Exhibit B to Administrative Expense Claim — In re Vyaire Medical

Summary

Doc 851-2 in In re Vyaire Medical, Case 24-11217-BLS, was filed December 23, 2024 as Exhibit B to an administrative expense claim and reproduces a Commercial Surety Application to The Hartford for a Wholesaler or Nonresident Wholesaler Surety Bond, with Vyaire Medical Inc. as applicant and the Maryland Board of Pharmacy as obligee. The application lists a bond amount of $100,000.00, an effective date of 05/01/2018 and Marsh USA Inc. as producer of record, and includes the Indemnity Agreement in favor of Hartford Fire Insurance Company.

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Case 24-11217-BLS    Doc 851-2    Filed 12/23/24    Page 1 of 6
Case 24-11217-BLS    Doc 390-1    Filed 08/15/24    Page 5 of 9
EXHIBIT B

EXHIBIT PAGES A-G.docx
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Case 24-11217-BLS    Doc 390-1    Filed 08/15/24    Page 6 of 9
Case 24-11217-BLS Doc 890-2 Filed 02/28/24 Page 3of 8

All Purpose

ial Applicati
Commercial Surety Application THE

HARTFORD

For all business complete page 1 of this application in its entirety.
Complete Section 2 — 7 for the appropriate bond category indicated in General Information section below.

| General Information Questions |

Application is being made for which one of these bond categories? (*Fill out section indicated.)

[7] License & Permit or Miscellaneous —*Sec.2 [] Lost Instrument (Include completed (] Public Official - *Sec. 4
Affidavit) — *Sec. 3
(C1 Fiduciary (Probate) — *Sec. 5 () Receiver or Bankruptcy Trustee — *Sec. 6 C] Court: Judicial — *Sec. 7

Type of Bond (describe purpose) Wholesaler or Nonresident Wholesaler Surety Bond

(Attach a copy of the bond form, if available)

PRODUCER OF RECORD (required): Marsh USA Inc. - Chicago

Agency Name: Marsh USA Inc.

RO/Agency Code: Sub Producer Code: Bond Number:
Agency City: Chicago Agency State: Illinois
Bond Amount: $ 100,000.00 Effective Date of Bond: 05/01/2018 Bond Term, if known: Annual

# of years

Applicant is: (select one) (1) Individual (() Partnership [Y) C-Corp [1] scop [J Ltc [J

Applicant (Principal): Vyaire Medical Inc.

Name to appear on Bond, if different from Applicant:

Applicant’s Address: 26125 N. Riverwoods Bivd., Mettawa, IL_ 60045

Applicant’s Business Description or Latest Occupation: Respiratory care manufacturer

Number of Years in Business: { \ A

Yes
Business Phone &p | Fax No.: Email:
Obligee — party requiring the bond (required): Maryland Board of Pharmacy
Obligee Address: 4201 Patterson Avenue, Baltimore, MD 21215
Billing Method: Agency Bill [] Direct Billed — full payment C] Direct Bill TABS Account
TABS Account No.:
Billing Address, if different from Applicant’s Address:
1 | General Underwriting Questions |
(required for all Applicants)
Does the Applicant have any other Surety bonds in force? B No [] Yes
Has another Surety company declined to write this or any previous bond? No [] Yes
Have you ever had a bond involuntarily terminated or cancelled? WM No ([] Yes
Has there ever been a claim or legal action against any bond executed on your behalf ? M No FI Yes
Do you or any of your companies have any pending lawsuits, unsatisfied judgments or liens? No f& Yes
Have you or any of your companies declared bankruptcy or become insolvent? FL No [| Yes
Have you or any of your companies been the subject of any legal or administrative proceedings resulting in
disciplinary action? Ba No [1 Yes
Have you ever been convicted of a felony? [J] No [J Yes

(If you answered Yes to any of the above questions, please attach a detailed explanation.)

CS - Rev 05/09/2012-0
1Step Form /APP2943
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Case 24-11217-BLS Doc 890-2 Filed 02/28/24 Page 86 of 8

7 | | License, Permit and Miscellaneous Bonds |

Has the Applicant continuously been in business under the current name and ownership for at least 3 years? 4] No [1 Yes

Does the bond guarantee the performance of a specific contract or agreement? ay No [LJ] Yes
If Yes, attach a copy of the contract or agreement. copy attached

Does the bond cover any type of environmental or pollution exposure? SINo [-] Yes

Does the bond guarantee the payment of taxes, fees, wages or payment of any type? [TNo fALyes

3 | | Lost Instrument Bonds |

Present Market Value Is the Bond: |_| Open Penalty or [] Fixed Penalty

Description of the lost instrument or security:

In whose name are the instruments or securities registered:

Have the instruments or securities been endorsed? [-] No [I Yes
Have the instruments or securities been assigned to another party? [1 No [LT Yes
Are the lost instruments or securities in bearer form? [i No [1 Yes
Has Notice of Loss been given? [-1No [J Yes
If Yes, to whom? Date:
Has a Stop Notice been issued? [1 No [_] Yes
Please complete an Affidavit, [_] copy attached
4 | I Public Official Bonds |
Elected CL] Appointed Position Title
Effective Date: Expiration of Term: or L] Term is indefinite
Have you held this position before? [TNo (Yes

If Yes, when?

If you have not held this position previously and the bond amount is greater than $100,000,

attach a copy of your resume. L] copy attached

Do you or your subordinates handle money or securities? [_JINo TJ Yes
If so, how much is handled annually?
Does an external CPA annually audit the financial accounts and fund balances? T] No Lives
If the bond amount is greater than $250,000, provide a copy of latest fiscal year-end statement L] copy attached

Total number of employees you directly or indirectly supervise:

5 | ‘i Fiduciary Bonds |

Applicant’s Age: Applicant’s Net Worth:

How long have you been with your current employer? Active or retired?

Date of your appointment: Name of Estate:

What is your relationship (personal and/or financial) with the deceased/incompetent/minor/beneficiary?

Are you indebted to the estate of the deceased/incompetent/minor/beneficiary? [1 No [1 Yes

If Yes, in what amount and what are the terms of repayment:

Attorney’s name and address:

Court jurisdiction (Obligee) in which bond will be filed:

Is there an ongoing business? [_JjNo [J Yes
If Yes, provide details: |
Inventory of the Assets: Cash: Securities: Real Estate: Other:
Name of Heirs/Beneficiaries Age - Relationship to the deceased Share of the Estate Residence (state)

Attach a copy of the Will, Trust or Court Order for ALL bonds greater than or equal to $100,000.

CS — Rev 05/09/2012-0
1Step Form /APP2943
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Case 24-11217-BLS    Doc 390-1    Filed 08/15/24    Page 8 of 9
Case 24-11217-BLS Doc 890-2 Filed 02/28/24 Page 4of®@

| 5a | | Complete for Administrator, Executor, Personal Representatives, etc. |

Date of Death:

Is the estate insolvent? T1No CT] Yes

Are there any disputes among the heirs? 1 No []| Yes

| 5b | i Complete for Guardianship, Conservatorship, Trustee, etc. |

This is in regardto a: [_] Minor and/or | Incompetent [ ] Beneficiary Age:

Where does minor/incompetent reside?

Will any assets be under court restrictions? [-] No [| Yes
If Yes, provide details:

Will joint control be used to restrict expenditures or distributions of assets? LI No [] Yes

Will professional accounting, investment or legal services be provided on an ongoing basis? [—] No [E] Yes

Does the presiding court require that an annual accounting be filed? {~ No F] Yes

Is the estimated duration of the bond anticipated to be longer than 3 years? {| No [J] Yes

6 | | Receiver, Bankruptcy Trustee, Assignee Bonds |

Debtor:

Address:

Type of Action: {_] Liquidation |_| Reorganization ["] Receiver of Rents [| Other

Do you carry Fidelity coverage? (CT No [I Yes
If Yes, in what amount? Carrier:

Do you carry Professional Liability or E & O coverage? .-|1No {1 Yes
If Yes, in what amount? Carrier:

Attach copy of Court Order, Judgment and/or other documents (J Copies attached

7 | | Court: Judicial Bonds |

Judgment / Claim Amount:

Type of Action:

Case Number: Court Jurisdiction:

Attorney’s name and address:

Summary of the Action:

Does the case involve a domestic dispute? | | No [_] Yes

Attach a copy of Court Order, Judgment and/or other supporting documents. LJ Copies attached

CS — Rev 05/09/2012-0
1Step Form /APP2943
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Case 24-11217-BLS    Doc 390-1    Filed 08/15/24    Page 9 of 9
Case 24-11217-BLS Doc 890-2 Filed 02/28/24 Page 8 of 8

Indemnity Agreement
The undersigned Applicant and Indemnitor(s), (all hereinafter called the Indemnitor(s)) hereby certify that the foregoing declarations made
and answers given are the truth without reservation, and are made for the purpose of inducing the Surety to execute a certain bond or
undertaking herein applied for, and any renewal, procurement, assumption, continuation or increase of the same, or any bond of similar
nature given in substitution or renewal thereof (all comprehended in the word “bond” or “undertaking” as herein used),

Indemnitor(s) hereby expressly authorize Hartford to access its credit records and to make such pertinent inquiries as may be necessary from
third party sources for the following purposes: (a) To verify information supplied to Hartford; (b) For underwriting purposes; and (c) Upon
receipt of a notice of claim or potential claim, for debt collection. Hartford may furnish copies of any and all statements, agreements, and
financial statements and any information, which it now has or may hereafter obtain concerning each of the Indemnitors, to other persons or
companies for the purpose of procuring co-suretyship or reinsurance.

If Hartford Fire Insurance Company, Hartford Plaza, Hartford, CT 061 15, itself or any of its affiliates, parent, subsidiaries, co-sureties, or re-
insurers, (individually and collectively called “Hartford”), as Surety, shall execute or procure the execution of the bond or undertaking
hereinbefore applied for, which bond and application are hereby referred to and made a part of this agreement, the undersigned, in
consideration thereof, jointly and severally covenant and agree with Hartford as follows:

Indemnitor(s) shall pay the premiums and renewal premiums for each bond issued hereunder, until Hartford has received written legal
evidence, satisfactory to Hartford, in its sole discretion, of its discharge from all such bonds and all liability related thereto.

Indemnitor(s) agree to indemnify Hartford and save it harmless from any and all loss and expense of whatsoever kind or nature, including,
but not limited to interest, court costs, attorney fees, incurred by Hartford in connection with or by reason of furnishing any bond hereunder.
The undersigned Indemnitor(s) hereby agree to deposit upon demand with Hartford an amount sufficient to discharge any claim or any such
bond, which deposit may be held by Hartford as collateral security against any loss or cost on this bond.

Indemnitors agree that any Obligee on any bond written pursuant to this Agreement is specifically authorized and requested to disclose any
and all information, including providing copies of documents, whether deemed confidential or not, requested by the Surety in it’s
investigation of any claim. The indemnitors irrevocably appoint Hartford as their Attorney in Fact with the right but not the obligation to
exercise its rights and execute or deliver any document in the name of the indemnitor deemed necessary to carry out the intent and purpose
of this paragraph.

A facsimile signature of this document shall be deemed an original signature for any and all purposes.

IT IS A CRIME TO KNOWINGLY PROVIDE FALSE, INCOMPLETE OR MISLEADING INFORMATION TO AN INSURANCE COMPANY FOR THE
PURPOSE OF DEFRAUDING THE COMPANY. PENALTIES MAY INCLUDE IMPRISONMENT, FINES AND DENIAL OF BENEFITS.

WITNESS the following signature(s) and seal(s) this|_774_|day of [APRIL i
If Indemnitor is a PARTNERSHIP , CORPORATION or LLC:

Look here to see who can sign [Vyaire Medical Inc. WO SEAL.
Name of Firm/Corporation
Witness signature: (Seal)
a SHEE no By signature:
F A. WY Print Above Name Here: Apryjy k&/emzZz
Le Title (Print): ZL y

Print Above Name Here

If Indemnitor is: | Individual (need Social Security) [7] 3rd-Party Individual (need Social Security) [~_]3rd-Party Company (need FEIN)

Witness signature: Indemnitor signature:

Print Name Above Print Name, Title, Social Security or FEIN # of above

If Indemnitor is: individual (need Social Security) EVara-Party Individual (need Social Securit) [ lsra-Party Company (need FEIN)
Witness signature: Indemnitor signature:

Print Name Above Print Name, Title, Social Security or FEIN # of above

If Indemnitor is: iM Individual (need Social Security) ‘i 3rd-Party Individual (need Social Security) ia 3rd-Party Company (need FEIN)
Witness signature: Indemnitor signature:

Print Name Above Print Name, Title, Social Security or FEIN # of above

| Reminder — Please make sure the application has been SIGNED, WITNESSED and DATED in the appropriate areas.
Case 24-11217-BLS    Doc 851-2    Filed 12/23/24    Page 6 of 6
Case 24-11217-BLS Doc 890-2 Filed 02/28/24 Page 8 of 98

CALIFORNIA NOTICE

California Notice: The Harford may charge a fee if this bond or policy is cancelled before
the end of its term. The fee can range between 5% to 100% of the pro rata unearned
premium. Please refer to the terms and conditions stated in the policy or bond. This
notice does not apply to cancellations initiated by The Hartford.

HR 04 HO51 00 1211


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