Annual Premiums Policies are tailored to fit the needs of each individual business Policy premiums will vary based on your actual needs

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1 Spa, Skincare, Hair Removal, and Body Modification Insurance Program Admitted, On Shore, A Rated (or better) Company in all states Occurrence Form Liability Coverage Special Form, Replacement Cost Property Coverage Eligibility Spa, Skincare, Hair Removal, and Body Modification businesses located anywhere in the United States Availability of property coverage is limited along the Gulf and Atlantic coasts Property coverage is not available in Florida Occurrence Form Liability Coverage Professional Liability $1,000,000 per occurrence / $2,000,000 aggregate Commercial General Liability $1,000,000 per occurrence / $2,000,000 aggregate Umbrella Liability Optional limits up to $10,000,000 available in most states Other optional limits of liability are available Optional Property Coverage Your choice select the amount you need Special form coverage including perils such as fire, lightning, smoke, wind, explosion, vandalism, malicious mischief, burglary, theft, and other causes of direct physical loss or damage subject to policy exclusions. Notable Exclusions Medical Services Removal or Attempted Removal of Pigment (tattoo pigment) Any Laser, laser type, or light based treatments (other than LED treatments) UV Tanning Health Hazards Exclusion Abusive Acts (abuse & molestation) optional coverage can be purchased Annual Premiums Policies are tailored to fit the needs of each individual business Policy premiums will vary based on your actual needs Application Options Via fax to Via mail to: One International Blvd., Suite 300, Mahwah, NJ 07495

2 ' E Z > >/ />/dz Θ WZKW Zdz QUESTIONNAIRE 1. Your name(s) 1.1. Entity Name 1.2. Business Name 1.3. Owner Name(s) 1.1 Include Inc., Corp., LLC, etc. If you are not an entity, leave this question blank or write none. 1.2 This is your dba or t/a name. If you don t have one, leave this question blank or write none. 1.3 This should be the applicant name. If you are an individual purchasing your own coverage, write your own name here. 2. Your address(es) 2.1. MAILING Address [street, city, state, zip] 2.2. LOCATION Address [street, city, state, zip, county] 2.2 Multiple location businesses should complete this questionnaire separately for each location. 3. Contact Information 3.1. Office Phone: 3.2. Mobile Phone: 3.3. Fax: Website: 3.6. May we your policy materials to the address provided above? Yes No 3.6 Whenever possible, insurance quotations will be returned via Legal Information 4.1. Federal Employer Identification Number 4.2. Social Security Number (if no F.E.I.N.) 4.3. Type of business ownership Corporation LLC Partnership Individual Booth Renter/Independent Contractor Employee 4.4. Years experience in this industry? 4.5. Are there any businesses or business locations owned or operated that will not be specifically Insured by this policy? Yes No ' If yes, please attach a detailed description. 1

3 5. Prior Insurance & Claims Information 5.1. Have there been any losses, claims or suits within the last 3 years? Yes No *** If yes, please attach detailed description of the loss and an explanation of what actions, if any, you have taken to prevent similar losses Previous Insurance Carrier Name (Not required in Missouri): 5.3. Previous Insurance Policy Number (Not required in Missouri): 6. Additional Interests? 6.1. Should your landlord be named on the policy? Yes No None n/a 6.2. Should your equipment lessor be named on the policy? Yes No None n/a 6.3. Should your mortgage company be named on the policy? Yes No None n/a *** If yes to any of the above, please attach the complete name, mailing address, and interest for each requested additional insured. 7. General & Product Liability Information 7.1. What is the square footage of your space? 7.2. Do you repair or install equipment or machines? Yes No 7.3. Do you rent equipment to others? Yes No 7.4. Do you sell products under your own label? Yes No 7.5. Do you sell products which you repackage, re label, or re manufacture? Yes No 7.6. Do you manufacture or re bottle any products at your business location? Yes No 8. General Liability Coverage Options 8.1. Include Employee Benefits Liability? Yes No 8.2. Include Hired and Non Owned Auto Liability? Yes No 8.3. Include Stop Gap Liability (ND, OH, WA, WV, and WY only)? Yes No 8.4. Desired General Liability Coverage Limits $1,000,000 each occurrence / $2,000,000 aggregate $2,000,000 each occurrence / $4,000,000 aggregate *** if higher limits are required, please attach a description of your needs 9. Is property coverage desired? Yes No *** if yes, complete questions 10, 11, and continue to the attached supplemental application *** if no, skip to the attached professional liability application 10. Property Information Is the business within 1,000 feet of a fire hydrant? Yes No Is the business within 5 miles of a fire station? Yes No

4 10.3. Is the business within 5 miles of a navigable waterway? Yes No Number of floors in building (how tall is it)? Appoximate age of building *** if the building is over ten years old, please attach description of any recent updates to the electrical, plumbing, heating, and roofing systems Type of building construction Frame (wood) Joisted Masonry (brick/block) Non combustible (steel) Masonry non combustible (concrete tilt up) Fire Resistive (superior) Types of other tenants in same building None Office/Medical Retail Apartment Restaurant Other (describe): Types of tenants in neighboring buildings None Office/Medical Retail Apartment Restaurant Other (describe): 11. Property Coverage Limits Business Personal Property (include the 100% replacement value of all contents, stock, furnishings, fixtures, and tenant improvements & betterments) $ Business Interruption (indicate the desired coverage limit for business interruption) $ Building (if owned by the applicant, include replacement value of the structure) $ Desired Property Loss Deductible $500 $1,000 $2,500 $5,000

5 COMMERCIAL PROPERTY SUPPLEMENTAL QUESTIONNAIRE Ma, New Jersey 0 Toll Free: 800- Facsimile: APPLICANT INFORMATION Name of Applicant Mailing Address: City: State: Zip Code: County: Phone: Facsimile: Website: Address: SUPPLEMENTAL PROPERTY INFORMATION 1. Are there any: Trailers, mobile homes or personal residences? Yes No Vacant or unoccupied buildings? Yes No Substandard buildings or buildings that are not maintained? Yes No Structures of which any part rests on piers or pilings, over water or on stilts? Yes No 2. Do you launder your own towels and/or robes at the described location? Yes No If yes: Do you provide professional services involving massage oils and/or essential oils? Yes No Do you use commercial-grade laundry equipment (washer/dryer)? Yes No Do you use commercial-grade laundry detergent? Yes No Do you allow the laundry machines to run when no one is in the building? Yes No Do end-of-day closing procedures include a check of all laundry equipment? Yes No Do end-of-day closing procedures include turning off water supply valves on all laundry Yes No equipment? Is all staff with laundry responsibilities trained in the proper use of the laundry equipment? Yes No Is the laundry area in a room separate from the balance of the business? Yes No Is the laundry area protected by a sprinkler system or another fire suppression device? Yes No Is the laundry area protected by a central station monitored fire alarm? Yes No What controls are in place to prevent unauthorized persons from operating laundry equipment and accessing the laundry areas? 3. Is coverage for buildings requested? Yes No If yes: Is all property up to current local building codes? Yes No Is there EIFS (Exterior Insulating Finishing Systems) on any supporting structures? Yes No If yes, was it constructed from 2005 or later by an approved contractor? Yes No

Agent Name: Agent Address: Agent City: State: Zip Code: Agent Phone: Fax:

Builders Risk Quick Quote All QUESTIONS MUST BE ANSWERED! AGENT INFORMATION Agent Name: Agent Address: Agent City: State: Zip Code: Agent Phone: Fax: E-mail: INSURED INFORMATION Insured Name: Insured Mailing