SECTION1-SCHEDULEOFBENEFITS BASICINSURANCE CLASS003 CLASSIFICATION: All Other Eligible Full-Time Employees LIFEAMOUNT: $50,000 AD&DPRINCIPALSUM: $50,000 ACCELERATEDLIFEBENEFIT(ALB):Youmayrequestpaymentof25%,50%or75%oftheLifeAmountshown above. This benefit is available on a Life Amount of $10,000 or more. The maximum payment is limited to 25%, 50% or 75% of the Life Amount shown above or $37,500, whichever is less. See Section 13. ACCIDENTALDEATHANDDISMEMBERMENTBENEFIT:Thisbenefitisincludedinthiscertificate.See Section 12. ADDITIONALACCIDENTALDEATHBENEFITS: SEATBELTBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12A. AIRBAGBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12B. REPATRIATIONBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12C. CHILDHIGHEREDUCATIONEXPENSEBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection 12D. CHILDCAREBENEFIT:Thisbenefitisincludedinthiscertificate.SeeSection12E. ANNUALBASESALARY:AnnualBaseSalarywithnoCommissionsorBonuses.AnnualBaseSalaryexcludes overtime. CHANGESININSURANCECOVERAGE:Immediate.SeeSection6. CONTRIBUTIONS:Employeepremiumcontributionsarenotrequired.SeeSection4. ELIGIBILITY:First of the Month. See Section 3. FULL-TIMEEMPLOYEEREQUIREMENT:30hoursormoreperweek.SeeSection2,Definitions-Employee,and Section 3, Eligibility. GC2510.2 SECTION1-SCHEDULEOFBENEFITS

Certificate of Insurance for Group Term Life Insurance - Page 4 Certificate of Insurance for Group Term Life Insurance Page 3 Page 5