If agency billed, payment is required within 14 days. If direct billed the payment option being requested

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1 Please note: In order to request binding of coverage, please use the following checklists. Missing items may result in delayed policy issuance. If the policy is direct-billed, you DO NOT need to collect any money. Fully completed and signed application Fully completed and signed page 1 of the quote If agency billed, payment is required within 14 days If direct billed the payment option being requested Umbrella: Completed and signed/initialed UM/UIM waiver On a premium financed policy, include a copy of the finance agreement and a proof of the minimum down payment of 25% of the base premium plus all applicable fees 33 Lennon Lane Walnut Creek, CA License # (8) (925) Fax (925)

2 J.E. BROWN & ASSOCIATES 33 Lennon Lane Walnut Creek, CA (925) ext. Ext 23 Fax: (925) Vincent Vincent Leung Insurance Services 829 Harrison Street Oakland, CA 9467 Vincent, Enclosed you will find an admitted Personal Umbrella quote for DAVID YU WONG. The quote number is PCL16ND639 Version 5. Section I- Section II- Section III- Section IV- Section V- Section VI- Details the premiums, taxes and fees associated with this account. In addition, it provides the Underwriting tes and covers any of the additional underwriting information that might be needed prior to binding or within 21 days of the inception date. Provides the underlying coverages. Communicates the underwriting information used to rate this account and develop this quote. Lists the required coverage forms, notices, endorsements and exclusions. Offers optional coverages that are available to the applicant but are not currently included in the quote. Provides the Direct Bill Payment Description. In addition we have included some materials that will assist in the evaluation of this offer of coverage. A Point of Sale piece that provides some claims scenarios this account may encounter and a coverage checklist that can be compared to the quotation of another carrier. The carrier will send the insured an invoice based on the terms reflected in this quote. Payment is due to the carrier. Payment options available to you are: 1. Send the invoice remittance slip with payment to the lockbox address on their invoice 2. Pay online at < 3. Pay by phone (automated system available 24/7) at The policyholder can register their policy at < By registering their policy, the insured will have access to additional information as well as the option to set-up recurring payments. Recurring payments are a great way to minimize the possibility of the insureds policy being cancelled or not renewed because payment was not received. We invite you to contact us to discuss the benefits of any coverages, the costs associated or simply to provide feedback! We welcome the opportunity to talk with you about this quote. Thank you for the opportunity to quote this account! Sincerely, Pam Pearson J.E. BROWN & ASSOCIATES (925) ext. Ext 23 Cover letter

3 J.E. BROWN & ASSOCIATES 33 Lennon Lane Walnut Creek, CA (925) ext. Ext 23 Fax: (925) Cover letter

4 J.E. BROWN & ASSOCIATES 33 Lennon Lane Walnut Creek, CA (925) ext. Ext 23 Fax: (925) PCL16ND639 Version 5 Quote is valid until 1/29/217 Please bind effective: Re: To: Attn: From: DAVID YU WONG Vincent Leung Insurance Services Vincent Commission: 12% Pam Pearson pam_pearson@jebrown.net / (925) ext. Ext 23 Confirm optional coverages: Do not include any optional coverages. Include the following optional coverages from Section VI (Taxes & Fees may apply to optional premium if purchased) Option 1 - (add: $165) - Increase Uninsured/Underinsured Motorist Coverage to $25, /$5, Option 2 - (add: $495) - Increase Uninsured/Underinsured Motorist Coverage to $1,, Option 3 - (add: $4) - Personal Injury - adds back Personal Injury Coverage if excluded on your primary liability policy. This policy is eligible to be Direct Billed. te: a $5. installment fee will apply to each installment after the first - please select one of the following: Direct Bill both this New Business and future Renewals (If checked - Select a Payment Plan): SINGLE PAYMENT TWO PAYMENTS - Premium must be over $4 See the last page of this quote for Payment Plan Descriptions Do not Direct Bill this New Business but do Direct Bill future Renewals Do not Direct Bill this policy NOTE: If the Direct Bill Option is selected, the Company will invoice the insured. Do not bill or collect the down payment. All taxes, surcharges and fees (except installment fees) will be billed in full with the first installment. I. PREMIUM AND UNDERWRITING NOTES/REQUIREMENTS PERSONAL UMBRELLA POLICY INFORMATION Carrier: Status: A.M. Best Rating: Signature: United States Liability Insurance Company Admitted A++ (Superior) - X LIMIT OPTIONS PREMIUM WHOLESALER AMOUNT DUE BROKER FEE $1,, $848. $35. $883. $2,, $1,324. $35. $1,359. $3,, $1,691. $35. $1,726. $4,, $1,966. $35. $2,1. $5,, $2,245. $35. $2,28. Please contact us with any questions regarding the terminology used or the coverages provided. **Read the quote carefully, it may not match the coverages requested** Page 1 of 4

5 PCL16ND639 Version 5 ADDITIONAL COSTS INCLUDE: Wholesaler Broker Fee $35. ADDITIONAL QUOTE INFORMATION This quote offers Optional Excess Uninsured / Underinsured Motorist Coverage (UM/UIM) with limits and an additional premium as shown in Section V Offer of Optional Coverages. $25, Excess Uninsured/Underinsured Motorist Coverage is included in the premium listed above Primary Automobile Uninsured/Underinsured limits must equal our Required Underlying Automobile Bodily Injury limits for this excess Uninsured or Underinsured coverage to apply. FREE AND DISCOUNTED BUSINESS SERVICES AVAILABLE TO USLI INSUREDS VISIT BIZRESOURCECENTER.COM FOR DETAILS Within 21 days of the inception date of coverage, this account will be subject to the following: Our completed & signed application; or A completed & signed ACORD application as long as all underwriting information needed has been provided to us; or A completed & signed application from another company as long as all underwriting information needed has been provided to us. A completed, signed Excess Uninsured/Underinsured Motorist Coverage Selection/Rejection Form within 21 days of binding coverage. Underwriting tes: In compliance with California Assembly Bill 244, cancellation by the insured may result in a short rate calculation (9% of unearned premium) to determine the return premium. Please note that the Minimum Underlying Limits for Automobile Liability for this Personal Umbrella Quotation are $25,/$5, /$1, Split Limits or $3, CSL. thanks Prior to Bind Requirements: this account is subject to the following: Coverage cannot be bound without the following information. We may modify the terms and/or premiums quoted or rescind this quote if the information provided below or on the completed application materially affects the rating or eligibility of the risk. Review of Motor Vehicle Reports (MVRs) which verify the driving history of all drivers listed on the quote. II. UNDERLYING COVERAGES Comprehensive Personal Liability Limits of Liability Combined Single Limit: $5, Recreational Vehicle Liability Limits of Liability Bodily Injury (Per Person): $25, Bodily Injury (Per Occurrence): $5, Property Damage (Per Occurrence): $1, Automobile Liability Limits of Liability Bodily Injury (Per Person): $25, Bodily Injury (Per Occurrence): $5, Property Damage (Per Occurrence): $1, Please contact us with any questions regarding the terminology used or the coverages provided. **Read the quote carefully, it may not match the coverages requested** Page 2 of 4

6 PCL16ND639 Version 5 Watercraft Liability Limits of Liability Bodily Injury (Per Person): $25, Bodily Injury (Per Occurrence): $5, Property Damage (Per Occurrence): $1, III. UNDERWRITING INFORMATION USED TO GENERATE THIS QUOTE Schedule In Brief 1 Primary Residence in the rating state of: California Additional Owner Occupied Locations 28 Additional 1-4 family residential units rented to others 3 Automobile(s) Motorcycle(s) and Vehicle(s) less than 4 wheels Acre(s) of Vacant Land Acre(s) of Farmland leased to others Watercraft Recreational Vehicle(s) Farm Location(s) Driver Name Date of Birth License Number License State Moving Violation Convictions (Last 3 Years) Major Moving Violations Convictions (Last 3 Years) At Fault Accidents (Last 3 Years) David Yu Wong 2/28/1961 c CA Binnie Wong 1/28/1971 b CA IV. REQUIRED FORMS & ENDORSEMENTS Excess Liability Endorsements CA-DN PCL PCL Jacket PCL-141 PCL-148 PCL-149 PCL-151 (5/6) Consumer Disclosure tice California PCL-153 (11/14) Retained Limit (7/9) Personal Umbrella Liability Coverage Form PCL-156 Drug or Alcohol Related Offenses (Last 5 Years) (12/15) Public Or Livery Conveyance Exclusion Endorsement (9/1) Personal Umbrella Liability Policy PCL-21 (11/1) Service Of Suit Address Change (1/15) Absolute Exclusion For Pollution, Organic Pathogen, Silica, Asbestos And Lead With A Hostile Fire Exception (6/12) Exclusion - Rental of Owned or Leased Auto (1/13) Coverage Extension - Excess Uninsured/Underinsured Motorist Coverage PCL-22 PCL-377 PCL-CA (8/11) Worldwide Territory Endorsement (11/15) Exclusion For Permissive Regular Operators (7/9) California Changes (5/13) Limited Pool Exclusion PR NOTICE (6/1) Privacy tice V. OFFER OF OPTIONAL COVERAGE(S) Based on the information provided, the following additional coverages are available to this applicant but are not currently included in the quotation. The additional premium may be subject to taxes & fees. For a firm final amount please contact us and we will revise the quote. Coverage Premium Option 1 Increase Uninsured/Underinsured Motorist Coverage to $25,/$5, $165 Important Information If this option is selected, the PCL-149 will apply Please contact us with any questions regarding the terminology used or the coverages provided. **Read the quote carefully, it may not match the coverages requested** Page 3 of 4

7 PCL16ND639 Version 5 Coverage Option 2 Increase Uninsured/Underinsured Motorist Coverage to $1,, $495 Important Information If this option is selected, the PCL-149 will apply Coverage Option 3 Personal Injury - adds back Personal Injury Coverage if excluded on your primary liability policy. $4 Important Information If this option is selected, the PCL-154 will apply VI. DIRECT BILL PAYMENT PLAN DESCRIPTIONS SINGLE PAYMENT TWO PAYMENTS One Year Payment Plan Descriptions: - The entire premium is invoiced immediately and is due 2 days after it is invoiced. Premium Premium - 5% of the premium is invoiced immediately and is due 2 days after it is invoiced; the balance is invoiced 6 days after inception. An installment fee as noted on page 1 of this quote applies to each installment after the first. Please contact us with any questions regarding the terminology used or the coverages provided. **Read the quote carefully, it may not match the coverages requested** Page 4 of 4

8 United States Liability Insurance Company PCL16ND639 Personal Umbrella/Excess Personal Umbrella Application Version 5 YOU CAN OBTAIN A QUOTE BY PROVIDING THE INFORMATION IN THE INSTANT QUOTE SECTION, SUBJECT TO THE REMAINDER PROVIDED PRIOR TO BINDING. I. INSTANT QUOTE INFORMATION Instant Quote is only available for accounts with no losses in the past 3 years. If there is loss history, please complete the entire application. Applicant's Name: David Yu Wong Occupation: Applicant Type: Individual NOTE: Any type other than Individual(s) requires submitting a completed Trust LLC Supplemental Questionnaire Address of Applicant or Applicant primary contact: Address of Primary Residence: Primary Personal Umbrella Underlying Personal Liability Limit: Underlying Auto Bodily Injury Underlying U.M./U.I.M. Limit: Excess Personal Umbrella. binniewong128@sbcglobal.net City: Dublin State: CA Zip: CSL 25/5/1 If so, Underlying Primary Umbrella Limit: Is any member of the household a federal or state political figure, professional athlete or coach, music or television entertainer or CEO of a Fortune 5 company? Does the applicant own or lease any location used for farm or ranch operations? Same as mailing address NOTE: Any "" response requires submitting a completed Supplemental Farm Application In addition to the Primary Residence: Enter the number of owner occupied secondary residences. Enter the number of 1-4 family residential units rented to others. (Duplex = 2 units) How many autos or Motor Homes are owned or furnished for the regular use of any operator in the household? How many Motorcycles or scooters are owned or furnished for the regular use of any operator in the household? How many recreational vehicles (vehicles not licensed for road use) are owned or furnished for the regular use of any operator in the household? Any Watercraft? If, Please complete watercraft information section Watercraft Information Craft Number Please list all watercraft owned, leased, chartered, or furnished for regular use Year Description Length *Type Max (Make and Model) Speed Total HP Waters Navigated 1. Inland U.S. 2. Coastal U.S. 3. International Waters 28 3 Underlying Liability *1. Sailboat 2. Powerboat 3. Jet Ski / Wave Runner Powerboats (other than Jet-Skis) with speed capabilities exceeding 5 MPH are Ineligible. Driving Record Information Enter the Number of: Moving Violations (over the past three years) *Major Moving Violations (over the past three years) At-Fault Accidents (over the past three years) Drug/Alcohol Offenses (over the past five years) Driver Information Enter the Number of Drivers: Age 19 or younger Between the ages of 2 and 22 Between the ages of 23 and 75 2 Between the ages of 76 and 89 Age 9 or older PU/EPU 12/16 - USLI Page 1 of 3

9 Operator Information (Automobiles, Watercraft, Recreational Vehicles). Please list all members of the applicants household age 14 or older, and all operators of Automobiles, Motorcycles, Watercraft and Recreational Vehicles. NOTE: Please include those members that are not yet licensed. Driver Name Date of Birth License Number License State Moving Violation Convictions (Last 3 Years) *Major Moving Violation Convictions (Last 3 Years) David Yu Wong 2/28/1961 c CA Binnie Wong 1/28/1971 b CA At Fault Accidents (Last 3 Years) Drug or Alcohol Related Offenses (Last 5 Years) *Major moving violation convictions include, but are not limited to, speeding 25 or more over the posted limit, evading the Police, leaving the scene, vehicular homicide, driving under a suspended license, and reckless driving. II. ELIGIBILITY CRITERIA *NOTE: For any "" response, please provide complete information in remarks area. Has the applicant or any resident of the applicant's household had a liability loss greater than $5, in the past 5 years or is there an open liability claim or lawsuit pending against them? Are any owned or leased locations used as rooming houses, student housing other than a college dormitory room, assisted living facilities, or group home facilities? Does the applicant or any resident of the applicants household operate any business at an owner-occupied residence? Are the Minimum underlying Limits for automobiles covered completely by a business auto or garage policy? Is any of the Required Underlying Insurance provided by a commercial general liability policy or coverage form? Residential Properties/Rental units and Apartments/Farms/Vacant Land. Include all units (duplex = 2 units) Location Occupancy Underlying Liability limit Owner occupied Tenant Occupied Farm Vacant Land Owner occupied Tenant Occupied Farm Vacant Land #Units: #Acres: #Acres: #Units: #Acres: #Acres: *Any Individual dwellings containing more than five units are ineligible Applicant s Mailing Address (if different than Primary Residence address): City: State: Zip: Phone: Remarks Fraud Statement (All Other States): Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. PU/EPU 12/16 - USLI Page 2 of 3

10 Retail Agency Name: Vincent Leung Insurance Services License #: Main Agency Phone Number: Agency Mailing Address: City: State: Zip: The signer of this application acknowledges and understands that the information provided in this Application is material to the Insurer s decision to provide the requested insurance and is relied on by the Insurer in providing such insurance. The signer of this application represents that the information provided in this Application is true and correct in all matters. The signer of this Application further represents that any changes in matters inquired about in this Application occurring prior to the effective date of coverage, which render the information provided herein untrue, incorrect or inaccurate in any way will be reported to the Insurer immediately in writing. The Insurer reserves the right to modify or withdraw any quote or binder issued if such changes are material to the insurability or premium charged, based on the Insurer s underwriting guides. The Insurer is hereby authorized, but not required, to make any investigation and inquiry in connection with the information, statements and disclosures provided in this Application. The decision of the Insurer not to make or to limit any investigation or inquiry shall not be deemed a waiver of any rights by the Insurer and shall not estop the Insurer from relying on any statement in this Application in the event the Policy is issued. It is agreed that this Application shall be the basis of the contract should a policy be issued and it will be attached and become a part of the Policy. Applicant's Signature: Title: Date: PU/EPU 12/16 - USLI Page 3 of 3

11 BUSINESS RESOURCE CENTER DID YOU KNOW THAT YOUR INSURANCE POLICY PROVIDES YOU WITH MORE THAN JUST INSURANCE COVERAGE? TAKE THE STEPS TO REDUCE YOUR CYBER RISK Credit monitoring and cyber risk up to $2, for out-of-pocket expenses related to identity restoration Access to four discounted identity theft HIRE THE RIGHT EMPLOYEES TO HELP YOU RUN YOUR HOME Background Check Services First one is FREE and then pricing for each additional screen starts at $1, may apply Motor Vehicle Reports Discounted Training Module FREE access to acquire the skills needed to select the right candidates for your company MORE RESOURCES DO YOU ALSO OWN YOUR OWN BUSINESS? TAKE ADVANTAGE OF: Human Resource Specialists and Training Modules Payroll Services Alcohol Safety Training Educational Resources MAKE THE RIGHT CHOICES WHEN BRINGING ON A NEW TENANT Access to tenant screenings ($15 and $2) - $15 tenant screen does not include the credit score Packages include multi-court criminal database search, multi-court eviction database search, online rental application, adverse action notices for unlimited users, and (optional) Marketing and Social Media Resources For more information and to utilize these services, contact your insurance agent or visit usli.com/brc BRCPersonalQuoteAttachment-1-14

12 UNITED STATES LIABILITY INSURANCE GROUP WAYNE, PENNSYLVANIA SELECTION/REJECTION OF OPTIONAL EXCESS UNINSURED/UNDERINSURED MOTORIST COVERAGE - CA Coverage selected on this Selection Form is subject to the terms and condition of the policy to which it is attached. I. I understand that, unless otherwise selected on this form, my policy provides a maximum of $25, in Excess Uninsured/Underinsured Motorist coverage for motor vehicles (Excess UM/UIM coverage), subject to required underlying insurance requirements. I understand that I have the option to purchase additional Excess UM/UIM coverage or to reject such optional Excess UM/UIM Coverage under my policy. I understand that if I reject optional additional Excess UM/UIM coverage, I am electing not to purchase a valuable coverage which would protect me and other Insureds in the event of a covered loss. I understand and agree that the limits shown in Item 3. POLICY LIMITS, Coverage B on the Declarations are the most the Company will pay for all damages resulting from any one accident regardless of the number of covered persons, claims made, vehicles or premium shown on the Declarations or vehicles involved in the incident. I understand and agree that, as a condition of Excess UM/UIM coverage under my policy, I will obtain and maintain underlying Excess UM/UIM coverage on all motor vehicles covered by my policy with limits equal to the limits of underlying Automobile Liability Insurance in Item 6. REQUIRED UNDERLYING INSURANCE COVERAGE on the Declarations or as shown on the Schedule of Underlying Insurance Endorsement or the Specified Automobile Endorsement (if applicable). If such underlying insurance is not obtained or maintained at the required limits of liability, Coverage B Excess Uninsured/Underinsured Motorist coverage may be reduced to no more than $25,, by the terms of the policy. I acknowledge that Excess UM/UIM coverage has been explained to me by my agent. I have been offered the option of selecting Excess UM/UIM coverage with limits equal to $1,,, or Excess UM/UIM coverage with limits lower than my liability limits. 1. I select Excess UM/UIM coverage equal to $1,, Bodily Injury (initials) 2. I select Excess UM/UIM coverage equal to my Automobile Bodily Injury Underlying Limits (initials) 3. I reject any optional Excess UM/UIM coverage beyond the $25, that is included in my policy premium (initials) te: One of the three options must be selected Named Insured s Full Name (Please Print Legibly) Signed Date SR E UM-UIM CA (8-11) Page 1 of 1