes No; Fence around Pool? Yes No; (Provide Picture of Pool); List any unusual hazards (Ponds, etc.):_ LOSS EXPERIENCE: NONE APPLICANTS SIGNATURE List all Losses within the past 3 years. DATE CAUSE OF LOSS & PROPERTY INVOLVED AMOUNT OF LOSS DWELLING REPLACEMENT COST ESTIMATE - Use the MS/B RCT software program & ATTACH THE RCT PRINTOUT. 2

3 Scheduled farm personal property - coverage E (Basic is Standard Coverage unless Special is checked) Code Item # Limit Description Premium _ Hay in the Open (includes hay, fodder, straw and other animal bedding) (stack limit of $10,000)... 4._ Machinery Not Described ($1,000 Maximum Limit Per Item)... Machinery Year Make Model and Serial Number Irrigation Equipment (For Center Pivot List Age, Manufacturer, Span/Towers and Location) _ Portable Crop Dryer 19. Total Amount of Insurance Total Premium NS Glass Breakage in Cabs - Number of Units with Cabs: Replacement Cost on Center Pivot Irrigation Equipment - complete and attach Replacement Cost Form (CF-1853) Schedule of barns, buildings, structures & add'l farm dwellings - coverage G (Basic, ACV is Standard Coverage, unless optional checked) - (Add'l Farm Dwellings - Basic, ACV Only) Optional Code Item # Loc # Limit Description Dimensions Type Const. Premium 1. x 2. x 3. x 4. x 5. x 6. x 7. x 8. x 9. x 10. x 11. x 12. x 13. x 14. x 15. x 16. x 17. x 18. x Total Amount of Insurance Total Premium NOTE: A per building base charge applies to all outbuildings except bins and Type 3 buildings. Broad Special Replace Special Are any of the Outbuildings heated? Yes No If yes, which building and type of heat Shingle Exclusion - Applies to the Following Bldgs (List Item Numbers) Other Restrictions - (List Item and Nature of Restriction) 3

4 FARM LIABILITY (NS-710) - COVERAGES L & M LIMITS: Coverage L - Personal Liability: $ Coverage M - Medical Payments to Others: $ Cov. Applies Yes/No Premium x BASIC FARM EXPOSURE CHARGE - Includes one dwelling, one set of buildings and Employer s Liability for part time employees working 40 days or less per year... $_ Non-Farming Discount (No farm land operated by insured/no making of hay and with 5 or less head of horses/other livestock)... - $_ ADDITIONAL CHARGES Additional Farm Premises with Buildings (Owned or Rented) Farm No. $_ Additional Residence Premises Maintained (Secondary or Seasonal) Location $_ Livestock Liability Exposure Charge... $_ Horses No.... $_ OPTIONAL COVERAGES Additional Insured Name Interest_ (Not Partners) Address_ $_ Babysitting Children (One Charge) No. of Children... $_ Business Activities: Who & What Classification $_ Custom Farming - Describe_ Estimated Receipts $ $_ (When Custom Farming exceeds $1,000, charge applies to receipts in excess of $1,000) Inboard and Inboard/Outboard Motor Boats Length Description Rated Speed (M.P.H.) H.P. $_ Incidental Office - Describe $_ Outboard Motor Boats (50 H.P. and under - No Charge) Over 50 H.P.: H.P. Make_ Serial No. $_ NOTE: For rating purposes, combine the H.P. of all outboard motors used together with any single watercraft owned by the insured. Partnership Endorsement (List all partners) Corporation (List all members) Name Relationship Resides at Farm No. $_ Name Relationship Resides at Farm No. $_ Personal Injury (Does not include Medical Payments) (Included with Farm Dwelling Plus)... $_ Personal Watercraft (Per Unit) Description $_ Recreational Vehicles (Does not cover any 2 wheel vehicles) Snowmobiles and All Terrain Vehicles (1 Charge) How many?_ $_ List Snowmobile(s) CC s List ATV(s) CC s_ Residence Premises Rented to Others No. of Families - Location $_ No. of Families - Location $_ DAMAGE TO PROPERTY OF OTHERS Increase to $ ($1,000 Included) (Can not be increased if custom farming is done)... $_ *EMPLOYER S LIABILITY (Part time employee working 40 days or less per year included) Each Full Time Employee, (working 180 days per year or more) No. $_ Each Part Time Employee, (working over 40 days but less than 180 days per year) No. $_ FARMER S MEDICAL PAYMENTS - DESIGNATED INSURED, AGES ($100 Deductible Applies) Name DOB Relationship $_ Name DOB Relationship $_ OTHER $_ SEPARATE FARM LIABILITY POLICY SURCHARGE... $_ FOR COVERAGES OR RATING SITUATIONS NOT SHOWN, REFER TO ONE GENERAL AGENCY 4 TOTAL PREMIUM $_ NOTICE - READ BEFORE SIGNING - As the applicant for this insurance, I grant permission to the agency listed on the front and to the underwriting departments of One General Agency and North Star Mutual to obtain claims information from previous insurer(s) and/or reports from investigative consumer organizations as to my credit (or credit-based insurance score), character, and/or condition of the property represented on this application. I understand that I have the right to make a request in writing as to the nature of any such information that may be developed and that I have the right to request that any such information be corrected by providing documented support for such correction. If my request is denied, I understand that I have the right to appeal to the Commissioner/Director (Oklahoma Insurance Commissioner, PO Box 53408, Oklahoma City, OK ). If this application for insurance is accepted, I grant permission to One General Agency and North Star Mutual to disclose information to the Mortgagee(s) or Loss Payee(s) that may be designated in this application or its(their) successor(s). (Reports prepared by insurance-support organizations may be retained by them and disclosed to others.) INSURANCE FRAUD IS A CRIME - I understand that a person who submits an application or claim information with intent to defraud an insurer is guilty of a crime. Applicant's Signature Date As the Agent for the applicant, I attest that the information in this application and attachments is correct to the best of my knowledge. Agent's Signature Date

5 NORTH STAR MUTUAL INSURANCE COMPANY UNSCHEDULED FARM PERSONAL PROPERTY INVENTORY - COVERAGE F (Unscheduled Farm Personal Property requires $50,000 minimum coverage) APPLICANT MACHINERY Auger Auger Auger Wagons Baler Beet Defoliator Beet Lifter Beet Planter Beet Thinner Chisel Plow Combine Combine Corn or Grain Head Cultivator Disc Drag Drills and Seeders Feed Grinder Feed Mixer Feed Trailer Fertilizer Spreader Garden Grain Cleaner Harrows Hay Conditioner Hay Racks Hay Rakes Manure Spreader Mowers Planters Plows Portable Elevators #1 FARM MACHINERY AND MISCELLANEOUS EQUIPMENT/TOOLS (Only list all items valued at $2,500 or Higher) VALUE MACHINERY (Continued) VALUE MACHINERY (Continued) Potato Harvester Potato Planter Rock Picker Rotary Hoe Silage Bagger Silage Blower Silage Cutter Silage Wagon Skid Loader Snow Blower Sprayer Stack Mover Stacker Stalk Chopper Swather Loader Trailers (Unlicensed) Vaculators Wagons Water Tanks VALUE * MISC. EQUIP./TOOLS VALUE (Only list items valued at $2,500 or Higher) Air Compressor Dual Tires Electric Motors Fencing Supplies Fuel Tanks and Stands Gas Engine Jacks Livestock Feeders Livestock Waterers Monitors Portable Corrals Portable Generator Portable Heating Units Posthole Digger Power Tool Pressure Sprayer Torch Welder #1 SUB-TOTAL TOOLS, SPARE PARTS AND MISCELLANEOUS EQUIPMENT VALUED UNDER $2,500 (A Minimum of 10% of the Farm Machinery and Misc. Equipment /Tools Inventory Sub-Total is required) _ #1 TOTAL FARM MACHINERY AND MISCELLANEOUS EQUIPMENT/TOOLS _ Refer to the policy for certain excluded items. To be covered, the following must be specifically insured: Installed Equipment, All Irrigation Equipment, Portable Buildings and Structures and Portable Crop Dryers. #1 MACHINERY AND EQUIPMENT RATE x _ #1 MACHINERY AND EQUIPMENT PREMIUM _ Special Form - Farm Machinery (coverage applies to all Scheduled and Unscheduled Farm Machinery and Miscellaneous Equipment/Tools) NS Glass Breakage in Cabs - Number of Units with Cabs: CF-1941a (Ed. 2-09) 1 * Installed equipment must be included with either building item or scheduled specifically.

6 UNSCHEDULED FARM PERSONAL PROPERTY INVENTORY - COVERAGE F (Unscheduled Farm Personal Property requires $50,000 minimum coverage) #2 LIVESTOCK NOTE: Livestock valued at more than $2,500 per head must be specifically insured - list under Scheduled Farm Personal Property CATTLE # VALUE TOTAL Bulls at Calves at Cows at Feeder Cattle at at at HOGS Boars at Feeder Pigs at Sows at at at HORSES Horses at Mules at at at SHEEP AND GOATS Ewes at Goats at Lambs at Rams at at at #2 SUB-TOTAL _ VETERINARY SUPPLIES AND OTHER ANIMAL CARE ITEMS VALUED UNDER $1,000 _ (A Minimum of 1% of the Livestock Inventory Sub-Total is required) #2 TOTAL LIVESTOCK #2 LIVESTOCK RATE x #2 LIVESTOCK PREMIUM #3 FEED, FARM PRODUCTS AND SUPPLIES FEED # VALUE TOTAL Feed at Hay at Silage at Straw at at at FARM PRODUCTS Barley at Corn at Milk at Milo at Oats at Rye at Sorghum at Soybeans at Sunflowers at Wheat at at at SUPPLIES Farm Chemicals at Fertilizer at Grease and Oil at Paint at Seed at Fuel at Building Material at at at #3 TOTAL FEED, FARM PROD/SUPPLIES #3 FEED, FARM PROD/SUPPLIES RATE x #3 FEED, FARM PROD/SUPPLIES PREMIUM TOTAL UNSCHEDULED FARM PERSONAL PROPERTY ANNUAL PREMIUM (Add 1, 2 & 3) If coverage for unscheduled farm personal property is a part of this policy, I/we certify that the inventory contains a full description of the total value of all unscheduled farm personal property. I/we agree and understand that an 80% coinsurance clause will be attached to the policy issued which will provide that I/we shall at all times maintain contributing insurance on unscheduled farm personal property insured to the extent of at least 80% of its actual cash value and failing to do so, shall to the extent of such deficit bear my/our portion of any loss. SIGNATURES: DATE AGENT APPLICANT 2

COMBINATION PACKAGE APPLICATION

COMBINATION PACKAGE APPLICATION New Renewal of: From: To: Fire Policy Number: AND (12:01 a.m. at address of named insured) Box 48 Cottonwood, Minnesota 56229 Individual Partnership Corp. Other Agency and