Insurance Peer Policy

INSURANCE PEER POLICY

Policy Number:    Effective Date:    Expiration Date:

INSURED / APPLICANT INFORMATION

POLICY DETAILS

Policy Type: Property Liability Professional Cyber Personal Accident

COVERAGES SELECTED

Bodily Injury Liability — Covers damages for bodily injury to third parties.

Property Damage Liability — Covers damage to third-party property.

Professional Errors & Omissions — Coverage for negligent acts, errors, or omissions in professional services.

Cyber Liability — Coverage for data breach, privacy liability and incident response.

EXCLUSIONS

The following are standard exclusions under this Policy. Mark each exclusion acknowledged by the Insured.

War, invasion, acts of foreign enemies, hostilities, civil war, rebellion, insurrection or military power.

Intentional acts, deliberate criminal acts or fraud by the Insured.

Pollution and contamination except where specifically endorsed.

Contractual liabilities assumed under contract except to the extent the Insured would have been liable in absence of contract.

BENEFICIARY DESIGNATION

Designate beneficiary or beneficiaries to receive any payable proceeds under this Policy in the event of a covered loss payable to the Insured's estate.

Percentages must total 100% for distribution. If percentages are not specified, distribution will follow the terms in this Policy and applicable law.

CLAIMS PROCEDURE (IF APPLICABLE)

Documentation Submitted:

Police Report

Photographs of Damage or Scene

Repair or Replacement Estimates

Medical Reports & Bills

DECLARATIONS, REPRESENTATIONS AND CONDITIONS

The Insured declares that all statements and answers in this Policy, and in any application, declaration or other document submitted in connection herewith, are true and complete to the best of the Insured's knowledge. The Insured acknowledges that material misrepresentation, concealment of fact or fraud by the Insured shall render this Policy voidable in whole or in part at the insurer's election and may result in denial of coverage.

Coverage is subject to the terms, conditions, endorsements, limits and exclusions of this Policy. The insurer's liability for any loss is limited to the coverage amounts stated herein and shall be reduced by applicable deductibles. The Insured must comply with all notice, cooperation and mitigation requirements following a loss as a condition precedent to coverage.

Subrogation: The Insured agrees that, upon payment of a covered loss, the insurer shall be subrogated to the Insured's rights of recovery against any third party. The Insured shall execute and deliver instruments and papers and do whatever else is necessary to secure such rights.

Governing Law and Venue: This Policy shall be governed by and construed in accordance with the law indicated on the Policy declarations and, absent such indication, by the law of the jurisdiction where the Insured is domiciled, without regard to conflict of law rules.

Amendment and Assignment: No amendment, waiver, or assignment of any provision of this Policy shall be valid unless made in writing and signed by an authorized representative of the insurer. Assignment by the Insured of interests under this Policy shall not be effective except with the insurer's prior written consent.

Notices: Any notice required or permitted under this Policy shall be in writing and delivered to the address provided in this Policy or another address designated in writing by the party.

By signing below, the Insured attests under penalty of perjury that the information provided in this Insurance Peer Policy is true, complete, and accurate, and authorizes the insurer to obtain, verify and exchange such information as may be reasonably necessary to administer this Policy, investigate claims, and determine eligibility.

Applicant Acknowledgement: I certify that the information provided is accurate and complete.

I consent to the terms, conditions and authorizations set forth in this Policy.

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