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8401 N. Central Expressway, Suite 1000 Dallas, Texas 75225 Toll Free: (800) 232-5830 | usrisk.com REV 12.10.2020 RECENTLY BOUND ACCOUNTS — ENVIRONMENTAL ■ Agriculture Cooperative – Site

Specialty Underwriting | SWD Program REV 12.02.2020 Building solid, professional relationships is the foundation of success. U.S. Risk is committed to this concept and considers it one of the

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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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

NAME OF TRACK FACILITY: Date: Date-0: Printed Name of Minor: DOB: Textfield-1: Printed Name of Parent or Guardian 1: Printed Name of Parent or Guardian 2: All Event Dates: Yes:

Abuse & Molestation Supplemental Questionnaire Named Insured I DBA Facility Address City I State I ZIP Code 1. Type of Facility 2. Please check each that describes your current and/ or planned

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

Health Club Facility Swimming Pool Supplemental Application I. General Information Named Insured I DBA Facility Address Website I Email How many pools? Indoor Outdoor II. Pool

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NAME OF TRACK FACILITY: I HAVE READ THIS RELEASE: SIGNATURE: PRINT NAME: TITLE: DATE SIGNED: CREDENTIALS: ADDRESS:

Facility Insurance Application Facility Name I Facility Age Contact Person I Title Facility Location Phone I Fax I Email Annual Admissions I Seating I Total Capacity I Total Gross Receipts

Health Club Facility Swimming Pool Supplemental Application I. General Information Named Insured I DBA Facility Address Website I Email How many pools? Indoor Outdoor II. Pool

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Wind Deductible Buyback Program FEATURES ■ Lloyd’s of London Coverholder ■ 24-hour turnaround with fully completed, signed and dated application ■ Available on Builder’s Risk ■ Overlying wind