Laserfiche WebLink
ITEM S. PREMIUM <br />Premium: Compliance with all surplus lines placement requirements, including stamping <br />the Policy and collection and payment of surplus lines taxes, is the <br />responsibility of the broker. <br />Premium: $2,650,000.00 <br />Total Amount Due: $2,650,000.00 <br />See Invoice for the date Premium is due and payable. Failure to pay the <br />premium in full may result in voidance of coverage. <br />ITEM 6. RETROACTIVE DATE: Full prior acts <br />ITEM 7. FORMS AND ENDORSEMENTS ATTACHED AT ISSUANCE: <br />LPL.COV.002 (0509) Lawyers Professional Liability Coverage Form <br />1. IRON.END.ALL.016 (0419) Insurer Address Change <br />2. ADM-OFAC-0419 - Sanction Limitation and Exclusion Clause <br />3. Service of Suit Clause - California - SC-7 (11_19) <br />4. LPL.CNR.CA (0120) Cancellation and Nonrenewal Endorsement -California <br />5. LPL.MANU.173-13 (0616) Most Favorable Venue Wording For Punitive Damages <br />6. LPL.MANU.518 (0716): Specific Mutual Consent <br />7. LPL.MANU.539 (0518): Self -Representation Endorsement <br />8. LPL.MANU.022-3 (0616): Deletion Of Section VII E <br />9. LPL.MANU.200-7 (0616): Risk Management Budget <br />10. LPL.MANU.514 (0616): Notice Of Claim Amended - Managing Partner, GC, Management Committee <br />11. LPL.MANU.513 (0616): Definition Of Claim Amended (Toll Or Waive Statute Of Limitations) <br />12. LPL.MANU.516 (0616): Definition Of Insured Amended (From Inception) <br />ITEM 8. INSURER <br />ADDRESS: Send to Company Indicated Above <br />c/o Ironshore Insurance Services, LLC <br />28 Liberty Street <br />5th Floor <br />New York, NY 10005 <br />ITEM 9. BROKER: <br />ADDRESS: <br />Craig Lewis <br />Brakke Schafnitz Insurance Brokers, Inc <br />28202 Cabot Rd Suite 600 <br />Laguna Niguel, CA 92677 <br />LPL.DEC.002(05/09) <br />RiskManagemedDiwion <br />Ra Ewacl&Mraw®Ry: <br />fn�arLK R. V llwnea1 <br />Risk Management Analyst <br />