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HomeMy WebLinkAboutContracts & Agreements_136-2017 Binding Requirements Recap Required no later than June 30, 2017 • Signed and dated Request to Bind Coverage form (below) • Signed and dated Surplus Lines forms as required by your state and attached to this proposal* • Signed and dated APIP Claims Reporting Acknowledgement(s) Receipt Form • Signed and dated Terrorism Risk Insurance ACT of 2002 as amended (a k a TRIPRA 2015) *-only required for coverage in the following states AR CA CT FL, KS, MA, MT, NE, NY, NC, ND, OH Ri WV,WY Request to Bind Coverage City of Redlands, CA We have reviewed the proposal and agree to the terms and conditions of the coverages presented This Autfiorization to Bind Coverage also acknowledges receipt and review ofall dIscIa/mers, disclosures, and loss notification requirements includ(Ing exposures used to develop insurance terms, contained within this proposal 7 Paul Barich, Mayor Pro Tempore Date Attest �annealdson, City Cleric This proposal does not constitute a binder of Insurance Binding is subject to final carrier approval. The actual terms and conditions of the pokey wil/prevai/, Date Issued June 7 2017 Alhant Insurance Services, Inc I www alliant.com I CA License No OC36861 Page 3 2017-2019 Alliant Crime Insurance Program Government Crime Insurance Proposal City of Redlands Request to Bind Coverage We have reviewed the proposal and agree to the terms and conditions of the coverages presented We are requestsng coverage to be bound as outlined by coverage line below Coverage Line Bind Coverage for: ACIP Government Crime Proposed Policy Period July 1, 2017 to July 1, 2019 (PREMIUM BILLED IN ANNUAL INSTALLMENTS ❑ Option 1 If Applicable FOR 2 YEAR POLIGY) ❑ Option 2 If Applicable ❑ Option 3 If Applicable This Auth nd Coverage also acknowledges receipt and review of all disclaimers and disclosures, including e osures used to develop insurance terms, contained within this proposal Authorized Si ature C� zv� 7 Paul Barich, Mayor Pro Tempore ate Attest anne Donaldson, City Clerk actual terms and conditions of the policy will prevail This proposal does not constitute a binder of insurance Binding is subject to final carrier approval The Alliart Insurance Services Inc I www alliant com I CA License No OC36861 Page 9