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INSURANCE PROPOSAL
POLICY TERM
2014 2015
EMPLOYMENT PRACTICES LIABILITY AND DIRECTORS & OFFICERS LIABILITY
PRESENTED BY
TAM ST. ARMAND
MAY 1, 2014
Capstone takes a strategic risk management approach with our clients by identifying
their risk exposures and developing a strategy to reduce the cost of risk. We
continuously research the industry for new products being offered and collaborate with
insurance companies to develop new products and programs.
CLAIMS ADVOCACY Our Claim Specialists assist in major medical claims
Employees have direct access to Agency Personal
Review claims throughout year to identify trends and
exposures
PROPERTY CASUALTY Pre-inspect Client Risks
Review and enhance current Safety Program to insure
OSHA compliance
Facilitate Safety Committee conduct onsite safety
meetings
Provide Safety Brochures and Newsletters
Assist with audits to minimize premiums
Dedicated Account Manager
EMPLOYEE BENEFITS Employee Direct Access Programs
Assist our clients HR Department
Assist with Enrollments Initial and New Hires
Promote Wellness Programs resulting in preferred
ratings
Annual Risk & Cost Analysis for every client
Dedicated Account Manager
INTRODUCTION TO OUR SERVICE TEAM
NAME POSITION EMAIL ADDRESS
Tam St. Armand Partner Tam@capstone1.com
Mary Thompson President Mary@capstone1.com
Fran Arcara, CISR
Commercial Lines
Manager
Fran@capstone1.com
Karen Blanchard Certificate Desk Karen@capstone1.com
Kathleen Murray Client Advocate Kathleen@capstone1.com
CAPSTONE BROKERAGE INC
8681 W. SAHARA AVE STE 100
LAS VEGAS, NV 89117
TOLL FREE: 888-773-0175
LOCAL: 702-227-5727
FAX: 702-227-5753
WWW.CAPSTONEBROKERAGE.COM
CONTENTS
SECTION PAGE #
Policy Information 5
Directors & Officers / Employment Practices Liability 6
Policy Forms 7
Premium Options 8
POLICY INFORMATION
NAMED INSUREDS FEIN
Locate Real Estate, LLC
BUSINESS DESCRIPTION
Real Estate Brokerage
MAILING ADDRESS
304 West 115
th
St. #PHB, New York, NY 10026
Page 5
DIRECTORS & OFFICERS LIABILITY
Client Name Locate Real Estate, LLC
Insurance Company Scottsdale Insurance Company Non-Admitted
AM Best Rating A+ XV
Policy Term TBD
Policy Form Claims Made
Retro Date Policy Effective Date
Prior & Pending Date Policy Effective Date
Defense Outside
COVERAGE
Limit of Liability $1,000,000
Retention TBD
EMPLOYMENT PRACTICES LIABILITY
Policy Form Claims Made
Continuity Date Policy Effective Date
Defense Outside
COVERAGE
Limit of Liability $1,000,000
Retention TBD
PREMIUM BASIS
Full Time Employees 5
Description of Claims Made:
A liability insurance policy that is triggered at the time a claim is first reported (claims-made
policy) or at the time the injury or damage occurs (occurrence policy)
Description of Retro Date:
A provision found in many claims-made policies that eliminates coverage for injuries or
damage that occurred prior to a specified date even if the claim is first made during the policy
period.
Page 6
POLICY FORMS
General Terms and Conditions Declarations
New York State Surplus Lines Notice General Terms & Conditions
Employment Practices Coverage Section Directors & Officers and Company Coverage
Section
Allocation Provision Amend Discovery Election 90 Days
Amend Notice of Circumstances D&O Amend Notice of Circumstances EPL
Amend Other Insurance to be Primary - D &O Amend Outside Services Exclusion D&O
Amend Pollution Exclusion Side A D&O Amend Subrogation Provision Final
Judgment
Amend Third Party EPL Amended Definition of Directors & Officers
Leased/Contracted Employees
Amended Insured Versus Insured Exclusion Amended Insured Versus Insured Exclusion
Foreign Jurisdiction D&O
Amended Insured Versus Insured Exclusion
with Creditor Committee Carveback D&O
Cost of Investigations Coverage D&O
Employed Lawyers Extension D&O Employee Privacy Coverage with Sub-Limit
EPL
Extradition Coverage Endorsement D&O Immigration Claim Endorsement EPL
Professional Services Exclusion Securities
Holder Exception D&O
Removal of Alternative Dispute Resolution
Provision
Scientific and Advisory Board Extension
D&O
Service of Suit Clause
Single Aggregate Limit of Liability for EPL &
D&O Coverage Sections
Tolling or Waiving the Statutes of Limitations
D&O
Wage and Hour Claim Costs Charges and
Expenses Only Endorsement EPL
$250,000 Sublimit and $25,000 Retention
Policyholder Disclosure Notice of Terrorism
Insurance Coverage
Third Party Extension (EPL)
$25,000 Retention
DISCOVERY PERIOD:
365 Days (1 year) at 100% Additional Premium
730 Days (2 years) at 125% Additional Premium
1,095 Days (3 years) at 150% Additional Premium
Page 7
PREMIUM OPTIONS
EMPLOYMENT PRACTICES COVERAGE SECTION
$5,000 Retention
Separate Shared
$7,500 Retention
Separate Shared
$10,000 Retention
Separate Shared
$3,892.50 $2,918.85 $3,698.40 $2,772.50 $3,503.25 $2,627.18
$15,000 Retention
Separate
Shared
$25,000 Retention
Separate
Shared
$3,309.15
$2,480.82
$3,114.00
$2,335.50
DIRECTORS & OFFICERS COVERAGE SECTION
$10,000 Retention
Separate Shared
$15,000 Retention
Separate Shared
$25,000 Retention
Separate Shared
$5,117.34 $4,143.69 $4,861.99 $3,936.09 $4,350.26 $3,521.91
Explanation of Separate vs. Shared Limits:
If you elect to purchase only one line of coverage on this policy, the premium for the separate
limit is applicable. If you elect to purchase both coverages as a package, the premium for the
shared limit is applicable.
SUBJECTIVITIES:
Completed application, signed and dated.
Premiums include New York State Surplus Lines Tax and Stamping Fee
No Flat Cancellations
25% Minimum Earned Premium upon Binding
Check for the annual premium made payable to Capstone Brokerage, Inc.
Page 8
ORDER TO BIND COVERAGE DISCLOSURE
____ I / We have received and reviewed the insurance proposal and here by accept the
following without changes.
____ I / We have received and reviewed the insurance proposal and here by accept the
following with changes.
ACCEPTED INSURANCE COMPANY LINE OF BUSINESS PREMIUM
Scottsdale Insurance
Company
Directors & Officers &
Employment Practices
Liability
Per Premium Options
Page
It is understood that this proposal provides only a summary of coverage limits. The policy will
contain the actual terms and conditions that will prevail in the event of a loss. I have read the
foregoing, understand and agree to bind coverage for the above selected policy(s).
The undersigned insured acknowledges its duty to select and maintain insurance coverage and
limits that it deems appropriate.
First Named Insured: Locate Real Estate, LLC
Email Address*:_______________________________________________________________
Signature:_____________________________
Name/Title:____________________________
Date:_________________________________
*All policies will be sent via email to the address listed above. Unless otherwise requested.
s@locaterealestate.com
Simon Mills CEO
May 2 2014
X
D and O only. $4,350.26 with $25,000 deductible.