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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: [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
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