Mid-Term Enrollment Form Claims Made & Reported Errors & Omissions Policy Period: August 1, 2014 to August 1, 2015 R CalSurance 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 92863-7048 Questions...Call CalSurance Associates at (866) 893-1097 or email at info@calsurance.com Certificates of Insurance...Go online: www.calsurance.com - Certificate Reprint - Sponsoring Group - Penn Mutual - Name and Agent Number Section 1 - Your Information (Please Print Clearly) First Name Business Address City State Daytime Phone Number E-mail Agent Number Section 2 - Eligibility Zip Code Last Name - - - - Date of Birth (MM-DD-YYYY) 1. Is your annual revenue greater than $250,000 per year? Yes No If your revenue exceeds $250,000 per year you are not eligible for this program. 2. Have you been the subject of disciplinary action by any regulatory or insurance authority? Yes No 3. Has any policy or application for E&O insurance or reinsurance on your behalf been declined, cancelled or renewal refused within the last five (5) years? Yes No 4. Have any E&O claims been made against you within the last ten (10) years? Yes No 5. Are you aware of any circumstances which may reasonably be expected to give rise to any E&O claims being made against you? 6. Please list any professional services and/or designations used with your clients other than as a life, accident and health insurance agent, or notary public (i.e.; registered representative, financial planner, TPA, attorney, CPA, actuary, P&C agent) 7. Do you carry E&O coverage* for each of the professional services or designations listed above? Yes No 8. If you answered no, please list any professional services or designations for which you do not carry E&O coverage. Section 3 - Effective Date and Limit Options Effective Date of - - Notice: Effective date of coverage cannot be prior to your date of contract with the Notice: sponsor Effective and cannot date be of backdated coverage to cannot a prior be month. prior to your date of contract with the sponsor and cannot be backdated to a prior month. Please refer to the Outline of for coverage level details. Option Standard: Life & Health $ Level 2: Standard + Fixed & Indexed Annuities $ Accident (Disability) Insurance Endorsement $ Amount Due: $ Limits of Liability: Section 4 - Payment $ 1,000,000 Each Claim $ 2,000,000 Aggregate Each Agent $20,000,000 Policy Aggregate Enter Premium from Premium Matrix (Billing Through CalSurance Associates, A Division of Brown & Brown Program Insurance Services, Inc.) Payment in Full by Check: Check made payable to CalSurance Associates for the full premium. Mail to: CalSurance Associates, P.O. Box 7048 Orange, CA 92863-7048 NOTE: For alternative payment options, please enroll online at: www.calsurance.com/pmllifebrokers Section 5 - Notices and Warranties NOTICE: I must be a currently contracted independent producer with Penn Mutual not registered with HTK or any other broker/dealer 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, and any amounts paid by me will be returned. I warrant that I am currently contracted with Penn Mutual. 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 www.calsurance.com/pmllifebrokers 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. *The E&O policy to which you are applying does NOT provide coverage for professional services other than as a life, accident and health insurance agent, or notary public. Producer s Signature (Required) CalSurance Associates A Division of Brown & Brown Program Insurance Services, Inc. PennIndBrokersApp_MidTerm_09252014v3 Today s Date California License # 0B02587 Page 1 of 16
LIFE Penn Mutual-Independent Brokers E & O Program Enrollment Instructions and Premium Matrix Policy Period: August 1, 2014 to August 1, 2015 Simply follow the steps below to easily enroll in the Penn Mutual Independent Brokers E&O Program. Should you currently have other coverage, you don t have to pass up the great benefits of this plan. 1. All eligible brokers who are not registered with HTK may join subject to the eligibility criteria. 2. Identify the month your coverage should be effective. 3. Complete the enrollment form using the premium matrix below. You may also enroll online at www.calsurance.com/pmllifebrokers. Installment Plans available online. 4. Sign and date the enrollment form, and enclose your check, if appropriate. 5. Keep in mind the E&O coverage under this program cannot be effective prior to the first of the month in which you enroll. To avoid gaps in your coverage you should elect an effective date equal to your current coverage expiration date. The following rates are inclusive of an administrative fee and state specific Surplus Lines tax, stamping fees, surcharges, and municipal/county taxes. PennIndependentBrokersApp_05072014v1 CalSurance Associates A Division of Brown & Brown Program Insurance Services, Inc. California License # 0B02587 Page 2 of 16
September Effective Date Alabama AL 4.00% $506.04 $601.20 $28.55 Alaska AK 3.70% $504.68 $599.57 $28.47 Arizona AZ 3.20% $502.42 $596.85 $28.33 Arkansas AR 4.00% $506.04 $601.20 $28.55 California CA 3.20% $502.42 $596.85 $28.33 Colorado CO 3.00% $501.51 $595.76 $28.27 Connecticut CT 4.00% $506.04 $601.20 $28.55 Delaware DE 2.00% $496.98 $590.31 $28.00 Florida FL 6.475% $517.25 $614.68 $29.23 Georgia- GA 4.00% $507.44 $602.60 $28.55 Hawaii HI 4.68% $509.12 $604.90 $28.73 Idaho *- ID 1.75% $496.46 $589.56 $27.93 Illinois IL 3.60% $504.23 $599.02 $28.44 Indiana- IN 2.50% $500.12 $593.91 $28.14 Iowa- IA 1.00% $492.80 $585.22 $27.72 Kansas KS 6.00% $515.10 $612.09 $29.10 Louisiana LA 5.00% $510.57 $606.65 $28.82 Maine- ME 3.00% $502.56 $596.81 $28.27 Maryland MD 3.00% $501.51 $595.76 $28.27 Massachusetts MA 4.00% $506.04 $601.20 $28.55 Michigan MI 2.50% $499.25 $593.04 $28.14 Minnesota MN 3.06% $501.78 $596.08 $28.29 Mississippi MS 7.00% $519.63 $617.53 $29.37 Missouri- MO 5.00% $512.32 $608.40 $28.82 Montana * MT 2.75% $500.38 $594.40 $28.20 Nebraska NE 3.00% $501.51 $595.76 $28.27 Nevada * NV 3.90% $505.59 $600.66 $28.52 New Hampshire NH 3.00% $501.51 $595.76 $28.27 New Jersey NJ 5.00% $510.57 $606.65 $28.82 New Mexico NM 3.003% $501.53 $595.77 $28.27 New York NY 3.80% $530.14 $625.11 $28.49 North Carolina NC 5.00% $510.57 $606.65 $28.82 North Dakota ND 1.75% $495.85 $588.95 $27.93 Ohio OH 5.00% $510.57 $606.65 $28.82 Oklahoma OK 6.00% $515.10 $612.09 $29.10 Oregon OR 2.30% $498.34 $591.95 $28.08 Pennsylvania PA 3.00% $551.51 $645.76 $28.27 Rhode Island RI 4.00% $506.04 $601.20 $28.55 South Carolina SC 6.00% $515.10 $612.09 $29.10 South Dakota SD 2.53% $499.38 $593.20 $28.14 Tennessee- TN 5.00% $512.32 $608.40 $28.82 Texas- TX 4.85% $511.59 $607.53 $28.78 Utah- UT 4.40% $509.39 $604.92 $28.66 Vermont VT 3.00% $501.51 $595.76 $28.27 Virginia VA 2.25% $498.12 $591.67 $28.07 Washington WA 3.00% $501.51 $595.76 $28.27 Washington, DC DC 2.00% $496.98 $590.31 $28.00 West Virginia WV 4.55% $508.53 $604.20 $28.70 Wisconsin WI 3.00% $501.51 $595.76 $28.27 Wyoming- WY 3.03% $502.71 $596.98 $28.28 Page 3 of 16
October Effective Date Alabama AL 4.00% $463.83 $550.46 $25.99 Alaska AK 3.70% $462.59 $548.97 $25.91 Arizona AZ 3.20% $460.53 $546.50 $25.79 Arkansas AR 4.00% $463.83 $550.46 $25.99 California CA 3.20% $460.53 $546.50 $25.79 Colorado CO 3.00% $459.71 $545.50 $25.74 Connecticut CT 4.00% $463.83 $550.46 $25.99 Delaware DE 2.00% $455.58 $540.55 $25.49 Florida FL 6.475% $474.03 $562.73 $26.61 Georgia- GA 4.00% $465.23 $551.86 $25.99 Hawaii HI 4.68% $466.63 $553.83 $26.16 Idaho *- ID 1.75% $455.16 $539.92 $25.43 Illinois IL 3.60% $462.18 $548.48 $25.89 Indiana- IN 2.50% $458.52 $543.90 $25.61 Iowa- IA 1.00% $451.81 $535.94 $25.24 Kansas KS 6.00% $472.08 $560.37 $26.49 Louisiana LA 5.00% $467.95 $555.42 $26.24 Maine- ME 3.00% $460.76 $546.55 $25.74 Maryland MD 3.00% $459.71 $545.50 $25.74 Massachusetts MA 4.00% $463.83 $550.46 $25.99 Michigan MI 2.50% $457.64 $543.03 $25.61 Minnesota MN 3.06% $459.95 $545.80 $25.75 Mississippi MS 7.00% $476.20 $565.33 $26.74 Missouri- MO 5.00% $469.70 $557.17 $26.24 Montana * MT 2.75% $458.67 $544.26 $25.68 Nebraska NE 3.00% $459.71 $545.50 $25.74 Nevada * NV 3.90% $463.42 $549.96 $25.96 New Hampshire NH 3.00% $459.71 $545.50 $25.74 New Jersey NJ 5.00% $467.95 $555.42 $26.24 New Mexico NM 3.003% $459.72 $545.52 $25.74 New York NY 3.80% $488.00 $574.47 $25.94 North Carolina NC 5.00% $467.95 $555.42 $26.24 North Dakota ND 1.75% $454.55 $539.31 $25.43 Ohio OH 5.00% $467.95 $555.42 $26.24 Oklahoma OK 6.00% $472.08 $560.37 $26.49 Oregon OR 2.30% $456.82 $542.03 $25.56 Pennsylvania PA 3.00% $509.71 $595.50 $25.74 Rhode Island RI 4.00% $463.83 $550.46 $25.99 South Carolina SC 6.00% $472.08 $560.37 $26.49 South Dakota SD 2.53% $457.77 $543.17 $25.62 Tennessee- TN 5.00% $469.70 $557.17 $26.24 Texas- TX 4.85% $469.03 $556.37 $26.20 Utah- UT 4.40% $467.02 $553.98 $26.09 Vermont VT 3.00% $459.71 $545.50 $25.74 Virginia VA 2.25% $456.61 $541.79 $25.55 Washington WA 3.00% $459.71 $545.50 $25.74 Washington, DC DC 2.00% $455.58 $540.55 $25.49 West Virginia WV 4.55% $466.10 $553.19 $26.13 Wisconsin WI 3.00% $459.71 $545.50 $25.74 Wyoming- WY 3.03% $460.89 $546.71 $25.75 Page 4 of 16
November Effective Date Alabama AL 4.00% $420.07 $497.86 $23.34 Alaska AK 3.70% $418.96 $496.53 $23.27 Arizona AZ 3.20% $417.11 $494.30 $23.16 Arkansas AR 4.00% $420.07 $497.86 $23.34 California CA 3.20% $417.11 $494.30 $23.16 Colorado CO 3.00% $416.37 $493.41 $23.11 Connecticut CT 4.00% $420.07 $497.86 $23.34 Delaware DE 2.00% $412.67 $488.96 $22.89 Florida FL 6.475% $429.23 $508.88 $23.89 Georgia- GA 4.00% $421.47 $499.26 $23.34 Hawaii HI 4.68% $422.59 $500.89 $23.49 Idaho *- ID 1.75% $412.35 $488.46 $22.83 Illinois IL 3.60% $418.59 $496.08 $23.25 Indiana- IN 2.50% $415.39 $492.06 $23.00 Iowa- IA 1.00% $409.31 $484.86 $22.66 Kansas KS 6.00% $427.48 $506.76 $23.79 Louisiana LA 5.00% $423.77 $502.31 $23.56 Maine- ME 3.00% $417.42 $494.46 $23.11 Maryland MD 3.00% $416.37 $493.41 $23.11 Massachusetts MA 4.00% $420.07 $497.86 $23.34 Michigan MI 2.50% $414.52 $491.19 $23.00 Minnesota MN 3.06% $416.59 $493.68 $23.13 Mississippi MS 7.00% $431.18 $511.21 $24.01 Missouri- MO 5.00% $423.77 $502.31 $23.56 Montana * MT 2.75% $415.44 $492.30 $23.06 Nebraska NE 3.00% $416.37 $493.41 $23.11 Nevada * NV 3.90% $419.70 $497.42 $23.32 New Hampshire NH 3.00% $416.37 $493.41 $23.11 New Jersey NJ 5.00% $423.77 $502.31 $23.56 New Mexico NM 3.003% $416.38 $493.43 $23.11 New York NY 3.80% $444.33 $521.97 $23.29 North Carolina NC 5.00% $423.77 $502.31 $23.56 North Dakota ND 1.75% $411.74 $487.85 $22.83 Ohio OH 5.00% $423.77 $502.31 $23.56 Oklahoma OK 6.00% $427.48 $506.76 $23.79 Oregon OR 2.30% $413.78 $490.30 $22.96 Pennsylvania PA 3.00% $466.37 $543.41 $23.11 Rhode Island RI 4.00% $420.07 $497.86 $23.34 South Carolina SC 6.00% $427.48 $506.76 $23.79 South Dakota SD 2.53% $414.63 $491.32 $23.01 Tennessee- TN 5.00% $425.52 $504.06 $23.56 Texas- TX 4.85% $424.92 $503.34 $23.53 Utah- UT 4.40% $423.09 $501.18 $23.43 Vermont VT 3.00% $416.37 $493.41 $23.11 Virginia VA 2.25% $413.59 $490.07 $22.94 Washington WA 3.00% $416.37 $493.41 $23.11 Washington, DC DC 2.00% $412.67 $488.96 $22.89 West Virginia WV 4.55% $422.11 $500.31 $23.46 Wisconsin WI 3.00% $416.37 $493.41 $23.11 Wyoming- WY 3.03% $417.54 $494.61 $23.12 Page 5 of 16
December Effective Date Alabama AL 4.00% $376.31 $445.26 $20.69 Alaska AK 3.70% $375.33 $444.08 $20.63 Arizona AZ 3.20% $373.69 $442.11 $20.53 Arkansas AR 4.00% $376.31 $445.26 $20.69 California CA 3.20% $373.69 $442.11 $20.53 Colorado CO 3.00% $373.03 $441.32 $20.49 Connecticut CT 4.00% $376.31 $445.26 $20.69 Delaware DE 2.00% $369.75 $437.37 $20.29 Florida FL 6.475% $384.43 $455.03 $21.18 Georgia- GA 4.00% $377.71 $446.66 $20.69 Hawaii HI 4.68% $378.54 $447.95 $20.82 Idaho *- ID 1.75% $369.54 $437.00 $20.24 Illinois IL 3.60% $375.00 $443.69 $20.61 Indiana- IN 2.50% $372.26 $440.22 $20.39 Iowa- IA 1.00% $366.82 $433.78 $20.09 Kansas KS 6.00% $382.88 $453.15 $21.08 Louisiana LA 5.00% $379.59 $449.21 $20.88 Maine- ME 3.00% $374.08 $442.37 $20.49 Maryland MD 3.00% $373.03 $441.32 $20.49 Massachusetts MA 4.00% $376.31 $445.26 $20.69 Michigan MI 2.50% $371.39 $439.35 $20.39 Minnesota MN 3.06% $373.23 $441.56 $20.50 Mississippi MS 7.00% $386.16 $457.10 $21.28 Missouri- MO 5.00% $381.34 $450.96 $20.88 Montana * MT 2.75% $372.21 $440.33 $20.44 Nebraska NE 3.00% $373.03 $441.32 $20.49 Nevada * NV 3.90% $375.98 $444.87 $20.67 New Hampshire NH 3.00% $373.03 $441.32 $20.49 New Jersey NJ 5.00% $379.59 $449.21 $20.88 New Mexico NM 3.003% $373.04 $441.33 $20.49 New York NY 3.80% $400.66 $469.48 $20.65 North Carolina NC 5.00% $379.59 $449.21 $20.88 North Dakota ND 1.75% $368.93 $436.39 $20.24 Ohio OH 5.00% $379.59 $449.21 $20.88 Oklahoma OK 6.00% $382.88 $453.15 $21.08 Oregon OR 2.30% $370.73 $438.56 $20.35 Pennsylvania PA 3.00% $423.03 $491.32 $20.49 Rhode Island RI 4.00% $376.31 $445.26 $20.69 South Carolina SC 6.00% $382.88 $453.15 $21.08 South Dakota SD 2.53% $371.49 $439.47 $20.39 Tennessee- TN 5.00% $381.34 $450.96 $20.88 Texas- TX 4.85% $380.80 $450.32 $20.85 Utah- UT 4.40% $379.17 $448.38 $20.77 Vermont VT 3.00% $373.03 $441.32 $20.49 Virginia VA 2.25% $370.57 $438.36 $20.34 Washington WA 3.00% $373.03 $441.32 $20.49 Washington, DC DC 2.00% $369.75 $437.37 $20.29 West Virginia WV 4.55% $378.12 $447.43 $20.79 Wisconsin WI 3.00% $373.03 $441.32 $20.49 Wyoming- WY 3.03% $374.19 $442.50 $20.49 Page 6 of 16
January Effective Date Alabama AL 4.00% $336.67 $397.62 $18.28 Alaska AK 3.70% $335.80 $396.57 $18.23 Arizona AZ 3.20% $334.35 $394.83 $18.14 Arkansas AR 4.00% $336.67 $397.62 $18.28 California CA 3.20% $334.35 $394.83 $18.14 Colorado CO 3.00% $333.77 $394.13 $18.11 Connecticut CT 4.00% $336.67 $397.62 $18.28 Delaware DE 2.00% $330.87 $390.64 $17.93 Florida FL 6.475% $343.85 $406.25 $18.72 Georgia- GA 4.00% $338.07 $399.02 $18.28 Hawaii HI 4.68% $338.65 $399.99 $18.40 Idaho *- ID 1.75% $330.76 $390.38 $17.89 Illinois IL 3.60% $335.51 $396.22 $18.21 Indiana- IN 2.50% $333.20 $393.26 $18.02 Iowa- IA 1.00% $328.32 $387.51 $17.76 Kansas KS 6.00% $342.47 $404.59 $18.63 Louisiana LA 5.00% $339.57 $401.10 $18.46 Maine- ME 3.00% $334.82 $395.18 $18.11 Maryland MD 3.00% $333.77 $394.13 $18.11 Massachusetts MA 4.00% $336.67 $397.62 $18.28 Michigan MI 2.50% $332.32 $392.39 $18.02 Minnesota MN 3.06% $333.95 $394.34 $18.12 Mississippi MS 7.00% $345.37 $408.08 $18.81 Missouri- MO 5.00% $341.32 $402.85 $18.46 Montana * MT 2.75% $333.05 $393.26 $18.06 Nebraska NE 3.00% $333.77 $394.13 $18.11 Nevada * NV 3.90% $336.38 $397.27 $18.27 New Hampshire NH 3.00% $333.77 $394.13 $18.11 New Jersey NJ 5.00% $339.57 $401.10 $18.46 New Mexico NM 3.003% $333.78 $394.14 $18.11 New York NY 3.80% $361.09 $421.92 $18.25 North Carolina NC 5.00% $339.57 $401.10 $18.46 North Dakota ND 1.75% $330.15 $389.77 $17.89 Ohio OH 5.00% $339.57 $401.10 $18.46 Oklahoma OK 6.00% $342.47 $404.59 $18.63 Oregon OR 2.30% $331.74 $391.69 $17.98 Pennsylvania PA 3.00% $383.77 $444.13 $18.11 Rhode Island RI 4.00% $336.67 $397.62 $18.28 South Carolina SC 6.00% $342.47 $404.59 $18.63 South Dakota SD 2.53% $332.41 $392.49 $18.02 Tennessee- TN 5.00% $341.32 $402.85 $18.46 Texas- TX 4.85% $340.84 $402.28 $18.43 Utah- UT 4.40% $339.37 $400.55 $18.35 Vermont VT 3.00% $333.77 $394.13 $18.11 Virginia VA 2.25% $331.60 $391.52 $17.98 Washington WA 3.00% $333.77 $394.13 $18.11 Washington, DC DC 2.00% $330.87 $390.64 $17.93 West Virginia WV 4.55% $338.27 $399.53 $18.38 Wisconsin WI 3.00% $333.77 $394.13 $18.11 Wyoming- WY 3.03% $334.92 $395.30 $18.11 Page 7 of 16
February Effective Date Alabama AL 4.00% $292.91 $345.02 $15.63 Alaska AK 3.70% $292.17 $344.12 $15.59 Arizona AZ 3.20% $290.93 $342.63 $15.51 Arkansas AR 4.00% $292.91 $345.02 $15.63 California CA 3.20% $290.93 $342.63 $15.51 Colorado CO 3.00% $290.43 $342.04 $15.48 Connecticut CT 4.00% $292.91 $345.02 $15.63 Delaware DE 2.00% $287.95 $339.06 $15.33 Florida FL 6.475% $299.05 $352.40 $16.00 Georgia- GA 4.00% $294.31 $346.42 $15.63 Hawaii HI 4.68% $294.60 $347.05 $15.73 Idaho *- ID 1.75% $287.95 $338.92 $15.29 Illinois IL 3.60% $291.92 $343.83 $15.57 Indiana- IN 2.50% $290.07 $341.42 $15.41 Iowa- IA 1.00% $285.82 $336.43 $15.18 Kansas KS 6.00% $297.87 $350.98 $15.93 Louisiana LA 5.00% $295.39 $348.00 $15.78 Maine- ME 3.00% $291.48 $343.09 $15.48 Maryland MD 3.00% $290.43 $342.04 $15.48 Massachusetts MA 4.00% $292.91 $345.02 $15.63 Michigan MI 2.50% $289.19 $340.55 $15.41 Minnesota MN 3.06% $290.58 $342.22 $15.49 Mississippi MS 7.00% $300.35 $353.96 $16.08 Missouri- MO 5.00% $297.14 $349.75 $15.78 Montana * MT 2.75% $289.81 $341.29 $15.44 Nebraska NE 3.00% $290.43 $342.04 $15.48 Nevada * NV 3.90% $292.67 $344.72 $15.62 New Hampshire NH 3.00% $290.43 $342.04 $15.48 New Jersey NJ 5.00% $295.39 $348.00 $15.78 New Mexico NM 3.003% $290.44 $342.05 $15.48 New York NY 3.80% $317.42 $369.42 $15.60 North Carolina NC 5.00% $295.39 $348.00 $15.78 North Dakota ND 1.75% $287.33 $338.31 $15.29 Ohio OH 5.00% $295.39 $348.00 $15.78 Oklahoma OK 6.00% $297.87 $350.98 $15.93 Oregon OR 2.30% $288.70 $339.95 $15.38 Pennsylvania PA 3.00% $340.43 $392.04 $15.48 Rhode Island RI 4.00% $292.91 $345.02 $15.63 South Carolina SC 6.00% $297.87 $350.98 $15.93 South Dakota SD 2.53% $289.27 $340.64 $15.41 Tennessee- TN 5.00% $297.14 $349.75 $15.78 Texas- TX 4.85% $296.72 $349.25 $15.76 Utah- UT 4.40% $295.45 $347.75 $15.69 Vermont VT 3.00% $290.43 $342.04 $15.48 Virginia VA 2.25% $288.57 $339.80 $15.37 Washington WA 3.00% $290.43 $342.04 $15.48 Washington, DC DC 2.00% $287.95 $339.06 $15.33 West Virginia WV 4.55% $294.28 $346.66 $15.71 Wisconsin WI 3.00% $290.43 $342.04 $15.48 Wyoming- WY 3.03% $291.57 $343.19 $15.49 Page 8 of 16
March Effective Date Alabama AL 4.00% $250.70 $294.28 $13.07 Alaska AK 3.70% $250.08 $293.53 $13.04 Arizona AZ 3.20% $249.04 $292.28 $12.97 Arkansas AR 4.00% $250.70 $294.28 $13.07 California CA 3.20% $249.04 $292.28 $12.97 Colorado CO 3.00% $248.63 $291.78 $12.95 Connecticut CT 4.00% $250.70 $294.28 $13.07 Delaware DE 2.00% $246.55 $289.29 $12.82 Florida FL 6.475% $255.83 $300.45 $13.38 Georgia- GA 4.00% $252.10 $295.68 $13.07 Hawaii HI 4.68% $252.11 $295.97 $13.16 Idaho *- ID 1.75% $246.65 $289.28 $12.79 Illinois IL 3.60% $249.87 $293.28 $13.02 Indiana- IN 2.50% $248.47 $291.41 $12.88 Iowa- IA 1.00% $244.83 $287.15 $12.70 Kansas KS 6.00% $254.85 $299.26 $13.32 Louisiana LA 5.00% $252.78 $296.77 $13.20 Maine- ME 3.00% $249.68 $292.83 $12.95 Maryland MD 3.00% $248.63 $291.78 $12.95 Massachusetts MA 4.00% $250.70 $294.28 $13.07 Michigan MI 2.50% $247.59 $290.54 $12.88 Minnesota MN 3.06% $248.75 $291.93 $12.95 Mississippi MS 7.00% $256.92 $301.76 $13.45 Missouri- MO 5.00% $254.53 $298.52 $13.20 Montana * MT 2.75% $248.11 $291.16 $12.92 Nebraska NE 3.00% $248.63 $291.78 $12.95 Nevada * NV 3.90% $250.49 $294.03 $13.06 New Hampshire NH 3.00% $248.63 $291.78 $12.95 New Jersey NJ 5.00% $252.78 $296.77 $13.20 New Mexico NM 3.003% $248.63 $291.79 $12.95 New York NY 3.80% $275.29 $318.78 $13.05 North Carolina NC 5.00% $252.78 $296.77 $13.20 North Dakota ND 1.75% $246.03 $288.67 $12.79 Ohio OH 5.00% $252.78 $296.77 $13.20 Oklahoma OK 6.00% $254.85 $299.26 $13.32 Oregon OR 2.30% $247.18 $290.04 $12.86 Pennsylvania PA 3.00% $298.63 $341.78 $12.95 Rhode Island RI 4.00% $250.70 $294.28 $13.07 South Carolina SC 6.00% $254.85 $299.26 $13.32 South Dakota SD 2.53% $247.65 $290.61 $12.89 Tennessee- TN 5.00% $254.53 $298.52 $13.20 Texas- TX 4.85% $254.16 $298.09 $13.18 Utah- UT 4.40% $253.07 $296.81 $13.12 Vermont VT 3.00% $248.63 $291.78 $12.95 Virginia VA 2.25% $247.07 $289.91 $12.85 Washington WA 3.00% $248.63 $291.78 $12.95 Washington, DC DC 2.00% $246.55 $289.29 $12.82 West Virginia WV 4.55% $251.84 $295.65 $13.14 Wisconsin WI 3.00% $248.63 $291.78 $12.95 Wyoming- WY 3.03% $249.75 $292.92 $12.95 Page 9 of 16
April Effective Date Alabama AL 4.00% $206.94 $241.68 $10.42 Alaska AK 3.70% $206.45 $241.08 $10.39 Arizona AZ 3.20% $205.62 $240.09 $10.34 Arkansas AR 4.00% $206.94 $241.68 $10.42 California CA 3.20% $205.62 $240.09 $10.34 Colorado CO 3.00% $205.29 $239.69 $10.32 Connecticut CT 4.00% $206.94 $241.68 $10.42 Delaware DE 2.00% $203.64 $237.70 $10.22 Florida FL 6.475% $211.04 $246.60 $10.67 Georgia- GA 4.00% $208.34 $243.08 $10.42 Hawaii HI 4.68% $208.07 $243.03 $10.49 Idaho *- ID 1.75% $203.84 $237.82 $10.20 Illinois IL 3.60% $206.28 $240.88 $10.38 Indiana- IN 2.50% $205.34 $239.57 $10.27 Iowa- IA 1.00% $202.33 $236.07 $10.12 Kansas KS 6.00% $210.25 $245.65 $10.62 Louisiana LA 5.00% $208.60 $243.67 $10.52 Maine- ME 3.00% $206.34 $240.74 $10.32 Maryland MD 3.00% $205.29 $239.69 $10.32 Massachusetts MA 4.00% $206.94 $241.68 $10.42 Michigan MI 2.50% $204.46 $238.70 $10.27 Minnesota MN 3.06% $205.39 $239.81 $10.33 Mississippi MS 7.00% $211.90 $247.64 $10.72 Missouri- MO 5.00% $210.35 $245.42 $10.52 Montana * MT 2.75% $204.88 $239.20 $10.30 Nebraska NE 3.00% $205.29 $239.69 $10.32 Nevada * NV 3.90% $206.78 $241.48 $10.41 New Hampshire NH 3.00% $205.29 $239.69 $10.32 New Jersey NJ 5.00% $208.60 $243.67 $10.52 New Mexico NM 3.003% $205.29 $239.70 $10.32 New York NY 3.80% $231.61 $266.28 $10.40 North Carolina NC 5.00% $208.60 $243.67 $10.52 North Dakota ND 1.75% $203.22 $237.21 $10.20 Ohio OH 5.00% $208.60 $243.67 $10.52 Oklahoma OK 6.00% $210.25 $245.65 $10.62 Oregon OR 2.30% $204.13 $238.30 $10.25 Pennsylvania PA 3.00% $255.29 $289.69 $10.32 Rhode Island RI 4.00% $206.94 $241.68 $10.42 South Carolina SC 6.00% $210.25 $245.65 $10.62 South Dakota SD 2.53% $204.51 $238.76 $10.27 Tennessee- TN 5.00% $210.35 $245.42 $10.52 Texas- TX 4.85% $210.05 $245.07 $10.51 Utah- UT 4.40% $209.14 $244.01 $10.46 Vermont VT 3.00% $205.29 $239.69 $10.32 Virginia VA 2.25% $204.05 $238.20 $10.25 Washington WA 3.00% $205.29 $239.69 $10.32 Washington, DC DC 2.00% $203.64 $237.70 $10.22 West Virginia WV 4.55% $207.85 $242.77 $10.48 Wisconsin WI 3.00% $205.29 $239.69 $10.32 Wyoming- WY 3.03% $206.40 $240.81 $10.32 Page 10 of 16
May Effective Date Alabama AL 4.00% $164.73 $190.94 $7.86 Alaska AK 3.70% $164.36 $190.49 $7.84 Arizona AZ 3.20% $163.73 $189.74 $7.80 Arkansas AR 4.00% $164.73 $190.94 $7.86 California CA 3.20% $163.73 $189.74 $7.80 Colorado CO 3.00% $163.48 $189.44 $7.79 Connecticut CT 4.00% $164.73 $190.94 $7.86 Delaware DE 2.00% $162.23 $187.94 $7.71 Florida FL 6.475% $167.82 $194.65 $8.05 Georgia- GA 4.00% $166.13 $192.34 $7.86 Hawaii HI 4.68% $165.58 $191.96 $7.91 Idaho *- ID 1.75% $162.54 $188.18 $7.69 Illinois IL 3.60% $164.23 $190.34 $7.83 Indiana- IN 2.50% $163.73 $189.56 $7.75 Iowa- IA 1.00% $161.34 $186.79 $7.64 Kansas KS 6.00% $167.22 $193.94 $8.01 Louisiana LA 5.00% $165.98 $192.44 $7.94 Maine- ME 3.00% $164.53 $190.49 $7.79 Maryland MD 3.00% $163.48 $189.44 $7.79 Massachusetts MA 4.00% $164.73 $190.94 $7.86 Michigan MI 2.50% $162.86 $188.69 $7.75 Minnesota MN 3.06% $163.56 $189.53 $7.79 Mississippi MS 7.00% $168.47 $195.44 $8.09 Missouri- MO 5.00% $167.73 $194.19 $7.94 Montana * MT 2.75% $163.17 $189.06 $7.77 Nebraska NE 3.00% $163.48 $189.44 $7.79 Nevada * NV 3.90% $164.60 $190.79 $7.85 New Hampshire NH 3.00% $163.48 $189.44 $7.79 New Jersey NJ 5.00% $165.98 $192.44 $7.94 New Mexico NM 3.003% $163.49 $189.44 $7.79 New York NY 3.80% $189.48 $215.64 $7.85 North Carolina NC 5.00% $165.98 $192.44 $7.94 North Dakota ND 1.75% $161.92 $187.56 $7.69 Ohio OH 5.00% $165.98 $192.44 $7.94 Oklahoma OK 6.00% $167.22 $193.94 $8.01 Oregon OR 2.30% $162.61 $188.39 $7.73 Pennsylvania PA 3.00% $213.48 $239.44 $7.79 Rhode Island RI 4.00% $164.73 $190.94 $7.86 South Carolina SC 6.00% $167.22 $193.94 $8.01 South Dakota SD 2.53% $162.90 $188.73 $7.75 Tennessee- TN 5.00% $167.73 $194.19 $7.94 Texas- TX 4.85% $167.49 $193.91 $7.93 Utah- UT 4.40% $166.77 $193.08 $7.89 Vermont VT 3.00% $163.48 $189.44 $7.79 Virginia VA 2.25% $162.55 $188.31 $7.73 Washington WA 3.00% $163.48 $189.44 $7.79 Washington, DC DC 2.00% $162.23 $187.94 $7.71 West Virginia WV 4.55% $165.42 $191.76 $7.90 Wisconsin WI 3.00% $163.48 $189.44 $7.79 Wyoming- WY 3.03% $164.58 $190.54 $7.79 Page 11 of 16
June Effective Date Alabama AL 4.00% $120.97 $138.34 $5.21 Alaska AK 3.70% $120.72 $138.04 $5.20 Arizona AZ 3.20% $120.31 $137.54 $5.17 Arkansas AR 4.00% $120.97 $138.34 $5.21 California CA 3.20% $120.31 $137.54 $5.17 Colorado CO 3.00% $120.14 $137.35 $5.16 Connecticut CT 4.00% $120.97 $138.34 $5.21 Delaware DE 2.00% $119.32 $136.35 $5.11 Florida FL 6.475% $123.02 $140.80 $5.33 Georgia- GA 4.00% $122.37 $139.74 $5.21 Hawaii HI 4.68% $121.53 $139.02 $5.24 Idaho *- ID 1.75% $119.72 $136.72 $5.10 Illinois IL 3.60% $120.64 $137.94 $5.19 Indiana- IN 2.50% $120.61 $137.72 $5.14 Iowa- IA 1.00% $118.84 $135.71 $5.06 Kansas KS 6.00% $122.62 $140.33 $5.31 Louisiana LA 5.00% $121.80 $139.33 $5.26 Maine- ME 3.00% $121.19 $138.40 $5.16 Maryland MD 3.00% $120.14 $137.35 $5.16 Massachusetts MA 4.00% $120.97 $138.34 $5.21 Michigan MI 2.50% $119.73 $136.85 $5.14 Minnesota MN 3.06% $120.19 $137.41 $5.16 Mississippi MS 7.00% $123.45 $141.32 $5.36 Missouri- MO 5.00% $123.55 $141.08 $5.26 Montana * MT 2.75% $119.94 $137.10 $5.15 Nebraska NE 3.00% $120.14 $137.35 $5.16 Nevada * NV 3.90% $120.89 $138.24 $5.21 New Hampshire NH 3.00% $120.14 $137.35 $5.16 New Jersey NJ 5.00% $121.80 $139.33 $5.26 New Mexico NM 3.003% $120.15 $137.35 $5.16 New York NY 3.80% $145.81 $163.14 $5.20 North Carolina NC 5.00% $121.80 $139.33 $5.26 North Dakota ND 1.75% $119.11 $136.10 $5.10 Ohio OH 5.00% $121.80 $139.33 $5.26 Oklahoma OK 6.00% $122.62 $140.33 $5.31 Oregon OR 2.30% $119.57 $136.65 $5.13 Pennsylvania PA 3.00% $170.14 $187.35 $5.16 Rhode Island RI 4.00% $120.97 $138.34 $5.21 South Carolina SC 6.00% $122.62 $140.33 $5.31 South Dakota SD 2.53% $119.76 $136.88 $5.14 Tennessee- TN 5.00% $123.55 $141.08 $5.26 Texas- TX 4.85% $123.37 $140.88 $5.25 Utah- UT 4.40% $122.84 $140.28 $5.23 Vermont VT 3.00% $120.14 $137.35 $5.16 Virginia VA 2.25% $119.52 $136.60 $5.12 Washington WA 3.00% $120.14 $137.35 $5.16 Washington, DC DC 2.00% $119.32 $136.35 $5.11 West Virginia WV 4.55% $121.43 $138.89 $5.24 Wisconsin WI 3.00% $120.14 $137.35 $5.16 Wyoming- WY 3.03% $121.23 $138.44 $5.16 Page 12 of 16
July Effective Date Alabama AL 4.00% $77.21 $85.74 $2.56 Alaska AK 3.70% $77.09 $85.60 $2.55 Arizona AZ 3.20% $76.89 $85.35 $2.54 Arkansas AR 4.00% $77.21 $85.74 $2.56 California CA 3.20% $76.89 $85.35 $2.54 Colorado CO 3.00% $76.81 $85.25 $2.53 Connecticut CT 4.00% $77.21 $85.74 $2.56 Delaware DE 2.00% $76.40 $84.77 $2.51 Florida FL 6.475% $78.22 $86.95 $2.62 Georgia- GA 4.00% $78.61 $87.14 $2.56 Hawaii HI 4.68% $77.49 $86.07 $2.58 Idaho *- ID 1.75% $76.91 $85.26 $2.50 Illinois IL 3.60% $77.05 $85.55 $2.55 Indiana- IN 2.50% $77.48 $85.88 $2.52 Iowa- IA 1.00% $76.35 $84.63 $2.48 Kansas KS 6.00% $78.03 $86.72 $2.61 Louisiana LA 5.00% $77.62 $86.23 $2.58 Maine- ME 3.00% $77.86 $86.30 $2.53 Maryland MD 3.00% $76.81 $85.25 $2.53 Massachusetts MA 4.00% $77.21 $85.74 $2.56 Michigan MI 2.50% $76.60 $85.01 $2.52 Minnesota MN 3.06% $76.83 $85.28 $2.54 Mississippi MS 7.00% $78.43 $87.21 $2.63 Missouri- MO 5.00% $79.37 $87.98 $2.58 Montana * MT 2.75% $76.71 $85.13 $2.53 Nebraska NE 3.00% $76.81 $85.25 $2.53 Nevada * NV 3.90% $77.17 $85.69 $2.56 New Hampshire NH 3.00% $76.81 $85.25 $2.53 New Jersey NJ 5.00% $77.62 $86.23 $2.58 New Mexico NM 3.003% $76.81 $85.26 $2.53 New York NY 3.80% $102.13 $110.64 $2.55 North Carolina NC 5.00% $77.62 $86.23 $2.58 North Dakota ND 1.75% $76.30 $84.64 $2.50 Ohio OH 5.00% $77.62 $86.23 $2.58 Oklahoma OK 6.00% $78.03 $86.72 $2.61 Oregon OR 2.30% $76.52 $84.91 $2.52 Pennsylvania PA 3.00% $126.81 $135.25 $2.53 Rhode Island RI 4.00% $77.21 $85.74 $2.56 South Carolina SC 6.00% $78.03 $86.72 $2.61 South Dakota SD 2.53% $76.62 $85.02 $2.52 Tennessee- TN 5.00% $79.37 $87.98 $2.58 Texas- TX 4.85% $79.26 $87.85 $2.58 Utah- UT 4.40% $78.92 $87.48 $2.57 Vermont VT 3.00% $76.81 $85.25 $2.53 Virginia VA 2.25% $76.50 $84.89 $2.52 Washington WA 3.00% $76.81 $85.25 $2.53 Washington, DC DC 2.00% $76.40 $84.77 $2.51 West Virginia WV 4.55% $77.44 $86.01 $2.57 Wisconsin WI 3.00% $76.81 $85.25 $2.53 Wyoming- WY 3.03% $77.88 $86.33 $2.53 Page 13 of 16
Penn Mutual Independent Brokers Agents E&O Program Outline of Policy Period: August 1, 2014 to August 1, 2015 Insurer: Aspen Insurance UK Limited (a member of The Aspen Group) 2013 A.M. Best's A (Excellent): XV This information obtained from A.M. Best is not in any way CalSurance s warranty or guaranty of financial stability of the insurer. The information is current only as of September 19, 2013, the date of publication. Risk Purchasing Group Membership: By applying for this insurance, Producers are applying for membership in 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 this membership. Limit of Liability (including Claims Expenses*): $1,000,000 Each Claim $2,000,000 Aggregate each Producer $20,000,000 Policy Aggregate *See the policy for additional details on Claims Expenses and the Limit of Liability Deductibles (applicable to payment of Damages and Claims Expense): $1,000 per Claim for products of Penn Mutual $2,500 per Claim for all other covered products or services Duty to Defend? Yes, for those Claims for which coverage applies : Claims Made and Reported coverage for negligent acts, errors or omissions arising out of the rendering of or failure to render Professional Services as a licensed life, accident and health agent. Retroactive ( prior acts ) Date: The inception date of your first continuously maintained claimsmade life insurance agents professional liability insurance policy from which coverage has been maintained in force without interruption. Claims involving Prior Acts must arise out of negligent acts, errors or omissions or Personal Injuries in rendering or failing to render Professional Services as defined in the policy. Eligible Participants/Insured: Independent Brokers who maintain a contract with Penn Mutual and who are not registered with a broker/dealer. Additional Insureds: Entity owned and controlled by the Agent Employees acting in the scope of their capacity and who are not contracted as an agent with an insurer Heirs/Estates/Administrator/Legal Representatives of an Agent Lawful spouse or domestic partner of any individual Agent, Penn Mutual for any vicarious liability based upon Wrongful Acts of an Agent Note: Additional Insureds do not have their own Limit of Liability. They share the Limit of Liability of the Producer. Professional Services Standard The solicitation, sale or servicing of life and health insurance, including long-term care insurance Tier II Standard plus the solicitation, sale or servicing of fixed and indexed annuities. Disability Insurance Endorsement For an additional premium, a rider can be added to further extend coverage to include the solicitation, sale or servicing of accident insurance including disability insurance Program Administration: CalSurance Associates A Division of Brown & Brown Program Insurance Services, Inc. California License Number: 0B02587 Claims Administration: Lancer Claims Services A Division of Brown & Brown Program Insurance Services, Inc. Extended Reporting Periods (ERP): Automatic: Terminated Producers 60 days from date of contract termination 1 year from date of contract termination for products issued by Penn Mutual Retired, Disabled or Estates of Deceased Producers 2 Years from date of retirement, disability or death This document is a summary of the coverage provided. All statements contained herein are subject to all of the terms, conditions, and exclusions of the actual policy. To request a copy of the policy, please contact CalSurance at 866-893-1097. Page 14 of 16
Penn Mutual Independent Brokers Agents E&O Program Outline of Optional: 3 years at 200% of the Producer s annual premium 5 years at 300% of the Producer s annual premium Unlimited at 400% of the Producer s annual premium Terminated Producers must be enrolled for coverage under this policy for at least 3 months to be eligible to purchase an Optional ERP. Producers whose contracts with Penn Mutual are terminated for disciplinary reasons are not eligible for an Automatic or Optional ERP. Producers who cancel their coverage under the policy (other than for contract termination, retirement, disability or death) are not eligible for an Automatic or Optional ERP and the Company shall retain the short rate proportion of their premium. Exclusions (including but not limited to): This Policy does not apply to any Claim based upon, arising out of, directly or indirectly, in whole or in part, or in any way involving: A. Any intentional wrongdoing, fraud, dishonesty, or malicious Wrongful Acts by an Insured, if a judgment or other final adjudication adverse to the Insured establishes such conduct, or if the Insured admits to such conduct. The Company shall continue to defend the Insured, if these allegations arise out of Wrongful Acts otherwise covered under this Policy, but the Insured shall reimburse the Company for Claims Expenses if such conduct is established as a matter of fact in a civil, arbitration, criminal or other proceeding, or is admitted to by an Insured. B. Any Claim brought or maintained, directly or indirectly, by or on behalf of any: 1. Insured; provided that this Exclusion shall not apply to any alleged Wrongful Termination; 2. Company or Broker-Dealer; 3. Insurance agent or broker; 4. Entity that is not a client of an Insured; provided that this Exclusion shall not apply to any Claim brought by an entity who is a beneficiary, heir, executor, conservator, or administrator of a deceased client of an Insured, and it shall further not apply to any alleged Wrongful Termination; 5. Entity: a. Wherein the Insured has a Controlling Interest; b. In which the Insured is: i. An officer; ii. A director; or iii. A partner; or c. Which wholly or partly owns, operates, or manages the Insured; 6. 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; provided that 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 and does not limit the availability of coverage pursuant to Section II. A. EXTENSIONS OF COVERAGE. C. Any fact, circumstance, situation, transaction, event or Wrongful Act that, before the Inception Date set forth in Item 2.(A) of the Declarations, was the subject of any notice given under any insurance policy issued by any insurer or any policy of which this Policy is a direct or indirect renewal or replacement. D. Any Claim, demand, suit, litigation or other proceeding pending against, or order, decree or judgment entered for or against any Insured which was pending on or existed prior to the Inception Date set forth in Item 2.(A) of the Declarations, or the same or substantially the same facts, circumstances, situation or allegations underlying or alleged therein. E. Any actual or alleged services as an accountant, tax preparer or advisor, actuary, architect, engineer, lawyer, real estate agent or broker, property or casualty insurance agent, title insurance agent, or third-party claims administrator. F. Any actual or alleged 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; provided that 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. G. Any actual or alleged ownership, formation, sale, servicing, operation, or administration of or administration of claims for any insurance company, health maintenance organization, preferred provider organization, captive, risk retention group, self-insurance group/program, purchasing group, Professional Employer Organization (PEO), or any pool, syndicate, association or other similar group This document is a summary of the coverage provided. All statements contained herein are subject to all of the terms, conditions, and exclusions of the actual policy. To request a copy of the policy, please contact CalSurance at 866-893-1097. SKP 05 23 14 Page 15 of 16
Penn Mutual Independent Brokers Agents E&O Program Outline of combination formed for the purpose of providing insurance or benefits. H. Any actual or alleged sale, servicing, or administration of, or advice or planning with respect to, any Multiple Employer Welfare Arrangement. I. Any pension, profit sharing, health, welfare or other employee benefit plan, insurance plan or trust, organized for the benefit of employees of any Insured. J. Any financial inability or refusal to pay, insolvency, receivership, conservatorship, bankruptcy, or liquidation of any entity in which an Insured has placed or recommended to be placed, coverage or the funds of a client; provided that 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. K. Any actual or alleged liability of others assumed by an Insured under any written or oral contract or agreement, provided that this Exclusion shall not apply to the extent that the Insured would have been liable in the absence of such contract or agreement. L. The Insured making representations, promises or guarantees as to the future value of any investment including but not limited to, representations, promises or guarantees as to interest rates, fluctuation in interest rates, future premium payments or market value(s). M. Any actual or alleged gaining of personal profit or advantage to which an Insured is not legally entitled. N. Any disputes involving an Insured s commissions, fees, charges, entitlements or other compensation. O. Any actual or alleged commingling, conversion, misappropriation, or defalcation of any funds by any Insured. P. Any actual or alleged 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 Securities. R. Any insurance or financial product owned in whole or in part by an Insured. S. Any structured settlements; provided that this Exclusion shall not apply to an underlying covered product. T. Any promissory notes, commodities, futures contracts, or option contracts. U. Any viatical or life settlements, reverse mortgages, or any similar product in which the present value of a condition contract is exchanged or sold. V. Any corporate owned life insurance, bank owned life insurance, or any other type of policies where the purchaser of the life product does not have an insurable interest in the Insured under such life product. W. Any accident and/or health insurance products sold into or part of an IRS Section 412(i) and/or 419 plan or the tax status or lack of eligibility relative to any IRS or other governmental ruling concerning IRS Section 412(i) or 419 plans. X. Any bodily injury, including sickness, injury, disease or death of any person; or injury to or destruction of any tangible property, including loss of use thereof. Y. Any actual or alleged discrimination, harassment, or misconduct: 1. 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 2. By an employee, former employee, or job applicant of an Insured in their capacity as such Z. Any actual or alleged 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. AA. Any allegation of a pattern or practice of wrongful act or conduct by the Sponsoring Company including, but not limited to, any class action allegation. BB. Any actual or alleged violation of : 1. The Telephone Consumer Protection Act (TCPA), including any amendment of or addition to such law, 2. The CAN-SPAM Act of 2003, including any amendment of or addition to such law, or 3. Any statute, ordinance or regulation other than the TCPA or CAN-SPAM Act of 2003 that prohibits or limits the sending, transmitting, communicating, or distribution of material or information. CC. Any notary services performed in the absence of the physical presence of the person whose signature is notarized. This document is a summary of the coverage provided. All statements contained herein are subject to all of the terms, conditions, and exclusions of the actual policy. To request a copy of the policy, please contact CalSurance at 866-893-1097. SKP 05 23 14 Page 16 of 16