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Specialty Underwriting | Oil & Gas Program Building solid, professional relationships is the foundation of success. U.S. Risk is committed to this concept and considers it one of the most

Energy Division Recently Bound Accounts 8401 N. Central Expressway, Suite 1000, Dallas, Texas 75225 Toll Free: 800.232.5830 | Local: 214.265.7090 | Visit us at usrisk.com IN-HOUSE

Specialty Underwriting | Environmental Programs Overview REV 12.02.2020 Building solid, professional relationships is the foundation of success. U.S. Risk is committed to this concept and

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ACCOUNT: DATE: 12 Mo. Ending Estimated next / / 12 Mo. -$ -$ ADD any other earnings derived from the operation of the business -$

Davies Group PO Box 110259 Lakewood Ranch, FL

PRG 142050 (12-22) ©All rights reserved. Page 1 of 1 SUPPLEMENTAL APPLICATION CONCESSIONAIRE GO KART Track Surface: Age of Track Re-surfaced (year) Describe track maintenance,

MOTORCYCLE SCHOOL SUPPLEMENTAL APPLICATION PRG 142062 (12-22) ©All rights reserved. Page 1 of 2 Applicant Name: _________________________________________________________________________________

PRG 142063 (12-22) ©All rights reserved. Page 1 of 2 MUD BOG / SAND DRAG SUPPLEMENTAL APPLICATION EVENTS SCHEDULED: □ Mud Bog □ Sand Drag COMPETITION AREA: Indoor or Outdoor event?

PRG 142068 (12-22) ©All rights reserved. Page 1 of 1 SUPPLEMENTAL APPLICATION ROADCOURSE NAME OF TRACK: Year Track Built: Age of Track Surface: Length of Track: Track Surface Material (

RACE TEAM SUPPLEMENTAL QUESTIONNAIRE Use in conjunction with ACORD General Liability & Auto Applications PRG 142074 (12-22) ©All rights reserved. Page 1 of 1 Under the named insured on your

SAFEHOLD SPECIAL RISK, INC. COMPLETE ALL SECTIONS PROMOTER TRACK SANCTIONING BODY / PROMOTER NHRA  TRACK PROMOTED  WDRA  IMCA  IHRA 

Name of Track andor Event: Event Dates: Textfield-0: Textfield-1: Textfield-2: Textfield-3: Textfield-4: Textfield-5: Textfield-6: Textfield-7: Textfield-8: Textfield-9:

PROFESSIONAL LIABILITY ■ Defense outside limit option available ■ Personal injury included when related to professional services ■ Contingent BI/PD coverage available ■ Claims Made and

Network Security & Privacy Liability System Business Interruption Privacy Regulatory Liability Privacy Breach Expenses Professional Liability Multimedia Liability Reputational Harm Cyber

COMPLETE ALL SECTIONS PROMOTER TRACK SANCTIONING BODY / PROMOTER NHRA  TRACK PROMOTED  WDRA  IMCA  IHRA  OTHER  _____________________ EVENT TYPE DRAG  OVAL  ROAD

Release and "Waiver of Liability Assumption of Risk and Indemnity Agreement Name of Track and/or Event: _______________________ Event Date(s) : __________ _ IN CONSIDERATION of being permitted to

Specialty Underwriting Entertainment Underwriting Program Loan-Out Corporations Features • Take1 is one of the largest General Agent with stated carrier Underwriting Authority focused on