Concert Promoter James River Insurance Company Supplemental Application and its Subsidiaries 6641 West Broad Street, Suite 300 SPORTS & ENTERTAINMENT Richmond, VA 23230 Division Email to [email protected] APPLICANT’S INSTRUCTIONS: 1. Answer all questions completely. Please attach extra sheets as required. Incomplete or illegible applications may be discarded. 2. Application must be signed and dated by the owner, partner, or officer not earlier than 90 days before the proposed effective date of coverage. 3. Please read the statements at the end of this application carefully. Thank you!

Additional information required for this submission: Premium and loss run records for the last 5 years

SECTION I – GENERAL INFORMATION Applicant name: Address: City: State: Zip: Phone: Ext: Website: Years in business under current management: Date established: Names of entertainers applicant promotes (attach separate sheet and prior schedules):

Does applicant require entertainers to provide evidence of insurance? Yes No a. If “Yes”, is applicant named as an additional insured? Yes No b. Does applicant agree to hold harmless the entertainers while performing? Yes No

SECTION II – RATING INFORMATION 1. Provide estimated number of annual performances: 2. Provide estimated gross annual receipts: 3. Indicate by percentage the type of concerts normally promoted: (percentages should add up to 100%) Alternative rock % Heavy metal % Rap/urban % Bluegrass % Hip hop % Rock, soft % Big band % Jazz % Rock, pop % Classical % Latin % Rock, hard % Country % New age % Rock, classic % Easy listening % Punk % Rock, oldies % Folk % R & B % Other (specify): % Total 0 % 4. What is the estimated number in attendance at each concert? Smallest: Largest: Average size: 5. Provide the following facilities information and attach a copy of the contractual agreements used: Name Location Capacity # of events Venue type* Seating**

*C – Club T – Theater/auditorium A – Arena S – Stadium G – Grandstand O – Open air amphitheatres ** S – Stationary P – Portable G – General admission N - None

Form JRAP0145 Page 1 of 3 © James River Insurance Co. 2015 6. Indicate the percentage of time applicant books the following types of venues: Clubs % Theaters/auditoriums % Arenas % Stadiums % Grandstands % Open air amphitheatres % 7. Does applicant have exclusive promotion rights at any venue? Yes No If “Yes”, please provide a copy of the contract with those venues. 8. Does applicant own any venue(s)? Yes No If “Yes”, please explain:

9. If event is held outdoors: a. Describe fencing or protection used to prohibit entry by non-ticket holders:

b. Type of seating used: Reserved seats General admission 10. Does applicant use any portable seating? Yes No If “Yes”, please explain:

11. Indicate the following activities/operations applicant normally responsible for (check all that apply): Merchandise sales Janitorial Ticket sales Ushers Staging Lights/rigging Sound/rigging Generators Special effects Pyrotechnics Transportation 12. Does applicant ever assume, by contract, the liability of other parties? Yes No If “Yes”, explain:

13. Who is responsible for security? a. Limits of liability carried: b. Does applicant require a hold harmless agreement? Yes No If “Yes”, what limits are required? c. Identify any additional security measures taken to minimize exposure to loss (i.e., local police used, ticket sale precautions, curfews, etc.):

d. Indicate the number and type of security used: e. Are any weapons carried? Yes No If “Yes”, describe fully:

14. Is a written emergency evacuation plan in place? Yes No 15. Indicate the precautions and contingencies in place for mosh pits: Specified mosh pit area Security present in pit Restricted entry to pit Video surveillance Explanation of rules Waiver/release from participants* Restrict body surfing/slam dancing *Provide a copy of waiver/release used 16. Describe first aid facilities:

a. Who is responsible: b. Is a contract in place? Yes No If “Yes”, attach a copy of the contract. c. Does applicant obtain a certificate of insurance? Yes No d. Is applicant named as an additional insured? Yes No 17. As the promoter, is applicant responsible for parking? Yes No If “Yes”: a. Indicate square footage of parking area: sq. ft. b. Is lot attended? Yes No

Form JRAP0145 Page 2 of 3 © James River Insurance Co. 2015 18. Is applicant responsible for concessions? Yes No a. If “Yes”, indicate annual receipts and type of concessions:

b. If “No”, provide a copy of certificate of insurance evidencing products liability with applicant’s organization added an additional insured. 19. Will liquor be sold at events? Yes No a. If “Yes”, can applicant provide a certificate of insurance evidencing liquor liability coverage? Yes No b. Who is responsible for liquor sales? 20. Has applicant’s promoter insurance under this or any previous name ever been cancelled or non-renewed? Yes No If “Yes”, provide details and carrier name:

21. Will any other underlying coverage be provided? Yes No If “Yes”, describe:

SECTION III – SIGNATURE, CONSENT AND AGREEMENT This Application is the basis for coverage; therefore, any incorrect or incomplete statements or answers could nullify coverage. Completion of this form neither binds coverage nor guarantees that a policy will be issued. (Not applicable in North Carolina) I hereby request that my application for insurance coverage be submitted for consideration to the company shown in this application. Accordingly, I authorize and direct any person or organization whatsoever to release and furnish to that company any and all information requested which may relate to my insurability. I hereby indicate that the aforementioned statements and answers are correct and complete. I further understand that an incorrect or incomplete statement or answer could void my protection. I hereby consent to the review by the company shown in this application of any incidents or occurrences likely to result in malpractice allegation or claim. I agree to cooperate in the review of claims and incidents which apply to the coverage requested. Where applicable, I hereby consent to the review of my application by the committees appointed by my county or state professional association/ society. I agree to cooperate with these committees. NOTICE TO APPLICANT The coverage applied for is solely as stated in the policy. If policy is issued on a "CLAIMS MADE" or “CLAIMS MADE AND REPORTED” basis, it provides coverage only for those claims that are first made against the insured during the policy period unless the extended reporting period option is exercised in accordance with the terms of the policy. If issued on an “OCCURRENCE” basis, the policy provides coverage only for those occurrences that take place during the policy period. The Insurer will rely upon this application and all such attachments in issuing the policy. If the information in this application or any attachment materially changes between the date this application is signed and the effective date of the policy, the Applicant will promptly notify the Insurer, who may modify or withdraw any outstanding quotation or agreement to bind coverage. I have read the statements above, understand their meaning and agree. Applicant’s signature:

Date: Applicant’s name: Applicant’s title:

Form JRAP0145 Page 3 of 3 © James River Insurance Co. 2015