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Contracts & Agreements_132-2017
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Contracts & Agreements_132-2017
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Last modified
2/4/2020 8:57:33 AM
Creation date
11/21/2017 9:22:25 AM
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Template:
Contracts & Agreements
Subject
Insurance Services
Details
Surplus Lines, TRIA Form, Claims Reporting, Bind Coverage.
Date
6/20/2017
Document Number
132-2017
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APIP Claims Reporting Acknowledgement(s) Receipt Form <br /> The Claims Reporting Forms are being included with your packet to ensure claims reporting procedures <br /> are known and available for future reference Please review the information We ask that you <br /> share these critical documents with all members of your team (and Pool Members and their staffs <br /> where applicable) <br /> We request that you review the items indicated as attached then complete the bottom portion, sign <br /> and submit to your Alliant Insurance Services representative either by a scanned a mad or mail to <br /> have it be included in your insurance records <br /> LSO APIP Property Claims Reporting <br /> Cyber Claims Reporting (thlslsa clalinsinadepollcj� if coverage is purchased <br /> 70 <br /> Pollution Liability Claims Reporting (thlsIsaclaliminadepollck if coverage is purchased <br /> Acknowledgement for Claims reporting procedures under Alliant Property Insurance Programs In <br /> effect. July 1,2017 until further notice <br /> I have read and been informed about these separate reporting requirements under the coverage pants <br /> that apply to our entity as indicated above and provided through APIP by Alhant <br /> Insured Entity Name City of Redlands, CA <br /> Authorized Signature <br /> Paul W Foster, Mayor Date j <br /> ('/2-1117 <br /> Attest Date <br /> J ne Donaldson, City Clerk <br /> Date Issued June 7 2017 Alhant Insurance Services, Inc I www alliant.com I CA License No OC36861 Page 5 <br />
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