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INSURANCE ELECTION AGREEMENT Enclosed Storage Space Coverage CUSTOMER INFORMATION FACILITY INFORMATION Name_________________________________________________________ Name _________________________________________________________SITE NAME Address_______________________________________________________ Address ________________________________________________________ City State Zip__________________________________________________ City State Zip ___________________________________________________ Daytime Phone ________________________________________________ Facility Number __________________ Storage Space ____________________ Email Address___________________________________________________ Fax form to 1 844 814 4660 Email form to enrollments storsmartinsurance com I UNDERSTAND AND AGREE THAT THIS STORAGE FACILITY DOES NOT INSURE MY PROPERTY HAS NO RESPONSIBILITY TO PROVIDE INSURANCE MY PROPERTY IS STORED AT MY SOLE RISK I HAVE AGREED TO INSURE MY PROPERTY AGAINST LOSS NEW HAMPSHIRE INSURANCE COMPANY APPLICATION FOR INSURANCE Certificate Number MM DD YY Facility Space Coverage effective date I elect to obtain this insurance coverage for my property exclusively available through Property First Group Insurance Agency I want to purchase the following amount of insurance with 100 Burglary and Robbery coverage Limit of Coverage Monthly Premium 2 000 9 3 000 13 5 000 22 7 500 32 Other ACKNOWLEDGEMENT I understand that the amount noted above is the Premium I must pay for the Limit of Coverage I have selected I authorize the Owner of this storage facility to conduct the administrative function of receiving the monthly Premium to send to the insurance agency on my behalf I understand that a portion of the Premium I am agreeing to pay for insurance covers the storage facility s cost of collecting accounting for and remitting premiums to the insurance agency I have read and completed this Insurance Election Agreement to apply for the coverage I have received and read a copy of the Certificate of Storage Insurance for New Hampshire Insurance Company Master Policy 10570468 COVERAGE EFFECTIVE DATE The insurance will become effective on the later of the completion of this application payment of the Premium and the start date of the lease ANY PERSON WHO WITH INTENT TO DEFRAUD OR KNOWING THAT HE IS FACILITATING A FRAUD AGAINST AN INSURER SUBMITS AN APPLICATION OR FILES A CLAIM CONTAINING A FALSE OR DECEPTIVE STATEMENT IS GUILTY OF INSURANCE FRAUD THIS FACILITY AND ITS EMPLOYEES ARE NOT QUALIFIED OR AUTHORIZED TO EVALUATE THE ADEQUACY OF ANY INSURANCE YOU MAY HAVE QUESTIONS REGARDING THIS STORAGE INSURANCE PROGRAM SHOULD BE DIRECTED TO PROPERTY FIRST GROUP INSURANCE AGENCY I CERTIFY THAT THERE HAVE BEEN NO LOSSES ACCIDENTS OR CIRCUMSTANCES THAT MIGHT GIVE RISE TO A CLAIM UNDER THIS STORAGE INSURANCE PROGRAM AS OF THE DATE AND TIME SIGNED BELOW Tenant lessee Signature_____________________________________ Date _______________ Time __________ am pm Agent Producer Signature _________ ___________________________ Agent Producer Name Michael Rhoads State License NC 1000114802 Offered by Property First Group LP 2451 Kingston Court York PA 17402 123087 07 16 1 888 545 7627 PA License 588404

Welcome to your new storage space and congratulations on your decision to insure your property through New Hampshire Insurance Company This storage insurance program provides you with the peace of mind knowing your items will be protected while being stored Now that you ve made the right choice to provide protection and peace of mind for your stored items let us offer you the following tips Use a disc or cylinder lock These locks provide a higher level of security compared to other locks Cover your items with plastic sheets This will better protect your items from dust moisture etc Keep moisture sensitive items off of the floor Pallets or other supports should be used to elevate your items Do not store valuables Jewelry currency or other valuable items should not be stored Do not store flammable or hazardous materials Storing these items are dangerous to you and the facility Make an inventory of your stored items Keep a copy of your inventory in safe place it will help expedite a claim POLICY HOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE COVERAGE INCLUDED Coverage for acts of terrorism is included in your policy You are hereby notified that under the Terrorism Risk Insurance Act as amended in 2015 the definition of act of terrorism has changed As defined in Section 102 1 of the Act The term act of terrorism means any act that is certified by the Secretary of the Treasury in consultation with the Secretary of Homeland Security and the Attorney General of the United States to be an act of terrorism to be a violent act or an act that is dangerous to human life property or infrastructure to have resulted in damage within the United States or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion Under your coverage any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act as amended However your policy may contain other exclusions which might affect your coverage such as an exclusion for nuclear events Under the formula the United States Government generally reimburses 85 through 2015 84 beginning on January 1 2016 83 beginning on January 1 2017 82 beginning on January 1 2018 81 beginning on January 1 2019 and 80 beginning on January 1 2020 of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage The Terrorism Risk Insurance Act as amended contains a 100 billion cap that limits U S Government reimbursement as well as insurers liability for losses resulting from certified acts of terrorism when the amount of such losses exceeds 100 billion in any one calendar year If the aggregate insured losses for all insurers exceed 100 billion your coverage may be reduced The portion of your annual premium that is attributable to coverage for acts of terrorism is 0 00 and does not include any charges for the portion of losses covered by the United States government under the Act 96556 1 15 2015 07 16 National Association of Insurance Commissioners 123087