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INSURANCE ELECTION AGREEMENT Enclosed Storage Space Coverage CUSTOMER INFORMATION FACILITY INFORMATION Name_________________________________________________________ Name_________________________________________________________AME SITE NAME Address_______________________________________________________ Address_______________________________________________________ City State Zip__________________________________________________ City State Zip__________________________________________________ Daytime Phone ________________________________________________ Facility _____________________ 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 MM DD YY Certificate Number 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 KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO MAY BE GUILTY OF A FRAUDULENT ACT WHICH MAY BE A CRIME AND MAY SUBJECT SUCH PERSON TO CRIMINAL AND CIVIL PENALTIES 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 OR 100170662 Offered by Property First Group LP 2451 Kingston Court York PA 17402 123089 03 17 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 96556 1 15 2015 National Association of Insurance Commissioners 123089 03 17