Loading...
INSURANCE BINDER (3) Q CORM I N S U RA N C E BINDER DATE(MMIDDNYYY) 03/20/2012 THIS BINDER IS A TEMPORARY INSURANCE CONTRACT,SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM. AGENCY COMPANY BINDER# Care Providers Insurance Services, LLC Arch Insurance Co. 812032009875 a div of NSM Insurance Group DATE EFFECTIVE TIME DATEXPIRATION TIME 16301 Quorum Drive - Ste. 130B X AM X 1201AM Addison, TX 75001 03/15/2012 12:01 ----- 04/14/2012 PM NOON PHONE FAX THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY CODE: SUB CODE: PER EXPIRING POLICY#. AGENCY 00005475 DESCRIPTION OF OPERATIONSNEHICLESIPROPERTY(Including Location) CUSTOMER ID. Package Policy #NCPKG0128102 INSURED Intercultural Advocacy Institute Inc. Auto Policy #NCAUT0128102 14155 58th Street No Suite 200 mbrella Policy #NCUMB0128102 Clearwater, FL 33760 COVERAGES LIMITS TYPE OF INSURANCE COVERAGEfFORMS DEDUCTIBLE COINS% AMOUNT PROPERTY CAUSES OF LOSS - BASIC BROAD SPEC GENERAL LIABILITY Abuse & Molestation Li ab-$1,000,000/$3,000,000 EACH OCCURRENCE $ 1,000,000 X Professional Liab-$1,000,000 $3,000,000 DAMAGETO 100,000 - COMMERCIAL GENERAL LIABILITY / ;_RENTEDPt3E[UJSES �� = CLAIMS MADE X OCCUR = MED EXP(Any one person) s $ 20,000 - PERSONAL&ADV INJURY $ 1,000,000 Employee Benefits Li ab-$1,000,000/$1,000,000 GENERAL AGGREGATE $ 3,000,000 RETRO DATE FOR CLAIMS MADE. PRODUCTS-COMP/OP AGG $ 3,000,000 VEHICLE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 .. - ANY AUTO - BODIL.Y.)P,JUE Y.�P.?.C.P.erson}.......€..$.............................................. -ALL OWNED AUTOS - BODILY INJURY(Per accident) _ $ - SCHEDULED AUTOS - PROPERTY DAMAGE $ X- HIRED AUTOS - MEDICAL PAYMENTS $ X NON-OWNED AUTOS PERSONAL INJURY PROT $ - UNINSURED MOTORIST $ VEHICLE PHYSICAL DAMAGE DED ALL VEHICLES SCHEDULED VEHICLES - ACTUAL CASH VALUE COLLISION Hired Car Physical Damage - EXCESS STATED AMOUNT $ OTHER THAN COL: ................................... Ded: Comp $100/Collision $1,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO : OTHER THAN AUTO ONLY EACH ACCIDENT AGGREGATE EXCESS LIABILITY EACH OCCURRENCE $ 1,000,000 _X._ UMBRELLA FORM AGGgEGATE 1 000 000 —' OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE. SELF-INSURED RETENTION 10,000 WC STATUTORY LIMITS WORKER'S COMPENSATION E.L.EACH ACCIDENT AND .............. $. EMPLOYER'S LIABILITY E .DISEASE-EA EMPLOYEE $ E .DISEASE-POLICY LIMIT SPECIAL :._FEES_ CONDITIONS I OTHER TAXES $. COVERAGES ESTIMATED TOTAL PREMIUM NAME&ADDRESS THIS BINDER IS A SUMMATION OF THE MORTGAGEE ADDITIONAL INSURED LIMITS, TERMS, COVERAGES AND LOSS PAYEE CONDITIONS ALL OF WHICH ARE LOAN# SUPERCEDED BY THE ACTUAL POLICY WHFLNHORIZED REPRESENTATIVE / i ISSUED. Geoffery McKernan/PAM (/( `' Page 1 of 2 ©ACORD CORPORATION 1993-2007. All rights reserved. ACORD 75(2007/01) The ACORD name and logo are registered marks of ACORD CONDITIONS This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company. This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the Rules and Rates in use by the Company. Applicable in California When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title of the form is changed from "Insurance Binder"to"Cover Note". Applicable in Colorado With respect to binders issued to renters of residential premises, home owners, condo unit owners and mobile home owners, the insurer has thirty(30) business days, commencing from the effective date of coverage, to evaluate the issuance of the insurance policy. Applicable in Delaware The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if the binder includes or is accompanied by: the name and address of the borrower; the name and address of the lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled within the term of the binder unless the lender and the insured borrower receive written notice of the cancel- lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of insurance coverage. Chapter 21 Title 25 Paragraph 2119 Applicable in Florida Except for Auto Insurance coverage, no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless the binder is replaced by a policy or another binder in the same company. Applicable in Nevada Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof of insurance for actual damages sustained therefrom. Applicable in the Virgin Islands This binder is effective for only ninety(90) days. Within thirty(30) days of receipt of this binder, you should request an insurance policy or certificate (if applicable)from your agent and/or insurance company. ACORD 75(2007/01) Page 2 of 2