ALL RISKS, LTD. LIMOUSINE APPLICATION. SECTION 1 - General Information

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1 NATIONAL INDEMINITY COMPANY NATIONAL FIRE & MARINE INSURANCE COMPANY COLUMBIA INSURANCE COMPANY NATIONAL LIABILITY & FIRE INSURANCE COMPANY NATIONAL INDEMNITY COMPANY OF MID-AMERICA WESCO-FINANCIAL INSURANCE COMPANY SUBMIT TO: (General Agent) ALL RISKS, LTD. LIMOUSINE APPLICATION Is this location within the corporate city limits? (c) Business hours from to If different from business address, complete 5. and Address where vehicles are garaged 6. Mailing Address Applicant's Name Applicant is: Individual Partnership Name of Legal Owner of Business: Business Address Person to Contact: For Inspection (Name and Phone Number) For Accounting Records (Name and Phone Number) Insurance is desired from: Is this a new operation? (Number) (Number) SECTION 1 - General Information (Street) (Street) Corporation 19 to Is your operation currently for sale? Do you now or have you ever had an interest in another transportation or leasing company? If yes, explain How long has this business operated under the above name? years Has this business ever operated under any other name? If yes, provide previous name and address: 12. (City) (City) (County) (County) (State) (State) Seasonal in nature? (Zip Code) (Zip Code) Current management has controlled the business since List major owners/shareholders/management: Name Years with Company (yr) and has been in public transportation business since % of Ownership Net Worth (yr) What is estimated net worth of the business? (c) Gross receipts last year? Estimate for coming year? (d) Percent of receipts from referral commissions? 15. Have you ever filed or are you contemplating filing for reorganization or bankruptcy? If yes, show date (month and year) and explain: 16. Have you been released from reorganization or bankruptcy? Date released Has insurance ever been declined, cancelled or nonrenewed? If yes, date and why? Do you plan on expanding or adding additional vehicles during the coming year? Are any lessors or others intended to be additional insureds? 18. If yes, list: Name Vehicle # Address Relationship/Interest 19. Is this your primary business? If no, what is your primary business? (Describe) 19. M-4003b (12/92) ARF2275

2 20. Do you long term lease your vehicle to another? their address Does lease agreement require: 21. Complete for desired coverages: (1) You to provide or hire the driver? (2) Drivers to be your employees? (3) You to indemnify the lessee? If yes, complete showing person or organization and (1) (2) (3) LIABILITY LIMITS DESIRED Physical Damage Deductible BI & PD Combined CSL Per Person BI Per Accident PD Per Accident CSL U.M. Per Person Per Accident Medical Payments PIP Specified Causes of Loss Collision Loss Payees (applicable only to Specified Causes of Loss and Collision Coverage) Unit # Name and address of Loss Payee Largest city entered within your radius of operation: Number of hours per day limo is available: Do you belong to any local or state limo association? Do you have safety belts installed in your limo for passengers? Does your State law require you to have safety belts installed for passengers? Are alcoholic beverages available in the passenger compartment? If yes, have all proper State and City licenses been obtained? Are vehicles equipped with fare box or meter? Are vehicles equipped with 2 way radios? Do you share dispatch services with any other company or entity? Do you share ride? Do you ever transport unscheduled passengers? Are prices or rates posted? Are odometer readings made? If yes, are charges based on miles traveled? Minimum number of hours rented? Are vehicles leased to drivers? Do all clients have prearranged reservations? If no, explain: Percent of business from hotels funeral directors other SECTION 2 - Limo Operations airport Explain Minimum charge? special occasion travel agencies Percent of gross receipts from overflow business of other livery services subcontracted to you: Are services provided to other livery services under written contract? If yes, are you required to provide your own liability insurance? Percent of gross receipts from your overflow business subcontracted to other livery services: Are services provided by other livery services or franchises under written contract? If yes, do you require them to provide their own liability insurance? tour operators 40. % To franchises: 42. % ARF2275B

3 SECTION 3 - Driver Information 43. Has applicant or any driver had his driver license revoked or suspended within the last 3 years? Are uniforms required? Do drivers operate the same vehicle each day? Are new drivers required to ride with experienced driver? Is previous chauffeur experience required? Is driver training provided? Have any drivers had any special training in techniques for eluding kidnappers and terrorists? Are drivers ever allowed to take vehicles home at night? If yes, will family members be allowed to drive? Driver selection: [ ] written application [ ] review MVR. Pre-employment [ ] [ ] written test [ ] background check Current number of full time drivers: total or Post-employment [ ] over 65 During the last 12 months, how many full-time drivers did you hire? How many part-time/seasonal drivers did you hire? How many owner/operators or leased drivers were used? How many different owner/operators in last 36 months? Driver's pay scale is (check all that apply): Union Other, explain: Driver's maximum hours: Driving On duty daily, daily, weekly weekly Do you provide Workers' Compensation for ALL drivers? Is equipment owner-driven only? If no, are any drivers considered independent contractors? If yes, explain n-union [ ] physical exam [ ] road test [ ] other - specify under 25 terminate? terminate? Hourly Trip Mileage 61. Driving standards: Minimum driving age? years old Minimum driving experience? years. (c) Maximum number driving violations Maximum number of accidents (d) Do you have a disciplinary program in place in dealing with problem drivers? If yes, explain (d) 62. (e) How often do you reorder MVR? Drivers (Complete for all drivers - If not sufficient space add by separate sheet) Driver's Name Date of Birth Social Security. Driver License. State Where Licensed. Yrs Previous Chauffeur Experience Date of Hire Co. Emp. Full or (C) Part Married Owner/ Operator Time (Y or N) (O/O) (F or P) Franchises (F). of Violations in Last 3 years * Major Accs Minor *Major violations include: DWI/DUI, license suspensions for moving violations, felonies, hit and run, eluding an officer, reckless/negligent operation of a vehicle. Accidents include all At-Fault accidents. Minor violations include any moving violation other than Major violations/accidents as defined above. ARF2275C

4 63. SECTION 4 - Filing Information Check Box 1 if you either applied for or currently hold operating authority or permits andcheck Box 2 for each state entered. AK AL AR AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OR OK PA RI SC SD TN TX UT VA VT WA WI WV WY Do you have an ICC Permit? If yes, Docket Number Are state filings required? Show states where needed and docket numbers Show exact name and address in which permits are issued Do you appoint agents/franchises to operate on your behalf? If yes, explain Do you lease your authority? If yes, to whom 66. Do you operate under any other name? If yes, explain 67. Do you operate as either a parent or a subsidiary of another company? If yes, complete the following: 68. Name of Entity/DBA ICC/PUC Number Year Established Location Address Number, Street City, State, Zip Code Relationship to Named Insured 65. Description of Operations Do you have agreements with other livery services or franchises for the interchange of equipment or transportation of passengers? If yes, attach a copy of current agreements and complete the following: With whom has such agreement(s) been made Is there a hold harmless in the agreement(s)? (c) Do the parties named in agreement carry automobile liability insurance? If yes, name of insurance company 69. (c) (d) Under whose permit does each of the parties to the agreement(s) operate? Is evidence of coverage required? If yes, list to whom and why: Lease information for lease terms under 6 months: Do you hire or lease any vehicles? If yes, attach a copy of all current lease agreements and complete the following: 71. LEASE With Driver Without Previous Year Lease Payments Current Year Upcoming Year Do you provide the Public Liability Insurance? Do you provide the Workers' Compensation? From Others 72. To Others Do you own or operate any vehicles not listed on this application? If yes, does applicant have other commercial liability insurance in force? If yes, give company, number of vehicles covered, limits and details: 72. SECTION 5 - Vehicle Information 73. PHYSICAL DAMAGE (complete when physical damage coverage to be afforded) Inside Outside Type of Facility Own or Maximum. Maximum Maximum Maximum Schedule of All Locations (Terminal, Garage, Storage, Lease of Vehicles Value of all. of Value of all Office) (O or L) Stored Vehicles Vehicles Vehicles Is Lot Fenced Lighted (Y or N) (Y or N) Security Guard (Y or N) ARF2275D

5 74. Number of Vehicles Operated in the Business (show all equipment even if you do not intend to insure): Sedan Formal Stretch to 60" Super Stretch (over 60") Van Stretch Van Mini Bus Motor Coach Others Can any vehicle provide open air seating such as rumble seat, hot tub, convertible? If yes, list unit # Is any vehicle equipped with bulletproof glass or armor plate? If yes, list unit # Is any vehicle equipped with duel rear wheels? If yes, list unit # Do you service your own vehicles? If no, explain How many mechanics do you employ? Do you have a parts department? Do you service vehicles of others? Are they certified? VEHICLE SCHEDULE - Complete all information for each unit (if more space needed use additional applications) Unit # Model Year Equipment Base Car Make/Model Vehicle Serial # (VIN) Number of Owned Vehicles Width of Stretch (Inches) Length of Stretch (Inches) Seating Capacity *(1) Leased Without Drivers Position of Rear Seats *(2) Number of Long Term Leased Vehicles Limousine Coach Builder Owner Operators Coach Builder Still in Business Y/N Vehicle Type *(3) Total Vehicles Garaging Location *1. Seating Capacity - Include total front passenger capacity (excluding driver) and rear seating capacity. *2. Position of rear seats, list all that apply: facing forward facing rear (c) left side (d) right side (e) jump seats *3. Designate vehicle type: S - Sedan F - Formal ST - Stretch SS - Super Stretch V - Van SV - Stretch Van MB - Mini Bus MC - Motor Coach Other Unit # Mileage Radius Estimated Annual Mileage (A) Armored (B) Open Air (C) Dual Rear (D) Anti-Lock Breaks (E) Air Bags (F) Anti-Theft Devices Date Purchased Cost New Purchase Price Current Value Owned (O) Leased (L) Or Hired (H) Purpose of Use Liability Coverage Desired (Y) - (N) Specified Causes of Collision Loss PHOTOGRAPH REQUIRED FOR EACH VEHICLE WITH A VALUE OF 50,000 OR MORE. 82. PREMIUMS (To Be Completed by Agent) Unit # Liability P.I.P. Added P.I.P. Auto Medical Payments Uninsured Motorists Underinsured Motorists U.M. P.D. Specified Causes Of Loss Collision TOTAL TOTAL PREMIUM ALL COVERAGES ARF2275E

6 SECTION 6 - Prior Loss Experience 83. Provide loss experience from prior insurance carriers for past full three years. List in order with most recent carrier first. From Policy Term To Insurance Company Name Policy.. of Power Units Is any insured aware of any facts or past incidents, circumstances or situations which could give rise to a claim under the insurance coverage sought in this application? If yes, provide complete details. of Accidents Liab Premium Phys Dam BI Total Amount Claims Paid & Reserve PD Coll Other MUST BE SIGNED BY THE APPLICANT PERSONALLY coverage is bound until the Company advises the Applicant or its representative that a policy will be issued and then only as of the policy effective date and in accordance with all policy terms. The Applicant acknowledges that the Applicant's Representative named below is acting as Applicant's agent and not on behalf of the Company. The Applicant's Representative has no authority to bind coverage, may not accept any funds for the Company, and may not modify or interpret the terms of the policy. The Applicant agrees that the foregoing statements and answers are true and correct. The Applicant requests the Company to rely on its statements and answers in issuing any policy or subsequent renewal. The Applicant agrees that if its statements and answers are materially false, the Company may rescind any policy or subsequent renewal it may issue. If any jurisdiction in which the Applicant intends to operate or the Interstate Commerce Commission requires a special endorsement to be attached to the policy which increases Company's liability, the Applicant agrees to reimburse the Company in accordance with the terms of that endorsement. The Applicant agrees that any inspection of autos, vehicles, equipment, premises, operations, or inspection of any other matter relating to insurance that may be provided by the Company, is made for the use and benefit of the Company only, and is not to be relied upon by the Applicant or any other party in any respect. The Applicant understands that an inquiry may be made into the character, finances, driving records, and other personal and business background information the Company deems necessary in determining whether to bind or maintain coverage. Upon written request, additional information will be provided to the Applicant regarding any investigation. The Applicant represents that she/he has completed all relevant sections of this Application prior to excution and that the Applicant has personally signed below (or if Applicant is a Corporation a corporate officer has signed below). Will premium be financed? If yes, with whom Witness Applicant's Signature Date Is this direct business to your office? Is this new business to your office? How long have you known applicant? REQUEST TO COMPANY GENERAL AGENT: Please quote Please bind at earliest possible date and issue policy Please issue policy effecitve TO BE COMPLETED BY APPLICANT'S REPRESENTATIVE (Time anddate Bound by General Agent) If not, explain: If not, how long have you had the account? Coverage was bound by (Name of Person in Company General Agent's Office Binging Coverage) Applicant's Representative's Name and Address Phone. ARF2275F

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