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PAGE 1 OF 9U.S. Risk HealthcarePros is a Specialty Program of U.S. Risk, LLC | Rev. 06.27.22 Medical Spa and Anti-Aging Clinics PL Application U.S. Risk, LLC | 8401 N. Central Expressway,

Page 1 of 9 Applicant Information Name Telephone Number Address City State ZIP Website FEIN# Inception Date Agent Information Agency Name Producer Address City State ZIP

JVBERi0xLjcNJeLjz9MNCjM4OCAwIG9iag08PC9MaW5lYXJpemVkIDEvTCA0OTExMjMvTyAzOTEvRSAyMDU2MjUvTiAzL1QgNDkwNTQwL0ggWyAxNTQ4IDEwODBdPj4NZW5kb2JqDSAgICAgICAgICAgIA02MDIgMCBvYmoNPDwvRGVjb2RlUGFybXM8PC9Db2x1bW5z

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8401 N. Central Expressway Suite 1000 Dallas, TX 75225 Insurance Professionals Errors & Omissions And Related Professional Services Insurance Application P: (214) 265-7090 (800)

HOME INSPECTORS ERRORS & OMISSIONS AND GENERAL LIABILITY APPLICATION 1. Name of Applicant (Company Name if applicable): Street: City: State: Zip: Telephone: Contact Name: Email: 2. Has your

PEO Supplemental Application Prospective Insured: Primary Insured Contact: Phone: Email: Website: Date of Incorporation: Premium, Payroll and Experience Mod History Please

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PAGE 1 OF 11StaffPak is a Specialty Program of U.S. Risk, LLC | Rev. 01.2024 Staffing and PEO Insurance Application U.S. Risk, LLC | 14241 Dallas Parkway, Suite 850, Dallas, Texas 75254

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 Concert Promoters Doing

PAGE 1 OF 2Take1insurance.com | Take1 is a Division of U.S. Risk, LLC | Rev. 01.14.2021 Equipment Rental House Supplemental Questionnaire 1. Name of Applicant: 2. Type of Equipment

MOTOR CARRIER APPLICATION FOR TRUCKERS INSURANCE FOR NON-TRUCKING LIABILITY AND VEHICLE PHYSICAL DAMANGE COVERAGE I. Policyholder Information*: Applicant Name:

AH 0201 OATI QUES 1 2013 Page 1 of 5 QUESTIONNAIRE – Transportation Insurance Program NOTE: There are 4 sections to this questionnaire. All sections must be completed for questionnaire

Specialty Underwriting | Contractors Pollution Liability REV 12.02.2020 Building solid, professional relationships is the foundation of success. U.S. Risk is committed to this concept and

Specialty Underwriting LIVE Event Service Providers Program Event Promoters Take1 is a division of U.S. Risk, LLC and its affiliate companies. U.S. Risk, Take1, and the Take1 logo are registered

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

CYBERSECURITY: CREDIT UNIONS HAVE NEW 72 HOUR REPORTING RULE Credit unions will need to quickly update their data incident response teams policies and procedures to meet the September 1st

M&A COVERAGE CONSIDERATIONS IMPORTANT RUNOFF POLICY CONSIDERATIONS A Runoff policy covers what would otherwise be a gap in coverage for directors and officers after the sale of a company and is