Laserfiche WebLink
UNITED STATES FIRE INSURANCE COMPANY <br />Administrative Offices: 5 Christopher Way • 3" Floor • Eatontown, NJ 07724 <br />BLANKET BENEFITS FOR ACCIDENTS ONLY <br />CERTIFICATE OF COVERAGE <br />This Certificate contains the terms under which the United States Fire Insurance Company agrees to insure <br />certain persons and pay benefits. <br />This Certificate is a part of, and is governed by, a Group Policy that has been issued in the state of ILLINOIS and <br />shall be governed by its laws. <br />Coverage under this Certificate is provided in consideration of payment of the initial premium, continued payment <br />of premiums when due, and completion of an Application. This Certificate is a part of, and is governed by, a <br />Group Policy. The Group Policy has been issued to, and is the contract between, the Group Policyholder and <br />The United States Fire Insurance Company. The Group Policy is held by the Group Policyholder and may be <br />inspected upon request at any reasonable time. The name of the Group Policyholder is shown in the Schedule. <br />This Certificate has been issued to you, the Certificateholder, as a Participant under the Group Policy, in <br />accordance with the terms, conditions, and limitations of the Group Policy. <br />10 DAY RIGHT TO RETURN THIS CERTIFICATE <br />If for any reason, you are not satisfied with this Certificate, you may return it to us within 10-days after receiving <br />it. Upon its return, we will refund any premium paid and this Certificate will be deemed void, just as though it had <br />never been issued. <br />THIS IS ACCIDENT ONLY COVERAGE. <br />READ IT CAREFULLY. <br />BENEFITS ARE NOT PAYABLE FOR LOSS DUE TO SICKNESS. <br />THIS CERTIFICATE PAYS BENEFITS FOR SPECIFIC LOSSES FROM ACCIDENTS ONLY. <br />THIS CERTIFICATE IS NOT RENEWABLE. <br />Signed for The United States Fire Insurance Company By: <br />Signature <br />Signature <br />M <br />Douglas M. Libby <br />James Kraus <br />Chairman and <br />CEO <br />Secretary <br />GAC26932 <br />ByRJkA&mP OVED <br />SMr4AceeD <br />24209 <br />�- <br />FRANONE R. VILLAREAL <br />