Ryan Maypa

Azul Risk & Finance Inc. dba Azul Insurance Solutions Oscar Rodriguez 22946 1/2 Lyons Ave Newhall, CA 91321 - email:- Insurance Application General Liability Application ID:- Date Insured Information Quote Information 05/19/2025 Advantage Roo ng Inc David Taylor 48 Zita Manor, Daly City, CA 94015 - email: advantageroo- General Liability Obsidian Specialty Insurance Company Manuscript Occurrence Desired Coverage Dates: 06/16/2025 - 06/16/2026 APPLICANT INFORMATION Mailing Address: 48 Zita Manor, Sample CA FEIN: N/A Entity of Company: Corporation Contractor's License Number: 123456 Contractor's License Type: Roo ng Contractor Years in Business: 19 Years of experience in the Trades for which you are applying for insurance: 45 States in which you do business that for which you are currently applying for insurance: California Will any of your work be performed in the 5 boroughs: No Are there any other business names which you have used in the past or are currently using in addition to that for which you’re currently applying for insurance?No Payment Option Details: Agile Premium Finance GENERAL LIABILITY COVERAGES Aggregate: Occurrence: Products/Completed Operations: Personal/Advertising Injury: Fire Legal: Med Pay: Self-Insured Retention: $2,000,000 $1,000,000 $2,000,000 $1,000,000 $100,000 $10,000 $5,000 CLASS CODE GROSS RECEIPTS Roo Roo Roo Roo $170,000 $680,000 $680,000 $170,000 ng (New Commercial) ng (New Residential) ng (Repair Residential) ng (Repair Commercial) - -P1  Applicant Page 1 of 6 CURRENT EXPOSURES Estimated Total Gross Receipts: $1,700,000 Estimated Sub Contracting Costs: $500,000 Estimated Material Costs: $800,000 Estimated Total Payroll: Over 150k Number of Field Employees*: Owner + 8 * For purposes of this application, "Employee" is de ned as an individual working for you (the applicant ), which receives a W-2 tax form or you withhold & pay employment related taxes for that individual. WORK PERFORMED Insurance Application Complete Descriptions of operations that for which you are currently applying for insurance: The process of constructing a roof on a new structure or repairing/remodeling a roof on an existing structure. Percentage of Residential work performed: 80% Percentage of Commercial work performed: 20% Percentage of New (Ground Up) work performed: 50% Percentage of Remodel/Service/Repair work performed: 50% Maximum # of Interior Stories: 0 Maximum # of Exterior Stories: 3 Maximum Exterior Depth Below Grade in Feet: 0 Describe the largest project you have performed in the last 5 years: $100,000 Re-roo ng, roof installation and repair work in the state of CA. What were the gross receipts of your largest project in the last 5 years: $100,000 What were your gross receipts for the 12 months prior to this application: $1,700,000 How many projects did you perform during the previous 12 months: 17 Will you perform OCIP (Wrap-up) work: Yes No If "Yes", what are the estimated receipts for work covered separately under OCIP/Wrap-up: Estimated Receipts for non-Wrap/OCIP: Number of losses in the last 5 years: 0 WORK EXPERIENCE Will you or do you perform or subcontract any work involving the following: blasting operations, hazardous waste, asbestos, mold, PCBs, oil elds, dams/levees, bridges, quarries, railroads, earthquake retro tting, fuel tanks, pipelines, or foundation repair? Yes No Yes No Will you perform structural work? Yes No Will you perform work in new tract home developments of 25 or more units? Yes No Will any of your work involve the construction of or be for new condominiums/townhouses/multi-unit residences?: Yes No Will you perform repair only for individual unit owners of condominiums/townhouses/multi-unit residences?: Yes No If "Yes", please explain: Will you or do you perform or subcontract any work involving the following: medical facilities (including new construction), hospitals (including new construction), churches or other house of worship, museums, historic buildings, airports, schools/playgrounds/recreational facilities (including new construction)? If "Yes", please explain: If "Yes", please explain: - -P2  Applicant Page 2 of 6 WORK EXPERIENCE - CONT. Will you perform or subcontract any roo ng operations, work on the roof or deck work on roofs? Yes No If "Yes", please explain: Yes No Do you use motorized or heavy equipment in any of your operations? Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No If "Yes", please explain: Re-roo ng.Performs roo ng operations as indicated by class code selection. Does your company perform any waterproo ng? If "Yes", please explain: Will you perform work (new/remodel) on single family residences, in which the dwelling exceeds 5,000 square feet? Insurance Application If "Yes", please explain: What percentage of your work will be on homes over 5,000 square feet: Will you perform work on commercial buildings over 20,000 square feet? If "Yes", please explain: What percentage of your work will be on commercial buildings over 20,000 square feet: Has any licensing authority taken any action against you, your company or any af liates? If "Yes", please explain: Have you allowed or will you allow your license to be used by any other contractor? If "Yes", please explain: Has the applicant or business owner ever had any judgements or liens led against them or led for bankruptcy? If "Yes", please explain: Has any lawsuit ever been led or any claim otherwise been made against your company (including any partnership or any joint venture of which you have been a member of, any of your company's predecessors, or any person, company or entities on whose behalf your company has assumed liability)? (For the purposes of this application, a claim means a receipt of a demand for money, services or arbitration.) If "Yes", please explain: Is your company aware of any facts, circumstances, incidents, situations, damages or accidents (including but not limited to: faulty or defective workmanship, product failure, construction dispute, property damage or construction worker injury) that a reasonably prudent person might expect to give rise to a claim or lawsuit, whether valid or not, which might directly or indirectly involve the company? (For the purposes of this application, a claim means a receipt of a demand for money, services or arbitration.) If "Yes", please explain: - -P3  Applicant Page 3 of 6 WRITTEN CONTRACT Do you have a written contract for all work you perform? Yes No Does the contract identify a start date for the work? If "No", please explain: Yes No Does the contract identify a precise scope of work? If "No", please explain: Yes No Does the contract identify all subcontracted trades (if any)? If "No", please explain: Yes No Does the contract provide a set price? If "No", please explain: Yes No Is the contract signed by all parties to the contract? If "No", please explain: Yes No Do you subcontract work? Yes No Do you always collect certi cates of insurance from subcontractors? If "No", please explain: Yes No Do you require subcontractors to have insurance limits equal to your own? If "No", please explain: Yes No Do you always require subcontractors to name you as additional insured? If "No", please explain: Yes No Do you have a standard formal agreement with subcontractors? If "No", please explain: Yes No If "Yes", does it have a hold harmless/indemni cation agreement in your favor? If "No", please explain: Yes No Do you require subcontractors to carry Worker's Compensation? If "No", please explain: Yes No Insurance Application If "Yes", answer the following questions: If "Yes", answer the following questions: POLICY ENDORSEMENTS Deletion of Roo ng Operations Exclusion Blanket Additional Insured Amendment of Exclusion For Open Structure Water Damage Amendment of Exclusion For Heating Devices - -P4  Applicant Page 4 of 6 NOTICE This is a quotation only. No coverage is in effect until an application is approved and policy binder is received. This policy is issued by your insurance company. Nothing is bound until nal underwriting approval. Your insurance company may not be subject to all of the insurance laws and regulations of your state. State insurance insolvency guaranty funds may not available. Therefore please consult with your insurance agent for further information. Please note that your policy is subject to audit. Audits are routinely performed and speci cally provided for in the policy. The initial premium is regarded as a deposit premium only since the underwriters are relying on the accuracy of the information provided by the insured. This includes the estimated gross receipts. Thus, the audit is necessary to verify the nancial information provided since the premium is based upon these representations. Obsidian Specialty Insurance Company policies are audited by Zoom Professional Services. Zoom is the authorized representative in regard to your policy audit. We appreciate your anticipated cooperation. Initial Insurance Application POLICY EXCLUSIONS Section I – Coverages, Coverage A – Bodily Injury and Property Damage Liability: Expected or Intended Injury; Action Over; Worker’s Compensation and Similar Laws; Aircraft, Auto or Watercraft; Mobile Equipment; Drywall Manufactured in China; Exterior Insulation and Finish Systems (“EIFS”); Assault and Battery; Professional Services; Damage to Property; Damage to Your Product; Damage to Your Work; Damage to Impaired Property or Property Not Physically Injured; Recall of Products; Work or Impaired Property; Personal and Advertising Injury; Subsidence, Movement, or Vibration of Land; School or Recreational Facility; Deleterious Substances; Open Structure “Water” Damage; Heating Devices; Explosives; Communicable Disease; Abuse or Molestation; Prior Work and Prior Products; Wrap Up. Common Policy Exclusions: Past Work or Construction Projects; Buildings and Structures Exceeding Three Stories; Water or Fire Damage Liability; Hospital, Medical or Care Facilities; Physical or Mental Disability or Impairment; Material Misrepresentation; Overspray; House/Structure Raising; Fall from Heights; Animals; Independent Contractors/Subcontractors Sublimit; Airports; House of Worship; Underground Utility Location; Fire Suppression Systems; Collapse; Injury or Damage to Day Laborers; Undisclosed Waterproo ng Operations; Abandoned Work; Urethane or Spray Roo ng; Museums and Historic Buildings and Structures; Tract Home Project. Coverage B – Personal and Advertising Injury: Knowing Violation of Rights of Another; Material Published with Knowledge of Falsity; Material Published Prior to Policy Period; Insureds in Media and Internet Type Business; Electronic Chat Rooms, Bulletin Boards, or Social Media; Unauthorized Use of Another’s Name or Product; “Bodily Injury” and “Property Damage” ; Quality or Performance of Goods – Failure to Conform to Statements; Wrong Description of Prices; Infringement of Copyright, Patent, Trademark or Trade Secret; Expected or Intended Injury or Damage; Common Policy Exclusions. Coverage C – Medical Payments: Any Insured; Hired Person; Injury on Normally Occupied Premises; Workers Compensation and Similar Laws; Athletic Activities; Products-Completed Operations Hazard, Coverage A and B Exclusions. Section II. Common Policy Exclusions: Breach of Contract/Contractual Liability; Employer’s Liability; Pollution; Residential Project/Structure Size Restriction Exclusion; Commercial or Mixed Use Building/Project Size Restriction Exclusion; Multi-Unit Structures; War or Terrorism; Employment Practices; Cross Suits; Fraudulent, Intentional, or Criminal Acts; Unlicensed Contractors; Non-Compliance with Safety Regulations; Prior Litigation; Prior Knowledge; Ongoing Operations; Unsolicited Communications; Punitive Damages, Fines or Penalties; Attorney, Expert, and Vendor Fees and Costs of Others; Classi cation Limitation Exclusion; Social and Entertainment Activities and Events; Force Majeure or Acts of God; Liquor Liability; State Speci c Operations; Electronic Data; Mental Injury; Roo ng Operations; Louisiana Operations; Slip and Fall, Underground Horizontal Drilling, Cyber. Please refer to the policy for a complete list of exclusions. This list is subject to change and may differ from prior policy years. * I have read and understand the policy exclusions identi ed above. Initial - -P5  Applicant Page 5 of 6 APPLICATION AGREEMENT The purpose of this application is to assist in the underwriting process information contained herein is speci cally relied upon in determination of insurability. 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 information contained herein is true and accurate to the best of his/her knowledge, information and belief. The undersigned Applicant warrants that the above statements and particulars, together with any attached or appended documents or materials ("this Application"), are true and complete and do not misrepresent, misstate or omit any material facts. The undersigned Applicant warrants that the representations and information supplied in each of the above sections entitled Applicant Information, Entity of Company, Additional Business Names, Description of Operations, Estimated Exposures, Previous Exposures, Work Experience and related information are speci cally relied upon in the 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 misrepresentation or omission of any information in any part of this Application shall constitute grounds for immediate cancellation of coverage and denial of claims, if any. It is further understood that the applicant and or af liated company is under a continuing obligation to immediately notify his/her underwriter 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 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 understands that any outstanding quotations may be modi ed or withdrawn based upon such changes at the sole discretion of the Company. Insurance Application Notwithstanding any of the foregoing, the Applicant understands the Company is not obligated nor under any duty to issue a policy of insurance based 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 and any false information provided on this application will result in the nulli cation of such policy. Furthermore, the Applicant authorizes the Company, as administrative and servicing manager, to make any investigation and inquiry in connection with the Application as it may deem necessary. For your protection, this information is provided as required by applicable State and Federal law. Any person who knowingly presents false, fraudulent, 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 coverage, amending insurance coverage, seeking insurance bene ts or to make a claim for the payment of a loss, is unlawful and is guilty of a crime and may be subject to nes and con nement in state or federal prison. Initial The applicant acknowledges that explanation of the terms, conditions and provisions of the policy of insurance, including but not limited to coverage being afforded, amendments, endorsements, exclusions and any other such information effecting the policy of insurance are provided solely by the applicant`s 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 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 company. Initial 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 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. 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 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. The self-insured retention shall remain applicable even if you le for bankruptcy, discontinues business or otherwise becomes unable to unwilling to pay the 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. Initial 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 during the policy period. Thus there is NO retroactive coverage. Please consult your policy and or agent/broker for further information. Initial 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 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 liability available to pay indemnity, settlements, judgments and "claim expenses" will be reduced, and may be exhausted, by payment of "claim expenses" including payment of any defense fees and costs. Please consult your policy and or agent/broker for further information. Initial Applicants must strictly comply with all applicable state and/or other governmental licensing requirements and regulations. Should an applicant`s license become suspended, revoked or inactive at any time during the policy period, then NO coverage will be afforded under the policy. Initial * Deposit Premium & Fees are fully earned. - 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 premium only and is based upon the information provided by the applicant and or its agent. This information is subject to audit. Please note that issuance of the policy includes membership in Preferred Contractors Association (PCA). For a complete list of bene ts and information, visit the website at www.pcamembers.com -P6  Applicant Signature of Applicant Date Title (Owner, Of cer, Partner) Signature of Producer (Agent or Broker) Page 6 of 6 OBSIDIAN SPECIALTY INSURANCE COMPANY BUYBACK ACKNOWLEDGEMENT FORM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY AMENDMENT OF EXCLUSION FOR OPEN STRUCTURE WATER DAMAGE SUBJECT TO $50,000 SUBLIMIT As of the date and time listed below, in consideration of additional premium it is acknowledged and agreed that the Open Structure "Water" Damage Exclusion (Section I – Coverage A - 2. Exclusions, "s") which reads as follows: Acknowledgment s. Open Structure "Water" Damage Any claim for "bodily injury" or "property damage" to any building or structure or to any property within such building or structure that arises out of, results from, is caused by, contributed to, alleged to be, or in any way related to, in whole or in part, "water", any liquid, rain, hail, sleet or snow entering such building or structure from any area of the structure where the exterior or interior waterproof protective covering has been removed for any reason, in whole or in part, regardless of the manner of removal, or has not been installed or has been installed incompletely or installed or secured inadequately or improperly. This exclusion applies even when a temporary covering has been utilized but failed, whether the installation of such temporary covering was, or was not, done properly. Is hereby amended by adding the following provision thereto: Notwithstanding the foregoing, this policy will extend coverage for liability for "bodily injury" or "property damage" within the abovecited exclusion, but such coverage (including indemnity and defense fees and costs) shall be subject to a maximum per-occurrence and maximum aggregate limit of $50,000. To be clear, the $50,000 maximum limit identi ed above includes any and all "claim expenses" as that term is de ned in the policy. Member/Insured: Advantage Roo ng Inc Member/Insured Signature: Date: Printed Name/Title: - -P1  Applicant OSIC SLOSWD- Page 1 of 1 OBSIDIAN SPECIALTY INSURANCE COMPANY BUYBACK ACKNOWLEDGEMENT FORM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY TERRORISM COVERAGE DISCLOSURE NOTICE TERRORISM COVERAGE PROVIDED UNDER THIS POLICY Acknowledgment The Terrorism Risk Insurance Act of 2002 and amendments thereto (collectively referred to as the "Act") established a program within the Department of the Treasury, under which the federal government shares, with the insurance industry, the risk of loss from future terrorist attacks. An act of terrorism is de ned as any act certi ed by the Secretary of the Treasury, in concurrence with the Secretary of State and the Attorney General of the United States, to be an act of terrorism; to be a violent act or an act that is dangerous to human life, property or infrastructure; to have resulted in damage within the United States, or outside the United States in the case of an air carrier or vessel or the premises of a United States Mission; and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to in uence the policy or affect the conduct of the United States Government by coercion. In accordance with the Act we are required to offer you coverage for losses resulting from an act of terrorism that is certi ed under the federal program as an act of terrorism. The policy's other provisions will still apply to such an act. This offer does not include coverage for incidents of nuclear, biological, chemical, or radiological terrorism which will be excluded from your policy. Your decision is needed on this question: do you choose to pay the premium for terrorism coverage stated in this offer of coverage, or do you reject the offer of coverage and not pay the premium? You may accept or reject this offer. If your policy provides commercial property coverage, in certain states, statutes or regulations may require coverage for re following an act of terrorism. In those states, if terrorism results in re, we will pay for the loss or damage caused by that re, subject to all applicable policy provisions including the Limit of Insurance on the affected property. Such coverage for re applies only to direct loss or damage by re to Covered Property. Therefore, for example, the coverage does not apply to insurance provided under Business Income and/or Extra Expense coverage forms or endorsements that apply to those coverage forms, or to Legal Liability coverage forms or Leasehold Interest coverage forms. Your premium will include the additional premium for terrorism as stated in the section of this Notice titled DISCLOSURE OF PREMIUM. DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM LOSSES You should know that where coverage is provided by this policy for losses resulting from certi ed acts of terrorism, such losses may be partially reimbursed by the United States government under a formula established by federal law. However, your policy may contain other exclusions which might affect your coverage, such as an exclusion for nuclear events. Under the formula, the United States government generally reimburses 80% beginning on January 1, 2020 of covered terrorism losses exceeding the statutorily established deductible paid by the insurance company providing the coverage. DISCLOSURE OF CAP ON ANNUAL LIABILITY You Should Also Know That the Terrorism Risk Insurance Act, As Amended, Contains A $100 Billion Cap That Limits U.S. Government Reimbursement As Well As Insurers’ Liability For Losses Resulting From Certi ed Acts Of Terrorism When The Amount Of Such Losses In Any One Calendar Year Exceeds $100 Billion. If The Aggregate Insured Losses For All Insurers Exceed $100 Billion, Your Coverage May Be Reduced. - -P1  Applicant OSIC TCDN- Page 1 of 2 OBSIDIAN SPECIALTY INSURANCE COMPANY DISCLOSURE OF PREMIUM Your premium for terrorism coverage is: $4,011.92 Premium charged is for the policy period up to your policy expiration. (This charge/amount is applied to obtain the nal premium.) You may choose to reject the offer by signing the statement below and returning it to us. Your policy will be changed to exclude the described coverage. If you chose to accept this offer, this form does not have to be returned. REJECTION STATEMENT I hereby decline to purchase coverage for certi ed acts of terrorism. I understand that an exclusion of certain terrorism losses will be made part of this policy. Acknowledgment Member/Insured: Advantage Roo ng Inc Member/Insured Signature: Date: Printed Name/Title: - -P2  Applicant OSIC TCDN- Page 2 of 2 OBSIDIAN SPECIALTY INSURANCE COMPANY BUYBACK ACKNOWLEDGEMENT FORM THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY OBSIDIAN SPECIALTY INSURANCE COMPANY COMMERCIAL GENERAL LIABILITY POLICY AMENDMENT OF EXCLUSION FOR HEATING DEVICES SUBJECT TO $50,000 SUBLIMIT AND CONDITION PRECEDENT As of the date and time listed below, in consideration of additional premium it is acknowledged and agreed that the Heating Devices Exclusion (Section I – Coverage A - 2. Exclusions, "s") which reads as follows: s. Heating Devices Acknowledgment "Bodily injury" or "property damage" arising out of, resulting from, caused by, contributed to, alleged to be, or in any way related to, in whole or in part, to the use of any " re or heating devices" by or on behalf of any insured. The term " re or heating devices" includes but is not limited to a heat wand, welding equipment, open ame devices, torches, heaters, or any type of heat application, or any other equipment that generates heat or sparks in the normal course of its operation. Is hereby amended by adding the following provision thereto: Notwithstanding the foregoing, this policy will extend coverage for liability for "bodily injury", "property damage", or "personal and advertising injury", within the above-cited exclusion, but such coverage (including indemnity and defense fees and costs) shall be subject to a maximum per-occurrence and maximum aggregate limit of $50,000. To be clear, the $50,000 maximum limit identi ed above includes any and all "claim expenses" as that term is de ned in the policy. Additionally, it shall be a condition precedent of any coverage under this policy, including defense and indemnity, that the insured adhere to each and every of the following precautions and requirements on each occasion where the insured or persons acting on behalf of the insured are operating any type of " re or heating device" or other equipment which generates heat or sparks in the normal course of its operation away from their own premises: 1. The immediate area in which the operation is to be carried out must be segregated by the use of screens made of metal and/or re retardant material; 2. The whole of this segregated area must be adequately cleaned and freed from all combustible material before operations commence; 3. Combustible oors or substances in or surrounding the segregated area must be liberally and extensively covered with sand or protected by overlapping sheets of incombustible material; 4. In circumstances in which work is being carried out in an enclosed area, an additional "employee" of the Insured or an employee of the occupier of the premises in question shall be present at all times to guard against an outbreak of re; 5. No work shall be carried out unless speci cally authorized by such occupier who must also be asked to approve (prior to work commencing) the safety arrangements put in place; 6. "Heating device" that are switched on or lit shall not be left unattended at any time; 7. The insured must keep suitable re extinguishers available at all times for immediate use at or near the scene of operations, and in no event more than thirty (30) feet from such operations; - 8. No welding, cutting, or heating shall be done where the application of ammable paints or the presence of other ammable compounds, or heavy dust concentrations creates a hazard; and 9. The Insured or "employee" of the insured must remain at the location where welding, cutting, or heating application is performed for a minimum of 1 hour after all heating device operations have ceased. Except as set forth above, all of the terms, conditions and exclusions of this policy apply and remain in effect. -P1  Applicant Member/Insured: Advantage Roo ng Inc Member/Insured Signature: Date: Printed Name/Title: OSIC SLCPHD- Page 1 of 1 IMPORTANT NOTICE: 1. The insurance policy that you have purchased is being issued by an insurer that is not licensed by the State of California. These companies are called “nonadmitted” or “surplus line” insurers. 2. The insurer is not subject to the financial solvency regulation and enforcement that apply to California licensed insurers. 3. The insurer does not participate in any of the insurance guarantee funds created by California law. Therefore, these funds will not pay your claims or protect your assets if the insurer becomes insolvent and is unable to make payments as promised. 4. The insurer should be licensed either as a foreign insurer in another state in the United States or as a non-United States (alien) insurer. You should ask questions of your insurance agent, broker, or “surplus line” broker or contact the California Department of Insurance at the toll-free number- or internet website www.insurance.ca.gov. Ask whether or not the insurer is licensed as a foreign or non-United States (alien) insurer and for additional information about the insurer. You may also visit the NAIC’s internet website at www.naic.org. The NAIC—the National Association of Insurance Commissioners —is the regulatory support organization created and governed by the chief insurance regulators in the United States. 5. Foreign insurers should be licensed by a state in the United States and you may contact that state’s department of insurance to obtain more information about that insurer. You can find a link to each state from this NAIC internet website: https://naic.org/state_web_map.htm. 6. For non-United States (alien) insurers, the insurer should be licensed by a country outside of the United States and should be on the NAIC’s International Insurers Department (IID) listing of approved nonadmitted non-United States insurers. Ask your agent, broker, or “surplus line” broker to obtain more information about that insurer. 7. California maintains a “List of Approved Surplus Line Insurers (LASLI).” Ask your agent or broker if the insurer is on that list, or view that listat the internet website of the California Department of Insurance: www.insurance.ca.gov/01-consumers/120company/07-lasli/lasli.cfm. 8. If you, as the applicant, required that the insurance policy you have purchased be effective immediately, either because existing coverage was going to lapse within two business days or because you were required to have coverage within two business days, and you did not receive this disclosure form and a request for your signature until after coverage became effective, you have the right to cancel this policy within five days of receiving this disclosure. If you cancel coverage, the premium will be prorated and any broker’s fee charged for this insurance will be returned to you. Date: Insured: D-1 (Effective January 1, 2020) Advantage Roo ng Inc 48 Zita Manor, Daly City, CA 94015 - email: advantageroo-Quote ID:- During the last Five (5) years, we warrant that with respect to the insurance being applied for: 1. I/ we have not sustained a loss 2. Have not had a claim made against us 3. Have not been denied coverage or had coverage canceled by an insurance company Loss Warranty Letter 4. Have no knowledge or a reason to anticipate a claims or loss. - -P1 If my business is less than ve (5) years old, the above referenced warranty applies to work performed through all my prior business entities whether as an owner or an employee. The undersigned Applicant understands and agrees that all of the statements, information and responses provided in the Application for this policy are material to the risk sought to be insured, and that the entirety of the information provided in the Application forms a basis for the insurer to provide the requested insurance, and that said insurance is provided in reliance on such material representations. The undersigned Applicant further authorizes the Insurer or its representative to obtain directly or on Applicant's behalf, any and all loss runs or other such information identifying any claim, action or loss against the undersigned Applicant or the denial of coverage or cancelation of insurance. This authorization shall also include and encompass any prior business entity as provided above. The Insurer or its representative may contact the undersigned Applicant's Insurance Brokers, Agents, Insurers, Attorneys or other such individuals for this information and its release. I understand that this warranty and authorization for release of information as provided above will be incorporated into the insurance contract. Advantage Roo ng Inc Company/ Member Date Signature of Partner, Of cer, Principal or Owner Title Warranty: The purpose of this no loss letter is to assist in the underwriting process information contained herein is speci cally relied upon in determination of insurability. The undersigned, therefore, warrants that the information contained herein is true and accurate to the best of his/her knowledge, information and belief. This no loss letter shall be the basis of any insurance that may be issued and will be a part of such policy. It is understood that any misrepresentation or omission shall constitute grounds for immediate cancellation of coverage and denial of claims, if any. It is further understood that the applicant and or af liated company is under a continuing obligation to immediately notify his/her underwriter through his/her broker of any material alteration of the information given.  Applicant Page 1 of 1 COMMERCIAL INSURANCE PREMIUM FINANCE AGREEMENT AND DISCLOSURE STATEMENT PO Box 181668 Fairfield, OH 45018 Phone:- Quote # _________________- Email:-Website/Online Payments: www.agile-pf.com Borrower (Insured): Name and Address as stated in Policy Advantage Roofing Inc 48 Zita Manor Daly City, CA 94015 Agency Azul Risk & Finance Inc. dba Azul Insurance Solutions 22946 1/2 Lyons Ave Newhall, CA 91321 - - Taxpayer ID #: Agency ID: SIS-11674 Schedule of Policies Coverage Type Policy Number Effective Date Gen Liab TBD App#- 6/16/2025 Policy Days Policy Short Subject MEP to Term Rate to Audit Cancel 12 15% $26,178.18 Obsidian Specialty Insurance Company SIS Taxes/Stamp: $0.00 Integrated Specialty Coverages-Obsidian Fees: $500.00 Specialty Insurance Company 1811 Aston Ave Ste 200 Carlsbad, CA 92008 10 Premium: Additional Policies are listed on the attached Schedule of Policies (if any) Total Premiums Down Payment Insurance Company Managing General Agency Premium Federal Truth in Lending Disclosures Unpaid Florida Doc Amount Premium Stamp Tax Financed Applicable in The amount of credit Balance Finance Charge Total of Payments The amount you will have paid after you have made all payments as scheduled Florida Only provided to you or on your behalf The dollar amount the credit will cost you $0.00 $22,251.45 $2,223.15 $24,474.60 The cost of interest on the loan as a yearly percentage Payment Amount Number of Payments Date of First Payment Due Date of All Subsequent Payments 21.24% $2,447.46 10 7/16/2025 16th $26,678.18 $4,426.73 $22,251.45 Annual Percentage Rate The finance charge will begin to accrue on the earliest policy effective date shown above or on attached schedule. Promise to Pay: In return for the payment(s) that Agile Premium Finance, a Division of First Financial Bank (herein after referred to as “First Financial Bank”) has advanced to pay my insurance policy or policies listed in this agreement, I promise to make monthly payments as shown in this agreement. I will make these monthly payments until I have paid the full amount advanced me or on my behalf, plus the finance charges and any other charges I may owe as shown on this agreement. I understand that payment will be payable at the office of Agile Premium Finance, PO Box 181668 Fairfield, OH 45018. Cross Collateralization: If you do not make a payment on time First Financial Bank reserves the right to utilize credits, payments, all monies received from or on behalf of the insured to apply towards any of the insureds past due accounts. Security: I am giving a security interest in all unearned premiums and/or dividends and, on commercial policies, loss payments which will reduce the unearned premium. I understand that I may not assign the policy or policies, except for the interest of mortgagees and/or loss payees, without the written consent of First Financial Bank. Prepayment: I understand that if I pay the full amount due First Financial Bank in advance, I may receive a refund of the unearned portion of the FINANCE CHARGE calculated using the statutory method required by my State. No refund will be made if less than one dollar ($1.00). Agent or Broker Warranty: The Agent or Broker does hereby Warrant to First Financial Bank that the foregoing agreement is valid; that all signatures are genuine; that all policies listed are correctly described and in full force and effect; that any amount received by the agent or broker from First Financial Bank will be properly forwarded to the insurance company or companies; and that any and all return premium received from the insurance company or companies will be forwarded to First Financial Bank immediately. The agent or broker warrants that the down payment has been collected and agent or broker has paid or will pay that down payment to the carrier or MGA as listed in contract in order that the policy or policies listed herein are put into effect on the date shown in this agreement. The agent or broker has read and agrees to the Agent or Broker Representations and Warranties section on page two of this agreement. NOTICE TO THE INSURED: By signing below I, the Insured, have read this agreement and agree to the terms and conditions on all pages. I have the right to pay off the full amount due in advance and may receive a partial refund of the finance charges. I also acknowledge the receipt of an executed copy at the time of execution thereof and represent that I have the authority to sign on behalf of the Insured. If the Insured is a corporation, an officer of the corporation must sign. All insureds designated on the policy must sign. Signature of Insured Title Page 1 of 32 Signature of Agent or Broker Date Title Date