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DATE:	May 16, 2011

TO:	Insured
Attn:

FROM:	Agent Name
Phone
Fax

Email

RE:	Name of Risk

Thank you for the opportunity to propose your insurance. This proposal is being offered on the basis shown below and may not necessarily provide the terms and/or coverages requested.

IMPORTANT: INSURANCE COVERAGE IS NOT BOUND. The following insurance proposal is for information only and does not bind coverage. If you wish to have insurance coverage placed in force, please consult with your Company Name Representative.

Non Profit Package Proposal

Directors & Officers Coverage Limits

Name of Carrier; “A++” A.M. Best’s rated

$1,000,000	Each Claim

$1,000,000	Annual Aggregate

$ 10,000	Deductible

Premium: $2,000 (Policy is subject to a $100 broker fee and applicable state tax)

Employment Practices Liability Coverage Limits

This coverage protects you if you are sued in your capacity as an employer for Sexual Harassment, Wrongful Termination or Discrimination. In addition, the United States Liability Insurance Group’s product offers coverage for those individuals who are actually employed by the owner of the building being managed.

Statistics show an Employer is more likely to have an employment claim than a Property or General Liability Claim.

Name of Carrier; “A++” A.M. Best’s rated

$	25,000	Each Claim

$	10,000	Deductible

Retro Active Date 8/15/2008

Claims Made Policy

Premium: $2,000 (Policy is subject to a $100 broker fee and applicable state tax)

Property Coverage Limits

Name of Carrier; “A++” A.M. Best’s rated

Risk Location: 11376 5th Avenue, Rancho Cucamonga, CA 91730

$250,000	Building Coverage

$100,000	Loss of Business Income

$ 50,000	Business Personal Property

Premium: $2,500 (Policy is subject to a $100 broker fee and applicable state tax)

General Liability Coverage Limits

Name of Carrier; “A++” A.M. Best’s rated

$1,000,000	Each Occurrence

$2,000,000	Annual Aggregate

$2,000,000	Products Aggregate

$1,000,000	Personal & Advertising Injury

$ 300,000	Damage to Premises Rented to You

$ 5,000	Medical Expense

$ 10,000	Deductible

Rating Basis: Payroll $100,000 or Sales $100,000 or Square Footage 1,000

Premium: $1,200 (Policy is subject to a $100 broker fee and applicable state tax)

Excess Liability Coverage Limits

Name of Carrier; “A++” A.M. Best’s rated

$1,000,000	Each Occurrence

$2,000,000	Annual Aggregate

$ 10,000	Deductible

Premium: $750 (Policy is subject to a $100 broker fee and applicable state tax)

Master Fidelity Coverage Limits

Name of Carrier; “A++” A.M. Best’s rated

$	375,000	Employee Theft

$	10,000	Computer and Funds Transfer Fraud

$	10,000	Forgery or Alteration

$	10,000	Money Orders & Counterfeit Currency

$ 1,000	Deductible

Premium: $358 (Policy is subject to a $100 broker fee)

Workers Compensation Coverage Limits

Name of Carrier; “A++” A.M. Best’s rated

$1,000,000	Each Accident

$1,000,000	Disease- Policy Limit

$1,000,000	Disease- Each Employee

Class Code: 9006

Payroll: $100,000

Premium: $1,750 (Policy is subject to a $100 broker fee and applicable state tax)

Professional Liability Premium Summary

$	0,000	Directors & Officers

$	0,000	Employment Practices Liability

Office Package Premium Summary

$	0,000	Property
$	0,000	Commercial General Liability

$	0,000	Excess Liability

$	0,000	Fidelity

$	0,000	Workers’ Compensation

$	0,000	Broker Fee

$	0,000	State Tax & Stamping Fee (3.225%)

$	0,000	Total Policy Charge

Billing Terms (Complete based on Carrier)

(Example) The premium must be paid in full prior to binding coverage unless you would like to finance the premium through name of company. I have enclosed the finance agreement for your review. Please note there is a $1,250.00 minimum earned premium and all fees are 100% earned at time of binding. No flat cancellations.

Please make your check payable to Company Name and address.

Exclusions (Complete based on Carrier)

(Example) Theft, theft of others, terrorism, nuclear energy, asbestos, subsidence of land, punitive or exemplary damage, lead contamination, fungi and bacteria, total pollution, silica, or silica related dust, damage to work performed by subcontractors on your behalf, violation of statues governing information and all operations in New York, New Hampshire and Vermont.

Additional Insureds

(Example) The proposal does not include any additional insured’s. There will be an additional premium plus taxes due for each entity requiring an additional insured endorsement during the policy term.

Binding Requirements (Complete based on Carrier)

(Example) Written request bind coverage including effective date, specified limits and coverage’s

(Example) Payment in full or down payment with signed finance agreement

(Example) Fully completed, signed and dated application(s)

(Example) Signed terrorism form

(Example) Signed D1 form

(Example) Signed broker agreement

(Example) Specific carrier requirements or Confirmation of information

To bind coverage please make sure to return all required forms, complete and sign where indicated, include with payment and return in the envelope provided. The application will be underwritten and bound once all eligibility requirements are met.

Thank you for choosing Company Name, we look forward working with you in the future. Please contact our office if you have any questions.

Sincerely,

Agency Closing

This quotation is for information purposes only. Coverage is not bound and no coverage will be afforded by this quotation. Regardless of whether an authorized representative has bound coverage, the coverages and premium stated herein are preliminary and subject to change based upon additional underwriting review. Coverage bound may be cancelled immediately upon notice to the insured and/or its agent subject to applicable state law. This quotation is valid for 30 days. Policy limits and coverage that have been selected are per the instructions of the policyholder and insured. This is merely a proposal and is not a Policy of Insurance or offer to insure. Rates quoted reflect the rates in effect as of the date of this proposal and are subject to revision. The company reserves the right to accept, reject or modify this insurance proposal after investigation, review of the application, and review of all other underwriting information.

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INVOICE

Agency Name

Address

Phone / Fax

Email

License#

Date	Date

Insured	Name

Insurance Company	Carrier Name (E&O)

Carrier Name (EPL)

Carrier Name (Package*)

Carrier Name (Excess Liability)

Carrier Name (Work Comp)

Policy Term	If NB type “Annual” / If RB type eff/exp dates

Office Package**	$	0,000.00 *

Excess Liability	$	0,000.00

Fidelity	$	0,000.00

Workers Compensation	$	0,000.00

Directors & Officers	$	0,000.00

Employment Practices Liability	$	0,000.00

State Surplus Lines Tax (3.000%)	$	0,000.00	*

State Stamping Fee (.225%)	$	0,000.00	*

Carrier/Policy Fee**	$	0,000.00

Broker Fee	**	$	0,000.00

Total Due	$	total.00

**please note, there is $1,951.24 in fully earned premium and fees. No flat cancellations.

Due Date	Upon Binding Coverage

Make Check Payable to	Agency Name

Disclosure: Premium DOES NOT include any optional coverages. Please contact us to purchase this coverage.

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(Please cut along dotted line and return bottom portion with remittance)

Insured	Name

Amount Enclosed	$

Policy Type

Mail Remittance to	Agency Name

Address

City, State, Zip

4 of 4

Insured

cbelden

2011-05-16

Cristina Cole