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>� fii T.i"� � i u a�.11�^ :uh ;i. 1,''i r•.. � ��.51�, .t^ ..}• <br /> 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 Authorization to Bind Coverage also acknowledges receipt and re view of all disclaimers, disc%sures, and loss <br /> notification requirements including exposures used to develop insurance terms, contained within this proposal <br /> �csl'-& ' -11, 6/aI17 <br /> Paul W Foster, Mayor /Date <br /> Attest <br /> Jolne Donaldson, City Clerk <br /> This proposal does not constitute a binder of insurance. Binding Is subject to final carrier approval The <br /> actua/terms and conditions ofthe po/icy wf//pfeval/ <br /> Date Issued June 7,2017 Alliant Insurance Services, Inc I www alliant.com l CA License No OC36861 Page 3 <br />