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Binding Requirements Recap <br /> Required no later than June 30, 2017 <br /> • Signed and dated Request to Bind Coverage form (below) <br /> • Signed and dated Surplus Lines forms as required by your state and attached to this proposal* <br /> • Signed and dated APIP Claims Reporting Acknowledgement(s) Receipt Form <br /> • Signed and dated Terrorism Risk Insurance ACT of 2002 as amended (a k a TRIPRA 2015) <br /> *-only required for coverage in the following states AR CA CT FL, KS, MA, MT, NE, NY, NC, ND, OH Ri WV,WY <br /> Request to Bind Coverage <br /> City of Redlands, CA <br /> We have reviewed the proposal and agree to the terms and conditions of the coverages presented <br /> This Autfiorization to Bind Coverage also acknowledges receipt and review ofall dIscIa/mers, disclosures, and loss <br /> notification requirements includ(Ing exposures used to develop insurance terms, contained within this proposal <br /> 7 <br /> Paul Barich, Mayor Pro Tempore Date <br /> Attest <br /> �annealdson, City Cleric <br /> This proposal does not constitute a binder of Insurance Binding is subject to final carrier approval. The <br /> actual terms and conditions of the pokey wil/prevai/, <br /> Date Issued June 7 2017 Alhant Insurance Services, Inc I www alliant.com I CA License No OC36861 Page 3 <br />