<p> GATHERING SYSTEM / PIPELINE SUPPLEMENT (complete one supplement for each system)</p><p>I. SYSTEM INFORMATION : 1. Name of system: </p><p>2. System consists of gathering lines: Yes No System is a common carrier pipeline: Yes No See definitions below.</p><p>3. Location (Field / County/Parish / State - lats/longs if available): </p><p>4. Length: Origin: Terminus: </p><p>5. Diameter: </p><p>6. Age: </p><p>7. Who operates the system? </p><p>8. What is the Applicant's insurable interest in the system? </p><p>9. Percentage of the system: above ground? % below ground? %</p><p>10 Percentage of the system: steel pipe? % poly pipe? %</p><p>11. Maximum operating pressure of the system? </p><p>12. What product is transported in the system? </p><p>13. Does the system transport only the Applicant's (and their JV partners') product? Yes No</p><p>14. Are there amine plants/compressor stations on the system? Yes No</p><p>15. Does the system service any end user? Yes No If Yes, list end user(s) If Yes, does the Applicant do hook-ups, monitoring, meter installation? Yes No If Yes, does the Applicant install storage tanks or appliances? Yes No If Yes, is the Applicant responsible for odorizing gas? Yes No</p><p>16. Does the system cross any: roadways? Yes No waterways? Yes No railroads? Yes No</p><p>If yes, please identify.</p><p>Gathering System - Pipeline Supplement Page 1 of 2 Form 407 (Ed. 09/11)</p><p>© 2016 JH Blades, is a division of and operates under the licenses of CRC Insurance Services, Inc. 17. Does the system traverse any populated areas? Yes No</p><p>If yes, please identify.</p><p>18. How often and how is the system inspected? </p><p>19. Does the system feature high/low pressure alarms? Yes No</p><p>20. Please attach any available schematics.</p><p>Definitions:</p><p>Flowlines: Flowlines transport fluids or gas from the wellhead to vessels used for separation, treating etc. at or near the well site. In multiple well fields, Flowlines transport fluids or gas from individual wells to a central facility for separation, treating, etc.</p><p>The Applicant does not need to provide information on their Flowlines.</p><p>Gathering Lines: Gathering Lines perform some of the same functions as Flowlines, the principal difference being that Flowlines are a network of lines tied to individual wells which move wellhead fluids or gas to the first point of accumulation of other Flowlines from like wells. Gathering Lines are tied to the Flowlines through an intermediary manifold. If separation, treating, etc. has not occurred along the Flowline before the fluid or gas is gathered, then the Gathering Lines will transport the fluids or gasses through a processing point such as a central facility. Gathering Lines are the lines upstream of the point at which the fluids or gas enter a Common Carrier Pipeline</p><p>Gathering System - Pipeline Supplement Page 2 of 2 Form 407 (Ed. 09/11)</p><p>© 2016 JH Blades, is a division of and operates under the licenses of CRC Insurance Services, Inc. Gathering System - Pipeline Supplement Page 3 of 2 Form 407 (Ed. 09/11)</p><p>© 2016 JH Blades, is a division of and operates under the licenses of CRC Insurance Services, Inc.</p>