Insured Name / Location of Property
City, County, State / Zip Code

The values reported below for buildings, machinery and equipment were established by:

Current independent appraisal
Updating a prior appraisal using acceptable cost indexes
Other - Explain

To the best of our knowledge and belief our 100% values are:(See Explanatory Notes on reverse side)

ZVP 0583-4 05/96

DESCRIPTION OF PROPERTY COVERED / REPLACEMENT COST
Amount to nearest dollar
Buildings & Structures / $
Machinery, Equipment, Furniture & Fixtures / $
EDP Equipment and Media / $
Stock Raw Materials(See note below)
Stock in Process
Finished goods / $
$
$
Property of Others in Your Custody / $
Tools, Records, Patterns, etc. / $
Property in Yard / $
Valuable Information property / $ / $
Other (Describe) / $
TOTAL REPLACEMENT COST OF PROPERTY COVERED / $

Note:The value of finished goods has been determined as follows:

ZVP 0583-4 05/96

Merchandise and finished stock purchased from others / Replacement Cost / Selling Price
Finished Stock manufactured by the Insured / Replacement Cost / Selling Price

PROPERTY EXCLUDED

If it is intended that any Personal Property of Others in your custody is to be excluded from the policy, please list below.

ZVP 0583-4 05/96

It is understood that the values given are confidential and will be used for insurance purposes only.

ZVP 0583-4 05/96

Date / Signed
Official Title

EXPLANATORY NOTES:

REPLACEMENT COSTis defined as the cost, at current prices to replace with new materials of like kind and quality on the same site.

BUILDINGS & STRUCTURESincludes buildings, permanent structures, equipment and apparatus associated with the service of buildings and structures, and the Insured's interest in improvements and betterments to buildings owned by others. The value of foundations and underground piping and wiring should also be included.

MACHINERY, EQUIPMENT,includes all personal, furnishings, utensils and contents not

FURNITURE & FIXTURESreported separately under other specific categories. Installation costs should be included in the value reported.

STOCKincludes raw materials, stock in process, finished goods, merchandise and supplies. Unless otherwise provided in the policy, values should be established as follows:

1.On Raw Materials, merchandise not manufactured by the Insured, and supplies - the replacement cost.

2.On Stock in Process - the value of raw stock and labor expended, plus the proper proportion of overhead charges.

3.On Finished Goods manufactured by the Insured - the regular cash selling price. Included in the value reported should be goods sold but not yet delivered.

PROPERTY OF OTHERSincludes property for which liability has been assumed,

IN YOUR CUSTODYsuch as goods of customers, leased equipment, property of employees, which is normally on the premises.

TOOLS, RECORDS, PATTERNSincludes, dies, templates, flasks, drawings, tracings, prints, Data Processing Media, etc. Values should be established as follows:

1.On Dies, Jigs and Patterns - the full replacement cost if they are active and would be replaced;

2.On Records, Manuscripts and Drawings - their value blank plus the cost of transcribing or copying them;

3.On Data Processing Media - the cost of replacing cards, tapes, etc. blank plus the cost of reproducing them from duplicates or originals of the previous generation. The cost of gathering information to permit reproduction should not be included.

PROPERTY IN YARDincludes such property as outside storage of stock, equipment and supplies, tanks, cranes, pavements, fences.

PROPERTY EXCLUDEDproperty which is intended to be excluded from coverage, and for which values have not been reported should be listed in the space provided.