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Agency Agreement Version 01.2026 Page 1 In California doing business as IGP Special Risk & Insurance Services, Inc. (CA DOI

Scottsdale Insurance Company Home Office: One Nationwide Plaza Columbus, Ohio 43215 Adm. Office: 8877 North Gainey Center Drive Scottsdale, Arizona 85258 Scottsdale Indemnity Company Home

PRODUCER NAME: CS REPRESENTATIVE NAME: OFFICE PHONE(A/C, No, Ext): AGENCY CUSTOMER ID: CODE: SUB CODE: ADDRESS: E-MAIL FAX(A/C, No): MOBILE PHONE: AGENCY NAME AND ADDRESS ASSOCIATION OTHER: "

Page 1 Aircraft Insurance Application U.S. Risk Insurance Group, Inc. Aircraft Insurance Application Name of Insured: Address of Insured: Phone: Business ( ) -

14241 Dallas Parkway Suite 850, Dallas, Texas 75254 Toll Free: 800.232.5830 | Local: 214.265.7090 | igpspecialty.com Remittance advice will be emailed to the primary accounting contact you

TM DAMAGE TO RENTED PREMISES DATE (MM/DD/YYYY) PHONEAGENCY APPLICANT(A/C, No, Ext): (FirstFAX Named(A/C, No): Insured) EFFECTIVE DATE EXPIRATION DATE PAYMENT PLAN AUDIT FOR COMPANY USE ONLYCODE