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        <City>Fairfield</City>
        <State>CT</State>
        <ZIPCode>06824</ZIPCode>
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      <NameControl>STIC</NameControl>
      <Phone>8008391754</Phone>
      <USAddress>
        <AddressLine1>15 West Thruston Boulevard</AddressLine1>
        <City>Dayton</City>
        <State>OH</State>
        <ZIPCode>45419</ZIPCode>
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      <Title>President</Title>
      <DateSigned>2012-10-19</DateSigned>
      <AuthorizeThirdParty>true</AuthorizeThirdParty>
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    <Preparer>
      <Name>Jeffrey D Haskell</Name>
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            <City>Dayton</City>
            <State>OH</State>
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      <SupplementaryInformation>
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