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City of Santa Ana /% CORE 360' <br /> err <br /> ❑Accept❑ Reject Excess DIC-$10M Excess$25M <br /> Palomar Excess and Surplus Insurance An additional $10M in limits for an additional <br /> Company, Princeton Excess&Surplus Lines Ins $170,247.00 in premium <br /> Co <br /> ❑Accept❑ Reject Excess DIC-$15M Excess$25M <br /> Palomar Excess and Surplus Insurance An additional $15M in limits for an additional <br /> Company, Princeton Excess&Surplus Lines Ins $252,791.00 in premium <br /> Co <br /> ❑Accept❑ Reject Terrorism <br /> ❑ Option# 1 Lloyd's Syndicate 3623(Beazley Furlonge <br /> Limited) <br /> ❑ Option#2 Texas Insurance Company <br /> ❑Accept❑ Reject TRIA-Terrorism <br /> For this coverage,TRIA cannot be rejected <br /> Additional Recommended Coverages <br /> Gallagher recommends that you purchase the following additional coverages for which you have exposure. By checking the <br /> box(es)below,you are requesting that Gallagher provide you with a Proposal for this coverage. By not requesting a Proposal for <br /> this coverage, you assume the risk of any uncovered loss. <br /> The above coverage(s)does not necessarily represent the entirety of available insurance products. If you are interested in <br /> pursuing additional coverages other than those listed in the Additional Recommended Coverages, please list below: <br /> pio y��gpg�y'NN$ll QIVIVJIUlIIf y��UUUJkkNN� N+'JkNAI11J�JUIJ�A'�'RNN i�U�IIIVD�IOU°YI�N11�V'�IllV11�11D I� <br /> Exposures and Values <br /> You confirm the payroll, values, schedules, and any other information pertaining to your operations, and submitted to the <br /> underwriters,were compiled from information provided by you. If no updates were provided to Gallagher, the values, exposures <br /> and operations used were based on the expiring policies.You acknowledge it is your responsibility to notify Gallagher of any <br /> material change in your operations or exposures. <br /> Additional Terms and Disclosures <br /> Gallagher is not an expert in all aspects of your business. Gallagher's Proposals for insurance are based upon the information <br /> concerning your business that was provided to Gallagher by you. Gallagher expects the information you provide is true, correct <br /> 46 <br /> ��� jj <br /> JJ i1111111III1111�D�lllll ll»�Il� JJ��Il <br /> _ _ ,,,,,,,,,,, «««�««���«������«����«�o����u�ll����i��illlllllfolllflllflllllll«OIIIIII�III�OIIIIIIIIIIIII01 � �� ����������� II�I�OI�I��III��III���I�I��I�IIIIII�(O�IIII�III�IIIIIII��III��IIIIIII��IIII�IIII�O�I IIII�III�I��I�IIIIII�III������II�II II���I���III�IIII IIII� <br />