第３章 参考文献2 CAMICO加入申込書
Part Ⅱ:Coverage（保証額）
14. Requested limit of liability and deductible (check all options you wish quoted):
Requested Limit of Liability:Per Claim/Annual Aggregate
□ $100,000/$100,000
□ $250,000/$250,000
□ $500,000/$500,000
□ $500,000/$1,000,000
□ $750,000/$750,000
□ $1,000,000/$1,000,000
□ $2,000,000/$2,000,000
□ $1,000,000/$2,000,000
□ $1,000,000/$3,000,000
□ $3,000,000/$3,000,000
□ $3,000,000/$6,000,000
□ $5,000,000/$5,000,000
□ other:$
Double and triple aggregate limits are available for most limits
Requested Deductible
□ Dollar One Defense
□ $1,000
□ $2,500
□ $5,000
□ $7,500
□ $10,000
□ $25,000
□ other:$
Double and triple aggregate limits are available for most limits.
If choosing Doller One Defence, select a deductible that applies to indemnity payments.The deductible does not apply to defense expenses paid.
Separate Limit of Defence
(Limit cannot exceed indemnity limit)
□ $100,000
□ $250,000
□ $500,000
□ $750,000
□ $1,000,000
15. Has any similar insurance for a partner, stockholder, employee of of the Firm or predecessor ever been declined, canceled, or non-renewed?(not applicable in Missouri) If yes, explain on Narrative Response Sheet(PartⅦ, page5)
□Yes □No
16. Has the Firm or its predecessor(s) carried accountants professional liability insurance during the past fine years?
If yes, complete the following:
□Yes □No
| From MM/DD/YY to MM/DD/YY | Insurance Company | Limit of Liability | Deductible | Premium |
| ___/___/___to___/___/___ | ||||
| ___/___/___to___/___/___ | ||||
| ___/___/___to___/___/___ | ||||
| ___/___/___to___/___/___ | ||||
| ___/___/___to___/___/___ |
2000 CAMICO Mutual Insurance Company
