the princeton excess and surplus lines ...notice/slsop 10 14 service of process/d2-2017 california...

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THE PRINCETON EXCESS AND SURPLUS LINES INSURANCE COMPANY Administration Office: 555 College Road East, Princeton, NJ 08543-5241 800.305.4975 Statutory Office: 2711 Centerville Road, Suite 400 – Wilmington, DE 19805 (a stock insurance company) ARE PR DEC 04 21 15 Page 1 of 2 REAL ESTATE BROKERS AND AGENTS ERRORS AND OMISSIONS LIABILITY POLICY THIS IS A CLAIMS MADE AND REPORTED POLICY. PLEASE READ CAREFULLY. DECLARATIONS POLICY NUMBER: RENEWAL OF: NAMED INSURED: D/B/A: MAILING ADDRESS: POLICY PERIOD: (AT 12:01 AM STANDARD TIME AT THE ADDRESS OF THE NAMED INSURED STATED ABOVE) FROM: TO: LIMITS OF LIABILITY: EACH CLAIM AGGREGATE DISCRIMINATION $100,000 DEDUCTIBLE: EACH CLAIM RETROACTIVE DATE: PREMIUM: THIS POLICY IS MADE AND ACCEPTED SUCH TO THE PRINTED CONDITIONS IN THIS POLICY TOGETHER WITH THE APPLICATION AND PROVISIONS, STIPULATIONS AND AGREEMENTS CONTAINED IN THE FOLLOWING FORM(S) OR ENDORSEMENT(S): ANNUAL SURPLUS LINES TAX STAMP FEE TOTAL ROSEVILLE CA 95678 $31.22 $2,500 $15,608.00 5/13/2013 $16,107.46 $1,000,000 2DA3PL0003466-01 $468.24 NEW VISION REALTY GROUP/TABLE REALTY/SUNFLOWER REALTY GROUP 6/11/2017 H AND M RE HOLDINGS, INC. 951 RESERVE DRIVE, SUITE 140 6/11/2018 ARE PR 00 01 07 14 REAL ESTATE BROKERS AND AGENTS ERRORS AND OMISSIONS LIABILITY POLICY /ARE PR 99 01 06 11 CHANGE ENDORSEMENT/ ARE PR 99 04 07 14 FUNGUS AND BACTERIA/ ARE PR 25 01 06 11 CLAIM EXPENSES INCLUDED IN THE LIMITS OF LIABILITY/ ARE PR 03 01 06 11 DEDUCTIBLE APPLICABLE TO DAMAGES AND CLAIM EXPENSES/ ARE PR 25 02 06 11 DISCRIMINATION - $250,000 LIMIT OF LIABILITY/ ARE_PR 99 01 06 11 CHANGE ENDORSEMENT / ARE PR 04 03 06 11 ENVIRONMENTAL HAZARDS - EACH CLAIM SUBLIMIT/ CAPP-1 03 03 PRIVACYFORM CAL UPDATED /IL N 177 09 12 CALIFORNIA PREMIUM REFUND DISCLOSURE NOTICE/SLSOP 10 14 SERVICE OF PROCESS/D2-2017 CALIFORNIA SURPLUS LINES DISCLOSURE N0TICE D-2/ $1,000,000 2DA3PL0003466-02

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Page 1: THE PRINCETON EXCESS AND SURPLUS LINES ...NOTICE/SLSOP 10 14 SERVICE OF PROCESS/D2-2017 CALIFORNIA SURPLUS LINES DISCLOSURE N0TICE D-2/ $1,000,000 2DA3PL0003466-02 THE PRINCETON EXCESS

THE PRINCETON EXCESS AND SURPLUS LINES INSURANCE COMPANY Administration Office: 555 College Road East, Princeton, NJ 08543-5241

800.305.4975 Statutory Office: 2711 Centerville Road, Suite 400 – Wilmington, DE 19805

(a stock insurance company)

ARE PR DEC 04 21 15 Page 1 of 2

REAL ESTATE BROKERS AND AGENTS ERRORS AND OMISSIONS LIABILITY POLICY

THIS IS A CLAIMS MADE AND REPORTED POLICY. PLEASE READ CAREFULLY.

DECLARATIONS

POLICY NUMBER: [3HA3PL0000000-00] RENEWAL OF: [3HA3PL0000000-00]

NAMED INSURED: [NAME]D/B/A:

MAILING ADDRESS:

POLICY PERIOD: (AT 12:01 AM STANDARD TIME AT THE ADDRESS OF THE NAMED INSURED STATED ABOVE) FROM: [00/00/0000] TO: [00/00/0000]

LIMITS OF LIABILITY: EACH CLAIM $[DOLLAR]

AGGREGATE $[DOLLAR]

DISCRIMINATION $100,000

DEDUCTIBLE: EACH CLAIM $[DOLLAR]

RETROACTIVE DATE: [00/00/0000]

PREMIUM:

THIS POLICY IS MADE AND ACCEPTED SUCH TO THE PRINTED CONDITIONS IN THIS POLICY TOGETHER WITH THE APPLICATION AND PROVISIONS, STIPULATIONS AND AGREEMENTS CONTAINED IN THE FOLLOWING FORM(S) OR ENDORSEMENT(S):

ANNUAL

SURPLUS LINES TAX

STAMP FEE

TOTAL

ROSEVILLE CA 95678

$31.22

$2,500

$15,608.00

5/13/2013

$16,107.46

$1,000,000

2DA3PL0003466-01

$468.24

NEW VISION REALTY GROUP/TABLE REALTY/SUNFLOWER REALTY GROUP

6/11/2017

H AND M RE HOLDINGS, INC.

951 RESERVE DRIVE, SUITE 140

6/11/2018

ARE PR 00 01 07 14 REAL ESTATE BROKERS AND AGENTS ERRORS AND OMISSIONS LIABILITY POLICY /ARE PR 99 01 06 11 CHANGEENDORSEMENT/ ARE PR 99 04 07 14 FUNGUS AND BACTERIA/ ARE PR 25 01 06 11 CLAIM EXPENSES INCLUDED IN THE LIMITS OFLIABILITY/ ARE PR 03 01 06 11 DEDUCTIBLE APPLICABLE TO DAMAGES AND CLAIM EXPENSES/ ARE PR 25 02 06 11 DISCRIMINATION -$250,000 LIMIT OF LIABILITY/ ARE_PR 99 01 06 11 CHANGE ENDORSEMENT / ARE PR 04 03 06 11 ENVIRONMENTAL HAZARDS - EACHCLAIM SUBLIMIT/ CAPP-1 03 03 PRIVACYFORM CAL UPDATED /IL N 177 09 12 CALIFORNIA PREMIUM REFUND DISCLOSURENOTICE/SLSOP 10 14 SERVICE OF PROCESS/D2-2017 CALIFORNIA SURPLUS LINES DISCLOSURE N0TICE D-2/

$1,000,000

2DA3PL0003466-02

Page 2: THE PRINCETON EXCESS AND SURPLUS LINES ...NOTICE/SLSOP 10 14 SERVICE OF PROCESS/D2-2017 CALIFORNIA SURPLUS LINES DISCLOSURE N0TICE D-2/ $1,000,000 2DA3PL0003466-02 THE PRINCETON EXCESS

THE PRINCETON EXCESS AND SURPLUS LINES INSURANCE COMPANY Administration Office: 555 College Road East, Princeton, NJ 08543-5241

800.305.4975 Statutory Office: 2711 Centerville Road, Suite 400 – Wilmington, DE 19805

(a stock insurance company)

ARE PR DEC 04 21 15 Page 2 of 2

LICENSED SURPLUS LINES BROKER:

[Name]

[Address]

[License Number]

[Nanda Number]

PROGRAM ADMINISTRATOR:

ARROWHEAD GENERAL INSURANCE AGENCY, INC. 537 WEST 600 SOUTH, SUITE 300 SALT LAKE CITY, UT 84101 (801) 521-4412

Authorized Representative

DATE PRINTED: [00/00/0000]

Policy is issued to the Named Insured as a participating member of The Real Estate Purchasing Group Inc which is a purchasing group established pursuant to the Liability Risk Retention Act of 1986, as amended.

ANNUAL

7/10/2017

AUSTIN & AUSTIN INSURANCE SERVICES, INC.

LICENSE # OC10853

5890 STONERIDGE DR, SUITE 209 PLEASANTON CA 94588