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on Rental: MIAMI FL Return: PALM BEACH FL Agreement Num r: 1 811 i Reciter Name: Reference Num r: Dale 03/17/06 03/25/06 352.74 03/25/06 SUNOCO 0920405800WEST PALM BEA FL 0017078 008432395 31.00 03/27/06 AMERICAN AIRLINES DALLAS, TX From: To: MIAMI FL ST THOMAS VIRGIN I Ticket Numb

5 and is subject to change with notice. This document does not supplement or replace the Policy. ADDITIONAL INFORMATION FOR RESIDENTS OF LOUISIANA (CRLDI-RDR1-LA 11105) The Rights of Recovery section is replaced with the following: If the Company makes any payment under this Policy and the Cardmember

89 WEST PALM BEA $2213 RESTAURANT FOOD $2223 06/16/17 PUBLIX WEST PALM BEACH FL $2126 4078321661 Description REFER TO RECEIPT 06/18/17 SUNOCO 0920405800 09204058C0 WEST PALM BEA Ft flan GAS STATION 06/19/17 PUBLIX PALM BEACH FL $21.67 8636881188 Description REFER TO RECEIPT 06/

coverages are underwritten by Tokio Marine Pacific Insurance Lirnited, Hagatna, Guam under Policy Numbers CRCB000000107 for EDP, CRCB000000108 for CRLDI, CRC.8000000109 for EW, CRCB000000110 for PP. and CRCB000000111 for TAI. This benefit is not available to residents of American Samoa. Federated Sta

RENCE Document Type PASSENGER TICKET 800-433-7300 Carrier: Class: AA G yy 00 rd 00 re 00 Date of Departure:03/20 TX $304.06 03/19/I7 SUNOCO 08462657000846265700 GAS STATION PALM BEACH GA FL $40.70 03/19/I7 SUN00008462657000846265700 GAS STATION PALM BEACH GA FL $10.05 03/19/17

coverages are underwritten by Tokio Marine Pacific Insurance Lirnited, Hagatna, Guam under Policy Numbers CRCB000000107 for EDP, CRCEI000000108 for CRLDI, CRC.E1000000109 for EW, CRCB000000110 for PP. and CRCB000000111 for TAI. This benefit is not available to residents of American Samoa. Federated St