GVHR » Topics » General Notes About Coverages

These excerpts taken from the GVHR 10-K filed Mar 16, 2009.

General Notes About Coverages

 

Coverage outlined in this document is for explanatory and reference purposes only.  The coverage provisions do not necessarily conform to any specifications furnished in the submission received from your representative.

 

The policy (or policies) that we issue to you shall contain the full and complete terms, conditions, exclusions and coverages provided under your insurance program.  In the case of any conflict between the insurance policy (or policies), and the provisions contained in this Proposal or binder, the provisions in the policy (or policies) shall govern.  Upon receipt, please review the policy (policies) thoroughly with your broker, and notify us promptly in writing if you have any questions or concerns.

 

The calculation of premiums, and other program features, included in this document have been established based upon the information provided by you and your representative.  Additional locations, changes in exposure, or other variations may make it necessary to re-evaluate the Proposal/Binder, premium calculations and plan factors.  Any modification we make shall be based on our evaluation of these changes and whether they represent a measurable difference from the insurance program originally contemplated at inception.

 

While it is our intention to honor the terms and conditions of our contract with you, we are required to follow all regulatory and filing requirements in effect for various states where you have an exposure.  We shall adhere to all state regulatory requirements.  We shall not issue any form, or apply any program, that is in contravention to a governing regulation, rule, statute or law.

 

Prior to the inception date of coverage, you must provide us with the following information: All applicable FEIN numbers, DMV reporting information (other than New York), Florida Acord 130 for Florida Workers’ Compensation coverage (fully completed, executed and notarized), and UAIN.

 

Florida Acord 130

 

Please be aware that in conjunction with your obligation to complete the Florida Workers Compensation Application [Accord form 130 FL (2002/07)] (“Application”), you are subject to the continuing obligation as required under Florida Statutes, Chapter 443, to provide us, as your workers’ compensation carrier, a copy of your quarterly earnings reports and self —audits supported by the quarterly earnings reports (“Reports”).

 

While you bear responsibility for additional obligations as set forth under Florida law and the terms of the Application, it is hereby required that you provide us with copies of the Reports at the end of each quarter.

 

Nothing herein is intended to modify, eliminate or amend any requirement you have to Provide us with information as detailed by the terms of the Application.

 

AIG acknowledges that the Florida Acord 130 has been received and that we do not expect a new form for the 2009 renewal.

 

Entities included as Named Insureds are those shown as such on the policy (policies) Declaration page, as well as in the appropriate Named Insured Endorsements attached to each individual policy, whether such are issued at inception, or included by an additional endorsement thereafter.

 

Any questions regarding this Proposal or Binder should be directed to Our AIG Risk Management Representative shown in this document. No Alterations to this Binder May Be Made Without the Prior Written Approval of AIG Risk Management.

 


*THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION 

 

21



 

General
Notes About Coverages



 



Coverage outlined in this
document is for explanatory and reference purposes only.  The coverage provisions do not necessarily
conform to any specifications furnished in the submission received from your
representative.



 



The policy (or policies)
that we issue to you shall contain the full and complete terms, conditions,
exclusions and coverages provided under your insurance program.  In the
case of any conflict between the insurance policy (or policies), and the
provisions contained in this Proposal or binder, the provisions in the policy
(or policies) shall govern.  Upon
receipt, please review the policy (policies) thoroughly with your broker, and
notify us promptly in writing if you have any questions or concerns.



 



The calculation of
premiums, and other program features, included in this document have been
established based upon the information provided by you and your representative.  Additional locations, changes in exposure, or
other variations may make it necessary to re-evaluate the Proposal/Binder,
premium calculations and plan factors. 
Any modification we make shall be based on our evaluation of these
changes and whether they represent a measurable difference from the insurance
program originally contemplated at inception.



 



While it is our intention
to honor the terms and conditions of our contract with you, we are required to
follow all regulatory and filing requirements in effect for various states
where you have an exposure.  We shall
adhere to all state regulatory requirements. 
We shall not issue any form, or apply any program, that is in
contravention to a governing regulation, rule, statute or law.



 



Prior to the inception
date of coverage, you must provide us with the following information: All
applicable FEIN numbers, DMV reporting information (other than New York),
Florida Acord 130 for Florida Workers’ Compensation coverage (fully completed,
executed and notarized), and UAIN.



 



Florida Acord 130



 



Please be aware that in
conjunction with your obligation to complete the Florida Workers Compensation
Application [Accord form 130 FL (2002/07)] (“Application”), you are subject to
the continuing obligation as required under Florida Statutes, Chapter 443, to
provide us, as your workers’ compensation carrier, a copy of your quarterly
earnings reports and self —audits supported by the quarterly earnings reports (“Reports”).



 



While you bear
responsibility for additional obligations as set forth under Florida law and
the terms of the Application, it is hereby required that you provide us with
copies of the Reports at the end of each quarter.



 



Nothing herein is
intended to modify, eliminate or amend any requirement you have to Provide us
with information as detailed by the terms of the Application.



 



AIG
acknowledges that the Florida Acord 130 has been received and that we do not
expect a new form for the 2009 renewal.



 



Entities included as
Named Insureds are those shown as such on the policy (policies) Declaration
page, as well as in the appropriate Named Insured Endorsements attached to each
individual policy, whether such are issued at inception, or included by an
additional endorsement thereafter.



 



Any questions regarding this
Proposal or Binder should be directed to Our AIG Risk Management Representative
shown in this document. No
Alterations to this Binder May Be Made Without the Prior Written Approval
of
AIG Risk Management.



 






*THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED
AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION
 



 



21
















 



General
Notes About Coverages



 



Coverage outlined in this
document is for explanatory and reference purposes only.  The coverage provisions do not necessarily
conform to any specifications furnished in the submission received from your
representative.



 



The policy (or policies)
that we issue to you shall contain the full and complete terms, conditions,
exclusions and coverages provided under your insurance program.  In the
case of any conflict between the insurance policy (or policies), and the
provisions contained in this Proposal or binder, the provisions in the policy
(or policies) shall govern.  Upon
receipt, please review the policy (policies) thoroughly with your broker, and
notify us promptly in writing if you have any questions or concerns.



 



The calculation of
premiums, and other program features, included in this document have been
established based upon the information provided by you and your representative.  Additional locations, changes in exposure, or
other variations may make it necessary to re-evaluate the Proposal/Binder,
premium calculations and plan factors. 
Any modification we make shall be based on our evaluation of these
changes and whether they represent a measurable difference from the insurance
program originally contemplated at inception.



 



While it is our intention
to honor the terms and conditions of our contract with you, we are required to
follow all regulatory and filing requirements in effect for various states
where you have an exposure.  We shall
adhere to all state regulatory requirements. 
We shall not issue any form, or apply any program, that is in
contravention to a governing regulation, rule, statute or law.



 



Prior to the inception
date of coverage, you must provide us with the following information: All
applicable FEIN numbers, DMV reporting information (other than New York),
Florida Acord 130 for Florida Workers’ Compensation coverage (fully completed,
executed and notarized), and UAIN.



 



Florida Acord 130



 



Please be aware that in
conjunction with your obligation to complete the Florida Workers Compensation
Application [Accord form 130 FL (2002/07)] (“Application”), you are subject to
the continuing obligation as required under Florida Statutes, Chapter 443, to
provide us, as your workers’ compensation carrier, a copy of your quarterly
earnings reports and self —audits supported by the quarterly earnings reports (“Reports”).



 



While you bear
responsibility for additional obligations as set forth under Florida law and
the terms of the Application, it is hereby required that you provide us with
copies of the Reports at the end of each quarter.



 



Nothing herein is
intended to modify, eliminate or amend any requirement you have to Provide us
with information as detailed by the terms of the Application.



 



AIG
acknowledges that the Florida Acord 130 has been received and that we do not
expect a new form for the 2009 renewal.



 



Entities included as
Named Insureds are those shown as such on the policy (policies) Declaration
page, as well as in the appropriate Named Insured Endorsements attached to each
individual policy, whether such are issued at inception, or included by an
additional endorsement thereafter.



 



Any questions regarding this
Proposal or Binder should be directed to Our AIG Risk Management Representative
shown in this document. No
Alterations to this Binder May Be Made Without the Prior Written Approval
of
AIG Risk Management.



 






*THIS CONFIDENTIAL INFORMATION HAS BEEN OMITTED
AND FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION
 



 



21
















 



EXCERPTS ON THIS PAGE:

10-K (3 sections)
Mar 16, 2009
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