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_ SUPPLEMENT <br />2 <br />d APPLICATION FOR <br />IF7suFiANCESERVICES. INc. LAWYERS PROFESSIONAL LIABiLfTY INSURANCE <br />FINANCIAL INSTITUTIONS <br />N,4MEOFAPIaLICANT Faustman; Carlton, DiSante & Fr•eudenberger, LL.P <br />THE TERMS "INSTITUTION" OR "FINANCIAL INSTITUTION" INCLUDES ANY SAVINGS & LOAN, BANK; <br />CREDIT UNION, pAASSOCIATION, <br />IASSOCIATION; SERVICE COMPANY, <br />SUBSIDIARY OR�RTiON OR HOLDING COMPANYOF, THAORMNT AFOREMENTIONED. <br />In the past did some employment work <br />SECTION <br />This supplement is to be completed by all applicants for Lawyers Professional Liability Insurance, when in the fast 5 years, <br />any lawyer associated with the applicant firm.andlor its predecessors has provided legal services for your firm's financial <br />institution or financial institution regulatory authority clients. <br />1. What percentage of your services are for your firm's financial institution clionts? ........ .... .. . <br />2 Of the percentage listed above, what percentage of these services include: Employment work only <br />I a) residential loan documentation, residential real estate closings/foreclosures, or title work . . . �iA- % <br />b) commercial loan documentation, commercial real estate closings/foreclasures, bankruptcy, NA - % <br />collection or trust work . .. .. .. .. .............. . ........... . <br />c) services other than a) and b) above . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . <br />Complete Section B on page 2.2 of this supplement if either questions 3, 4, or 5 are answered "Yes". <br />S. Have any lawyers performed services for your firm's financial institution clients other Yes No <br />than those listed below? .. . ... . . .. . .. ......... .......... . <br />- Bankruptcy --Real estate closings <br />—Collection —Real estate foreclosures <br />---Loan documentation --Title work/conveyances <br />.—Loan workout T st work <br />Emp oyment-work - Marie DiSante <br />Chris Robertson <br />4. Has any lawyer: X" No <br />a) had any financial control over or equity interest in a financial institution? ......... �� Yes <br />b) acted as director, officer, general counsel or committee member for a financial Yes _ No <br />institution? ... . ... . .. ... . . ........................ . <br />c) been involved with the initial formation of orprovided any securities services for a Yes X - Na. <br />financial institution? . -. .. . . . . .. ....... • .. • • . • . • • • • • <br />5. Are any of your firm's financial institution clients uninsured by a government agency such Yes NA No <br />as the FDIC, or NCUA? ........ ... ........ .... ...... . , ... .. <br />Please sign and date page 2.2 of this supplement. <br />-2.t- - <br />