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Builders' Risk Supplemental Application Installation Floater for Single Project Insured Information Named Insured I OBA Street Address City I State I ZIP Code I County Effective Date I Expiration

Builders' Risk Supplemental Application I. Insured InformationNamed Insured I DBA Address City I State I ZIP Code I County Phone I Cell I Fax Email Address II. Insurance InformationRequested

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

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

Please complete for each location which provides wine storage. NAMED INSURED Name: __________________________________________ Location Address: __________________________________________

100 Glen Eagles Court Carrollton GA 30117 800.842.8917 www.igpspecialty.com www.safehold.com Solar Panel Questionnaire If the insured wishes for coverage to apply to the solar panels and

Rev (01/2026) Page 1 of 10 HEALTH CLUB FACILITY APPLICATION I. GENERAL INFORMATION Policy Dates: from ____________________ to ___________________ First Named Insured: ________________________

Rev (01/2026)

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

Application For Concert Promoters CA License #OG67921 Take1 Application Lighthouse Underwriters, LLC 2 Concert Promoters Supplemental Application In addition to this application, please

Application D.I.C.E. Supplemental (Documentary Industrial Commercial Educational CA License #0F82757 Take1 Application 2 D.I.C.E. Supplemental 1. Applicant’s Name: 2. Mailing Address: City,

Application For Event/Party Planners and Coordinators CA License #0F82757 Take1 Application Lighthouse Underwriters, LLC 2 Event/Party Planners & Coordinators Supplemental Application (Send

Event Services Firms Supplemental Application ▶ INCLUDING EVENT PRODUCTION OR EVENT RENTAL WITH OR WITHOUT OPERATOR PAGE 1 OF 3Take1insurance.com | Take1 is a Division of Innovation Growth

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 the Rental & Staging, Event

Application For Motion Picture and Television Companies CA License #0F82757 Page 1 Motion Picture/Television Production Application General Information 1. Name of Production Company

Application Touring Entertainer Supplemental Application CA License #OG67921 2 Touring Entertainer Supplemental Application 1. Named Insured: 2. Type of Music (Please attach Bio): 3.

PAGE 1 OF 5 Community Association Insurance Application 14241 Dallas Parkway, Suite 850 | Dallas, Texas 75254 TCAP (Tailored Community Association Plan) is a Division of Innovation Growth

EAPP 350 03 21 Copyright, Everest Reinsurance Company, 2021 Page 1 of 5 Veterinarian Professional Liability Multi-State Insurance Application This application is intended for use in all states