Lloyd’s Certificate This Insurance is effected with certain Underwriters at Lloyd’s, London. This Certificate is issued in accordance with the limited authorization granted to the Correspondent by certain Underwriters at Lloyd’s, London whose syndicate numbers and the proportions underwritten by them can be ascertained from the office of the said Correspondent (such Underwriters being hereinafter called “Underwriters”) and in consideration of the premium specified herein, Underwriters hereby bind themselves severally and not jointly, each for his own part and not one for another, their Executors and Administrators. The Assured is requested to read this Certificate, and if it is not correct, return it immediately to the Correspondent for appropriate alteration. All inquires regarding this Certificate should be addressed to the following Correspondent: 303 Congressional Boulevard Carmel, IN 46032 1-800-335-0611 317-575-2652 317-575-2659 FAX www.sevencorners.com SLC-3 (USA) NMA 2868 (24/08/2000 From approved by Lloyd’s Underwriters’ Non-Marine Association Limited EASON PRINTING CO., CHICAGO Inbound USA Program Summary 2009 - 1 LON09-090401-01TM Rev 01-13-10 CERTIFICATE PROVISIONS 1. Signature Required. This Certificate shall not be valid unless signed by the Correspondent on the attached Declaration Page. 2. Correspondent Not Insurer. The Correspondent is not an Insurer hereunder ...
This Insurance is effected with certain Underwriters at Lloyd’s, London. This Certificate is issued in accordance with the limited authorization granted to the Correspondent by certain Underwriters at Lloyd’s, London whose syndicate numbers and the proportions underwritten by them can be ascertained from the office of the said Correspondent (such Underwriters being hereinafter called “Underwriters) and in consideration of the premium specified herein, Underwriters hereby bind themselves severally and not jointly, each for his own part and not one for another, their Executors and Administrators. The Assured is requested to read this Certificate, and if it is not correct, return it immediately to the Correspondent for appropriate alteration. All inquires regarding this Certificate should be addressed to the following Correspondent:
SLC-3 (USA) NMA 2868 (24/08/2000 From approved by Lloyd’s Underwriters’ Non-Marine Association Limited EASON PRINTING CO., CHICAGO
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LON09-090401-01TM Rev 01-13-10
CERTIFICATE PROVISIONS 1. Signature Requi r e T d hi . s Certificate shall not be valid unless signed by the Correspondent on the attached Declaration Page. 2. Correspondent Not Ins u T r h e e r. CorrespondentisnotanInsurerhereunderandnesithhaellrbisenliaorbleforanyloscslaoirmwhatsoever.TheIenr s uhrereunderahreotseUnderwritersatLloyd’s,Londonwhosesyndicatenuamnbebres acscertainedashereinbeforesetAfsortuhs.edinthisCertificate“Untdeersrwrsihallbedeemedtoincludeincorporatedaswel unincorporatedpersonsorentitieasrethUatnderwriteartsLloyd’s,London.3. Cancellatio n If . thisCertificateprovidesfoerllc a tinocnandthisCertificateiscanacfteellretdheinceptiondate,earnedpremiubmepmauisdtforthetimetheinsurancehasbeeninforce.4. Service of S u i I t t . isagreedthatintheeventofthefailureofeUrnsdteorwpraityanyamountclaitmoebdeduehereunder,Underwritetrhse, raetquestoftheAesds,urwillsubmittothejurisdictionofaCourtofcompetentjurisdictionwititheindtShteatUesn.NothinginthisClauseconstitutesorshdoeurlsdtoboedutnoconstituteawaivUenrdoefrwriters’rightstocommencea action in any Court of competent jurisdiction in the Un,i t eodreSmtaotveesanactiontoaUnitedStatesDistrictoCosueret,koarttransferofacasetoanotherCourtaspermittedbythel theUnitedStatesorofanyStateintheUnitedStates.Itisfurtheragreedthatserviceofprocessinsucuhposnui t hmeafiyrmbeormpaedresonnamein6itoeftmheattachedDeclarationPage, and that in any ssutii t uitnedagainstanyoneofuthpeonm thiscontract,UnderwrwiitlelrasbidebythefinaldeciosfiosnuchCourtorofanyAppellateCourtintheeventofanappeal.Theabove-namedareauthorizedanddirectedtoacceptprsoecreviscseo nf behalfofUnderwirnitearnsysuchsuitand/orurpeoqnuestoftheAssuredvteo agi written undertaking to the AssuredthattheywilleantgereneralappearanceuponwUrnitdeerrs’behalfintehv e nt such a suit shall be instituted. Further,pursuanttoanystatuteofae,ntyesrrtiattoryordistrictoftheUniatt e dsSwthichmakesprovisiontherefor,wrUitnerdserherebydesignatetheSuepnedrei n t ,CommissionerDiroerctorofInsuranceorotherofficerspecifiedforthatpurposeuitne,thore shtisatsuccessorsinoffice,astheirtrueandorlanewyfulupaottnwhommaybeservedanylawfulprocessinanyaction, proceedinginstitutedbyoronbehalfsofstuhr e dAoranybeneficiaryhereuarnidsienrgoutofthiscontractofinsuradnch e ,raenbydesignatetheabove-omn e dntiasthepersontowhomthesaid officer is authorized to mail such process or a true copy thereof. 5. Assignme n T t. hisCertificateshallnotbeassignedeitherininwphaorltewoirthoutthewrittenconsentoftheCorrespondenteerneodno.rsedh 6. Attached Conditions Incorpo r T at hi e s d . Certificate is made and accepted subject t o vailslitohnes,pcronditionsandwarrasne t ifeosrthherein,attacheednodrorsed,allofwhicharetobeconsideredasirnpc o rated herein. 7. Short Rate Cancella t i If o t n h . eattachedprovisionsprovicdaenfcoerllation,thetablebelowwillbe ucsaelcdutloatetheshroar t e proportion hoef tpremium when applicable under the terms cancellation. Short Rate Cancellation Table for Term of One Year. Days Insurance Per Cent of Days Insurance Per Cent of Days Insurance Per Cent of Days Insurance Per Cent of In Force One Year Premium In Force One Year Premium In Force One Year Premium In Force One Year Premium 1.......................................5%66-69...................................291%54-............................1..5..6.53256-..........................2...6..0..77 2....................................... 6 70 - 73 ................................... 30 % % 34.......................................774-76...................................31157-............................1..6..0.54261-..........................2...6..4..78-5-6.......................................877-80...................................32161-............................1..6..4.55265-..........................2..6...9..797-8.......................................981-83...................................33165-...........................1...6.7..56270-...............2..7..3(9mos.)809-10.....................................1084-87...................................34168-............................1..7.1..57274-..........................2..7...8..8111-12.....................................1188-91(3mos.).......................35172-...........................1..7..5..58279-..........................2..8...2..8213-14.....................................1292-94...................................36176-............................1..7..8.59283-...........................2..8..7..8315-16.....................................1395-98...................................37179-................1..8.2(6mos.)60288-...........................2..9..1..8417-18.....................................1499-10.2..................................38183-...........................1..8..7..61292-..........................2..9...6..8519-20.....................................15103-..........................1...0..5..39188-...........................1..9..1..62297-..........................3..0...1..8621-22.....................................16106-...........................1..0..9..40192-............................1..9..6.63302-.............3..0..5(10mos.)8723-25.....................................17110-...........................1..1..3..41197-...........................2..0..0..64306-..........................3..1...0..8826-29.....................................18114-...........................1..1..6..42201-...........................2..0..5..65311-..........................3..1...4..8930-32(1mos.).......................19117-..........................1..2...0..43206-............................2..0..9.66315-..........................3..1...9..9033-36.....................................20121-...............1..2..4(4mos.)44210-...............2..1..4(7mos.)67320-..........................3..2...3..9137-40.....................................21125-..........................1..2...7..45215-...........................2..1...8.68324-..........................3...2..8..9241-43.....................................22128-...........................1..3..1..46219-............................2..2..3.69329-..........................3..3...2..9344-47.....................................23132-...........................1..3..5..47224-............................2..2..8.70333-.............3...3.7(11mos.)9448-51.....................................24136-...........................1..3..8..48229-............................2..3..2.71338-...........................3..4..2..9552-54.....................................25139-..........................1..4...2..49233-............................2..3..7.72343-...........................3..4..6..9655-58.....................................26143-..........................1..4...6..50238-............................2..4..1.73347-...........................3..5..1..9759-62(2mos.).......................27147-..........................1..4...9..51242-................2..4.6(8mos.)74352-...........................3..5..5..9863-65.....................................28150-...............1..5..3(5mos.)52247-............................2..5..0.75356-..........................3..6...0..99251-............................2..5..5.76361-.............3..6..5(12mos.)100Rules applicable to insurance with terms less than or more than one year: A. Ifinsurancehasbeeninforceforoneyearorless,haoprptlryat heetasbleforannualinsurancetothefullannuadleptr e r m i unmedasforinsuranitct e nwrforatermofoneyear.B. If insurance has been in force for more than one year: 1. Determinefullannualpremiumasfroarnicnesuwrittenforatermononeyear.2. Deductsuchpremiumfromthefullinsurancepremium,raenmdaio n dtehrecalculatetheptraoer a rnedpremiumonthebatshiseorfatioofthelengthoftimebeyondon yeartheinsurancehasbeeninforcetothelengbtheyoofntidmoeneyearforwhichthcey pwoalisoriginallywritten.3. Addpremiumproducedinaccordancewithitems(1)oabntadin(2e)atronedpremiumduringfiuoldl ipnesrurancehasbeencine.for Inbound USA Program Summary 2009 - 2 LON09-090401-01TM Rev 01-13-10