after school program proposal - robot u · robot u is a “for profit” after school enrichment...

8/13/2014

“Preparing Students for the Future”

AFTER SCHOOL PROGRAM PROPOSAL

After School Program Proposal 2014 INDEX

Cover

Index Page 1

Why you should consider Robot U

Class Descriptions Page 3 - 4

Fee Schedule Page 5

Disclaimer Page 6

Endorsements Page 7

Curriculum Grid Page 8 – 14

Background Check Page 15

W-9 Page 16

Business License Page 17

Insurance Page 18

Misc. Facts & Fliers Page 19 - 23

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After School Program Proposal 2014 Why should you consider hosting a Robot U® LEGO® MINDSTORMS® robotic program?

Robot U is a “for profit” after school enrichment class focused on providing a solid understanding of programming and engineering through the use of the LEGO® Group’s educational robot making product MINDSTORMS® and its supporting lesson plans that were developed with the help of Carnegie Mellon University. Its primary focus is on 4th through 8th grade students interested in the more advanced programming and engineering capabilities of LEGO® robotics, not the students interested in free play.

Our classes use one new competition level set (the EV3 education plus expansion set) and a tablet pc for every two students. This is very generous by industry standards. Most programs will have four or more students using an older NXT set and a laptop. Our investment is north of $1,300 per pair of students, far more than any other program. We offer this level of investment so the students will have the optimum level of exposure to the sets (the same sets they will probably be using in competition) while they learn to work as part of a two person team.

Another reason that may interest you is that Robot U also actively seeks out to hire qualified mentors that are excellent students and members of the local area’s high school, college, and amateur robotic clubs along with retired engineers, when available. The students naturally gravitate to the student teachers and try to emulate them. This is a win for the students and a win for the teachers.

The Goals and Objectives of Robot U are; 1. To be a sought out established S.T.E.M. program that

offers its students a superior path to success through rudimentary programming and engineering training.

2. To Adopt and teach FIRST® core values of Gracious Professionalism®, Coopertition®, and Creativity.

3. To provide networking opportunities with higher education, businesses, and mentors.

4. To be a program where the students have both fun and a sense of achievement and mastery from being challenged.

5. To benefit its high school student staff with an educational mentor activity to add to their college applications.

Robot U’s Philosophy Robot U’s philosophy is to tirelessly redefine and improve the after school experience for students through the teaching of STEM skills with robotics and programming. To offer parents a worthy enrichment program for their financial investment and their child’s time that both expands their students grasp and develops their sense of confidence in science, technology, engineering, and math while learning the cooperation and team building skills that will serve them well in to the future and put them on the path to higher learning and success. All while having a great deal of fun.

The Owner’s Background: 1. Ran his own design business 2. Managed others business’s 3. Trained graphic designer 4. Coached FIRST® FLL robotics teams and served as a

judge at the competitions 5. Extensive experience with youth organizations

a. Boy Scouts of America – Den leader and Eagle Scout

b. The Y – Coached T Ball c. FIRST®LEGO® League

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After School Program Proposal 2014 Class descriptions

Primary Offering Robot U provides a curriculum of classroom instruction and open-ended, problem-solving activities that make learning science, technology, engineering, and mathematics through real-life robotics engaging and fun for students.

Tailored to children from grades 4th through 8th and built around the LEGO® MINDSTORMS® educational robot system. Our program will teach the students to master their robotic engineering and programming skills. The students will begin with an introductory 10 week session. The classes are structured; Lesson (or two); duplicate; modify and explore; and share and explain (with a competition thrown in here and there). The students are encouraged to share and seek each other’s input instead of going it alone and keeping what they have figured out to themselves. After the students have graduated from the first session they may sign up continually and learn even more, but they will be asked to be open to helping the new students. This creates an environment where students start to develop leadership skills and the newer students have a more tangible understanding of what they can achieve. The more experienced students will also have the opportunity to be self-directed.

Session 1 Make It Move: Students are challenged to design, build, and program robots that move using motors with rotation sensors. Students will apply mathematics and their science knowledge to create robots that measure distance and speed, move without using wheels, maximize power to move up an incline or travel faster, and move and turn to create regular polygons. Students will also apply their knowledge of simple and complex machines and the use of ratios to describe proportional relationships. Session 2 Make It Smarter: Students are challenged to experiment with more sensors on their robots to control behavior and to measure, graph, and analyze sensor data. Students will develop robots that use

sensors that measure ambient and reflected light, distinguish between specific colors, measure distances from objects, recognize a touch-sensor state (pressed or not pressed, or pressed and released), and measure angular displacement or rate of change. Session 3 Make a System: Students are challenged to design, build, and program robotics systems built from subsystems. Students develop systems that move a ball, pick and place objects, simulate manufacturing, sort colors, and communicate their location. Students test their system, gather data, and use that evidence to engineer system optimizations and improvements. Session 4 Take it to the Next Level: Is designed to enable students to take their experience of robotics to the next level. Students may sign up as many times as they wish because this where they are challenging themselves to learn more. Students will build larger and more complex models and do more research. If they are active in robotic competitions this is where they will have an opportunity to work on their own special problems and use the resources of the class including other students and the instructors. Other Classes and Camps The “Locomotion Commotion” Class During a full day or an hour a day for one week the students work in groups building complex robots and if time permits learning a little about the programming that runs them. This is a very popular program with the students because by the end of class they have created something pretty cool to show off. “Me & You” Workshops Host a workshop where fathers/mothers can work side by side with their children to create various models or compete in a challenge, such as sumo, maze, or hide n seek. This is an excellent opportunity to engage with other families through mutual likes.

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After School Program Proposal 2014 WeDo® Junior Robotics The LEGO® Education WeDo® Construction Set is an easy-to-use set that introduces young students to robotics. Students will be able to build LEGO® models featuring working motors and sensors; program their models; and explore a series of cross-curricular, theme-based activities while developing their skills in science, technology, engineering, and mathematics as well as language, literacy, and social studies.

This is a great class to introduce students to these concepts and plant the seed for future interests in engineering and programming. There are many similarities between this graphical interface and the significantly more advanced MINDSTORMS® interface that we use in the advance robotic classes. The sets use motors, sensors, and a computer to program them just like MINDSTORMS®.

The drag-and-drop software powered by LabVIEW™, is icon based, provides an intuitive programming environment. Activities are divided into four themes

• Amazing Mechanisms • Wild Animals • Play Soccer • Adventure Stories

Scratch Game Creation Using our tablet pc’s students learn to program and create different games using MIT’s very popular graphical programming program, Scratch.

The classes are designed to explore;

1. Computational thinking concepts (sequence, loops, parallelism, events, conditionals, operators, data)

2. Practices (working iteratively and incrementally, testing and debugging, reusing and remixing, abstracting and modularizing)

3. And perspectives (expressing, connecting, questioning).

Using a simple drag and drop interface students will quickly learn to create unique projects that they can share at home with friends and family. As they get more comfortable with the concepts most quickly start to experiment and discover that programming is really fun.

Future Classes in the “Forge”

Sketchbook An art class that uses the popular and hugely versatile natural drawing program “Sketchbook” is under review. The owner, being a trained graphic designer, sees the incredible power that using this program with our tablets that use a pressure sensitive stylus could help aspiring artist make huge leaps creatively.

“Gearl’s” Only A course is under consideration for promoting more participation from young women who are interested, but fear that they would be the only girl in the class. This is usually not the case, but they do tend to be the minority. If this sounds like something that your school would benefit from please contact us so we can get this underway.

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After School Program Proposal 2014

After School Fee Schedule Class minimum size is 8 students. Maximum must be arranged inadvance.

Base price per student

Supplied Materials per 2 students

Per Session

8 sessions

1 season

10 sessions

2 seasons

20 sessions

3 seasons

30 sessions

2 hour workshop

3 hour workshop

6 hour workshop

LEGO® MINDSTORMS® Competition set &

Tablet PC $25.00 $160.00 $190.00 $340.00 $500.00 $45.00 $55.00 $100.00

Tablet PC Only Scratch® Game Creation $20.00 $120.00 $140.00 $240.00 $350.00 $35.00 $45.00 $75.00

MINDSTORMS Robotic Kits need to have a computer with preloaded software. Some schools may already have this available and be able to qualify for the "MINDSTORMS®" only discounted price. "Laptop" only is for game creation classes.

Class size Target ratio of student

to staff One Mentor One Mentor and

One Helper One Mentor and

Two helpers Split Class Student Count 8 - 12 12 - 18 18 - 24 24+ The supporting organization is responsible to supply at least one supervising adult if the class is only large enough to warrant one

instructor to keep “two deep” supervision.

Special Pricing is available to schools that sponsor the classes during school hours and non-profits such as the YMCA that provide their own advertising and class helpers.

Sign Up Policy

Students can either be signed up on our website or through the sponsoring organization. A first and last name, along with age, gender, and emergency contact information must be available during every class.

Classes are filled on a first come first paid basis. If the class is filled an attempt to increase size will be made. If a slot is reserved but not paid for in advance the party that has made the reservation will be contacted to confirm their continued interest and asked for payment if there is more interest than space in the class.

Payment for enrollment needs to be paid by the end of the first class by either the individual or organization.

Refund Policy

If a student decides that the class is not what they desire, they may drop out after the first class and receive a full refund. If a second class is attended there will be no opportunity for a refund.

Scholarships are available.

If an organization offers scholarships, Robot U will offer one free slot per every 10 students. It is up to the organization to arrange this ahead of time.

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After School Program Proposal 2014 Robot U carries liability insurance and does back ground checks on all of its employees to ensure security and safety. First Aid and CPR certification is available to employees if required by hosting body. Every effort is made to safe guard students and property. Robot U is solely responsible for its materials and does not hold the hosting company or organization responsible for lost or damaged goods. If a student is found to be willfully damaging Robot U’s property they will be immediately removed from class and their guardian will be contacted to retrieve them and asked to pay for damages or losses. The hosting company or organization will be notified of the infraction and actions to taken. Every opportunity will be made to educate and safe guard against negative experiences during classes.

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After School Program Proposal 2014 Customer Endorsements Jeanie Bookout - Thanks Don, Isabelle has really enjoyed this class! ________ Amanda Lo - He (Kadyn) loved the class and would be ecstatic to be able to take another one! ________ Alicia Whiting - He (Torrey) really really enjoyed your class! Thank you! ________ Demetra Biros - He (Kosta) has really enjoyed the class and would consider signing up again in the future. ________ Lucy Shtanukina - Thank you for having Vladimir in your class. He enjoyed programming very much. Also, it was realy convenient to have this class during "short school days". ________ Lisa Wray - He (Jaxsen) has really liked the class. In fact, we enjoyed it so much that we are signing my boyfriend's daughter up for the same class in Michigan. Great job! ________ Anagha Koshti - Thanks Don. Tanushree really enjoyed her robotics class. ________ Raisa Topaz - My son (Tony Braude) liked the classes a lot and early release Wednesdays work just perfectly into his schedule. ________ Thank you, Don, for such a wonderful class! My son, Zach, raved about you and thought the class was so much fun. He'd love to take another one in the future. We really enjoyed watching your video tonight too--thank you for sending it. I am fine if you want to post the video or pictures on your website. Thanks again! Angie Holland ________ Hi Don, My daughter Elizabeth had such a fun week with this class! Thank you for coming to Cedar Wood. It was the highlight of her week for sure and if you are able to come back for another camp/class I'm sure she'd want to do it again. No problem in posting pictures/video of her. And thanks for sending this one - I'm going to forward it to the grandparents... :) Jen Hirman ________ My daughter, Emma, had a great time in your robot class last week at Cedar Wood. Yes, she would like a kit for Christmas. And after seeing the price, no, she will not be getting one... Please keep us on a mailing list if it exists for future class offerings, either during the school year or summer break. Thanks for offering the class and making it enjoyable. Amy Arnold ________

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LEGO, the LEGO logo and MINDSTORMS are trademarks of the/sont des marques de commerce de/son marcas registradas de LEGO Group. ©2013 The LEGO Group. 062615.

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Common Core Science Framework

Make It Move Make It Smarter Make a System

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Practices

1.1 Asking questions

1.2 Developing and using models

1.3 Planning and carrying out investigations

1.4 Analyzing and interpreting data

1.5 Using mathematics, Informational and Computer Technology, and computational thinking

1.6 Constructing explanations and designing solutions

1.7 Engaging in argument from evidence

1.8 Obtaining, evaluating and communicating information

Cross-cutting Concepts

2.1 Patterns

2.2 Cause and effect: Mechanism and explanation

2.3 Scale, proportion and quantity

2.4 Systems and system models

2.5 Energy and matter: Flows, cycles and conservation

2.6 Structure and function

2.7 Stability and change

Core Ideas: Physical Science

3.PS.1 Matter and its interactions

3.PS.2 Motion and stability: Forces and interactions

3.PS.3 Energy

3.PS.4 Waves and their applications in technologies for information transfer

Core Ideas: Life Science

3.LS.1 From molecules to organisms

3.LS.2 Ecosystems

3.LS.3 Heredity

3.LS.4 Biological evolution

Core Ideas: Earth and Space Science

3.ESS.1 Earth’s place in the universe

3.ESS.2 Earth’s systems

3.ESS.3 Earth and human activity

Core Ideas: Engineering, Technology and Application of Science

3.ETS.1 Engineering Design

3.ETS.2 Links among engineering, technology, science and society

Curriculum Grid


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Introduction

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Common Core Mathematics Standards


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Practices

1.1 Make sense of problems and persevere in solving them

1.2 Reason abstractly and quantitatively

1.3 Construct viable arguments and critique the reasoning of others

1.4 Model with mathematics

1.5 Use appropriate tools strategically

1.6 Attend to precision

1.7 Look for and make use of structure

1.8 Look for and express regularity in repeated reasoning

Ratios and Proportional Relationships

Grade 6 Understand ratio concepts and use ratio reasoning to solve problems

Grade 7 Analyze proportional relationships and use them to solve real-world and mathematical problems

The Number System

Grade 6 Apply and extend previous understandings of multiplication and division to divide fractions by fractions

Grade 6 Compute fluently with multidigit numbers and find common factors and multiples

Grade 6 Apply and extend previous understandings of numbers to the system of rational numbers

Grade 7 Apply and extend previous understandings of operations with fractions to add, subtract, multiply and divide rational numbers

Grade 8 Understand that there are numbers that are not rational, and approximate them by rational numbers

Expressions and Equations

Grade 6 Apply and extend previous understandings of arithmetic to algebraic expressions

Grade 6 Reason about and solve one-variable equations and inequalities

Grade 6 Represent and analyze quantitative relationships between dependent and independent variables

Grade 7 Use properties of operations to generate equivalent expressions

Grade 7 Solve real-life and mathematical problems using numerical and algebraic expressions and equations

Grade 8 Work with radicals and integer exponents

Grade 8 Understand the connections between proportional relationships, lines and linear equations

Grade 8 Analyze and solve linear equations and pairs of simultaneous linear equations

Function

Grade 8 Define, evaluate and compare functions

Grade 8 Use functions to model relationships between quantities

Continues...


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Introduction

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Common Core Mathematics Standards


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Geometry

Grade 6 Solve real-world and mathematical problems involving area, surface area and volume

Grade 7 Draw, construct and describe geometrical figures and the relationship between them

Grade 7 Solve real-life and mathematical problems involving angle measure, area, surface area and volume

Grade 8 Understand congruence and similarity using physical models, transparencies or geometry software

Grade 8 Understand the Pythagorean theorem

Grade 8 Solve real-world and mathematical problems involving volume of cylinders, cones and spheres

Statistics and Probability

Grade 6 Develop an understanding of statistical variability

Grade 6 Summarize and describe distributions

Grade 7 Use random sampling to draw inferences about a population

Grade 7 Investigate chance processes and develop, use and evaluate probability models

Grade 8 Investigate patterns of association in bivariate data

Continued from previous page


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Introduction

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ITEEA Standards for Technological Literacy


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The Nature of Technology

1 Students will develop an understanding of the characteristics and scope of technology

2 Students will develop an understanding of the core concepts of technology

3 Students will develop an understanding of the relationships among technologies and the connections between technology and other fields of study

Technology and Society

4 Students will develop an understanding of the cultural, social, economic and political effects of technology

5 Students will develop an understanding of the effects of technology on the environment

6 Students will develop an understanding of the role of society in the development and use of technology

7 Students will develop an understanding of the influence of technology on history

Design

8 Students will develop an understanding of the attributes of design

9 Students will develop an understanding of engineering design

10 Students will develop an understanding of the role of troubleshooting, research and development, invention and innovation, and experimentation in problem solving

Abilities for a Technological World

11 Students will develop abilities to apply the design process

12 Students will develop abilities to use and maintain technological products and systems

13 Students will develop abilities to assess the impact of products and systems

The Designed World

14 Students will develop an understanding of and be able to select and use medical technologies

15 Students will develop an understanding of and be able to select and use agricultural and related biotechnologies

16 Students will develop an understanding of and be able to select and use energy and power technologies

17 Students will develop an understanding of and be able to select and use information and communication technologies

18 Students will develop an understanding of and be able to select and use transportation technologies

19 Students will develop an understanding of and be able to select and use manufacturing technologies

20 Students will develop an understanding of and be able to select and use construction technologies


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Introduction

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ISTE National Education Technology Standards


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1. Creativity and Innovation

Students demonstrate creative thinking, construct knowledge, and develop innovative products and processes using technology.

a Apply existing knowledge to generate new ideas, products or processes

b Create original works as a means of personal or group expression

c Use models and simulations to explore complex systems and issues

d Identify trends and forecast possibilities

2. Communication and Collaboration

Students use digital media and environments to communicate and work collaboratively, including at a distance, to support individual learning and contribute to the learning of others.

a Interact, collaborate and publish with peers, experts or others employing a variety of digital environments and media

b Communicate information and ideas effectively to multiple audiences using a variety of media and formats

c Develop cultural understanding and global awareness by engaging with learners of other cultures

d Contribute to project teams to produce original works or solve problems

3. Research and Information Fluency

Students apply digital tools to gather, evaluate and use information.

a Plan strategies to guide inquiry

b Locate, organize, analyze, evaluate, synthesize and ethically use information from a variety of sources and media

c Evaluate and select information sources and digital tools based on the appropriateness to specific tasks

d Process data and report results

4. Critical Thinking, Problem Solving and Decision Making

Students use critical-thinking skills to plan and conduct research, manage projects, solve problems, and make informed decisions using appropriate digital tools and resources.

a Identify and define authentic problems and significant questions for investigation

b Plan and manage activities to develop a solution or complete a project

c Collect and analyze data to identify solutions and/or make informed decisions

d Use multiple processes and diverse perspectives to explore alternative solutions

5. Digital Citizenship

Students understand human, cultural and societal issues related to technology and practice legal and ethical behavior.

a Advocate and practice safe, legal, and responsible use of information and technology

b Exhibit a positive attitude toward using technology that supports collaboration, learning and productivity

c Demonstrate personal responsibility for lifelong learning

d Exhibit leadership for digital citizenship

6. Technology Operations and Concepts

Students demonstrate a sound understanding of technology concepts, systems and operations.

a Understand and use technology systems

b Select and use applications effectively and productively

c Troubleshoot systems and applications

d Transfer current knowledge to learning of new technologies

Web Search No Record Found ReportWashington State Patrol

Identification and Criminal History Section

P.O. Box 42633

Olympia, Washington 98504-2633

Telephone (360) 534-2000

THE FOLLOWING WEB SEARCH NO MATCH FOUND REPORT

IS FURNISHED FOR OFFICIAL USE ONLY

This report was generated from a transaction run on 09/13/2013 at 11:13

Conviction Criminal History RCW 10.97.050(1)

Pursuant to the purpose of inquiry, NO RECORD was found in the Washington State

Criminal History Repository based on the descriptors provided:

GRONNING,DON L DOB 10/12/1961

This may mean that the person you searched for has no criminal conviction record OR

that your search criteria did not match the spelling of the person's name or date of

birth.

Positive identification or non-identification in the Washington State Patrol's database,

can only be determined by fingerprint comparison.

Form W-9(Rev. December 2011)Department of the Treasury Internal Revenue Service

Request for Taxpayer Identification Number and Certification

Give Form to the requester. Do not send to the IRS.

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Name (as shown on your income tax return)

Business name/disregarded entity name, if different from above

Check appropriate box for federal tax classification:

Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate

Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) ▶

Other (see instructions) ▶

Exempt payee

Address (number, street, and apt. or suite no.)

City, state, and ZIP code

Requester’s name and address (optional)

List account number(s) here (optional)

Part I Taxpayer Identification Number (TIN)Enter your TIN in the appropriate box. The TIN provided must match the name given on the “Name” line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3.

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

Social security number

– –

Employer identification number

–

Part II CertificationUnder penalties of perjury, I certify that:

1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and

2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and

3. I am a U.S. citizen or other U.S. person (defined below).

Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4.

Sign Here

Signature of U.S. person ▶ Date ▶

General InstructionsSection references are to the Internal Revenue Code unless otherwise noted.

Purpose of FormA person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA.

Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to:

1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued),

2. Certify that you are not subject to backup withholding, or

3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners’ share of effectively connected income.

Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester’s form if it is substantially similar to this Form W-9.

Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are:

• An individual who is a U.S. citizen or U.S. resident alien,

• A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States,

• An estate (other than a foreign estate), or

• A domestic trust (as defined in Regulations section 301.7701-7).

Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners’ share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income.

Cat. No. 10231X Form W-9 (Rev. 12-2011)

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05/26/2014

HISCOX INSURANCE COMPANY INC. (A Stock Company)233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601

Certificate of Commercial General Liability Insurance

This certificate is issued for informational purposes only.

It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies.

Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits.

Named Insured: Donald Gronning

Insurer Name: Hiscox Insurance Company Inc.

Policy Number: UDC-1380732-CGL-13

Type of Coverage: Occurrence

Policy Effective Date: September 11, 2013 Policy Expiration Date: September 11, 2014

Limits of Insurance

Each Occurrence: $ 1,000,000

Damage to Premises Rented to You: $ 100,000 Any one premisesAny one premises

Medical Expense: $ 5,000 Any one personAny one person

Personal & Advertising Injury: $ 1,000,000

General Aggregate: $ 2,000,000

Products/Completed Operations Aggregate:

Products-completed operations are subject to the General Aggregate Limit

General Aggregate Limit applies per: Policy

Description of Endorsements/Special Provisions

Not applicable

January 31, 2014

Authorized Representative Date

CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., withits permission. © ISO Properties, Inc., 2000

Page 1

HISCOX INSURANCE COMPANY INC. (A Stock Company)233 North Michigan Avenue, Suite 1840 Chicago Illinois 60601

Certificate of Commercial General Liability Insurance

This certificate is issued for informational purposes only.

It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies.

Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits.

Named Insured: Donald Gronning

Insurer Name: Hiscox Insurance Company Inc.

Policy Number: UDC-1380732-CGL-13

Type of Coverage: Occurrence

Policy Effective Date: September 11, 2013 Policy Expiration Date: September 11, 2014

Limits of Insurance

Each Occurrence: $ 1,000,000

Damage to Premises Rented to You: $ 100,000 Any one premisesAny one premises

Medical Expense: $ 5,000 Any one personAny one person

Personal & Advertising Injury: $ 1,000,000

General Aggregate: $ 2,000,000

Products/Completed Operations Aggregate:

Products-completed operations are subject to the General Aggregate Limit

General Aggregate Limit applies per: Policy

Description of Endorsements/Special Provisions

Not applicable

Additional Insured Status

Certificate holder maintains Additional Insured Status if this boxed checked.ΠΠΠΠ

This certificate does not grant any coverage or rights to the certificate holder. If this certificate indicates that the certificate holder is an additional insured, the policy(ies) must either be endorsed or contain spe-cific language providing the certificateholder with additional insured status. The certificate holder is an additional insured only to the extent indicated in such policy language or endorsement.

Cancellation

In the event of cancellation of any policy described above, the insurer will attempt to mail 10 days written notice to the certificate holder prior to the effective date of cancellation. However, failure to do so will not impose any duty or liability upon the insurer, its agents or representatives, nor will it delay cancellation.

CG DS 01 01 10 Includes copyrighted material of Insurance Services Office, Inc., withits permission. © ISO Properties, Inc., 2000

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