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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

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

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

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

FREQUENTLY ASKED QUESTIONS PLEASE READ BEFORE YOU COMPLETE YOUR APPLICATION Can you provide some quick guidance on pricing before I start my application? We value your time and we hope to

© 1980-2013 ACORD CORPORATION. All rights reserved.Page 1 of 4ACORD 130 (2013/01) MONTHLY QUARTERLY SEMI-ANNUAL AT EXPIRATION AUDIT % DOWN:QUARTERLY SEMI-ANNUAL ANNUAL PAYMENT PLAN STATUS

Innovation Growth Partners Specialty, LLC 1 Concourse Parkway, Suite 700 | Atlanta, Georgia 30328 (800) 232-5830 | igpspecialty.com Payment Instructions Important Note: Please reference

PAGE 1 OF 7 Financial Services Protection Insurance Application Administered by THIS IS AN APPLICATION FOR INSURANCE WRITTEN ON A “CLAIMS MADE AND REPORTED” BASIS WHICH APPLIES ONLY TO CLAIMS

Management Liability (D&O/EPL/Fiduciary/Crime/K&R) ■ Public Companies ■ Private Companies ■ Non-Profit Organizations ■ General Partner Liability ■ Healthcare Organizations ■ Financial

Page 1 of 3 INSURED INFORMATION NAMED INSURED INSURED ADDRESS CITY STATE ZIP WELL DETAILS WELL NAME CLOSEST ADDRESS CITY STATE ZIP WELL DEPTH ft COVERAGE COVERAGE BASIS Total

New/ Ground-Up Construction Supplemental Application *** THIS SUPPLEMENTAL APPLICATION MUST BE ATTACHED TO THE ACORD GENERAL APPLICANT INFORMATION APPLICATION - ACORD 125*** Insured Information

OUR TOP CLASSES ■ Home Healthcare ■ Hospice PROGRAM HIGHLIGHTS ■ Professional and General Liability (limits up to $1M/$3M) ■ Incident Sensitive Claims Trigger ■ Claims Made Professional

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Umbrella Liability—Energy & Marine CONTACT US Noel Martinsen, CPCU, AMIM, ASLI Lloyd’s Coverholder Since 1982 (504) 669-5852 noel.martinsen@igpspecialty.com Visit us at igpspecialty.com

PRG 142049 (12-22) ©All rights reserved. Page 1 of 1 SUPPLEMENTAL APPLICATION CONCERTS Track Name/Named Insured: Event Date(s) and Time each day: Indoors or Outdoors? Type of Concert/

PRG 142057 (12-22) ©All rights reserved. Page 1 of 1 FOREIGN DRIVER QUESTIONNAIRE Named Insured: ______________________________________________________________ Policy Number: _________________

PRG 142060 (12-22) ©All rights reserved. Page 1 of 2 MONSTER TRUCK SUPPLEMENTAL APPLICATION Is insured required to indemnify MONSTER TRUCK promoters/owners? □ Yes □ No □ Do Not Know * If

CONSENT FOR ELECTRONIC DISCLOSURE, GENERAL FRAUD STATEMENT & COMPENSATION PLEASE READ, COMPLETE AND SIGN/DATE, WHERE INDICATED CONSENT FOR ELECTRONIC DISCLOSURES UNDER THE ELECTRONIC