Insurance Account Agreement

INSURANCE ACCOUNT AGREEMENT

Applicant / Insured Information

Individual Corporation LLC Partnership

Policy Details

Policy Number:

Coverage Limit:    Deductible:

Premium Amount:    Billing Frequency: Annual Monthly Quarterly

Policy Period: From to

Coverages Selected

The insured selects the following coverages subject to the terms, conditions and exclusions of the policy:

Commercial General Liability — Coverage for bodily injury and property damage arising from insured operations.
Property — Coverage for direct physical loss or damage to insured property.
Business Interruption — Loss of income due to covered physical loss.
Cyber Liability — Coverage for network security and privacy liabilities.
Flood — Coverage for flood-related losses (subject to separate deductible).
Earthquake — Coverage for earthquake-related losses.
Umbrella/Excess — Excess limits above primary policies.

Exclusions and Limitations

The following standard exclusions apply unless specifically endorsed: intentional acts or willful misconduct; fraudulent acts by insured; war, nuclear hazard; pollution unless endorsed; wear and tear, deterioration or latent defect; professional liability unless endorsed. Any additional exclusions specific to this account are set forth below.

Beneficiary / Payee Designation

Designate the primary payee for claim proceeds and return premiums.

Claims Reporting and Documentation

Insured must report occurrences or claims as soon as reasonably practicable and cooperate with insurer in claim investigation, settlement and subrogation. Failure to timely report may prejudice coverage.

Police report (if applicable)
Photographs of damage
Receipts / invoices
Repair / replacement estimates

Premium Payment Authorization

The insured authorizes the insurer or its administrator to collect premiums and fees by the selected payment method. Insured represents that payment information provided is accurate and that insured is authorized to direct payment from the account identified.

Bank Transfer / ACH Credit Card Check

Declarations, Representations and Agreement

By signing this Insurance Account Agreement (Agreement), the insured certifies that the statements and representations contained herein are true, complete and accurate to the best of insured's knowledge. Insured acknowledges that coverage is afforded only to the extent set forth in the policy forms, endorsements and declarations issued by the insurer, subject to all terms, conditions, limitations and exclusions therein.

Insured authorizes insurer to obtain, use and disclose underwriting, claims and loss information relevant to this account from and to third parties for purposes of underwriting, claim handling, audit, fraud prevention and premium determination. Insured agrees to cooperate with insurer in claim investigations and to provide truthful statements under oath if requested.

Cancellation: Insurer or insured may cancel the policy in accordance with the policy's cancellation provisions. Any return premium due, subject to applicable offsets, will be computed in accordance with insurer's customary rules and policy terms. Reinstatement of coverage after cancellation requires affirmative underwriting acceptance.

Assignment: This Agreement and rights under the policy are not assignable without the prior written consent of the insurer, except that proceeds payable to a named beneficiary will be paid in accordance with the beneficiary designation provided above.

Governing Law and Dispute Resolution: This Agreement and the policy shall be governed by the laws of the jurisdiction specified in the policy. Any dispute arising out of or relating to this Agreement or the policy shall be submitted to binding arbitration if required by the policy or applicable law; otherwise disputes shall be resolved in the courts having jurisdiction where the insured's principal address is located.

Fraud Warning: Any person who knowingly and with intent to defraud any insurance company submits an application or claim containing false, incomplete or misleading information may be guilty of insurance fraud and subject to civil and criminal penalties under applicable law.

Acknowledgment and Certification

By signing below the insured acknowledges receipt of the policy declarations page upon issuance, understands the scope of coverages and exclusions set forth in the policy, and certifies the accuracy of the information provided in this Agreement. The insured further authorizes charged premiums and agrees to the premium payment schedule selected above.

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