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U.S. Risk Insurance Agents Application Including Group Benefit Supplement.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/apps-page-only/professional/u.s.-risk-insurance-agents-application-including-group-benefit-supplement.pdf?v=496879

4/19/2021 3:29:19 PM

USRINSAPP (8/12) 1 of 5 Dallas 800‐232‐5830 Scottsdale 800‐949‐5245 Santa Ana 800‐856‐7035 INSURANCE PROFESSIONALS ERRORS & OMISSIONS AND RELATED PROFESSIONAL LIABILITY INSURANCE

COVID-19-Communicable Disease Supplement.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/health/supplemental/covid-19-communicable-disease-supplement.pdf?v=49687c

12/13/2021 7:25:05 PM

U.S. Risk Claim Incident Supplemental Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/pros/agents/us-risk-claim-incident-supplemental-application.pdf?v=49687d

4/19/2021 3:37:17 PM

JVBERi0xLjcNJeLjz9MNCjIxIDAgb2JqDTw8L0xpbmVhcml6ZWQgMS9MIDE4NjU4Ny9PIDI0L0UgMTc4NDI3L04gMS9UIDE4NjI1Ny9IIFsgOTg3IDQwM10+

U.S. Risk Cyber Insurance Application–Short.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/pros/agents/u.s.-risk-cyber-insurance-applicationshort.pdf?v=49687d

4/20/2022 3:14:25 PM

JVBERi0xLjcNJeLjz9MNCjIxIDAgb2JqDTw8L0xpbmVhcml6ZWQgMS9MIDE4NzA3Ni9PIDI0L0UgMTc4ODUyL04gMS9UIDE4Njc0Ni9IIFsgMTA5NSA0MDNdPj4NZW5kb2JqDSAgICAgICAgICAgICAgIA0xMzggMCBvYmoNPDwvRGVjb2RlUGFybXM8PC9Db2x1bW5z

ArmorPark Parking Operator Supplemental Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/parking/armorpark-parking-operator-supplemental-application.pdf?v=49687c

4/19/2021 3:34:32 PM

U.S. Risk Marine Hull Program Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/marine/us-risk-marine-hull-program-application.pdf?v=49687c

4/19/2021 3:33:52 PM

JVBERi0xLjcNJeLjz9MNCjY5MyAwIG9iag08PC9MaW5lYXJpemVkIDEvTCA2Mzc4MjIvTyA2OTYvRSAxODQxNTIvTiA0L1QgNjM3MTQ5L0ggWyAxMTg1IDE0NjVdPj4NZW5kb2JqDSAgICAgICAgICAgIA04MzcgMCBvYmoNPDwvRGVjb2RlUGFybXM8PC9Db2x1bW5z

U.S. Risk Financial_Collateral Protection Insurance Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/financial/us-risk-financial_collateral-protection-insurance-application.pdf?v=49687a

4/19/2021 5:37:12 PM

JVBERi0xLjcNJeLjz9MNCjE1NSAwIG9iag08PC9MaW5lYXJpemVkIDEvTCAzOTQ3MDcvTyAxNTgvRSAyMDM0NDYvTiAyL1QgMzk0MjUyL0ggWyAxMDUwIDY0NF0+

U.S. Risk Financial_Mortgage Impairment Insurance Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/financial/us-risk-financial_mortgage-impairment-insurance-application.pdf?v=49687a

4/19/2021 5:37:12 PM

JVBERi0xLjcNJeLjz9MNCjQ4MiAwIG9iag08PC9MaW5lYXJpemVkIDEvTCA3NzcyODMvTyA0ODUvRSAyMjMyNjgvTiA1L1QgNzc2NjMyL0ggWyAxMDE0IDExNjFdPj4NZW5kb2JqDSAgICAgICAgICAgIA02MDEgMCBvYmoNPDwvRGVjb2RlUGFybXM8PC9Db2x1bW5z

U.S. Risk Producer Agreement (08-2016).pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/~misc/u.s.-risk-producer-agreement-08-2016.pdf?v=496877

4/19/2021 3:07:40 PM

Version 08/2016 1 PRODUCER AGREEMENT BETWEEN U. S. RISK, LLC its Underwriting and Wholesale Brokerage Subsidiaries, and Each Division Thereof Each hereinafter referred to as

TCAP Wind-Hail Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/tcap/tcap-wind-hail-application.pdf?v=496880

4/19/2021 3:41:26 PM

JVBERi0xLjcNJeLjz9MNCjIxIDAgb2JqDTw8L0xpbmVhcml6ZWQgMS9MIDIwNzY2Ni9PIDI0L0UgMTk5MzI5L04gMS9UIDIwNzMzNS9IIFsgMTA1MCAzODddPj4NZW5kb2JqDSAgICAgICAgICAgICAgIA0xMTIgMCBvYmoNPDwvRGVjb2RlUGFybXM8PC9Db2x1bW5z

ACORD 130_FL_2019.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/wc/acord-130_fl_2019.pdf?v=496880

12/9/2021 9:11:07 PM

Incorporated by Reference in Rule 69O-189.003 ACORD 130 FL (2019/07) LOCATIONS - LIST ALL PHYSICAL LOCATIONS, INCLUDING OTHER STATES, WHETHER COVERAGE IS REQUESTED OR NOT. IF APPLICANT IS

ERM-14 Instructions.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/wc/erm-14-instructions.pdf?v=496880

12/9/2021 9:11:07 PM

U.S. Risk Excess WC Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/wc/us-risk-excess-wc-application.pdf?v=496880

4/19/2021 3:42:21 PM

08/26/2014 1 APPLICATION FOR EXCESS WORKERS’ COMPENSATION Date: Submitted By: Producer: Insured: Address:

StaffPak Abuse and Molestation Supplemental Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/staffing/staffpak-abuse-and-molestation-supplemental-application.pdf?v=49687f

4/19/2021 3:40:29 PM

JVBERi0xLjcNJeLjz9MNCjEyMSAwIG9iag08PC9MaW5lYXJpemVkIDEvTCA0ODY1MjIvTyAxMjQvRSAyOTU0NTgvTiAyL1QgNDg2MDY1L0ggWyAxMTk0IDY3N10+

Take1 Event Planners Application.pdf

https://www.usrisk.com/siteassets/documents/forms-and-applications/take1/take1-event-planners-application.pdf?v=49687f

4/19/2021 3:40:57 PM

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 Event/Party Planners and

U.S. Risk Houston Contacts 2020.pdf

https://www.usrisk.com/siteassets/documents/sales-collateral/brokers/us-risk-houston-contacts-2020.pdf?v=496881

8/9/2021 5:26:14 PM

Gary Atkins (281) 243-5722 garya@usrisk.com Casualty | Residential, Commercial and Industrial Contractors; Products Liability; Oil and Gas Lease Operators; Oil and Gas Contractors and Consultants

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