151 Charles St,Suite 100

Kitchener, ONCanada N2G 1H6

519-573-1186

24 Hour ReportReport Date: April 5, 2017

Claim IDNB345-039

Claim DateJuly 12, 2016

Address758 Mill Drive Berlin, ON,Canda

Policyholder NameJane Jones Demo

Insurance CompanyAce Mutual

Emergency Estimate / Reserve$100,000

Repair Estimate / Reserve$65,000

Contents Estimate / Reserve$5,000

Total Replacement Value$7,069.36

Total Cash Value$5,219.09

Front Elevation

Report Details

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This report can include as much detail as needed. Click on the photos to zoom in or play video

Claim DetailsFNOL July 12, 2016 7:30

Kitchen area looded. Presumed to be dishwasher malfunction. Possible damage to hardwoodloor in kitchen and surrounding rooms, kitchen cupboards, contents of base cupboards anddishwasher unit.

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Table of ContentsExterior

Overview Photos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Photo Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Contents (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

FoyerOverview Photos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Photo Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Text Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8Contents: Restore (5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

KitchenOverview Photos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Overview Videos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Photo Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Sketches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Contents (3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Contents: special list id (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Contents: Discard (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Contents: Non-Restorable (9) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Contents: Replace (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Family RoomOverview Photos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Sketches . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Contents (6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Contents: Keep As Is (5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Contents: Replace (2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Contents: Restore (1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

FoyerOverview Photos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Photo Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

subtrade photoOverview Photos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Attachments1. Privacy Consent

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Exterior

OVERVIEW PHOTOS: Exterior

Photo 1 2016-07-13Photo 1 2016-07-13 Photo 2 2016-07-13Photo 2 2016-07-13 Photo 3 2016-07-13Photo 3 2016-07-13

Photo 4 2016-07-13Photo 4 2016-07-13 Photo 5 2016-07-13Photo 5 2016-07-13 Photo 6 2016-07-13Photo 6 2016-07-13

Photo 7 2016-07-13Photo 7 2016-07-13 Photo 8 2016-07-13Photo 8 2016-07-13 Photo 9 2016-07-13Photo 9 2016-07-13

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Photo 10 2016-07-13Photo 10 2016-07-13

PHOTO NOTES: ExteriorPre-existing Damage

2016-07-132016-07-13 2016-07-132016-07-13

cracked driveway upon arrival

Pre-existing Damage

2016-07-132016-07-13

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CONTENTS: ExteriorItem

Item 1 2017-03-02Item 1 2017-03-02

Foyer

OVERVIEW PHOTOS: Foyer

Photo 1 2016-07-13Photo 1 2016-07-13 Photo 2 2016-07-13Photo 2 2016-07-13 Photo 3 2016-07-13Photo 3 2016-07-13

Photo 4 2016-07-13Photo 4 2016-07-13 Photo 5 2016-07-13Photo 5 2016-07-13 Photo 6 2016-07-13Photo 6 2016-07-13

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PHOTO NOTES: Foyer

Pre-existing Damage

2016-07-132016-07-13 2016-07-132016-07-13 2016-07-132016-07-13

2016-07-132016-07-13

Site Protection

2016-07-132016-07-13

Add foam loor protection and cardboard wall protection.

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TEXT NOTES: Foyer

Work Order

Bring in supplies:Poly and poly polesCardboardFoam loor protection

CONTENTS: Foyer – Restore

Decorative Pot (Good)

Replacement Value: $149.95 Actual Cash Value: $119.96

Item 1 2016-08-05Item 1 2016-08-05

ITEM REPLACEMENTS: Decorative Pot

$149.95Sunset Flowers Terracotta Floor Vase | Pier 1 Importshttp://www.pier1.com/sunset-flowers-terracotta-floor-vase/2781850.html?cgid=vases-decorative-bowls#start=1

Ceiling Light (Excellent)

Replacement Value: $99.98 Actual Cash Value: $79.98

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Item 2 2016-08-05Item 2 2016-08-05

ITEM REPLACEMENTS: Ceiling Light

$99.98 Hampton Bay 3 Light Drum Pendant | The Home Depot Canadahttps://www.homedepot.ca/en/home/p.3-light-drum-pendant.1000788393.html

small vase (Good)

Item 3 2016-08-05Item 3 2016-08-05

french rug (Worn)

Replacement Value: $199.99 Actual Cash Value: $159.99

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Item 4 2016-08-05Item 4 2016-08-05

ITEM REPLACEMENTS: french rug

$199.99Obelia 3-Piece Rug Set | Sears Canadahttp://www.sears.ca/product/lsquoobeliarsquo-3-piece-rug-set/602-000963611-8177NR3P

Decorative Plate (Good)

Replacement Value: $21.51 Actual Cash Value: $17.21

Item 5 2016-08-05Item 5 2016-08-05

ITEM REPLACEMENTS: Decorative Plate

$21.51 Angelstar Golden Plate & Reviews | Wayfairhttp://www.wayfair.com/Golden-Plate-19062-19061-ANGS1215.html

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Kitchen

OVERVIEW PHOTOS: Kitchen

Photo 1 2016-07-13Photo 1 2016-07-13 Photo 2 2016-07-13Photo 2 2016-07-13 Photo 3 2016-07-13Photo 3 2016-07-13

Photo 4 2016-07-13Photo 4 2016-07-13 Photo 5 2016-07-13Photo 5 2016-07-13 Photo 6 2016-07-13Photo 6 2016-07-13

Photo 7 2016-07-13Photo 7 2016-07-13 Photo 8 2016-07-13Photo 8 2016-07-13 Photo 9 2016-07-13Photo 9 2016-07-13

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OVERVIEW VIDEOS: Kitchen

2016-07-132016-07-13

PHOTO NOTES: KitchenCause Of Loss

2016-07-132016-07-13 2016-07-132016-07-13

Connection to dishwasherfailed looding kitchen

Work Order

Empty kitchen cabinet bases. Disconnect Plumbing to sink and washer. Disconnect Hydro 2washer. Remove Island counter cabinets. Remove chairs and furniture. Remove looring andprepare for dryers. Remove appliances and base cupboards.

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2016-07-132016-07-13 2016-07-132016-07-13 2016-07-132016-07-13

2016-07-132016-07-13 2016-07-132016-07-13 2016-07-132016-07-13

2016-07-132016-07-13 2016-07-132016-07-13

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SKETCHES: KitchenKitchen #1

Dishwasher water entry

CentreIsland Table

Counter

20 ft.

20 ft.

1

2

3

4

1 Kitchen #1 Photos

Photo 1 2016-08-05Photo 1 2016-08-05

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2 Kitchen #1 Photos

Photo 1 2016-08-05Photo 1 2016-08-05

3 Kitchen #1 Photos

Photo 1 2016-08-05Photo 1 2016-08-05

4 Kitchen #1 Photos

Photo 1 2016-08-05Photo 1 2016-08-05

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CONTENTS: KitchenItem

Item 10 2016-10-18Item 10 2016-10-18

Item in box Family Room 6

Item Photo

Item 13 2016-10-19Item 13 2016-10-19

Photo Note

Item 13 2016-10-19Item 13 2016-10-19

Item

Item 17 2016-12-22Item 17 2016-12-22

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CONTENTS: Kitchen – special list id

Samsung Dishwasher DW80F600UTS/AC1 – 2 years (Good)

Depreciation Category: Dishwasher Serial #: B00GG9MF500620VReplacement Value: $699.99 Actual Cash Value: $524.99Retailer: Samsung Purchase Price: $1,000

Item 1 2016-07-13Item 1 2016-07-13 Item 1 2016-07-13Item 1 2016-07-13

ITEM REPLACEMENTS: Dishwasher

$699.99Samsung 24” Built-In Dishwasher with Stainless Steel Tub Silver DW80F600UTS- Best Buyhttp://www.bestbuy.com/site/samsung-24-built-in-dishwasher-with-stainless-steel-tub-stainless-steel/1150152.p?skuId=1150152

Cup

Item 14 2016-12-15Item 14 2016-12-15

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CONTENTS: Kitchen – DiscardItem

Item 15 2016-12-15Item 15 2016-12-15

Item

Item 16 2016-12-15Item 16 2016-12-15

CONTENTS: Kitchen – Non-RestorableVarious Bowls And

Serving Platters in boxKitchen1

Item 2 2016-07-13Item 2 2016-07-13

5 × Various CleaningSupplies in box Kitchen2

Item 3 2016-07-13Item 3 2016-07-13

Small Pot in box Kitchen3

Replacement Value: $9.99 Actual Cash Value: $7.99

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Item 4 2016-07-13Item 4 2016-07-13

ITEM REPLACEMENTS: Small Pot

$9.99 Starfrit® Mini Egg Poacher 10cm (with riveted silicone handle) | Sears Canadahttp://www.sears.ca/product/starfrit-mini-egg-poacher-10cm-with-riveted-silicone-handle/611-000026245-33082

Manual Juicer in boxKitchen3

Item 5 2016-07-13Item 5 2016-07-13

Food Processor in box Kitchen3

Replacement Value: $39.97 Actual Cash Value: $31.98

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Item 6 2016-07-13Item 6 2016-07-13

ITEM REPLACEMENTS: Food Processor

$39.97 Cuisinart s® Mini-Prep™ Plus Food Processor | Walmart.cahttp://www.walmart.ca/en/ip/cuisinarts-mini-prep-plus-food-processor/6000195417275

Samsung Stainless Steel French door fridge (Good)

Replacement Value: $2,449.99 Actual Cash Value: $1,959.99

Item 7 2016-08-05Item 7 2016-08-05

ITEM REPLACEMENTS: Stainless Steel French door fridge

$2,449.99 Samsung® 25.5 cu. ft 3-Door French Door Refrigeratorhttp://www.costco.ca/Samsung%c2%ae-25.5-cu.-ft-3-Door-French-Door-Refrigerator-.product.100213972.html

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Samsung Single DoorOven (Good)

Item 8 2016-08-05Item 8 2016-08-05

4 × Ikea Bar stool (Good)

Replacement Value: $215 × 4 = $860 Actual Cash Value: $172 × 4 = $688

Item 9 2016-08-05Item 9 2016-08-05

ITEM REPLACEMENTS: Bar stool

$215.00CorLiving™ Antonio Bar Height Bonded Leather Barstool - Cream White | SearsCanadahttp://www.sears.ca/product/corliving-antonio-bar-height-bonded-leather-barstool-cream-white/602-000962183-DAD-413-B

KitchenAid Wine Cooler

Replacement Value: $1,199.99 Actual Cash Value: $959.99

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Item 11 2016-10-18Item 11 2016-10-18

ITEM REPLACEMENTS: Wine Cooler

$1,199.99Silhouette 5.1 cu. ft. Bottle Wine Cooler (DWC518BLS) : Wine Coolers - Best BuyCanadahttp://www.bestbuy.ca/en-ca/product/silhouette-silhouette-5-1-cu-ft-bottle-wine-cooler-dwc518bls-dwc518bls/10122912.aspx?

CONTENTS: Kitchen – Replace

Item in box Family Room 5

Item 12 2016-10-19Item 12 2016-10-19

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Family Room

OVERVIEW PHOTOS: Family Room

Photo 1 2016-08-02Photo 1 2016-08-02 Photo 2 2016-08-02Photo 2 2016-08-02 Photo 3 2016-08-02Photo 3 2016-08-02

Photo 4 2016-08-02Photo 4 2016-08-02 Photo 5 2016-08-02Photo 5 2016-08-02 Photo 6 2016-08-02Photo 6 2016-08-02

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SKETCHES: Family RoomFamily Room

Ceiling Height 8'

Windoww4,h6

11,6

13,6

1

2

3

1 Family Room Photos

Photo 1 2016-08-02Photo 1 2016-08-02

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2 Family Room Photos

Photo 1 2016-08-02Photo 1 2016-08-02

3 Family Room Photos

Photo 1 2016-08-02Photo 1 2016-08-02

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Water Damage

Ceiling Height 8'

Windoww4,h6

11,6

13,6

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Equipment Location

Ceiling Height 8'

Windoww4,h6

11,6

13,6

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Family Room

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Sketch 7

12,9

CONTENTS: Family Room

Tv

Item 9 2016-10-22Item 9 2016-10-22

Table

Item 10 2016-10-22Item 10 2016-10-22

Sand Ornament

Item 11 2016-10-22Item 11 2016-10-22

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Item

Item 12 2016-10-22Item 12 2016-10-22

Item

Item 13 2016-10-22Item 13 2016-10-22

Couch

Item 14 2016-10-22Item 14 2016-10-22

CONTENTS: Family Room – Keep As Is

Table Lamp – 7 years(Good) in box Family

Room 1

Item 2 2016-08-05Item 2 2016-08-05

Glass Sculpture – 10years (Excellent) in box

Family Room 1

Item 3 2016-08-05Item 3 2016-08-05

RogersVCR/DVD/CABLES (With

Cables) 1995-5353 – 4years (Good) in box Family

Room 1

Item 4 2016-08-05Item 4 2016-08-05

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Fireplace Inc. Fireplace –10 years (Used) in box

Family Room 1

Item 7 2016-08-05Item 7 2016-08-05

Samsung TV 1234-5678 –5 years in box Family

Room 1

Item 8 2016-08-05Item 8 2016-08-05

CONTENTS: Family Room – Replace

Walmart Left Couch 5235-3364 – 5 years (Used) in box Family Room 4

Depreciation Category: UpholsteredFurniture

Replacement Value: $1,338

Actual Cash Value: $669

Item 1 2016-08-05Item 1 2016-08-05

ITEM REPLACEMENTS: Left Couch

$1,338.00 Singular Sofa White | Walmart.cahttp://www.walmart.ca/en/ip/singular-sofa-white/6000189273898

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$1,338.00 Singular Sofa White | Walmart.cahttp://www.walmart.ca/en/ip/singular-sofa-white/6000189273898

Bed bath & Beyond Right Couch 5235-3364 – 5 years in box Family Room 3

Depreciation Category: Upholstered Furniture

Item 5 2016-08-05Item 5 2016-08-05

CONTENTS: Family Room – Restore

Woods Oak Table – 15 years (Worn) in box Family Room 2

Depreciation Category: Wood Furniture Retailer: Wood Co.Purchase Price: $1,500

Item 6 2016-08-05Item 6 2016-08-05

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Foyer

OVERVIEW PHOTOS: Foyer

Photo 1 2016-08-23Photo 1 2016-08-23

PHOTO NOTES: Foyer

Pre-existing Conditions

2016-08-232016-08-23 2016-08-232016-08-23 2016-08-232016-08-23

2016-08-232016-08-23

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subtrade photo

OVERVIEW PHOTOS: subtrade photo

Photo 1 2017-01-19Photo 1 2017-01-19 Photo 2 2017-01-19Photo 2 2017-01-19 Photo 3 2017-01-19Photo 3 2017-01-19

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151 Charles St,

Suite 100

Kitchener, ON

Canada N2G 1H6

519-573-1186

Privacy Disclosure and Consent

CLAIM NO: NB345-039

NAME: Jane Jones

I have provided personal information in this document and by other means and I may in the future provide further

personal information. Some of this personal information may include, but is not limited to, medical and health

information, and employment and income information. I authorize the company to collect, use and disclose any of this

personal information as permitted by law for the purposes necessary to establish and maintain contact with me; assess

and underwrite risks on a prudent basis; investigate and pay claims; detect and prevent fraud or other illegal activities;

compile statistics; and comply with the law or requests of law enforcement agencies or regulators.

SIGNATURE

July 27 2016

DATE

NAME: Ff

ADDRESS: 758 Mill Drive Berlin, ON,Canda