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APPLICATION AGREEMENT
<br />The purpose of this application is to assist in the underwriting process information contained herein is speciDcally relied upon in determination of insurability.
<br />The no loss letter shall be the basis of any insurance that may be issued and will be a part of such policy. The undersigned, therefore, warrants that the
<br />information contained herein is true and accurate to the best of his/her knowledge, information and belief.
<br />The undersigned Applicant warrants that the above statements and particulars, together with any attached or appended documents or materials ("this
<br />Application"), are true and complete and do not misrepresent, misstate or omit any material facts. The undersigned Applicant warrants that the
<br />representations and information supplied in each of the above sections entitled Applicant Information, Entity of Company, Additional Business Names,
<br />Description of Operations, Estimated Exposures, Previous Exposures, Work Experience and related information are speciDcally relied upon in the
<br />determination of insurability, are material to the risk to be insured, and will be a part of any policy issued. The undersigned Applicant understands that any
<br />misrepresentation or omission of any information in any part of this Application shall constitute grounds for immediate cancellation of coverage and denial of
<br />claims, if any. It is further understood that the applicant and or afDliated company is under a continuing obligation to immediately notify his/her underwriter
<br />through his/her broker of any material alteration of the information given. The Applicant agrees to notify the Company of any material changes in the
<br />answers to the questions on this Application which may arise prior to the effective date of any policy issued pursuant to this Application. The Applicant
<br />understands that any outstanding quotations may be modiDed or withdrawn based upon such changes at the sole discretion of the Company.
<br />Notwithstanding any of the foregoing, the Applicant understands the Company is not obligated nor under any duty to issue a policy of insurance based
<br />upon this Application. The Applicant further understands that, if a policy is issued, this Application will be incorporated into and form a part of such policy
<br />and any false information provided on this application will result in the nulliDcation of such policy. Furthermore, the Applicant authorizes the Company, as
<br />administrative and servicing manager, to make any investigation and inquiry in connection with the Application as it may deem necessary.
<br />For your protection, this information is provided as required by applicable State and Federal law. Any person who knowingly presents false, fraudulent,
<br />misleading, incomplete or misleading facts or information or aids, abets, solicits, or conspires with any person to do so, for the purpose of obtaining insurance
<br />coverage, amending insurance coverage, seeking insurance beneDts or to make a claim for the payment of a loss, is unlawful and is guilty of a crime and
<br />may be subject to Dnes and conDnement in state or federal prison.
<br />Initial
<br />The applicant acknowledges that explanation of the terms, conditions and provisions of the policy of insurance, including but not limited to coverage being
<br />afforded, amendments, endorsements, exclusions and any other such information effecting the policy of insurance are provided solely by the applicant`s
<br />agent, broker or producer and NOT the Company. The coverage type, nature, amounts and insurance needs of the applicant are the sole responsibility of the
<br />applicant and its agent/ broker or producer. The applicant understands the agent/ broker or producer has no authority to act on behalf of the insurance
<br />company.
<br />Initial
<br />Applicant acknowledges that this policy is subject to a self-insured retention. The total limit of liability as stated in the policy declarations shall apply in
<br />excess of the self-insured retention. The limits of insurance applicable to such coverages will not be reduced by the amount of such self-insured retention.
<br />This policy applies only to the amount excess of the self-insured retention. Complete satisfaction of the SIR by the applicant is a "condition precedent" to
<br />Company`s duty to defend and/or indemnity. Please note that Company is not obligated to defend and/or indemnify the applicant until the SIR is paid in full.
<br />The self-insured retention shall remain applicable even if you Dle for bankruptcy, discontinues business or otherwise becomes unable to unwilling to pay the
<br />self-insured retention. The risk of insolvency is retained by you and is not transferrable. Please consult your policy for the full terms and conditions of the SIR.
<br />Initial
<br />If you are applying for a "claims made" policy then please note that policy provides coverage only for "claims made" and reported to the company in writing
<br />during the policy period. Thus there is NO retroactive coverage. Please consult your policy and or agent/broker for further information.
<br />Initial
<br />The coverage provided by your policy may also be subject to other limitations including, but not limited to, sublimits of liability and/or, per- project shared
<br />aggregate limits of liability. In addition, defense costs and claim expenses are included within the applicable limits of liability. This means that the limits of
<br />liability available to pay indemnity, settlements, judgments and "claim expenses" will be reduced, and may be exhausted, by payment of "claim expenses"
<br />including payment of any defense fees and costs. Please consult your policy and or agent/broker for further information.
<br />Initial
<br />Applicants must strictly comply with all applicable state and/or other governmental licensing requirements and regulations. Should an applicant`s license
<br />become suspended, revoked or inactive at any time during the policy period, then NO coverage will be afforded under the policy.
<br />Initial
<br />* Deposit Premium & Fees are fully earned.
<br />We will compute all premiums for this policy in accordance with our rules and rates. Premium shown in this policy as advance premium is a deposit
<br />premium only and is based upon the information provided by the applicant and or its agent. This information is subject to audit.
<br />Please note that issuance of the policy includes membership in Preferred Contractors Association (PCA). For a complete list of beneDts and information, visit
<br />the website at www.pcamembers.com
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<br />Applicant
<br />Signature of Applicant Date
<br />Title (Owner, OfDcer, Partner)
<br />Signature of Producer (Agent or Broker)Page 6 of 6
<br />3632609
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<br />0028468257P6
<br />07 / 15 / 2025
<br />CEO
<br />Document Ref: WWZGI-C9ON9-3YW3U-DDXRG Page 6 of 28
<br />Docusign Envelope ID: C32ED128-E8C0-4517-B42B-471D21968944
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