Rental House Supplemental Application

ENTERTAINMENT RENTAL HOUSE SUPPLEMENTAL APPLICATION 700 N. Central Avenue, 8th Floor 385 Washington Street, SB04G 485 Lexington Avenue, Suite 400 Glendale, CA 91203 Saint Paul, MN 55102 New York, NY 10017 Phone: 818.409.4087 Phone: 651.310.2156 Phone: 917.778.6461 Fax: 866.308.3217 Fax: 651.310.8119 Fax: 917.778.7007 [email protected] [email protected] [email protected] Coverage provided by St. Paul Fire & Marine Insurance Company Please complete application and send all attachments: Agent/Broker: Date of Application Address: Contact: Telephone Number: Email: Fax Number:

APPLICANT INFORMATION

1. Name of insured 2. Address: 3. In business under present management since: 4. The applicant is: An individual A partnership A corporation Other: 5. Dates of coverage requested: From: To: 6. Limits and deductibles Limits Deductible Rental property (include owned and rented): No conversion With conversion With limited conversion Rental income Rental costs 7. Damage waiver included in rental contract: Yes No 8. Receipts for last three years: $ Year Gross Sales Gross Rental Receipts Installation Receipts

9. Estimated annual receipts for policy term: Sales receipts $ Rental receipts $ 10. Do you ever rent items to customers for more than 90 days? Yes No 11 What is the average age of the equipment? 12. Is equipment ever altered? Yes No 13. Are all equipment items marked with an ID? Yes No 14. Buildings equipped with burglar alarms? None Central station Local

EE-RH-01 (12-11) Page 1 of 2 ENTERTAINMENT RENTAL HOUSE SUPPLEMENTAL APPLICATION

15. Watchman? Yes No 16. If yes, outside service? Yes No 17. Is the property fenced and gated? Yes No 18. Buildings equipped with fire alarms? None Central station Local 19. Buildings sprinklered? Yes No 20. Do you allow equipment to be taken out of the country? Yes No 21. Describe the types of equipment rented? 22. Do you perform credit checks on the rentee prior to releasing the equipment? Yes No Describe: 23. Do you perform a background check on the rentee prior to releasing equipment? Yes No Describe: 24. Do you install, rig or set up any equipment? Yes No Describe if answered yes: 25. Do you use an insured vendor who names you as additional insured? Yes No 26. List the nine (9) highest value rental items, their value and age, or attach separate schedule: Description Age Value $ $ $ $ $ $ $ $ $ 27. Premium and loss record for the last five (5) years (attach complete loss runs): If this is a new entity, provide a resume of prior experience: 28. List all additional interests/certificates of insurance that will be required (attach separate sheet if needed). Name Interest Certificate Request

A COPY OF THE RENTAL AGREEMENT MUST BE ATTACHED TO THE APPLICATION.

EE-RH-01 (12-11) Page 2 of 2 © The Travelers Indemnity Company. All rights reserved. Travelers and the Travelers Umbrella logo are registered trademarks of The Travelers Indemnity Company in the U.S. and other countries.