CERTIFICATE OF INSURANCE

U.S. Specialty Insurance Company

Administrative Offices: 13403 Northwest Freeway,
Houston, Texas 77040
Underwritten & Serviced by: Fidelis Marine Underwriters LLC
2300 North Barrington Rd., Suite 400, Hoffman Estates, IL 60169
Open Cargo Policy No. CULXXX Certificate of Insurance No. XXXXX

Amount Insured (US Dollars): X,XXX (Place and Date) Month, Day, Year

This Company, in consideration of an agreed premium and subject to the Terms and Conditions of Open Cargo Policy No.CULXXXX
does insure, lost or not lost, Company Name / Client Name
or for the account of whom it may concern in the sum of XXXX
on
Description of item(s) to be insured
Owner of items to be insured
Person receiving items to be insured

valued at sum insured, to be shipped by Transporter Name or other vessel, connecting

conveyances at and from City, State, Zip, Country to City, State, Zip, Country
leaving on or about Month, Day Year . Loss if any, payable to XXXX

Average Terms and Conditions

Against all risks of physical loss or damage from any external cause, irrespective of percentage, but excepting those risks excluded by the F.C. & S., Nuclear Exclusion and
S.R. & C.C. warranties of this Policy.

Coverage excludes chipping, scratching and breakage howsoever caused.

Clauses:
Warehouse to Warehouse Perils Carrier Clause Marine Extension
F.P.A. Clause Paramount Claims Against Third Parties S.R. & C.C.
Delay Duty of the Assured Rights of Subrogation War Risk
Other American Institute Fumigation Other Insurance South American 60 day
Paramount Warranties Partial Loss Suit or Action OFAC

Whenever coverage provided by this Policy would be in violation of any U.S. economic or trade sanctions such as, but not limited to, those sanctions administered and
enforced by the U.S. Treasury Department’s Office of Foreign Assets Control (“OFAC”), such coverage shall be null and void.

Similarly, any coverage relating to or referred to in any certificates or other evidences of insurance or any claim that would be in violation of U.S. economic or trade sanctions
as described above shall also be null and void.

This insurance is subject to the current terms and conditions of the American Institute War Risks policy and S.R. &C.C. Endorsement attached to the Ocean Cargo policy.

Please refer to the policy for all clauses and specific wording.
In the event of a claim please contact:

Mr. Mike Shreve

2235 N. Highway 190, Covington, Louisiana

IN WITNESS WHEREOF, this Company has caused this certificate to be signed by its President, but this certificate shall not be transferrable unless countersigned by an
authorized representative of this Company or the Assured

Countersigned President

ORIGINAL
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 INSTRUCTIONS IN CASE OF CLAIM

Claims: Compliance with the following will facilitate the handling and collection of your claim under this certificate. Failure to
comply may prejudice your right to claim.

1) Give immediate notice to the Claims Agent listed on this Certificate of Insurance and request them to conduct a survey. (Survey fee charged by the
Claims Agent is customarily paid by claimant and may be included in a valid claim against these Assurers). If there is no Claims Agent in the vicinity,
apply for a survey to the nearest Correspondent of the American Institute of Marine Underwriters or Lloyd ’s Agent. Invite Carrier’s representative
to attend survey. If loss or damage is apparent after the goods are landed on the docks, have survey held there without delay.

2) Take proper exception on the Delivery Receipt when any loss or damage is apparent at time of taking delivery. In no circumstances, except under
written protest, give a clean receipt if goods are received in a doubtful or damaged condition.

3) Promptly file claim in writing against the delivering carrier holding them responsible as soon as loss or damage is discovered, even though the full
extent thereof may not yet be determined; details can be furnished later.

If the loss or damage is not apparent at time of delivery but is discovered thereafter, file claim in writing against the carrier or his representative within
3 days of delivery on shipments by an ocean carrier or 7 days on shipments by air.

When delivery is made by container, examine the container and its seals immediately before taking delivery. If the container is delivered with seals
broken or missing or with seals other than as stated in the shipping documents, note the delivery receipt accordingly and retain all defective or
irregular seals for subsequent identification.

Preserve containers or other shipping packages and their contents in condition received until survey is held, unless further damage would result.

4) Collecting supporting documents to substantiate your insurance claim consisting of:

a. Original and duplicate of this Certificate of Insurance, duly endorsed by Loss Payee.
b. Claims Agent Survey Report or Certificate of Damage.
c. Copies of delivery receipts which show exceptions taken at time of delivery.
d. Copy of written claim against the Carrier or others with their reply, when available.
e. Copy of Commercial Invoice(s) covering the entire shipment insured by this Certificate of Insurance.
f. Copy of packing list(s) and/ or freight note(s), if any, which apply.
g. Copy of Bill(s) of Lading or Air Waybill(s) covering the entire shipment insured.
h. Additional documents as may be required.

Have claims Agent authenticate all proofs of loss.

5) Claims may be collected, if recoverable under this Policy, upon its presentation, duly endorsed, together with supporting documents, at the
following office.

Worldwide: Fidelis Claims Service LLC

2235 N. Hwy 190
Covington, LA 70433

ORIGINAL
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