FRESNO COUNTY EMPLOYEES RETIREMENT ASSOCIATION PRIMARY FIDUCIARY LIABILITY INSURANCE PROPOSAL

Size: px
Start display at page:

Download "FRESNO COUNTY EMPLOYEES RETIREMENT ASSOCIATION PRIMARY FIDUCIARY LIABILITY INSURANCE PROPOSAL"

Transcription

1 INSURANCE COMPANY AIG (National Union Fire Insurance Company of Pittsburg, PA AIG (National Union Fire Insurance Company of Pittsburg, PA A.M. BEST S RATING A+, Superior; Financial Size Category XV ($2,000,000,000 or more) A+, Superior; Financial Size Category XV ($2,000,000,000 or more) as of February 14, 2008 STANDARD & POORS RATING AA+ (Very Strong) AA+ (Very Strong) as March 30, 2005 CALIFORNIA STATUS Admitted Admitted POLICY PERIOD April 30, 2007 to April 30, 2008 April 30, 2008 to April 30, 2009 CONTINUNITY DATE April 30, 2004 April 30, 2004 COVERAGE PROVIDED Primary Fiduciary Liability for Public Employers policy on CLAIMS MADE FORM. Coverage is provided for: Breach of fiduciary duty Counseling employees on an insured Plan Same as Present Page 1 of 6

2 Providing interpretations on an insured Plan Handling records on an insured Plan Activities effecting enrollment, termination or cancellation of participants or beneficiaries on an insured Plan INSURED PLANS Fresno County Employees Retirement Association Fresno County Employees Retirement Association LIMITS $10,000,000 Annual Aggregate including defense costs, charges and expenses $ 100,000 Sublimit of Liability for CAP Penalties $10,000,000 Annual Aggregate including defense costs, charges and expenses $ 100,000 Sublimit of Liability for CAP Penalties Page 2 of 6

3 ENDORSEMENTS Named Plan Endorsement: Fresno County Employee s Retirement Association CA Cancellation/Non-Renewal Endorsement Public Employer-Plan Trustee Endorsement Retention Endorsement: $100,000 Appendix A Employee Benefit Plan Fiduciary Liability Panel Counsel Terrorism Exclusion Waiver of Recourse (if purchased) OFAC Endorsement Forms Index Endorsement HIPAA Extension $25,000 Specific Claims Exclusion: County of Fresno v. Board of Retirement of the County of Fresno; Fresno County Employees Retirement Association Case No. 03 CE CG 01569; Government Claim of Linzie L. Danie Claim #086FRT NR / #086-FR-T RG and all related matters Specific Claim Exclusion: Claim # Letter dated 04/29/05; Claim # Alberto Mestas Carlos Same as Present Page 3 of 6

4 DEDUCTIBLE $100,000 Per claim including defense costs $100,000 Per claim including defense costs PREMIUM $114,343 $ 250 $114,765 Annual Premium (10) Waivers of Recourse Total Premium $114,859 $118,305 Annual premium without TRIA* Annual premium with TRIA* *Does not include Waivers of Recourse DISCOVERY PERIOD EXTENSION OPTION 1 (for policy period from 4/30/2008 to 5/31/2009) Twelve months available for 75% additional premium if the Company or the Insured terminates or cancels Aggregate Limit Sublimit for CAP Penalties Premium with TRIA* Premium without TRIA* $10,000,000 $100,000 $128,357 $124,619 Twelve months available for 75% additional premium if the Company or the Insured terminates or cancels QUOTE VALIED UNTIL Not applicable April 30, 2008 BINDING CONDITIONS: No longer applicable Written request to bind coverage Page 4 of 6

5 Completed, signed and dated Policyholder Disclosure indicating decision to accept or reject Terrorism Attached Notification of acceptance of Waiver of Recourse with number of trustees and names Please note that the information above is required prior to binding coverage. The company is not required to bind coverage prior to receipt, review and underwriting approval of the above information. However, if the Company does bind coverage prior to such approval, it shall be for a temporary period of not more then 30 days. Such temporary binding of coverage shall be null and void ab initio ( from the beginning ) if they have not received reviewed and approved in writing such materials within 30 days from the effective date of the temporary binder. This 30 day temporary conditional binder may be extended only in writing by the Insurer. Payment of premium shall not operate to extend the binding period or nullify the automatic voiding as described above. This indication is strictly conditional upon no material change in the risk occurring between the date of this proposal and the inception date of the proposed policy. In the event of such change in risk, the Insurer may in its sole discretion, whether or not this indication has been already accepted by the Insured, modify and/or withdraw this indication. Page 5 of 6

6 DATE PREPARED April 28, 2008 BROKER ALLIANT INSUANCE SERVICES, INC. Newport Beach CA Ralph Hurst, Vice Chairman Valentin Torres, Account Representative Sunny Schrimsher, Account Representative Commissions are customarily paid by the insurance carriers to their agents and to brokers as a percentage of premiums. In addition to the commissions that Driver Alliant receives, its related entity, Alliant Specialty Insurance Services, Inc. ("ASIS") may receive compensation from Driver Alliant and/or the carrier for providing underwriting services. The financial impact of the compensation received by ASIS is a cost included in the premium. Additionally, the related entities of Driver Signature Services and/or Strategic HR may receive compensation from Driver Alliant and/or the carrier for providing designated, value-added services. Services contracted for by the client directly will be invoiced accordingly. Otherwise, services will be provided at the expense of Driver Alliant and/or the carrier. Further information is available upon written request directed to: Driver Alliant Insurance Services, Attention: Chief Operating Officer, 1620 Fifth Avenue, San Diego, CA Analyzing insurers over-all performance and financial strength is a task that requires specialized skills and in-depth technical understanding of all aspects of insurance company finances and operations. Insurance brokerages such as Driver Alliant typically rely upon rating agencies for this type of market analysis. Both A.M. Best and Standard and Poor have been industry leaders in this area for many decades, utilizing a combination of quantitative and qualitative analysis of the information available in formulating their ratings. A.M. Best has an extensive database of nearly 6,000 Life/Health, Property Casualty and International companies. You can visit them at For additional information regarding insurer financial strength ratings visit Standard and Poor s website at To learn more about companies doing business in California, visit the California Department of Insurance website at NOTE: THIS PROPOSAL IS FOR INFORMATIONAL PURPOSES ONLY AND DOES NOT AMEND, EXTEND OR ALTER THE POLICY IN ANY WAY. PLEASE REFER TO THE POLICY FORM FOR COMPLETE COVERAGE AND EXCLUSION INFORMATION. Page 6 of 6

September 23, Special Liability Insurance Program (SLIP) Allied World National Assurance Company September 29, 2008 to September 29, 2009

September 23, Special Liability Insurance Program (SLIP) Allied World National Assurance Company September 29, 2008 to September 29, 2009 DRIVER SPECIALTY GROUP September 23, 2008 Becky Van Wyk Fresno County Employees' Retirement Association as respects to Building Located at 1111 H. Street, Fresno, CA 93721 1111 H Street Fresno, CA 93721

More information

FRESNO COUNTY EMPLOYEES RETIREMENT ASSOCIATION

FRESNO COUNTY EMPLOYEES RETIREMENT ASSOCIATION FRESNO COUNTY EMPLOYEES RETIREMENT ASSOCIATION Donald C. Kendig, CPA, Retirement Administrator BOARD AGENDA LETTER DATE: June 7, 2017 TO: FROM: Board of Retirement Donald C. Kendig, CPA Retirement Administrator

More information

INFORMATIONAL REPORT

INFORMATIONAL REPORT INFORMATIONAL REPORT DATE ISSUED: July 5, 2018 REPORT NO: HCR18-069 ATTENTION: Chair and Members of the San Diego Housing Commission For the Agenda of July 13, 2018 SUBJECT: Annual Insurance Report Fiscal

More information

CERTIFICATE OF LIABILITY INSURANCE

CERTIFICATE OF LIABILITY INSURANCE 1SLIP MASTER 09A-L.pri 2-page CONTACT NAME: PHONE (A/C, No, Ext): E-MAIL ADDRESS: FAX (A/C, No): COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED

More information

Memorandum. Recommendation. Background/Discussion

Memorandum. Recommendation. Background/Discussion DATE: January 25, 2017 TO: Members, Board of Retirement FROM: Brenda Shott, Assistant CEO-Finance and Internal Operations SUBJECT: FIDUCIARY INSURANCE POLICY Recommendation Authorize Staff to bind a one

More information

21 st CENTURY GENERAL AGENCY, INC. Commercial Business Producers Agreement

21 st CENTURY GENERAL AGENCY, INC. Commercial Business Producers Agreement 21 st CENTURY GENERAL AGENCY, INC. Commercial Business Producers Agreement The parties hereto, in consideration of the mutual promises set forth herein, agree as follows Section 1 AUTHORIZATION AND AUTHORITY

More information

CALIFORNIA JPIA EARTHQUAKE & FLOOD COVERAGE DETAIL (Optional Coverage) Excess policies per Schedule of Insurers. A+, Strong Financial Security

CALIFORNIA JPIA EARTHQUAKE & FLOOD COVERAGE DETAIL (Optional Coverage) Excess policies per Schedule of Insurers. A+, Strong Financial Security EARTHQUAKE & FLOOD COVERAGE DETAIL (Optional Coverage) NAMED INSURED PRIMARY POLICY REINSURED BY: California JPIA and Participating Member Agencies Lexington Insurance Company - Primary Policy Policy #B128410009W13

More information

Property Program Manual

Property Program Manual February 2017 Prepared by: Alliant Insurance Services, Inc. 100 Pine Street, 11 th Floor San Francisco, CA 94111-5101 415-403-1400 TABLE OF CONTENTS 1. INTRODUCTION 2. CLAIMS HANDLING PROCEDURES 3. COPY

More information

AMERICAN INTERNATIONAL SPECIALTY LINES INSURANCE COMPANY 175 Water Street Group, Inc. New York, NY 10038

AMERICAN INTERNATIONAL SPECIALTY LINES INSURANCE COMPANY 175 Water Street Group, Inc. New York, NY 10038 AIG COMPANIES AIG MERGERS & ACQUISITIONS INSURANCE GROUP SELLER-SIDE R&W TEMPLATE AMERICAN INTERNATIONAL SPECIALTY LINES INSURANCE COMPANY 175 Water Street Group, Inc. New York, NY 10038 A Member Company

More information

EXECUTIVE SUMMARY HOUSING COMMISSION EXECUTIVE SUMMARY SHEET

EXECUTIVE SUMMARY HOUSING COMMISSION EXECUTIVE SUMMARY SHEET ITEM 100 DATE: March 9, 2018 EXECUTIVE SUMMARY HOUSING COMMISSION EXECUTIVE SUMMARY SHEET REPORT NO: HCR18-035 ORIGINATING DEPT: Financial Services BOARD REPORT: 2018-2019 Procurement of Property Insurance

More information

Dear Mark: Your Environmental Liability policy will be renewing shortly. Attached is our quotation for coverage.

Dear Mark: Your Environmental Liability policy will be renewing shortly. Attached is our quotation for coverage. February 3, 2017 Mark Langdorf Brevard County School Board Risk Management Services 2700 Judge Fran Jamieson Way Viera, FL 32940 Re: Environmental Liability Policy Effective: 3/24/2017 to 3/24/2019 Dear

More information

Certificate of. Insurance Information. Packet

Certificate of. Insurance Information. Packet Insurance INSURANCE Certificate of CERTIFICATE Insurance Information INFORMATION Packet PACKET INSURANCE CERTIFICATE INFORMATION PACKET Insurance Requirements The California State University has established

More information

HULL & COMPANY, INC. DBA: Hull & Company MacDuff E&S Insurance Brokers PRODUCER AGREEMENT

HULL & COMPANY, INC. DBA: Hull & Company MacDuff E&S Insurance Brokers PRODUCER AGREEMENT HULL & COMPANY, INC. DBA: Hull & Company MacDuff E&S Insurance Brokers PRODUCER AGREEMENT THIS PRODUCER AGREEMENT (this Agreement ), dated as of, 20, is made and entered into by and between Hull & Company,

More information

BROKER SERVICES AGREEMENT between Alliant Insurance Services, Inc. and Ventura County Transportation Commission

BROKER SERVICES AGREEMENT between Alliant Insurance Services, Inc. and Ventura County Transportation Commission BROKER SERVICES AGREEMENT between Alliant Insurance Services, Inc. and Ventura County Transportation Commission I. PARTIES. The PARTIES to this BROKER SERVICES AGREEMENT are Ventura County Transportation

More information

Hedge Fund Protector SM. C o v e r a g e I n s i g h t s

Hedge Fund Protector SM. C o v e r a g e I n s i g h t s Hedge Fund Protector SM C o v e r a g e I n s i g h t s The number of hedge funds has more than doubled since 2002, reaching over 8,200 in 2005. 1 The investment regulatory environment has been changing

More information

Request for Proposals (RFP) Insurance Brokerage Services for the Port of Stockton

Request for Proposals (RFP) Insurance Brokerage Services for the Port of Stockton Request for Proposals (RFP) for the Port of Stockton April 6, 2018 PROPOSAL DUE DATE: MAY 3, 2018, 4:30 p.m. INSURANCE BROKERAGE SERVICES For the Stockton Port District (DBA: Port of Stockton) The Port

More information

NOTICE. To: All Admitted Property & Casualty Insurers, Licensed Independent Insurance Adjusters, Insurance Agent/Brokers, and other Interested Parties

NOTICE. To: All Admitted Property & Casualty Insurers, Licensed Independent Insurance Adjusters, Insurance Agent/Brokers, and other Interested Parties STATE OF CALIFORNIA DEPARTMENT OF INSURANCE EXECUTIVE OFFICE 300 CAPITOL MALL, 17 TH FLOOR SACRAMENTO, CA 95814 (916) 492-3500 (916) 445-5280 (Fax) www.insurance.ca.gov Dave Jones, Insurance Commissioner

More information

National Association of Enrolled Agents Frequently Asked Questions

National Association of Enrolled Agents Frequently Asked Questions Policy Number: ME 07336209 Insurer: Interstate Fire & Casualty Company Policy Period: July 1, 2018 - July 1, 2019 National Association of Enrolled Agents Frequently Asked Questions 1. Who is Interstate

More information

Hull & Company, LLC Tampa Bay Branch PRODUCER AGREEMENT

Hull & Company, LLC Tampa Bay Branch PRODUCER AGREEMENT Hull & Company, LLC Tampa Bay Branch PRODUCER AGREEMENT THIS PRODUCER AGREEMENT (this Agreement ), dated as of, 20, is made and entered into by and between Hull & Company, LLC, a Florida corporation (

More information

NOTICE. You must be a currently contracted agent/broker of Infinity Insurance Group to be eligible for enrollment in this E&O program.

NOTICE. You must be a currently contracted agent/broker of Infinity Insurance Group to be eligible for enrollment in this E&O program. NOTICE You must be a currently contracted agent/broker of Infinity Insurance Group to be eligible for enrollment in this E&O program. If you enroll in this program and you do not have an ACTIVE contract

More information

Bind Instructions & EFT Authorization Form - Sutter Business Auto

Bind Instructions & EFT Authorization Form - Sutter Business Auto P.O. BOX 87023, YORBA LINDA, CA 92885 PHONE: 714-738-1383 213-383-5590 WWW.RMISMGA.COM Bind Instructions & EFT Authorization Form - Sutter Business Auto 1. Obtain signatures on application, UM waiver,

More information

CND Auto Policy Letter Kit

CND Auto Policy Letter Kit 0000003260 7/01/2015 CND RON WRIGHT MIKE MENATH INSURANCE, INC. 333 Village Boulevard, Suite 203 Incline Village, NV 89451-8211 Fax Number: 775-831-6235 Phone Number: 775-831-3132 CND Auto Policy Letter

More information

FINANCIAL SERVICES GUIDE

FINANCIAL SERVICES GUIDE FINANCIAL SERVICES GUIDE WWW.WILLIS.COM.AU W0365AU (2014) Willis Employee Benefits Pty Ltd ABN 68 059 019 911 AFS Licence No 233764 Date of Issue: 1 September 2014 Introduction This Financial Services

More information

Please fax or the completed information to Sam Frappalini: ( fax) or

Please fax or  the completed information to Sam Frappalini: ( fax) or Dear Broker TGI, Inc looks forward to doing business with your agency and beginning a good working relationship. Checklist Legible copy of your current broker s license Legible copy of your broker s bond

More information

Expanded Market Programs

Expanded Market Programs Expanded Market Programs Empowering you to say Yes more often! Ivantage and NEA are affiliates of Allstate, who offer Exclusive Agents access to additional products for risks outside of Allstate s market

More information

The Risk Manager s Role in Mitigating Employment Practices Liability Losses (INS005)

The Risk Manager s Role in Mitigating Employment Practices Liability Losses (INS005) The Risk Manager s Role in Mitigating Employment Practices Liability Losses (INS005) Speakers: Dean Constantine, Global Head, Employment Practices, AIG Property Casualty Kelly O Shea, Director, Risk Management,

More information

CSAC EXCESS INSURANCE AUTHORITY UNDERWRITING AND CLAIMS ADMINISTRATION STANDARDS

CSAC EXCESS INSURANCE AUTHORITY UNDERWRITING AND CLAIMS ADMINISTRATION STANDARDS Adopted: December 6, 1985 Amended: January 23, 1987 Amended: October 6, 1995 Amended: October 1, 1999 Amended: October 3, 2003 Amended: October 1, 2004 Amended: March 6, 2009 CSAC EXCESS INSURANCE AUTHORITY

More information

National Association of Enrolled Agents Frequently Asked Questions

National Association of Enrolled Agents Frequently Asked Questions Policy Number: ME07336207 Insurer: Interstate Fire & Casualty Company Policy Period: July 1, 2016 - July 1, 2017 National Association of Enrolled Agents Frequently Asked Questions 1. Who is Interstate

More information

District School Board of Pasco County

District School Board of Pasco County District School Board of Pasco County BUILDER S RISK INSURANCE RENEWAL PROPOSAL 2016-2017 Brian Cottrell Public Risk Insurance Agency P O Box 2416 Daytona Beach, FL 32115 Phone: 386-252-6176 Fax: 386-239-4049

More information

EXECUTIVE RISK REVIEW 2018

EXECUTIVE RISK REVIEW 2018 EXECUTIVE RISK REVIEW 2018 A LITTLE BACKGROUND Established in 1977; Wholly Owned Subsidiary of HMA 11/2017 Lead Team Members and Key Responsibilities: James Charlesworth, ARM, President contract risk manager

More information

FIDUCIARY LIABILITY COVERAGE PART

FIDUCIARY LIABILITY COVERAGE PART FIDUCIARY LIABILITY COVERAGE PART I. INSURING AGREEMENTS Fiduciary Liability The Insurer shall pay Loss on behalf of the Insureds resulting from a Fiduciary Claim first made against the Insureds during

More information

Bulletin No November 1, Broadway, Suite 900 Oakland, CA Fax

Bulletin No November 1, Broadway, Suite 900 Oakland, CA Fax WCIRB Bulletin Bulletin No. 2016-24 November 1, 2016 1221 Broadway, Suite 900 Oakland, CA 94612 415.777.0777 Fax 415.778.7007 www.wcirb.com wcirb@wcirb.com Impact of Assembly Bill No. 2883 on In-Force

More information

Best Practices in Fiduciary Liability

Best Practices in Fiduciary Liability Best Practices in Fiduciary Liability Laverne Wingfield, Ullico Casualty Group James Martinez, Arthur J Gallagher Timothy Bowen, Mesirow Financial Fiduciary Liability Insurance Protect the board and the

More information

SMALL GROUP MASTER CONTRACT

SMALL GROUP MASTER CONTRACT McLAREN HEALTH PLAN, INC. G-3245 Beecher Road Flint, MI 48532 SMALL GROUP MASTER CONTRACT GROUP: EFFECTIVE DATE: McLaren Health Plan, Inc. ( Plan ), a Michigan health maintenance organization, and the

More information

NEA Community Learning Center LLC Insurance Proposal

NEA Community Learning Center LLC Insurance Proposal NEA Community Learning Center LLC 2014-2015 Insurance Proposal Prepared By: Thuy Ly, Director, School Insurance California Charter Schools JPA P.O. Box 969, Weimar, CA 95736 Phone: (888) 901-0004 Fax:

More information

Reinsurance Broker Request for Proposals I. INTRODUCTION

Reinsurance Broker Request for Proposals I. INTRODUCTION Reinsurance Broker Request for Proposals I. INTRODUCTION A. BACKGROUND The Special Districts Association of Oregon (SDAO) is a non-profit association of nearly 950 special district units of local governments

More information

LIMITED PRODUCER AGREEMENT

LIMITED PRODUCER AGREEMENT LIMITED PRODUCER AGREEMENT THIS PRODUCER AGREEMENT (the Agreement ) is made as of by and between, SAFEBUILT INSURANCE SERVICES, INC., Structural Insurance Services, SIS Insurance Services, SIS Wholesale

More information

IMPORTANT NOTICE REGARDING INDIVIDUALS EXCLUDED FROM YOUR POLICY IMMEDIATE RESPONSE REQUIRED

IMPORTANT NOTICE REGARDING INDIVIDUALS EXCLUDED FROM YOUR POLICY IMMEDIATE RESPONSE REQUIRED IMPORTANT NOTICE REGARDING INDIVIDUALS EXCLUDED FROM YOUR POLICY IMMEDIATE RESPONSE REQUIRED , , Re: Notice of Change in Law Effective 1/1/17 due to AB 2883

More information

PORTFOLIO ADVISORS, INC.

PORTFOLIO ADVISORS, INC. PORTFOLIO ADVISORS, INC. INVESTMENT ADVISORY AGREEMENT We appreciate the opportunity to provide you with investment advisory services and we look forward to being of assistance. This Agreement is entered

More information

PROFESSIONAL SERVICES AGREEMENT FOR LUSARDI CREEK PIPELINE RESTORATION PROJECT FOR THE OLIVENHAIN MUNICIPAL WATER DISTRICT 18AGRXXX R-E-C-I-T-A-L-S

PROFESSIONAL SERVICES AGREEMENT FOR LUSARDI CREEK PIPELINE RESTORATION PROJECT FOR THE OLIVENHAIN MUNICIPAL WATER DISTRICT 18AGRXXX R-E-C-I-T-A-L-S PROFESSIONAL SERVICES AGREEMENT FOR LUSARDI CREEK PIPELINE RESTORATION PROJECT FOR THE OLIVENHAIN MUNICIPAL WATER DISTRICT 18AGRXXX This Agreement is entered into by and between the Olivenhain Municipal

More information

Bernards (Project Name) CCIP Insurance Manual

Bernards (Project Name) CCIP Insurance Manual Bernards (Project Name) CCIP Insurance Manual Policy Year: xxxx-xxxx Alliant Version 01 1 Table of Contents 1.1 INTRODUCTION... 3 1.2 Overview... 3 1.3 About this Manual... 4 2.0 PROJECT DIRECTORY... 5

More information

County of Riverside Human Resource Dept. Risk Management Div. Insurance Requirements In Contracts JEFFREY L. HUNTER SR RISK ANALYST

County of Riverside Human Resource Dept. Risk Management Div. Insurance Requirements In Contracts JEFFREY L. HUNTER SR RISK ANALYST County of Riverside Human Resource Dept. Risk Management Div. Insurance Requirements In Contracts JEFFREY L. HUNTER SR RISK ANALYST INSURANCE REQUIREMENTS IN CONTRACTS The County s insurance requirements

More information

Lloyd s Insurance. This Insurance is effected with certain Underwriters at Lloyd s, London.

Lloyd s Insurance. This Insurance is effected with certain Underwriters at Lloyd s, London. CERTIFICATE PROVISIONS Lloyd s Insurance This Insurance is effected with certain Underwriters at Lloyd s, London. This Certificate is issued in accordance with the limited authorization granted to the

More information

NATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT

NATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT NATIONAL INSURANCE UNDERWRITERS, LLC. AUTO PRODUCER S AGREEMENT This Agreement between National Insurance Underwriters, LLC., with principle offices located at 800 Yamato Road, Suite 100, Boca Raton, FL

More information

PRODUCER AGREEMENT PACKAGE

PRODUCER AGREEMENT PACKAGE PRODUCER AGREEMENT PACKAGE Thank you for your interest in writing business with Evolution Insurance Brokers, LC ( EIB ). Attached is a copy of our Independent Producer s Agreement ( Agreement ), which

More information

Underwriting Bulletin

Underwriting Bulletin Underwriting Bulletin To: All Colony Contract Producers Date: January 23, 2008 Re: Revised Policyholder Notices and Endorsements Associated With the Terrorism Risk Insurance Program Reauthorization Act

More information

Item B. Policy Period: «f11» to «f12» both days at 12:01 a.m. standard time at the principal address stated in Item A. SPECIMEN

Item B. Policy Period: «f11» to «f12» both days at 12:01 a.m. standard time at the principal address stated in Item A. SPECIMEN This Declaration Page is attached to and forms part of certificate provisions (Form SLC-3). Previous No. «f1» Authority Ref. No. B1216PRW1 1853 Certificate No. «f2» EXCESS LIABILITY COVERAGE FORM CLAIMS

More information

POOLED LIABILITY ASSURANCE NETWORK JOINT POWERS AUTHORITY (PLAN) MASTER PROGRAM DOCUMENT (MPD) FOR THE POOLED LIABILITY PROGRAM (PLP)

POOLED LIABILITY ASSURANCE NETWORK JOINT POWERS AUTHORITY (PLAN) MASTER PROGRAM DOCUMENT (MPD) FOR THE POOLED LIABILITY PROGRAM (PLP) POOLED LIABILITY ASSURANCE NETWORK JOINT POWERS AUTHORITY (PLAN) MASTER PROGRAM DOCUMENT (MPD) FOR THE POOLED LIABILITY PROGRAM (PLP) ARTICLE I: DEFINITIONS The following definitions apply to this MPD:

More information

APPLICATION FOR ASSET SHIELD ASSET MANAGEMENT PROTECTION POLICY

APPLICATION FOR ASSET SHIELD ASSET MANAGEMENT PROTECTION POLICY Home Office: One Nationwide Plaza Columbus, Ohio 43215 Administrative Office: 8877 North Gainey Center Drive Scottsdale, Arizona 85258 1-800-423-7675 APPLICATION FOR ASSET SHIELD ASSET MANAGEMENT PROTECTION

More information

North Carolina Insurance Underwriting Association. North Carolina Joint Underwriting Association

North Carolina Insurance Underwriting Association. North Carolina Joint Underwriting Association North Carolina Insurance Underwriting Association North Carolina Joint Underwriting Association Beach Plan FAIR Plan September, 2000 -IMPORTANT INFORMATION PLEASE RETAIN IN YOUR OFFICE- To: All Producers

More information

FIDUCIARY LIABILITY COVERAGE PART

FIDUCIARY LIABILITY COVERAGE PART FIDUCIARY LIABILITY COVERAGE PART I. INSURING AGREEMENTS Fiduciary Liability The Insurer shall pay Loss on behalf of the Insureds resulting from a Fiduciary Claim first made against the Insureds during

More information

Rating Tool Checklist

Rating Tool Checklist Rating Tool Checklist REQUIRED SUBMISSION DOCUMENTATION n Rating Tool Submission Form* n Application for Group Insurance* (PPO Dental, Life and Disability, Vision. These forms may vary by state.) n DHMO

More information

For Not-For-Profit Organizations

For Not-For-Profit Organizations For Not-For-Profit Organizations (Inclusive of Directors & Officers Liability, Employment Practices Liability, Fiduciary Liability and Crime & Fidelity) INSURANCE APPLICATION NOTICE: APPLICABLE TO ALL

More information

ARTISAN CONTRACTORS PROGRAM

ARTISAN CONTRACTORS PROGRAM Offered through: PO Box 747 Tustin CA 92781 714-389-2460 FAX (714) 783-3291 Edition 05/01/2005 TABLE OF CONTENTS PAGE Program Summary 1 Part I. Scope of Coverage 1 Part II. General Rules 1 A. Policy Term

More information

R-T SPECIALTY, LLC Transit Road Depew, NY (716) ext. Ext 4837 Fax: (716)

R-T SPECIALTY, LLC Transit Road Depew, NY (716) ext. Ext 4837 Fax: (716) R-T SPECIALTY, LLC 6450 Transit Road Depew, NY 14043 (716) 856-3065 ext. Ext 4837 Fax: (716) 856-8057 Enclosed you will find an admitted General Liability/Liquor Liability Special Event quote for North

More information

G. J. Sullivan Co. Insurance Services Sullivan Brokers Wholesale Insurance Solutions PRODUCER AGREEMENT

G. J. Sullivan Co. Insurance Services Sullivan Brokers Wholesale Insurance Solutions PRODUCER AGREEMENT G. J. Sullivan Co. Insurance Services Sullivan Brokers Wholesale Insurance Solutions PRODUCER AGREEMENT Please provide the following required documents: Copy of Producer s License Signed Producer Agreement

More information

SAN DIEGO CITY EMPLOYEES' RETIREMENT SYSTEM REQUEST FOR PROPOSAL (RFP) FOR GENERAL INVESTMENT CONSULTANT

SAN DIEGO CITY EMPLOYEES' RETIREMENT SYSTEM REQUEST FOR PROPOSAL (RFP) FOR GENERAL INVESTMENT CONSULTANT SAN DIEGO CITY EMPLOYEES' RETIREMENT SYSTEM REQUEST FOR PROPOSAL (RFP) FOR GENERAL INVESTMENT CONSULTANT SAN DIEGO CITY EMPLOYEES RETIREMENT SYSTEM GENERAL INVESTMENT CONSULTANT RFP SEPTEMBER 2014 Table

More information

IMPORTANT NOTICE REGARDING INDIVIDUALS EXCLUDED FROM YOUR POLICY IMMEDIATE RESPONSE REQUIRED <Date>

IMPORTANT NOTICE REGARDING INDIVIDUALS EXCLUDED FROM YOUR POLICY IMMEDIATE RESPONSE REQUIRED <Date> IMPORTANT NOTICE REGARDING INDIVIDUALS EXCLUDED FROM YOUR POLICY IMMEDIATE RESPONSE REQUIRED , , Re: Notice of Change in Law Effective 1/1/17 due to AB 2883

More information

ON-CALL CIVIL ENGINEERING CONSULTING SERVICES AGREEMENT BETWEEN THE CITY OF PITTSBURG AND [NAME OF CONSULTANT]

ON-CALL CIVIL ENGINEERING CONSULTING SERVICES AGREEMENT BETWEEN THE CITY OF PITTSBURG AND [NAME OF CONSULTANT] ON-CALL CIVIL ENGINEERING CONSULTING SERVICES AGREEMENT BETWEEN THE CITY OF PITTSBURG AND [NAME OF CONSULTANT] THIS Agreement ( Agreement ) for consulting services is made by and between the City of Pittsburg

More information

CENTRAL SAN JOAQUIN VALLEY RISK MANAGEMENT AUTHORITY POOLED AUTO PHYSICAL DAMAGE PROGRAM MASTER PLAN DOCUMENT AMENDED JULY 1, 2001

CENTRAL SAN JOAQUIN VALLEY RISK MANAGEMENT AUTHORITY POOLED AUTO PHYSICAL DAMAGE PROGRAM MASTER PLAN DOCUMENT AMENDED JULY 1, 2001 POOLED AUTO PHYSICAL DAMAGE PROGRAM AMENDED JULY 1, 2001 FOR THE POOLED AUTO PHYSICAL DAMAGE PROGRAM TABLE OF CONTENTS ARTICLE I - GENERAL... 1 A. AUTHORITY... 1 B. PURPOSE... 1 C. WHO MAY PARTICIPATE...

More information

EXCESS FIDUCIARY LIABILITY INSURANCE FOLLOWING FORM POLICY CERTIFICATE

EXCESS FIDUCIARY LIABILITY INSURANCE FOLLOWING FORM POLICY CERTIFICATE SOLIDARITY PROTECTION GROUP a voluntary membership organization operating pursuant to the Liability Risk Retention Act of 1986 and whose principal office is: 4323 Warren Street, NW, Washington, DC 20016-2437

More information

Aircraft Hull & Liability Insurance Proposal for:

Aircraft Hull & Liability Insurance Proposal for: Aircraft Hull & Liability Insurance Proposal for: Fort Bend County, Texas 301 Jackson Street Suite 224 Richmond, TX 77469 September 17, 2016 - September 17, 2017 Presented: 9/6/2016 Presented by: Paul

More information

Colusa Veterans Hall Bathrooms and Kitchen Remodel Contract

Colusa Veterans Hall Bathrooms and Kitchen Remodel Contract This services contract to remodel the Colusa Veterans Hall bathrooms and kitchen ( Contract ) is between the County of Colusa ( County ), a political subdivision of the State of California and ( Contractor

More information

CITY OF LOS ANGELES REQUEST FOR QUALIFICATIONS RISK MANAGEMENT CONSULTANT SERVICES

CITY OF LOS ANGELES REQUEST FOR QUALIFICATIONS RISK MANAGEMENT CONSULTANT SERVICES CITY OF LOS ANGELES REQUEST FOR QUALIFICATIONS RISK MANAGEMENT CONSULTANT SERVICES MAY 31, 2017 1 I. INTRODUCTION AND BACKGROUND 1. Invitation The City of Los Angeles is seeking qualified consultants to

More information

I GENERAL INFORMATION

I GENERAL INFORMATION PEST CONTROL PROGRAM EMPLOYMENT PRACTICES LIABILITY INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS-MADE POLICY. PLEASE READ YOUR POLICY CAREFULLY Applicant may qualify for a QUICK QUOTE by completing

More information

Sales Vice President for North American Company since 2014 Specializes in broker-dealer market Dedicated to helping independent agencies grow their

Sales Vice President for North American Company since 2014 Specializes in broker-dealer market Dedicated to helping independent agencies grow their Sales Vice President for North American Company since 2014 Specializes in broker-dealer market Dedicated to helping independent agencies grow their business North American Company for Life & Health Insurance

More information

CROOK COUNTY SCHOOL DISTRICT PRINEVILLE, OREGON REQUEST FOR PROPOSALS (RFP) INSURANCE AGENT OF RECORD

CROOK COUNTY SCHOOL DISTRICT PRINEVILLE, OREGON REQUEST FOR PROPOSALS (RFP) INSURANCE AGENT OF RECORD CROOK COUNTY SCHOOL DISTRICT PRINEVILLE, OREGON REQUEST FOR PROPOSALS (RFP) INSURANCE AGENT OF RECORD Proposals Due by 2:00 p.m., Friday, March 22, 2013 Notice is hereby given that Crook County School

More information

REQUEST FOR QUALIFICATIONS/PROPOSALS CHESAPEAKE COLLEGE (RFQ/RFP) INSURANCE BROKER SERVICES FOR PROPERTY AND CASUALTY PROGRAM

REQUEST FOR QUALIFICATIONS/PROPOSALS CHESAPEAKE COLLEGE (RFQ/RFP) INSURANCE BROKER SERVICES FOR PROPERTY AND CASUALTY PROGRAM REQUEST FOR QUALIFICATIONS/PROPOSALS CHESAPEAKE COLLEGE (RFQ/RFP) INSURANCE BROKER SERVICES FOR PROPERTY AND CASUALTY PROGRAM Submit Sealed Proposals/Qualifications To: Karen Smith Director of Budget and

More information

RETIREMENT PLAN INVESTMENT MANAGEMENT AGREEMENT TRINITY PORTFOLIO ADVISORS LLC

RETIREMENT PLAN INVESTMENT MANAGEMENT AGREEMENT TRINITY PORTFOLIO ADVISORS LLC vs.4 RETIREMENT PLAN INVESTMENT MANAGEMENT AGREEMENT TRINITY PORTFOLIO ADVISORS LLC Name of Plan: Name of Employer: Effective Date: This Retirement Plan Investment Management Agreement ( Agreement ) is

More information

SELECT PARTNER FHA REQUEST / DECLINE with EXHIBIT E. Company Name

SELECT PARTNER FHA REQUEST / DECLINE with EXHIBIT E. Company Name SELECT PARTNER FHA REQUEST / DECLINE with EXHIBIT E Company Name Is company requesting FHA Principal / Agent Relationship at this time? Yes No If No, this is the only required page. Please sign and return.

More information

The Insurer and the Insureds agree as follows, in consideration of the payment of the premium and in reliance upon the Application:

The Insurer and the Insureds agree as follows, in consideration of the payment of the premium and in reliance upon the Application: EXCESS INSURANCE POLICY NOTICE: THIS IS A CLAIMS MADE POLICY AND, SUBJECT TO ITS PROVISIONS, APPLIES ONLY TO ANY CLAIM FIRST MADE AGAINST THE INSUREDS DURING THE POLICY PERIOD. NO COVERAGE EXISTS FOR CLAIMS

More information

REQUEST FOR PROPOSALS:

REQUEST FOR PROPOSALS: REQUEST FOR PROPOSALS: The Lawrence County Schools Council of Government (C.O.G) is seeking proposals from benefits consulting firms to provide on-going assistance in benefit plan selection, cost effectiveness,

More information

THE OREGON FIRE DISTRICT DIRECTORS ASSOCIATION LENGTH OF SERVICE AWARD PLAN FOR VOLUNTEERS PLAN DOCUMENT

THE OREGON FIRE DISTRICT DIRECTORS ASSOCIATION LENGTH OF SERVICE AWARD PLAN FOR VOLUNTEERS PLAN DOCUMENT THE OREGON FIRE DISTRICT DIRECTORS ASSOCIATION LENGTH OF SERVICE AWARD PLAN FOR VOLUNTEERS PLAN DOCUMENT THE OREGON FIRE DISTRICT DIRECTORS ASSOCIATION LENGTH OF SERVICE AWARD PLAN FOR VOLUNTEERS PLAN

More information

Provide Insurance Broker/Agent/Consulting Services for Property and Casualty Program Exhibits

Provide Insurance Broker/Agent/Consulting Services for Property and Casualty Program Exhibits Provide Insurance Broker/Agent/Consulting Services for Exhibit No. 1: Scope of Work The AGENCY shall be state licensed, experienced, capable, and associated with a customer service focused firm. The AGENCYshall

More information

BROKERAGE AGREEMENT. This Brokerage Agreement (the Agreement ) is made and entered into by and between

BROKERAGE AGREEMENT. This Brokerage Agreement (the Agreement ) is made and entered into by and between BROKERAGE AGREEMENT This Brokerage Agreement (the Agreement ) is made and entered into by and between Broker Name & Address: (the Broker ) and P. E. Brokerage 105 Montgomery Ave PO Box 249 Montgomeryville,

More information

BINDER BILL-EOC ALL TERMS, PROVISIONS, CLAUSES AND EXCLUSIONS OF THE POLICY NOTED ABOVE ARE AS EXPIRING UNLESS OTHERWISE INDICATED.

BINDER BILL-EOC ALL TERMS, PROVISIONS, CLAUSES AND EXCLUSIONS OF THE POLICY NOTED ABOVE ARE AS EXPIRING UNLESS OTHERWISE INDICATED. 11575 Great Oaks Way, Suite 200 Alpharetta, GA 30022 Telephone (678) 795-4000 Facsimile (404) 264-6840 May 31, 2018 Alison Kelly Maritime Program Group 1709 Mt Vernon Rd Ste A Atlanta, GA 30338 Subject:

More information

EXCESS INSURANCE POLICY

EXCESS INSURANCE POLICY EXCESS INSURANCE POLICY In consideration of the payment of the premium and in reliance on all statements made and information furnished to Continental Casualty Company (hereinafter called the "Insurer"),

More information

(City) (State) (Zip) Description of Operations

(City) (State) (Zip) Description of Operations DESIGNED PROTECTION APPLICATION FOR AGENTS AND BROKERS ERRORS AND OMISSIONS LIABILITY INSURANCE (Claims Made or Claims Made and Reported Basis) If space is insufficient to answer any question fully, attach

More information

Insurance Proposal for Bronze Leaf Condominium Association

Insurance Proposal for Bronze Leaf Condominium Association Insurance Proposal for Bronze Leaf Condominium Association Presented by HUB International Mountain States Limited Producer: Blaine D. Martin, CIC Account Manager: Jamie M. Roe, CIC, AIS Date: December

More information

3. Producer agrees that any materials furnished by Pro General shall always remain the property of Pro General and shall be returned upon demand.

3. Producer agrees that any materials furnished by Pro General shall always remain the property of Pro General and shall be returned upon demand. This producer s agreement (the Agreement ) made this day of, 20 by and between Pro General Insurance Solutions, Inc. (hereinafter called Pro General ) and DBA, an insurance agency, (hereinafter called

More information

ABC 401(k) Plan. Benchmark Fee Report. May 19, Report created by: James Jones Advisors Inc. (410)

ABC 401(k) Plan. Benchmark Fee Report. May 19, Report created by: James Jones Advisors Inc. (410) May 19, 2017 Report created by: James Jones Advisors Inc. (410) 296-1000 Are Your Plan s Fees Reasonable? Introduction Fees and expenses associated with the management of a qualified retirement plan have

More information

Please fax completed forms to New Agent Appointments fax# or send by

Please fax completed forms to New Agent Appointments fax# or send by Please fax completed forms to New Agent Appointments fax# 1-800-275-3194 or send by email newagent@combinedgroup.com For questions regarding the appointment forms please call Bobbie Hayes @ 214-295-1651

More information

PROPOSAL FOR GENERAL PARTNERS LIABILITY INSURANCE INCLUDING PARTNERSHIP REIMBURSEMENT

PROPOSAL FOR GENERAL PARTNERS LIABILITY INSURANCE INCLUDING PARTNERSHIP REIMBURSEMENT U.S. SPECIALTY INSURANCE COMPANY HOUSTON CASUALTY COMPANY 13403 Northwest Freeway Houston, Texas 77040 PROPOSAL FOR GENERAL PARTNERS LIABILITY INSURANCE INCLUDING PARTNERSHIP REIMBURSEMENT NOTICE: THIS

More information

BROKER PROFILE. Name of Agency/Broker: Headquarters Location Street Address: Mailing Address. Main Contact for Agency:

BROKER PROFILE. Name of Agency/Broker: Headquarters Location Street Address: Mailing Address. Main Contact for Agency: BROKER PROFILE This form is used only if we bind coverage. It is due within 15 days after you receive notification of our intent to provide coverage. You may submit business for review and quotation without

More information

CITY OF LIVERMORE BID #4050 FOR: FIRE AND BURGLAR ALARM MONITORING NOTICE TO BIDDERS

CITY OF LIVERMORE BID #4050 FOR: FIRE AND BURGLAR ALARM MONITORING NOTICE TO BIDDERS NOTICE TO BIDDERS Notice is hereby given that the City of Livermore invites sealed bids for FIRE AND BURGLAR ALARM MONITORING SERVICES IN CITY OWNED BUILDINGS. Each bid shall be in accordance with the

More information

Thank you for your interest in becoming a broker for the Counter Products offered through Sonoran National!

Thank you for your interest in becoming a broker for the Counter Products offered through Sonoran National! BROKER PACKET Thank you for your interest in becoming a broker for the Counter Products offered through Sonoran National! Once we receive the completed Broker Questionnaire, along with a copy of your current

More information

1. Company Name: Full Legal Name of Company. 2. Street Address: Mailing Address: (if different) 3. City, State, Zip:

1. Company Name: Full Legal Name of Company. 2. Street Address: Mailing Address: (if different) 3. City, State, Zip: Texas EMPLOYER PARTICIPATION AGREEMENT/APPLICATION Home Office Use Only Group Number: Instructions for completing this agreement: 1) The employer or employer representative and agent must sign and date

More information

INSURANCE BROKER/CONSULTANT SERVICES RFP

INSURANCE BROKER/CONSULTANT SERVICES RFP MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT MARICOPA INTEGRATED HEALTH SYSTEM TO THE REQUEST FOR PROPOSALS FOR COVER SHEET POSTED 1-14-2019 BY SIGNING AND RETURNING THIS COVER SHEET, I CERTIFY RECEIPT

More information

EMPLOYER GROUP ENROLLMENT APPLICATION

EMPLOYER GROUP ENROLLMENT APPLICATION EMPLOYER GROUP ENROLLMENT APPLICATION INSTRUCTIONS: Please complete the entire application. Please print using black ink. Section 1 Employer Demographics Type of Application: q New Group q Change to Existing

More information

Insurance Services Professional Liability Insurance Application

Insurance Services Professional Liability Insurance Application Insurance Services Professional Liability Insurance Application CLAIMS MADE WARNING FOR APPLICATION: This Application is for a Claims Made and Reported Policy, relating to claims made against the Insureds

More information

Texas FAIR Plan Producer Requirements and Performance Standards

Texas FAIR Plan Producer Requirements and Performance Standards Texas FAIR Plan Producer Requirements and Performance Standards John W. Polak, CPCU 2002 The following Texas FAIR Plan Association ("Association") requirements and producer performance standards ("Requirements

More information

Please Send Correspondence To: Answered all applicable questions? P.O. Box 19032, Green Bay, WI Selected a method of payment?

Please Send Correspondence To: Answered all applicable questions? P.O. Box 19032, Green Bay, WI Selected a method of payment? Employer Application Alternate Funding Employer Data Employer Tax ID No. All Savers Have you: Signed all forms necessary for health plan application? Please Send Correspondence To: Answered all applicable

More information

THIS IS AN APPLICATION FOR A CLAIMS MADE POLICY

THIS IS AN APPLICATION FOR A CLAIMS MADE POLICY THIS IS AN APPLICATION FOR A CLAIMS MADE POLICY Travelers SelectOne SM for Investment Advisers and Funds Application IMPORTANT NOTE: THE POLICY FOR WHICH APPLICATION IS MADE, IF ISSUED, WILL BE ON A CLAIMS

More information

The Non Profit Wrap New Business Application

The Non Profit Wrap New Business Application The Non Profit Wrap New Business Application Application for All Coverage Parts NOTICE: THE WRAP LIABILITY COVERAGE PARTS FOR WHICH APPLICATION IS MADE APPLY, SUBJECT TO THEIR RESPECTIVE TERMS, ONLY TO

More information

Bulletin No November 14, Broadway, Suite 900 Oakland, CA Fax

Bulletin No November 14, Broadway, Suite 900 Oakland, CA Fax WCIRB Bulletin Bulletin No. 2017-26 November 14, 2017 1221 Broadway, Suite 900 Oakland, CA 94612 415.777.0777 Fax 415.778.7007 www.wcirb.com wcirb@wcirb.com California Department of Insurance Notice Regarding

More information

TIME INSURANCE COMPANY EMPLOYER STOP LOSS APPLICATION for Assurant Self-Funded Program

TIME INSURANCE COMPANY EMPLOYER STOP LOSS APPLICATION for Assurant Self-Funded Program TIME INSURANCE COMPANY EMPLOYER STOP LOSS APPLICATION for Assurant Self-Funded Program Instructions for completing this agreement: 1) The employer or employer representative must complete the entire Application

More information

STATE NATIONAL INSURANCE COMPANY, INC.

STATE NATIONAL INSURANCE COMPANY, INC. INSURANCE APPLICATION STATE NATIONAL INSURANCE COMPANY, INC. APPLICATION DETAIL Effective / Expiration Date Policy Number Date [MM/DD/YYYY] [MM/DD/YYYY] 12:01 AM Standard Time at the residence premises

More information

Jacksonville Police & Fire Pension Fund

Jacksonville Police & Fire Pension Fund CECIL W. POWELL & COMPANY Insurance, International Financial Planning and Surety INSURANCE PROPOSAL PREPARED FOR: Jacksonville Police & Fire Pension Fund Presented by: Russell D. Grice Senior Account Executive

More information

DECLARATIONS. HISCOX INSURANCE COMPANY INC. (A Stock Company) 104 South Michigan Avenue, Suite 600, Chicago, IL (646)

DECLARATIONS. HISCOX INSURANCE COMPANY INC. (A Stock Company) 104 South Michigan Avenue, Suite 600, Chicago, IL (646) DECLARATIONS HISCOX INSURANCE COMPANY INC. (A Stock Company) 104 South Michigan Avenue, Suite 600, Chicago, IL 60603 (646) 452-2353 NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE

More information

Information Paper Business Administration Committee Annual Operational Insurance Policy Renewals. October 2014

Information Paper Business Administration Committee Annual Operational Insurance Policy Renewals. October 2014 M E T R O P O L I T A N W A S H I N G T O N A I R P O R T S A U T H O R I T Y Information Paper Business Administration Committee Annual Operational Insurance Policy Renewals October 2014 M E T R O P O

More information