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© Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved. 1  ERM-14 Form Instructions How to Submit The ERM-14 Form is available on the Frequently Accessed Forms

Innovation Growth Partners Specialty, LLC | igpspecialty.com REV 06.26.25 CONTACT US Traci Huskey (941) 444-1659 | traci.huskey@igpspecialty.com Brian Rudolph (941) 444-1643 | brian.rudolph@

Builders' Risk Prior Start Supplemental Application DATE: TO: COMPANY: ------------------ PHONE: FAX: TO BE COMPLETED ONLY IF THE JOB HAS STARTED Re: Name: Quote#: Please answer the

8401 N. Central Expressway, Suite 1000 Dallas, Texas 75225 Toll Free: (800) 232-5830 | usrisk.com REV 12.10.2020 RECENTLY BOUND ACCOUNTS — ENVIRONMENTAL ■ Agriculture Cooperative – Site

δ GENERAL INFORMATION Insured : Mailing Address : Property Address (if different to above) UNDERWRITING INFORMATION 100% R.C Values : Building (s) $______________ Contents

Metals and Plastics Manufacturing Program (MaP) Application Name Insured: ___________________________________________________________________________

Davies Group PO Box 110259 Lakewood Ranch, FL 34211 www.davies-group.com IGP Specialty – Metals & Plastics Program (MaP) Claim Reporting Instructions **Insured: Claims should be submitted

PRG 142053 (12-22) ©All rights reserved. Page 1 of 2 Drifting Supplemental Application 1. Track Name: ____________________________________________________ 2. Physical Address: _______________

PRG 142059 (12-22) ©All rights reserved. Page 1 of 1 LIQUOR LIABILITY APPLICATION Name of Applicant (show all names including legal & dba’s) Location Address: Mailing Address: Phone

Acuerdo de liberación y exención de responsabilidad, asunción de riesgos e indemnidad Nombre de la pista o del evento: _____________________ Fecha(s) del evento: ___________________

Nom de la piste etou de Ievenement: Dates de Ievenement: Textfield-0: Textfield-1: Textfield-2: Textfield-3: Textfield-4: Textfield-5: Textfield-6: Textfield-7: Textfield-8:

Release and Waiver of Liability Assumption of Risk and Indemnity Agreement Event Name/Location: Event Date(s): IN CONSIDERATION of being permitted to compete, officiate, observe,

Skating Facility Supplemental General Liability Application Separate application required for each location I. General Information Named Insured I DBA Facility Address Website I Email D

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JVBERi0xLjcNJeLjz9MNCjEzIDAgb2JqDTw8L0xpbmVhcml6ZWQgMS9MIDM4NTY2NC9PIDE2L0UgMzc3NzUxL04gMS9UIDM4NTM0My9IIFsgNjgxIDMwMV0+

Skating Facility Supplemental General Liability Application Separate application required for each location I. General Information Named Insured I DBA Facility Address Website I Email D

The Take1 101 Series101 What is a loan-out corporation? Loan-out corporations are separate legal entities (corporations or LLCs) whose purpose is to “loan out” the owner of the entity for their

Specialty Underwriting LIVE Event Service Providers Program Event Promoters Features • Take1 is the largest General Agent with stated carrier Underwriting Authority focused on all aspects of the