Would you like to proceed with an application for coverage?
(You will be required to provide additional information)
Would you like to proceed with an application for coverage?
(You will be required to provide additional information)
*IMPORTANT: PLEASE READ CAREFULLY
In order to complete the underwriting process, we require that you send us the additional information requested above. We are not required to bind coverage prior t your receipt, review and underwriting approval of the information. If between the date of the quotation and the Effective Date of the proposed policy there is a significant adverse change in the condition of this Applicant, or an occurrence of an event, or other circumstances which could substantially change the underwriting evaluation of of Applicant, then, at our option, this quotation may be with drawn by written notice thereof to the Applicant. We also reserve the right to modify the final terms and conditions upon review of the complete application and any other information requisition by the underwriter heron. If such material change in the risk is discovered after binding, the insurance coverage will be void ab initio (“from the beginning”).
This quotation is contained upon the Applicant’s agreement to accept delivery of the policy, endorsements and any policyholder notices by electronic means. The Applicant’s acceptance of this quotation signifies their agreement to this.
Any applicable taxes, surcharges or countersignature fees, etc. are in addition to the above premium. You office is responsible for making state surplus lines filings and complying with all applicable laws.