Policy Declaration2
Professional Insurance Exchange Mutual, Inc.
policy-declaration2 POLICY NO.
Class ii-H FIP
DECLARATIONS
1. NAME OF INSURED | SCHEDULE | ||
---|---|---|---|
Individual Professional Liability Claims-Made Coverage Ashley Zufelt Dentistry Ashley Zufelt street city, state zip usa |
RETROACTIVE DATE jan 1, 2000 |
||
2. A POLICY FROM dec 20, 2023 to dec 20, 2024 12:01 a.m. standard time issued to the Named Insured stated herein. |
|||
In consideration of the premium cited below and paid by the Insured, professional liability coverage is extended as indicated by specific premium charge or charges. The limit of the Company’s liability related to coverage extended shall be subject to all terms of the Policy referenced. Coverage applies to incidents occurring after the Retroactive Date listed and claims reported to the Company in writing by the insured or by claimants during the time period listed in #2 above. |
COVERAGES | LIMITS OF LIABILITY | PREMIUM |
---|
Professional Liability Claims-Made Form Class ii-H FIP |
Each Claim $1,000,000 |
Annual Aggregate $3,000,000 |
Annual Premium $1,300 |
Authorized Signature CEO David L. Alvord DDS |
Rate Type: Faculty annual Payment Schedule |