Fases del procedimiento

04/20/2015 Effective Date : 9906-10-98 Policy Number :

COMMERCE BANCSHARES, INC. AND ALL SUBSIDIARIES, DIVISIONS, AND AFFILIATED Policyholder :

COMPANIES THAT NOW EXIST OR HEREAFTER MAY BE CONSTITUTED

04/20/2015 to 04/20/2018 Policy Period :

FEDERAL INSURANCE COMPANY Name of Company :

3/31/2015 Issue Date :

It is agreed that the Policy is amended as follows:

Section C Payment of the Beneficiary Provision in the General Provisions is deleted and replaced with the following:

The Benefit Amount for Loss of Life will be paid to the beneficiary designated by You. This choice must be in writing and filed with the Policyholder. Any Benefit Amount payable due to the Loss of Life of a Dependent Child will be paid to You, absent any beneficiary designation by the Dependent Child. All other Benefit Amounts are paid to You, unless otherwise directed by You, or Your designee.

If You have not chosen a beneficiary under Our Policy, We will pay the Loss of Life Benefit Amount to the beneficiary named by You on the Group Life Policy issued to the Policyholder and in effect on the date of Your Loss of Life. If You have not chosen a beneficiary under the Group Life Policy or are not insured under the Group Life Policy; or if the beneficiary is not alive when You die, We will pay to the first surviving party in the following order:

Your Spouse or Domestic Partner; a)

in equal shares to Your surviving children: b)

in equal shares to Your surviving parents; c)

in equal shares to Your surviving brothers and sisters; d)

Your estate. e)

If You have named multiple beneficiaries and one or more dies before You have, their share of the payment will be redistributed proportionately among the surviving beneficiaries.

All other terms and conditions of the policy remain unchanged.

Authorized Representative 47

BT 1005

NOTICE CONCERNING COVERAGE

LIMITATIONS AND EXCLUSIONS UNDER THE LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION ACT

Residents of this state who purchase life insurance, annuities or health insurance should know that the insurance companies licensed in this state to write these types of insurance are members of the Missouri Life and Health Insurance Guaranty Association. The purpose of this association is to assure that policyholders will be protected, within limits, in the unlikely event that a member insurer becomes financially unable to meet its obligations. If this should happen, the guaranty association will assess its other member insurance companies for the money to pay the claims of insured persons who live in this state and, in some cases, to keep coverage in force. The valuable extra protection provided by these insurers through the guaranty association is not unlimited, however. And, as noted in the box below, this protection is not a substitute for consumers' care in selecting companies that are well-managed and financially stable.

The Missouri Life and Health Insurance Guaranty Association may not provide coverage for this policy. If coverage is provided, it may be subject to substantial limitations or exclusions, and require continued residency in Missouri. You should not rely on coverage by the Missouri Life and Health Insurance Guaranty Association in selecting an insurance company or in selecting an insurance policy. Coverage is NOT provided for your policy or any portion of it that is not guaranteed by the insurer or for which you have assumed the risk, such as a variable contract sold by prospectus. Insurance companies or their insurance producers are required by law to give or send you this notice. However, insurance companies and their insurance producers are prohibited by law from using the existence of the guaranty association to induce you to purchase any kind of insurance policy. YOU MAY CONTACT EITHER THE ASSOCIATION OR THE MISSOURI DEPARTMENT OF INSURANCE AT THE FOLLOWING ADDRESSES SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE.

The Missouri Life and Health Insurance Guaranty Association 994 Diamond Ridge, Suite 102

Jefferson City, MO 65109 Missouri Department of Insurance

PO Box 690 Jefferson City, MO 65102-0690

The state law that provides for this safety-net coverage is called the Missouri Life and Health Insurance Guaranty Association Act. On the next page is a brief summary of this law's coverages, exclusions and limits. This summary does not cover all provisions of the law; nor does it in any way change anyone's rights or obligations under the Act or the rights or obligations of the guaranty association.

Generally, persons will be covered if they live in this state, and hold a life or health insurance contract or annuity, or a certificate under a group policy or contract. However, not all individuals with a right to recover under life or health insurance policies or annuities are protected by the Act. A person is not protected when- 1. The person is eligible for protection under the laws of another state;

2. The person purchased the insurance from a company that was not authorized to do business in this state; 3. The policy is issued by an organization which is not a member insurer of the association; or

4. The person does not live in this state, except under limited circumstances.

Additionally, the Association may not provide coverage for the entire amount a person expects to receive from the policy. The Association does not provide coverage for any portion of the policy where the person has assumed the risk, for any policy of reinsurance (unless an assumption certificate was issued), for interest rates that exceed a specified average rate, for employers' plans that are self-funded, for parts of plans that provide dividends or credits in connection with the administration of policy, or for unallocated annuity contracts (which are generally issued to pension plan trustees). The Act also limits the amount the Association is obligated to pay persons on various policies. The Association does not pay more than the amount of the contractual obligation of the insurance company. The Association does not have to pay more than three hundred thousand dollars ($300,000) in death benefits for any one life regardless of the number of policies that insure that life. The Association does not have to pay amounts over one hundred thousand dollars ($100,000) in cash surrender or withdrawal benefits on one life regardless of the number of policies insuring that individual. For health insurance benefits, the Association is not obligated to pay over: (i) one hundred thousand dollars ($100,000) of coverages other than disability insurance or basic hospital, medical and surgical insurance or major medical insurance or long-term care insurance, including net cash surrender and withdrawal values; (ii) three hundred thousand dollars ($300,000) for disability insurance and three hundred thousand dollars ($300,000) for long-term care insurance; (iii) five hundred thousand dollars ($500,000) for basic hospital, medical and surgical insurance or major medical insurance. On an annuity contract, the Association is not liable for over two hundred fifty thousand dollars ($250,000) in present value of annuity benefits, including net cash surrender and net cash withdrawal values. With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, two hundred fifty thousand dollars ($250,000) in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values, if any. Finally, the Association is never obligated to pay more than a total of three hundred thousand dollars ($300,000) for any one insured for any combination of insurance benefits, except with respect to benefits for basic hospital, medical and surgical insurance and major medical insurance, in which case the aggregate liability of the association shall not exceed five hundred thousand dollars ($500,000) with respect to any one individual. With respect to one owner of multiple nongroup policies of life insurance, whether the policy owner is an individual, firm, corporation or other person and whether the person insured are officers, managers, employees or other persons, the liability of the association will not be obligated to pay more than five million dollars ($5,000,000) regardless of the number of policies and contracts held by the owner.

4051

THIS NOTICE IS BEING SENT TO THE MASTER POLICYHOLDER OF A GROUP INSURANCE POLICY. IT DESCRIBES CHUBB'S POLICY FOR HANDLING CERTAIN PERSONAL INFORMATION OF ITS INDIVIDUAL CUSTOMERS.

This notice describes what we do with your personal information. We do not sell customer information to anyone. We do not share customer information with anyone for the purpose of marketing their products to Chubb

Respects

Privacy you but we may share with other financial institutions if permitted by a joint marketing agreement. To protect your personal information from unauthorized access and use, we use security measures that comply with state and federal law. We engage in limited information sharing and, as a result, are not required to offer the options to limit sharing that are typically offered by companies that engage in more extensive information sharing practices.

Financial companies choose how they share your personal information. Federal and state law gives consumers the right to limit some but not all sharing. Federal and state law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do. How?

The types of personal information we collect and share depend on the product or service you have with us. This information can include:

What?

• Social Security number and medical information • transaction history and payment history

• credit-based insurance scores and insurance claim history

When you are no longer our customer, we continue to share your information as described in this notice.

All financial companies need to share customers' personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers' personal information; the reasons Chubb chooses to share; and whether you can limit this sharing.

Why?

Can you limit this sharing? Does

Chubb share? Reasons we can share your personal information

Not applicable Yes

For our everyday business purposes - such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus

Not applicable Yes

For our marketing purposes - to offer our products and services to you

Not applicable Yes

For joint marketing with other financial companies

Not applicable Yes

For our affiliates' everyday business purposes - information about your transactions and experiences

We don't share No

For our affiliates' everyday business purposes - information about your creditworthiness

We don't share No

For our affiliates to market to you

We don't share No

For nonaffiliates to market to you

The Chubb Group of Insurance Companies, which is the marketing name used to refer to certain subsidiaries of The Chubb Corporation. A list of the Chubb companies covered by this notice is located at the end of this document.

Who is providing this notice?

To protect your personal information from unauthorized access and use, we use security measures that comply with state and federal law. These measures include computer safeguards and secured files and buildings. How does Chubb protect my personal information?

We collect your personal information, for example, when you How does

Chubb collect my personal information?

• apply for insurance or pay insurance premiums • file an insurance claim or give us your contact information • provide account information

We also collect your personal information from others, such as credit bureaus, affiliates, or other companies.

Federal law gives you the right to limit only: Why can't I

limit all sharing?

• sharing for affiliates' everyday business purposes - information about your creditworthiness • affiliates from using your information to market to you

• sharing for nonaffiliates to market to you

State laws may give you additional rights to limit sharing. See below for more on your rights under state law.

Companies related by common ownership or control. They can be financial and nonfinancial companies. Affiliates

• Our affiliates include companies with a Chubb name and financial companies such as Federal Insurance Company and Great Northern Insurance Company.

Companies not related by common ownership or control. They can be financial and nonfinancial companies.

Nonaffiliates

A formal agreement between nonaffiliated financial companies that together market financial products or services to you.

Joint marketing

Questions and other important information

State law may give you additional rights with regard to your personal information, such as the right to access and correct information we have about you. Please see your policy for a description of such rights, or contact us by sending an email to [email protected], calling 1-908-903-2000 or mailing to Privacy Inquiries, Chubb Group of Insurance Companies, 15 Mountain View Road, Warren NJ 07059.

This notice is being provided by the following Chubb companies to their consumer customers located in the United States: Chubb Custom Insurance Company, Chubb Indemnity Insurance Company, Chubb Insurance Company of New Jersey, Chubb Insurance Solutions Agency, Inc., Chubb Lloyds Insurance Company of Texas, Chubb National Insurance Company, Executive Risk Indemnity Inc., Executive Risk Specialty Insurance Company, Federal Insurance Company, Great Northern Insurance Company, Pacific Indemnity Company, Texas Pacific Indemnity Company and Vigilant Insurance Company.