Approximate Sq. Ft.: 1200 sq. ft. Property Inspection Checklist Property Owner Sample DOS Property Address 10133 Hwy 59 City/St/Zip Evansville, WI 53515 Insurance Carrier WIAMPC001 - Ampul Policy Number & Date 4766 4/12/2017 *The property is located on a rural Highway outside Evansville and Edgerton WI. Overall the property appears maintained. Overall Risk Grade A B C D F Report Type Home Farm Was the insured interviewed? Yes (persons name) No * Insured. Is the property vacant? Yes No U/D Nearest Fire Hydrant <100 ft 100-500 ft >1000 ft None Nearest Resonding Fire Station < 1 Mile 1- 5 Miles > 5 Miles * Edgerton FD Dwelling Information Approximate Sq. Ft.: 1200 sq. ft. Approximate Age: 100+ yrs. for stone portion of dwelling, newer section approx 20 yrs. # of Stories: 1 1 1/2 Below Grade 2 2 1/2 3 Tri-Level Bi-Level Other (state type) Basement Crawl Slab Open Foundation Piers Dwelling Condition Very Good Good Average Fair Poor Central Air Yes No Garage Type Attached Detached * Built into basement at rear. Roof Type Asphalt Shingle Metal Rolled Roofing Cedar Shake Rubber Other Roof Age 0-5 years 6-12 12-18 19+ Roof Condition Very Good Good Average Fair Poor

Electrical Service Size Siding Type Vinyl Alum Wood Hard Board Brick (Veneer) Brick (solid) Asbestos Slate Log Other (state type) * Stone on older portion of the dwelling, vinyl siding on newer portion. Siding Condition Very Good Good Average Fair Poor Window Condition Very Good Electrical Service Size Good Average Fair Poor 60 AMP 100 AMP 200 AMP 400 AMP Unable to Determine Electrical Service Condition Type Of Furnace Natural Gas Propane Oil Electric Other Evidence of Solid Fuel Yes No U/D Hot Tub Yes No U/D Pool Yes No U/D Trampoline Yes No U/D Yard Maintenance Very Good Good Average Fair Poor Trip Fall Hazards Yes (see photo) No Dogs on Property Yes No # of Dogs Breed: None Nature of Dog's Friendly Number: Pleasant Protective Aggressive Attack if it Could Unable to Determine (inside or barking) Horses Yes No U/D N/A Horses on Property Number: None Livestock on Property & Type Yes No U/D Fencing in Good Condition Yes No N/A Farm Machinery on Site Yes No Business on Premises Yes (type & name if known) No Unknown

Overall Property Impression 1 2 Action Needed 3 4 5 6 7 8 9 10 Yes (describe) No Follow-Up * 1) Consider reduced or reducing coverage on the Hay shed due to conditions and possible collapse risk.

Address Verification Front Front

Side / Front Side Side

Rear Side / Rear Side

Side Side Electrical Service

Air conditioner unit Electrical meter Propane Tank

Machine shed Machine shed Machine shed

Machine shed Machine shed Hay Shed

Hay Shed Hay Shed Hay Shed

Hay Shed Hay Shed Hay Shed (missing siding pieces)

Hay shed (possible collapse risk)