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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

Put our expertise in healthcare risks to work for you. HEALTHCARE MARKETS ■ ACE/Westchester ■ Admiral ■ AIG ■ Allied World (AWAC) ■ Ambridge/Brit ■ American Empire ■ Applied Financial ■

Real Estate E&O COVERAGE FORM FEATURES ■ First Dollar Defense ■ Additional Defense Limits ■ Aggregate Deductible ■ Consent to settle wording (Soft Hammer Clause) ■ Defense of Fair Housing

©2025 Innovation Growth Partners Specialty, LLC | igpspecialty.com REV 08.22.25 Social Services Risks | Wholesale Brokerage SOCIAL SERVICES CLASSES ■ Adult / Respite & Special Needs Day Care

TECHNOLOGY CLIENTS WE SERVE ■ Application Service Providers ■ Branding and Marketing Services ■ Business Process Outsourcing Firms ■ Cloud and Data Center Providers ■ Cyber Security Services ■

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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

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

PAGE 1 OF 2©2026 Innovation Growth Partners Specialty, LLC. All rights reserved. | igpspecialty.com | Rev. 02.17.26 Natural Disaster Program Application PERILS TO BE COVERED • Flood-only

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Batting Cages Supplemental Questionnaire Separate application required for each location I. General InformationNamed Insured I OBA Facility Address Website I Email II. Batting Cage

1 GAMING SUPPLEMENTAL QUESTIONAIRE Insured Name: 1. Provide description of gaming operation, # of gaming machines, tables etc. ____________________________________________ ___________________

Liquor Liability Application This is a warrantee application for primary or excess liquor liability insurance. All questions must be answered. If the answer to any question is none, state 'none'

Skating Facility Inflatables Supplemental Application Separate application required for each location I. General Information Named Insured I DBA Facility Address Website I Email II.

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