Sample. Instructions. There are two new items that will be required annually:

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1 Instructions 1. Please enter your State agency; contact name; contact name s phone number; contact s address and RSTARS code on each individual tab, as required. 2. Please enter all requested information in each of the worksheet tabs. All areas that are required to be completed are shaded in yellow on each survey form. The Excel worksheets will automatically calculate the totals. 3. This year we are providing the Property/EDP data your agency submitted last year. To update the Property/EDP tab: a. Please enter the updated 2018 values for Building, Contents and EDP in the blank columns provided. b. Please provide complete address information for each location. c. Any new locations should be added in the blank rows provided at the end of the worksheet. d. For locations that should be deleted, please enter the word DELETE instead of a value and confirm in the 2018 Comments colu e. Please confirm the Building, Contents and EDP totals for your agency are correct at the bottom of the worksheet. When you are completing the Property/EDP and Vessel surveys, please keep in mind that the requested value is the current replacement cost, not the purchase price, land value, fixed asset value, or market value. When considering building replacement costs, remember that building materials and labor costs typically increase a small amount annually. Rarely should there be a reduction in these values. If there is reduction a comment should be included to explain why the value(s) are reduced from the prior year. A comment column has been included for that purpose. There are two new items that will be required annually: First, please include any State-owned drones on the property insurance survey form. Indicate where they are typically stored when not in use in the address section and show the replacement cost value in the contents column. Second, if your agency has any insurance procurement authority in the law or has any written delegated insurance procurement authority, please attach a list of all of the insurance policies you currently procure. The list should include the named insured, the insurance company, the policy effective and expiration dates, the name of the broker you used and a brief description of the type of insurance. This will help our claims department in the event of a loss. Please the completed surveys or any questions to Felicia Steward at the Insurance Division: FStewart@treasurer.state.md.us

2 Automobile/Mobile Equipment Survey 2018 Survey State Agency: University of Maryland, College Park Campus RSTARS code: Contact name: R30B22 Phone: (RSTARS code such address: as C82, or K00A13) RETURN THIS FORM EVEN IF YOU ARE CLAIMING THERE ARE NO AUTOS OWNED BY YOUR AGENCY. Just let the zero appear in the total box below! Class* Description of Class Total Number Owned in Class 1 thru 2 Sedans and 4 Police/Law Enforcement Sedans and Light Trucks/Vans 40 5 thru 18 Light trucks and vans thru 22 Heavy Trucks 20 Off Road All self-propelled off road equipment such as tractors, loaders, graders, 10 backhoes etc. Motorcycles Two-wheeled motor vehicle 5 Bus 30 Specialty Vehicles Vehicles valued over $1,000,000 (new or currently valued) and please describe each below All Other Please describe each 0 TOTAL 405 *Class numbers above are per DBM Guidelines of Standard State Vehicles Classifications. 0

3 STATE OWNED FINE ARTS SURVEY 2018 Survey State Agency: Contact Name: Phone: Address: University of Maryland, College Park RSTARS Code: R30B22 (RSTARS code such as C82 or K00A13) RETURN THIS FORM EVEN IF YOU ARE CLAIMING THERE ARE NO FINE ARTS OWNED! (If there are no fine arts owned, just show zero in the total box.) # DESCRIPTION OF ITEM ADDRESS 1 ADDRESS 2 CITY STATE ZIP CODE CURRENT APPRAISED VALUE (Whole dollars only.) Game Changing (suite of 4 prints) by Derrick Adams: screenprint and gold leaf on paper Dark Palace by Wafaa Bilal: archival inkjet photograph Perseus Beheading Medusa by Wafaa Bilal: cold cast resin, enamel paint, shrinkwrap, and crude oil 1220 Stamp Student Union College Park MD $ 8, Stamp Student Union College Park MD $ 4, Stamp Student Union College Park MD $ 3,000 Total Value for Agency: $ 15,000

4 2018 SORT CODE AGENCY CODE LOCATION NAME ADDRESS 1 ADDRESS 2 COUNTY CITY STATE ZIP ZIP + 4 YEAR BUILT YEAR RENOVATED HISTORIC (NRHP) 2017 BUILDING 2017 CONTENTS 2017 EDP 2018 BUILDING 2018 CONTENTS 2018 EDP STORIES CONSTRUCTIO N FLOOD ZONE SQ FT SPRINKLER SYSTEM? OCCUPANCY 2018 COMMENTS COMMENTS LAST APPRAISAL EXPOSURE POPLAR HILL AGRICULTURAL CHEMICAL 6942 R30B NANTICOKE ROAD WICOMICO SALISBURY MD $121,521 $11,780 $100,000 $133,673 $12,958 $110,000 1 frame 1,260 NS STORAGE (572) POPLAR HILL EQUIPMENT STORAGE R30B NANTICOKE ROAD WICOMICO SALISBURY MD $231,468 $16,276 $200,000 $254,615 $17,904 $220,000 1 wood pole 2,400 NS (573) 6962 R30B22 CLARKSVILLE EQUIPMENT STORAGE (622) 4240 FOLLEY QUARTER HOWARD ELLICOTT CITY MD $463,339 $116,397 $300,000 $509,673 $128,037 $330,000 1 wood pole 5,024 NS herbicides/pestici de storage equipment storage(trucks, tractors, & mowers) equipment storage(trucks, tractors, & mowers) 6963 R30B22 CLARKSVILLE HEIFER BARN 1 (623) 4240 FOLLEY QUARTER HOWARD ELLICOTT CITY MD $431,861 $8,637 $0 $475,047 $9,501 $0 1 wood pole 4,100 NS animal housing 2,426 NS 6982 R30B22 CENTRAL MD OFFICE ANNEX (668) BEAVER DAM ROAD LAUREL MD $904,396 $42,307 $0 $994,836 $46,538 $0 metal frame 1 offices, (trailer) conference room AVRUM GUDELSKY VETERINARY CENTER offices/classroom 7050 R30B LARGO ROAD COLLEGE PARK MD $55,112,577 $8,290,318 $25,340 $60,623,835 $9,119,350 $27,874 2 brick 84,430 AS 100% AS (795) s/sci labs 7051 R30B22 LABORATORY FOR PHYSICAL SCIENCE (796) 8077 GREENMEADE RD COLLEGE PARK MD $43,915,534 $3,860,350 $123,338 DELETE DELETE DELETE 1 brick 66,500 AS offices & labs Delete location. 100% AS CENTER FOR EDUCATIONAL PARTNERSHIP NEW R30B ADELPHI ROAD RIVERDALE MD $15,506,330 $310,127 $0 1 brick 35,000 AS offices 100% AS (CEP) (804) 100% AS - Per DM , yes offices & NEW R30B22 PATAPSCO BLDG (805) 6200 SHERIDAN STREET COLLEGE PARK MD $23,709,673 $1,453,796 $206,727 3 brick 53,965 AS the contents drop is accurate- classrooms BCB offices, labs & NEW R30B22 TECHNOLOGY VENTURES BUILDING (806) PAINT BRANCH PARKWAY COLLEGE PARK MD $33,229,416 $1,133,096 $840,782 4 brick 50,332 AS 100% AS classrooms TOTAL $101,180,696 $12,346,065 $748,678 $135,437,097 $12,231,306 $1,735,383

5 Ocean Marine Survey of Vessels 2018 Survey State Agency: University of Maryland, College Park RSTARS Code: Contact name: R30B22 Phone#: (Agency code such address: as C82 or K00A13) ONLY AGENCIES THAT OWN VESSELS OR WATERCRAFT NEED TO RETURN THIS FORM!! Class Number Value I Outboards 10 $ 300,000 II Inboards, under $50,000 in value 3 $ 140,000 III Inboards, over $50,000 in value 2 $ 90,000 IV Sailing Vessel, no aux. power 2 $ 50,000 Totals 17 $ 580,000 (Please use whole dollars only.) Additional Insureds: Please complete the information below for each vessel that your agency operates that is not OWNED by the State and that the owner is required by contract to be named as Additional Insured: Re: Vessel Description Value Agency Use Vessel Owner & Mailing Address: Name Mail Address ALSO please complete the Vessel Underwriting Information page attached. Copies of all forms are also avaiblable on the Treasurer's website,

6 2018 Vessel Underwriting (UM) Information RSTARS Name University of Maryland, College Park Financial Agency C R30B22 In addition to the survey of vessels, below is information needed to properly identify and insure marine exposures for State vessels. Please provide relevant information and attach to your Ocean Marine survey and Schedule of vessels for your agency. 1. Please provide a schedule of marine vessels for your agency to include individual and total values. Any vessels that are leased or on loan, but not owned by your agency should be included and the owner identified. (See Survey Form) 2. Please identify the most valuable vessel owned. Value? 3. Are any major acquisitions anticipated in the upcoming year? 4. Are volunteers involved in any marine operations? Yes or no? If so, how many? 5. Is there outsourcing of any of the services provided by the State of Maryland in connection with the marine operations to be covered? If yes, please explain. 6. Provide details if there are any fee or fare-paying passengers on any vessels. 7. Do you rent or charter boats to the public? No Yes If yes, complete a) through e): a) What types of boats are rented/chartered? b) Are they equipped with motors or engines? c) What supervision & procedures are provided to lessee? d) What months are rental/charter vessels in use? e) Identify the agency division responsible for this operation