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Builders Risk and Installation
2 9. Proposal
i�
remium Summary ;-
Prepared .For Theodore Ferguson
1085:1 South Ocean Drive
Jensen Beach, FL 34957
Presented By US ASSURE. INSURANCE SERVICES OF FLORIDA, INC.
P.O. BOX 10610
JACKSONVILLE, FL 32247-0120
0
ZURICH�„
Proposed Policy Period From o1/0112015 To 01/01/2016
(12:01 a.m. Standard Time at your address as stated herein)
This is intended
only as a brief
outline and does not.
T e of cavera e
— g
alter any.of the
Builders Risk
coverages,
conditions,
exclusions or
provisions
contained in the
policy.
Proposed Policy Premium*
State Taxes & Surcharges
Total Proposed Policy Premium*
Total Premium (all locations
$520.00
$520.00
$7,.49
$527.49,
Premium quotation valid for 30 days from the date on the first page of this proposal..
Policy is fully earned
See attached Disclosure of Terrorism Premium.
This is,a proposal for "insurance. It is net an insurance policy. Only the policy itself provides coverage. The coverages offered in this
proposal are based on information received through the agent and may not include all:available coverages_ The client and their
agent should discuss any,additional or optional coverages needed. Coverage descriptions are abbreviated and -do not indicate in
force coverage. This proposal is; not a part of and is not incorporated into the insurance policy. If there is any conflict between the
coverage descriptions shown in this proposal and -the actual insurance.policy,'the insurance policy prevaiis.The insurance policy
supercedes: this proposal.
"If you want to learn more about the compensation.Zurich pays agents and brokers visit:
http://www:zurichnaprodu.cercompensation.corh,or call the following toll free number:.(866).903-1192, This Notice of Disclosure is
provided on behalf of Zurich.RmericanInsurance 'Company and its underwriting subsidiaries."
Date Generated: 11/19/2014.10:38:41 AM Page 3 of 6