AmRisc Application General Insured Information

1 AmRisc ApplicationGeneral Insured InformationSTARRED (*) ITEMS ARE MANDATORY AND REFLECT EXCLUSIONS OR WARRANTS IN THE POLICY UNLESS Information IS PROVIDEDOTHERWISE HEREIN.*First Named Insured :*Expiration Date of Existing Coverage:Describe any gut rehabs including location number, year and extent of any Locations less than 200 ft. apart?Has any applicant been convicted of arson in the past 10 years?Are there any bankruptcies or tax credit leans against applicant in prior 5 years?Property losses min 3 years, prefer 5 years. Warranted Summary (Material misstatements may void policy back to inception)DOLC auseIncurred($)Status (Open/Closed)*Number of years provided:*Does the applicant have any reason that they would not be aware of all losses for the prior 5 years?

2 If so, explainAny person who knowingly and with intent to defraud any insurance company files an Application for insurance or statement of claim containing any materially false or misleading Information , or conceals for the purpose of misleading, Information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY; substantial) civil penalties. In some states insurance benfits may also be denied. By submission of this Application the Insured and the agent represent that all Information is true and correct to the best of their knowledge and that they have not deleted or altered the questions herein. Has any policy or coverage been declined, cancelled or non-renewed during the prior 3 years?

3 (Not applicable in MO.)Is the applicant a S-Chapter corporation, partnership or any other type of sole proprietor organization?*Do any of the buildings have unrepaired damage from a recent loss? If yes, describe extent of damage. Y (Describe Below)NYNY (Describe Below)NY (Describe Below)NY (Describe Below)NY (Describe Below)NY (Describe Below)NAmRisc ApplicationLocation/Building Information -Hab*First Named Insured :Building Number:Location Name:*Street Address:*City:*State:*Zip:*County:*Build ing Value ($):Other Values (Outdoor property, EDP, open sided bldgs, etc):Description:Value ($):*Contents Value ($):*Rental Income ($):Total Other Values:TIV ($):(Non-building values may be excluded unless AmRisc CAT Covered Property Endorsement)*Describe any tax credits, Sr.

4 Housing or otherwise subsidized properties (Warranted):Number of Buildings:(Buildings must be separated by 5 ft. clear space with no connection)*ISO Construction (Circle One):1 - Frame2- JM3-NC4-MNC5-SFR6-Fire ResConstruction Description:*Any Wood Shake Shingles?:Number of Stories:Number of Units:*Original Year Built:*Square Footage:Percent Sprinklered:%ISO Protection Class:Year Building Updated (Mandatory if >25 years):Flood Zone of Location:(Mandatory if flood quote is requested)Date Location Acq'd:*Percent Occupied:%Owned or Managed?*Percent Subsidized:% Type:*Type of Wiring (Circle One):CopperUnprotected AluminumProtected AluminumPercent Hard Wired Smoke Detection:%Is there a credit check for all tenants on file?

5 Average Unit Rental Per Month:Location (Circle One)CitySuburbRuralOnsite Guard Service (Circle One):ArmedUnarmedNoneAny person who knowingly and with intent to defraud any insurance company files an Application for insurance or statement of claim containing any materially false or misleading Information , or conceals for the purpose of misleading, Information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY; substantial) civil penalties. In some states insurance benfits may also be denied. By submission of this Application the Insured and the agent represent that all Information is true and correct to the best of their knowledge and that they have not deleted or altered the questions herein.

6 The data provided in this form is intended to be transferred over to the AmRisc Application /Schedule of Values in spreadsheet form prior to submission to AmRisc . YNYNG rossNetAmRisc ApplicationWind SupplementFirst Named Insured :Bldg/Loc Number:Bldg/Loc Name:Street Address:City:State:Zip:County:Is Property within 1000 ft of saltwater?Distance to Salt Water:Basement:1 - Basement w/unknown flood Protection2 - Basement w/Flood Protection3 - No Basement1 - Engineered 2 - Non-Engineered1 - Certified Design2 - Cert. Of Occupancy3 - No Design Review4 - Signs of Distress1 - Poured Concrete2 - Precast Concrete3 - Heavy Steel Frame4 - Light Steel Purlin5 - Wood PurlinShape of Roof:1 - Gable - High Pitch2 - Hip/Combination3 - Gable - unk Pitch4 - Flat5 - Gable - Low Pitch6 - Gable - Med Pitch7 - Monoslope8 - Braced Gable9 - Braced Gable - High Pitch1 - Concrete Fill2 - Metal Sheathing3 - Single Ply Membrane4 - Built Up5 - Comp Shingle (55 mph)6 - Concrete/Clay Tiles7 - Wood Shingle8 - Rated Shingle (110 mph) 9 - Rated Shingle w/ Water Resistance1 - Metal / Bolt Anchors (Strapped)2 - Toe Nailed (Not Strapped)3 - No Anchorage1- Maintenance Enforced2 - No MaintenanceExterior Cladding.

7 1 - Reinf Mas/Concrete2 - UnReinf Mas/Concrete3 - Brick Veneer4 - Metal Sheathing5 - Wood6 - EIFS7 - Laminated Glass8 - Non-protected GlassChoose predominant classification defined as over 66% of wall surface area. If none exceed 66%, circle all that exceed 10% and comment:Is Risk Eligible for the Wind Pool?:Year Roof Covering was last Replaced:Roof Framing / Structure:Type of Roof Covering:Roof Anchor / Straps (ISO 1 or 2):Building Maintenance:Any person who knowingly and with intent to defraud any insurance company files an Application for insurance or statement of claim containing any materially false or misleading Information , or conceals for the purpose of misleading, Information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY; substantial) civil penalties.

8 In some states insurance benfits may also be denied. By submission of this Application the Insured and the agent represent that all Information is true and correct to the best of their knowledge and that they have not deleted or altered the questions herein. The following questions are to aid in the underwriting of a wind exposed risk. This wind supplement is required for any locations within 100 miles to the Gulf or Atlantic coasts. Circle the category that applies to the Foundation:Construction Quality:The data provided in this form is intended to be transferred over to the AmRisc Application /Schedule of Values in spreadsheet form prior to submission to AmRisc . YNYN