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PAGE 1 OF 11StaffPak is a division of Innovation Growth Partners Specialty, LLC | Rev. 12.17.25 Staffing and PEO Insurance Application 14241 Dallas Parkway, Suite 850 | Dallas, Texas 75254

Stop Gap Questionnaire 14241 Dallas Parkway, Suite 850 | Dallas, Texas 75254 StaffPak is a division of Innovation Growth Partners Specialty, LLC | Rev. 11.20.25 Applicant/Named Insured:

Third-Party Crime Questionnaire 14241 Dallas Parkway, Suite 850 | Dallas, Texas 75254 StaffPak is a division of Innovation Growth Partners Specialty, LLC | Rev. 11.20.25 Applicant/Named

1 WORKERS’ COMPENSATION - Temporary Staffing Supplemental Application Applicant Name:________________________________________________________________________________________ Applicant Primary

EVENT CANCELLATION & NON-APPEARANCE APPLICATION BROKER INFORMATION Broker/Agency Name: Contact Person: Phone #: E-Mail: GENERAL APPLICANT INFORMATION Name of Insured: Name of Applicant (if

EVENT CANCELLATION & NON-APPEARANCE APPLICATION BROKER INFORMATION Broker/Agency Name: Contact Person: Phone #: E-Mail: GENERAL APPLICANT INFORMATION Name of Insured: Name of Applicant (if

SpecialEvents@Take1insurance.com SPECIAL EVENTS APPLICATION 1. Name of Applicant Federal Employer I.D. No. 2. Address Street City County State ZIP Code 3. Event Dates: From

WEATHER INSURANCE APPLICATION BROKER INFORMATION Broker/Agency Name: Address: City: State: Zip: Contact Person: Phone #: E-Mail: GENERAL APPLICANT INFORMATION Name of Insured: Insured Street

Wind/Hail Deductible Buyback Application 14241 Dallas Parkway, Suite 850 | Dallas, Texas 75254 TCAP (Tailored Community Association Plan) is a Division of Innovation Growth Partners Specialty,

EAPP 351 03 21 Copyright, Everest Reinsurance Company, 2021 Page 1 of 6 Veterinarian Professional Liability Multi-State Insurance Application This application is intended for use in all states

EAPP 351 03 21 Copyright, Everest Reinsurance Company, 2021 Page 1 of 6 Missouri Veterinarian Professional Liability Insurance Application This application is intended for use in MISSOURI only.

Veterinary & Animal Services Renewal Summary Application RENEWAL EFFECTIVE/EXPIRATION DATES: From To 12:01 A.M., Standard Time, at the address of the Applicant Legal Name and DBA/AKA (include

Veterinary and Animal Services Application (2018/10)  Version 1  Business Auto Insurance Supplement: Important: Please provide a copy of your current policy Declaration Page listing the Named

EAPP 352 03 21 Copyright, Everest Reinsurance Company, 2021 Page 1 of 2 Veterinarian Professional Liability Multi-State Insurance Application Supplementary Schedule This supplementary schedule

Page 1 of 8 Workers Compensation Supplemental Application (To be completed with ACORD 130 application) Named Insured: Web Address: Insured’s FEIN: Contact Name and Phone Number Inspections:

Form W-9 (Rev. March 2024) Request for Taxpayer Identification Number and Certification Department of the Treasury Internal Revenue Service Go to www.irs.gov/FormW9 for instructions and the

Does Wealth Change the Way You Think? Risk tolerance, tangible assets, and risk management: observations for prosperous families and their advisors* September 22, 2021 L O N G R E P O R T *

APPLICATION Life and Health Insurance Agents and Brokers Errors and Omissions Insurance Underwritten by Utica Mutual Insurance Company New Hartford, New York THIS IS AN

SEPTEMBER 2022 T H E S T A T E O F F R A U D A N D F I N A N C I A L C R I M E I N T H E U. S. T A B L E O F C O N T E N T S Introduction . . . . . . . . . . . . . . .

A Strategic Specialty Partner for the Ironpeak Agent Network As specialty risks grow more complex and standard markets continue to tighten, Ironpeak agents need specialty partners who deliver broad