Insurance Corporate OCI Bid

INSURANCE CORPORATE OCI BID

Bid Identification

Bid Date:    Bid Number:    Proposal Valid Until:

Entity Type: Corporation LLC Partnership Other

Project / Owner Information

Project Type:    Estimated Project Value: $    Anticipated Commencement: — Estimated Completion:

Policy Proposal Summary

Provide limits, deductibles and premium quotations for each line of coverage. Quoted terms are subject to underwriting, inspection and acceptance of policy forms.

Coverage Options & Endorsements

Please indicate inclusion of the following endorsements and additional insureds as part of the OCI program:

Primary and non-contributory wording for additional insureds
Waiver of subrogation where required by contract
Per-project aggregate endorsement
Cross‑liability / severability of interest
Pollution liability extension (if available)

Exclusions

Standard policy exclusions apply unless specifically listed otherwise. Identify any non-standard exclusions below and state whether substitution or exception will be considered.

Claims / Prior Loss Information

Have there been any claims or losses on this project or involving the named insured within the past 5 years? Yes No

Beneficiary / Additional Insured Designation

Identify any parties to be named as primary certificate holders, additional insureds, or beneficiaries under the proposed OCI program.

Relationship to Project:    Interest / Coverage Percentage:

Underwriting Conditions, Certifications and Limitations

The undersigned certifies that all information provided in this bid is true, complete and accurate to the best of the signatory's knowledge. Submission of this bid constitutes an offer to provide insurance coverage subject to satisfactory completion of underwriting, receipt of required inspections, execution of policy forms and payment of premium. Quotations set forth in this bid are valid only for the Proposal Valid Until date indicated above and may be withdrawn earlier by the insurer in accordance with applicable law.

The insurer acknowledges that any acceptance of this bid by the named owner or its agents shall be evidenced by issuance of a policy or certificate. Coverage under any policy issued in reliance on this bid is limited to the terms, conditions, exclusions and endorsements of the executed policy forms. No agent, broker or representative has authority to modify policy terms unless such modification is documented in writing and executed by an authorized representative of the insurer.

Acknowledgment and Certification

By signing below, the undersigned certifies under penalty of perjury that the information contained in this Insurance Corporate OCI Bid is true and correct, that the undersigned is duly authorized to submit this bid on behalf of the named insurer, and that the insurer will comply with applicable regulatory requirements governing the issuance of insurance policies and certificates in connection with this proposal.

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