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DocuSign Envelope ID: 3FD37DED-3EFC-49BB-BD08-D6EFCA4FEB76 <br /> C a <br /> PO BaX 59689 Nrmfn ham AL 35259-9889 phone: 800 824-9709 Fax "0 879-3739 <br /> ATTN.- Carol Smith Email: JCarol.Smith@_bbandtcom <br /> AGENCY; 1313&T-Commercial Client Center QUOTATION EXP DATE: 711312016 <br /> We are pleased to confirm the following quotation that has been received from the carrier shown below. <br /> Please note that this quotation is based on the coverage,terms and conditions listed below, which may be <br /> different from those requested in your original submission. As you are the representative of the insured,i <br /> is incumbent upon you to review the terms of this quotation carefully with your Insured,and reconcile an <br /> differences from the terms requested in the original submission. CRC Insurance Services, Inc. disclaim <br /> any responsibility for your failure to reconcile with the Insured any differences between the terms quote <br /> Blow and those terms originally requested. THIS COVERAGE MAY NOT BE BOUND WITHOUT A FULL <br /> EXECUTED BROKERAGEAGREEMENT. <br /> The terms of the quotation are as follows: <br /> Insured Name: Senior Care of Orange County, Inc. <br /> Description: Q--' L'-LA PAIJ <br /> Carrier: Evanston Insurance Company <br /> Form: CLAIMS MADE <br /> Tenn: 7/13/2015 to 7/13/2016 <br /> Limit: Professional Liability <br /> $1,000,000 Each Claim <br /> $3,000,000 Aggregate <br /> General Liability <br /> $1,000,000 Each Claim Coverage A <br /> $1,000,000 Each Claim Coverage B <br /> $5,000 Limit Med Pay Coverage C <br /> $3,000,000 Limit Aggregate All Coverages <br /> Deductible: Professional Liability <br /> $5,000 Each Claim <br /> General Liability <br /> $5,000 Each Claim <br /> Terms&Conditions: The Insurance Carrier indicated in this quotation reserves the right,at its sole <br /> discretion,to amend or withdraw this quotation if the Carrier becomes aware of <br /> any new,corrected or updated information that the Carrier believes would be a <br /> material change and would cause them to change their original underwriting <br /> decision. <br /> Premium is due upon receipt of invoice. <br /> Fees are fully earned upon binding. <br /> 25%Minimum Earned Premium <br /> Retro active date: July 13,2005 for GL and PL <br /> Rate: FLAT <br />