Agents Affiliated with Senior Market Sales, Inc. Agent s E&O Program Outline of Coverage
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2 Policy Period: September 1, 2012 to September 1, 2013 Insurer: Aspen American Insurance Company and Aspen Specialty Insurance Company (New York Agents Only) Members of The Aspen Group Aspen American Insurance Company is an admitted carrier Aspen Specialty Insurance Company is a non-admitted carrier. Rated A (Excellent) XV, by A.M. Best Company The information obtained from A.M. Best dated October 12, 2011 is not in any way CalSurance Associate s warranty or guaranty of the financial stability of the Insurer and the information is current only as of the date of the publication. Policy Number: TBD Risk Purchasing Group Membership: By applying for this insurance, Agents are applying for membership in the Financial Sales Professionals Risk Purchasing Group, a group formed and operating pursuant to the Liability Risk Retention Act of 1986 (15 USC 3901 et seq.). There is no additional charge for membership. Limit of Liability: Each Claim Aggregate OR Each Claim Aggregate Deductible (Damages and Defense): $250 Products sold through Senior Market Sales, Inc. $1,500 All other Covered Products Retroactive Date: The inception date of the Agent s first claims-made life insurance agents professional liability policy from which coverage has been maintained in force without interruption. Insured: 1) Agents Affiliated with Senior Market Sales, Inc. who have enrolled in the program and paid their premiums. 2) An entity owned and controlled by an Agent, arising solely from the performance of Professional Services provided by the Agent; 3) An employee acting in his or her capacity as such on behalf of an Agent, arising solely from the performance of Professional Services by the Agent; 4) The legal heir, executor, administrator or legal representative of an Agent in the event of such Agent s death, incapacity or bankruptcy; 5) The lawful spouse or domestic partner of any individual which qualifies as an Insured under Sub-sections 1., 3., or 4., above, for a Claim arising solely out of spousal or domestic partner status, and not out of any alleged independent wrongful acts, of such individual; or 6) The Sponsoring Company, but only for its vicarious liability for the covered acts of an Agent. Agents Affiliated with Senior Market Sales, Inc. Agent s E&O Program Outline of Coverage Coverage: The Insurer shall pay on behalf of the Insured all sums in excess of the deductible which the Insured shall be legally obligated to pay as Damages resulting from Claims first made for any actual or alleged negligent act, error or omission solely while performing Professional Services for others, including Personal Injury. Professional Services: The solicitation, sale or servicing of: a) Individual or group accident or health insurance, Medicare Supplement, Medicare Advantage (including Medicare Part D), disability insurance, and senior dental insurance; b) Final expense and guaranteed final expense; c) Long term care insurance; d) Fixed life insurance and fixed annuities (covered under Basic Plus coverage option); or e) Providing financial planning services solely in connection with the products sold in Sub-sections a. d. Note: Level A includes products listed above when sold through sponsor only; Level B includes products listed above regardless of whether they are sold through the sponsor. Coverage Extensions: Disciplinary Proceedings Subpoena Compliance Privacy Breach Mediation/Deductible Credit Reimbursement of Expenses Pre-Claims Assistance Crisis Management Public Relations E-Discovery Error and Educational Instruction Extended Reporting Period: If, during the Policy Period, the Sponsoring Company terminates an Agent s contract, the insurance for such Insured shall continue until the end of this Policy Period. If, during the Policy Period, an Agent retires or becomes disabled or deceased, the Agent or its legal representative may elect to purchase an Extended Reporting Period - 3 years: 200% of last annual premium - 5 years: 300% of last annual premium - Unlimited: 400% of last annual premium Claims Administrator: Lancer Claims Services 681 S. Parker St. #300 Orange, CA (800) Program Administration: CalSurance Associates California License #0B02587 Please review the attached program materials. A complete copy of the specimen policy is available by calling or by visiting SMS_HL AgentsOnly v2 CalSurance Associates California License # 0B02587 Page 2 of 6
3 EXCLUSIONS This Policy does not apply to any Claim based upon, arising out of, directly or indirectly, or in any way involving A. Any dishonest, fraudulent, criminal, malicious or purposeful act, error or omission committed by or at the direction of an Insured; however, notwithstanding the foregoing, the Insured shall be afforded a defense, if these allegations arise out of Wrongful Acts otherwise covered under this Policy, until the allegations are subsequently proven by a final adjudication or if the Insured admits such allegation. In such event, the Insured shall reimburse the Insurer for all Claims Expenses incurred by the Insurer. B. Any Claim brought or maintained, directly or indirectly, by or on behalf of any: 1) Insured; however this Exclusion shall not apply to any alleged Wrongful Termination; 2) Insurer or Broker-Dealer; 3) Insurance agent or broker; 4) Entity that is not a client of an Insured; however, this Exclusion shall not apply to any Claim brought by an entity who is an alleged beneficiary, heir, executor or administrator of a deceased client of an Insured; 5) Any entity which an Insured owns, operates, controls or manages; or 6) Any governmental or quasi-governmental entity, or Self- Regulatory Organization including, but not limited to, any state or federal insurance or securities commission or agency, or the Financial Industry Regulatory Authority or the Securities and Exchange Commission,; however, this Exclusion shall not apply to a Claim brought by or on behalf of such entity in its capacity as a client of an Insured or to the extent it is inconsistent with Section II.A.EXTENSIONS OF COVERAGE. C. Any fact, circumstance, or situation which has been the subject of any written notice given under any insurance policy issued by any insurer, including any policy of which this Policy is a renewal or replacement. D. Any Claim, demand, suit, litigation or other proceeding against any Insured which was pending on or existed prior to the inception of the Policy Period, or the same or substantially the same facts, circumstances or allegations which are the subject or the basis for such Claim, demand, suit, litigation or other proceeding. E. Any Wrongful Act or Interrelated Wrongful Acts first occurring before the applicable Retroactive Date, even if the Wrongful Act or Interrelated Wrongful Acts continue after the Retroactive Date. F. Any services as, or which may only be performed by, an accountant, actuary, lawyer, real estate agent/broker, property/casualty insurance agent, or third-party claims administrator. G. Any placement of a client s coverage or funds directly or indirectly with any entity which is not licensed to conduct business in the state or jurisdiction with authority to regulate such business; however, this Exclusion shall not apply to the placement of a client s coverage or funds directly or indirectly with an eligible surplus lines insurer in the state or jurisdiction with authority to regulate such business. H. Any ownership, formation, sale, servicing, operation, or administration of any insurance company, health maintenance organization, preferred provider organization, captive, risk retention group, self-insurance group/program, or purchasing group. I. Any sale, servicing, or administration of, or advice or planning with respect to, any Multiple Employer Welfare Arrangement. J. Any pension, profit sharing, health/welfare or other employee benefit plan, insurance plan or trust, sponsored by an Insured as an employer. K. Any financial inability or refusal to pay, insolvency, receivership, bankruptcy, or liquidation of any entity in which an Insured has placed or recommended to be placed, coverage or the funds of a client; however, this Exclusion shall not apply to any insurer that was rated A- or better by A.M. Best at the time of the Insured s acts. L. An Insured s inability or refusal to pay or collect premium, claim or tax monies. M. Any liability of others assumed by an Insured under any contract or agreement, unless such liability would have attached to an Insured even in the absence of such an agreement; or any guarantees or warranties. N. Any gaining of any personal profit or advantage to which an Insured is not legally entitled, or any disputes involving an Insured s fees, charges, entitlements, or other compensation. O. Any commingling or use of client funds or accounts. P. Any willful violation of the rules or regulations of the Financial Industry Regulatory Authority, Securities and Exchange Commission, Securities Act of 1933, Securities Exchange Act of 1934, Investment Company Act of 1940, or the Investment Advisors Act of 1940 and any amendments thereto, or of any state securities statute or state regulatory agency. Q. Any Security(ies). R. Any insurance or financial product owned in whole or in part by an Insured. S. Any structured settlements. T. Any bodily injury, sickness, disease, emotional distress, mental anguish, outrage, humiliation or death; or injury to or destruction of any tangible property, including loss of use thereof. U. Any discrimination, harassment, or misconduct by an Insured because of race, creed, color, age, gender, sex, sexual preference or orientation, national origin, religion, disability, handicap, marital status, or any other class protected under federal, state, local or other law; or by an employee, former employee, or job applicant, of an Insured in their capacity as such. V. Any infringement of copyright; plagiarism, piracy or misappropriation of ideas; or infringement of title, slogan, trademark, trade name, trade dress, service mark or service name; or any patent or trade secret; or any unfair competition, deceptive advertising, anticompetitive acts, restraint of trade, price fixing, or antitrust. W. 1) Promissory notes, issuer callable Certificates of Deposits, or step-up or step down Certificates of Deposits; 2) Viatical or life settlements, reverse mortgages, or any similar transaction in which the present value of a conditional contract is exchanged or sold; or 3) Tangible personal property, including but not limited to, any precious metals, gemstones, stamps, sports or other cards, antiques, jewelry, coins or other collectibles; however, this Exclusion shall not apply to gold or silver. SMS_EXCL_ v1 CalSurance Associates California License # 0B02587 Page 3 of 6
4 Agents Affiliated with Senior Market Sales, Inc. Enrollment Form - Non New York Claims Made & Reported Errors & Omissions Coverage Policy Period: September 1, 2012 to September 1, 2013 By purchasing this insurance, agents become members of the Financial Sales Professionals Purchasing Group, a group formed and operating pursuant to the Liability Risk Retention Act of 1986 (15 USC 3901 et seq.). There is no additional charge for membership. Instructions... ALL sections must be completed. Incomplete forms will take additional time to process. Please allow up to ten (10) business days for processing. Return this form along with payment to: CalSurance Associates, P.O. Box 7048, Orange, CA Coverage Questions...Call CalSurance Associates at (800) or at info@calsurance.com Certificates of Insurance...Go on-line: - Certificate Reprinting - Sponsoring Group - Senior Market Sales, Inc. Section 1 - Your Information First Name Street Address City Contact Phone Number Birthdate Section 3 - Payment - - X X (Please Print Clearly) Last Name State Fax Number X - X X Zip Code Last four (4) digits of Social Security Number Section 2- Effective Date and Amount Due Effective Date of Coverage - - NOTICE: Effective date of coverage cannot be prior to your date of contract with the sponsor and cannot be backdated to a prior month. Limit of Liability: (Select One) Coverage Level*: (Select One) Products Covered*: (Select One) per Claim / Aggregate per Claim / Aggregate Level A: (Products sold through Senior Market Sales, Inc.) Level B: (Products sold through all companies) Basic: (A&H, FInal Expense, and Long Term Care) Basic Plus: (Also includes fixed life and fixed annuities) *Please refer to the Outline of Coverage for coverage level details. Check or or Money Order: Check made payable to CalSurance Associates for the total amount due. Other payment options including installments by credit card or ACH (Debit to Checking) are available online at: Section 4-Warranty Statement (Signature Required) - - Calculate Total Amount Due R CalSurance NOTICE: I must be a currently affiliated with Senior Market Sales, Inc. to be eligible for this program. Otherwise, I will not be considered an Insured under this program and no claims made against me will be covered. I warrant that I am currently contracted with Senior Market Sales, Inc. NOTICE: This is a claims made and reported policy. If I have knowledge of any claim or incident that could give rise to a claim under the proposed policy and any claim or action arises therefrom, it is excluded from coverage for which this form applies. A potential gap in coverage may occur if I elect an effective date that is not continuous with my prior expiration date, and may result in the denial of a claim. I warrant that I have no knowledge of any pending claim or incident that could give rise to a claim under the proposed policy. I acknowledge that the specimen policy and program materials have been delivered to me via and I have reviewed these documents prior to enrolling in the program. I warrant and represent that the above statements are true and that I have not suppressed or misstated any material facts and I agree that this application shall be the basis of the contract with the company issuing the policy. It is understood that completion of this application does not bind the company to issue or the applicant to purchase the insurance. I have read the above notices and warranties and agree. $ Premium for Selected Options (See Premium Chart) + $35 Admin Fee + Total Amount Due Signature (Required) SrMktSales-NON-NY-App v5 CalSurance Associates Today s Date California License # 0B02587 Page 4 of 6
5 Premium Chart E&O Program For Agents Affiliated with Senior Market Sales, Inc. Program Effective September 1, 2012 to September 1, 2013 Limit of Liability (per Claim/ Aggregate Effective Month Level A Products of Senior Market Sales, Inc. Only Level B Products of Senior Market Sales, Inc. & Other Companies Basic (Accident & Health, Final Expense and Long Term Care) Basic Plus (Also includes Fixed Life and Fixed Annuities) Basic (Accident & Health, Final Expense and Long Term Care) Basic Plus (Also includes Fixed Life and Fixed Annuities) September, 2012 $350 $415 $405 $475 $400 $465 $455 $525 October, 2012 $322 $381 $372 $437 $368 $427 $418 $482 November, 2012 $292 $346 $338 $396 $334 $388 $380 $438 December, 2012 $263 $312 $305 $357 $301 $350 $342 $395 January, 2013 $234 $277 $270 $317 $267 $310 $304 $350 February, 2013 $204 $242 $236 $276 $233 $271 $265 $306 March, 2013 $177 $210 $205 $240 $202 $235 $230 $265 April, 2013 $147 $174 $170 $200 $168 $195 $191 $220 May, 2013 $118 $140 $137 $161 $135 $157 $154 $177 June, 2013 $ 89 $105 $ 103 $120 $101 $118 $ 115 $133 July, 2013 $ 60 $ 71 $ 69 $ 81 $ 68 $ 80 $ 78 $ 90 August, 2013 $ 30 $ 36 $ 35 $ 41 $ 34 $ 40 $ 39 $ 45 Above rates do not include the non-refundable $35 administrative fee nor the state surplus lines tax for New York agents. SrMarketSalesMarix v2 CalSurance Associates California License # 0B02587 Page 5 of 6
6 AUTHORIZATION AGREEMENT FOR PRE-AUTHORIZED DEBITS Senior Market Sales Errors & Omissions Coverage September 1, 2012 to September 1, 2013 FAX THIS COMPLETED FORM TO I (we) hereby authorize CalSurance Associates, hereinafter called COMPANY, to initiate electronic debit entries or effect a change by any other commercially accepted method, to my (our) checking account indicated below at the financial institution named below, hereinafter called Depository. This authority is to remain in full force and effect until COMPANY and Depository have each received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and Depository a reasonable opportunity to act on it, but no less than three (3) business days before the next scheduled date. I (we) agree that if premiums are not paid on the dates specified on the Payment Change Form, or in the event the withdrawals are dishonored, coverage shall terminate upon ten (10) days Notice of Cancellation. Once cancelled, the agent will be eligible for reinstatement of coverage ONE time only within 10 days of the effective date of cancellation by paying appropriate premium in addition to a declined/non-sufficient fund fee of $ Name of Financial Institution: Address or Branch: City: State: Zip: Transit / ABA Number: Account Number: This authority is to remain in full force and effect until COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford COMPANY and Financial Institution a reasonable opportunity to act on it, but no less than three (3) days before scheduled installment date. Name: Signature: Signature: (If account requires two signatures) Date: Please attach a voided check, or photocopy thereof applicable to the above account in this space (enrollment will not be processed without it). September SrMktSalesACH v1 CalSurance Associates California License # 0B02587 Page 6 of 6
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