Orange County NC Website
Browse       Search
DocuSign Envelope ID: FCD9FE56-CF01-4E96-B983-B8E8DFE6811C 17 <br /> AMOUNT REQUIRED FOR AMOUNT CURRENTLY ADDITIONAL(RETURN) <br /> LOSS FUND TYPE ALL YEARS(HISTORICAL HOLDING(HISTORICAL AMOUNT DUE <br /> AND CURRENT) POLICIES) <br /> Deductible Plan Deposit $25,000 $0 $25,000 <br /> TOTAL LOSS FUND DUE(OR RETURN) $25,000 <br /> COLLATERAL TYPE AMOUNT REQUIRED FOR AMOUNT CURRENTLY ADDITIONAL(RETURN) <br /> ALL YEARS(HISTORIC AND HOLDING AMOUNT DUE <br /> CURRENT) <br /> Letter Of Credit $300,000 $0 $300,000 <br /> TOTAL $300,000 $0 $300,000 <br /> TOTAL COLLATERAL DUE PER COLLATERAL SCHEDULE $300,000 <br /> COLLATERAL TYPE AMOUNT DUE DATE <br /> Letter Of Credit <br /> $300,000 07/01/2022 <br /> TOTAL COLLATERAL DUE $300,000 <br /> PAYMENT TYPE DUE DATE AMOUNT DUE <br /> Rating Plan Obligations Payable in 4 equal installments,beginning July 01,2022 and $227,358 <br /> the 1st day of each succeeding quarter thereafter. <br /> Loss Fund Due with First installment $25,000 <br /> Installment Payments:Remit to Agent/Broker <br /> Plan Loss Payments:Pay Direct to Travelers <br /> Plan Adjustment Payments:Pay Direct to Travelers <br /> It is the agent's or broker's responsibility to comply with any applicable laws regarding disclosure to the policyholder of commission or <br /> other compensation We pay,if any,in connection with any Policy or program. <br /> TRAVELERS <br /> Version 02.01.22 2022 Program Exhibit Orange County Page 15 <br /> CA Form-W04M8F19 <br /> ©(2019)The Travelers Indemnity Company.All rights reserved <br />