Insurance Policy Terms

INSURANCE POLICY TERMS

Applicant / Insured Information

Policy Details

Policy Number:    Policy Type:

Policy Period: From to

Coverages (select applicable)

General Liability (Bodily Injury & Property Damage) — Limit:

Property Damage — Limit:

Personal Injury / Advertising Injury — Limit:

Medical Payments — Limit:

Comprehensive / Other Property Coverages — Specify:

Exclusions

The following items are explicitly excluded from coverage unless a separate endorsement is issued: intentional acts or criminal conduct by the Insured; contractual liability assumed by the Insured except to the extent covered by statute; punitive or exemplary damages where prohibited by law; nuclear hazard; war, insurrection or military action; pollution and contamination except as specifically endorsed; wear and tear or gradual deterioration. Additional exclusions may be set forth in endorsements attached to this policy.

Insured acknowledges receipt and review of the exclusions set forth herein and understands that coverage is subject to the full policy language and any applicable endorsements.

Acknowledgment of Exclusions: I acknowledge that I have read and understand the exclusions contained in this policy.

Claims Reporting and Duties

The Insured shall give written notice to the insurer as soon as practicable of any occurrence or claim which may give rise to coverage under this policy. Failure to provide timely notice may prejudice coverage as set forth in the Loss Reporting and Notice provisions of the policy.

Documentation Checklist (attach as applicable):

Police report / incident report

Photographs of damage

Repair or loss estimates

Other supporting documentation:

Beneficiary Designation

Primary Beneficiary Name:

Relationship:    Share (%):

Contingent Beneficiary Name:

Relationship:    Share (%):

Limits, Adjustments and Payments

Limits of liability stated in this policy are maximum limits subject to the terms, conditions, endorsements and exclusions set forth herein. Premiums may be subject to audit and adjustment upon review of the Insured's records and exposures. The Insured agrees to provide records requested for audit and to pay any additional premium determined to be due.

Cancellation, Endorsements and Notices

This policy may be cancelled in accordance with the Cancellation and Nonrenewal provisions contained in the policy. Endorsements modifying coverage, limits or conditions will be effective only if issued by the insurer and attached to this policy. All notices required under this policy shall be given in writing to the address specified below.

General Provisions

Governing Law: This policy shall be governed by and construed in accordance with the substantive law of the jurisdiction declared in the policy declarations. Severability: If any provision of this policy is held invalid, the remaining provisions shall remain in full force and effect. Subrogation: To the extent the insurer pays a loss, the insurer shall be subrogated to the Insured's rights of recovery against any person or organization responsible for the loss. Arbitration: Disputes arising under this policy may be subject to arbitration where permitted by law and by agreement of the parties.

Declarations and Certifications

By signing below the Applicant/Insured certifies that all statements and representations contained in the application for this policy and in any attachments or supplements are true and complete to the best of the Applicant's knowledge and belief. The Applicant understands that material misrepresentations or omissions may result in denial of coverage, rescission of the policy, or other remedies permitted by law.

The Applicant authorizes the insurer to obtain and exchange information necessary to underwrite and service this policy, to the extent permitted by law, including but not limited to claims history and loss experience.

Certification: I certify that the information provided in this document is true and correct.

Authorization: I authorize the insurer to collect, use and disclose information relevant to underwriting, claims handling, and premium audit as permitted by applicable law.

Additional Endorsements or Riders

Sign Now