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100 Glen Eagles Court Carrollton GA 30117 800.842.8917 www.safehold.com www.safehold.com Propane/Gas Sales Questionnaire If the insured wishes for coverage to apply to the Business

Staffing Abuse and Molestation Supplemental Application 14241 Dallas Parkway, Suite 850 | Dallas, Texas 75254 PAGE 1 OF 2StaffPak is a division of Innovation Growth Partners Specialty, LLC |

PEO Supplemental Application Prospective Insured: Primary Insured Contact: Phone: Email: Website: Date of Incorporation: Premium, Payroll and Experience Mod History Please

Managed by: Scott Carroll, Director of Take1 1551 N. Tustin Ave., Suite 430 Santa Ana, CA 92705 Phone: (800)856-7035 scott@take1insurance.com Application For Concert Promoters CA License

Managed by: Scott Carroll, Director of Take1 1551 N. Tustin Ave., Suite 430 Santa Ana, CA 92705 Phone: (800)856-7035 scott@take1insurance.com Application Touring Entertainer Supplemental

Animal Related Services Supplemental Application . Page | 1 ANIMAL RELATED SERVICES SUPPLEMENTAL APPLICATION Humane Societies & SPCA, Pet Grooming, Sitting, Training or Boarding Kennels

Incorporated by Reference in Rule 69O-189.003 ACORD 130 FL (2019/07) LOCATIONS - LIST ALL PHYSICAL LOCATIONS, INCLUDING OTHER STATES, WHETHER COVERAGE IS REQUESTED OR NOT. IF APPLICANT IS

ERM-14 (Rev. 2/20) © Copyright 2018 National Council on Compensation Insurance, Inc. All Rights Reserved. Page 1 of 2 REQUEST FOR OWNERSHIP INFORMATION—ERM-14 FORM The purpose of this

© Application is hereby made for coverage (s), as specified per the signed attached quotation, to become effective on _______________________ , at 12:01 A.M. Central Standard Time at the address

REV. 10.13.25 Specialty Programs and Market Solutions Designed to help agents and brokers win SPECIALTY INSURANCE ELEVATED Programs available to all producers IGP Specialty delivers tailored

Davies Group PO Box 110259 Lakewood Ranch, FL 34211 www.davies-group.com IGP Specialty – Commercial Agriculture Program Claim Reporting Instructions Insured: Claims should be submitted through

APPCY01 Page 1 of 5 (Edition 04-18) CYBER PROTECTION APPLICATION – SHORT FORM New Renewal NOTICE: SECTION II.B. OF THIS APPLICATION APPLIES TO CLAIMS-MADE COVERAGE. IF SELECTED, THIS COVERAGE

Metals and Plastics Manufacturing Program (MaP) Supplemental Questions Name Insured: _____________________________________________________________________________ Aircraft/Aerospace Products:

Self-Storage Supplemental Application (Please complete this form in addition to the ACORD 125 -Applicant Information Section for EACH LOCATION) (When @SA is shown behind an option, please also

FIREWORKS QUESTIONNAIRE Safehold Sports is a division of Innovation Growth Partners Specialty, LLC 866.904.9742 ● igpspecialty.com PRG 142056 (12-22) ©All rights reserved. Page 1 of 1 Name of

RIDE & DRIVE SUPPLEMENTAL APPLICATION PRG 142066 (12-22) ©All rights reserved. Page 1 of 1 Website address Please describe the Ride & Drive operations in detail (attach schedule): List the

PRG 142067 (12-22) ©All rights reserved. Page 1 of 2 RIDE AND DRIVE EVENT CERTIFICATE QUESTIONNAIRE Named Insured: ______________________________________________________________ Type of Event:

Karting Oval (Open Wheel) PRODUCT LIABILITY SUPPLEMENTAL Use in Conjunction with an ACORD Application PRG 142073 (12-22) ©All rights reserved. Page 1 of 2 I. OPERATIONS Type of Product:

Name of Track andor Event: Event Dates: 1: Mother: Guardian: Guardian-0: Textfield: Father: Mother-0: Guardian-1: Guardian-2: Printed Name of MINOR Participant: DOB:

Hired & Non-Owned Auto Supplemental Application Separate application required for each location To be completed and returned with Commercial Auto ACORD application I. General Information Named