This is an application for CLAIMS-MADE & REPORTED INSURANCE. Such insurance
applies only to claims that are first made against you and reported
to the Insurer in writing during the policy period, any subsequent
renewal of the policy or any extended reporting period and may
additionally limit coverage applicable to acts, errors, omissions
or offenses made prior to the inception of the policy period.
The limits of liability are reduced by amounts paid for legal
defense and such payments for legal defense are applied
against the deductible amount.
The following coverages are now available with your Errors & Omissions Liability policy.
If you would like us to provide a quotation please check the applicable boxes and complete the required information.
THIRD PERSONS BOND (Coverage to protect your client fees from theft by an employee in your office)
COMMERCIAL GENERAL LIABILITY
Limit: $1,000,000 occurrence
Deductible: $2,500 per paralegal firm
Form of Busines:
Partnership or Joint Venture
Contents and Office Equipment (excludes earthquake, flood, and sewer back up)
List all locations at which business is conducted, providing details indicated below.
Tripemco Burlington Insurance Group Limited values you as a customer
and we thank you for your confidence in choosing our company
to place your insurance with one of our approved insurance companies.
As a policyholder, you trust us with your personal information.
We respect that trust and want you to be aware of our commitment
to protect the information you share with us in the course of
doing business with us.
How We Use and Disclose Your Information
When you purchase insurance from us, you share personal information
so that we may provide you with the products and services that
best meet your needs and provide the insurance protection you
have requested. In order to do this, we may use and disclose
your personal information to:
� Communicate with you.
� Assess your application for insurance including underwriting
and pricing your policies.
� Evaluate claims.
and prevent fraud.
� Analyze business results.
as required or authorized by law.
We assume your consent
for our company to use this information in an appropriate manner.
All personal information is safeguarded with appropriate security
What We Will NOT Do With Your Information
We do not sell customer information to anyone. Nor do we share
customer information with organizations outside of our associated
We Strive to Protect Your Personal Information
All employees, agents, independent brokers and suppliers who
are granted access to customer records understand the need to
keep this information protected and confidential. They know
they are to use the information only for the purposes intended.
This expectation is clearly communicated and reinforced. We
have also established physical and systems safeguards, along
with the proper processes, to protect customer information from
unauthorized access or use.
Your Privacy Choices
You may withdraw your implied consent at any time (subject to
legal or contractual obligation and on providing us reasonable
notice) by contacting our Privacy Officer. Please be aware that
withdrawing your consent may prevent us from providing you with
the requested product or service.
For more information about our privacy policies and procedures,
please contact our Privacy Officer:
Tripemco Burlington Insurance Group Limited
99 Highway #8
Stoney Creek, Ontario L8G 1C1
Toll Free: 800-461-5083
Vince Vaccarello, RIBO
Royal and Sun Alliance Insurance Company of Canada
Attention: Claims Department
18 York Street, Suite 800
Toronto, Ontario M5J 2T8
AVP | ProFin
Global Specialty Lines
SIGNATURES AND ACKNOWLEDGEMENTS
Applicant acknowledges receipt of and agrees to the Privacy
Disclosure and Consent provisions contained in this form.
I hereby declare that the above statements and particulars
are true and that we have not suppressed or misstated any material
facts and we agree that this application and its supplements
shall be the basis of the contract with the Insurer. It is understood
and agreed that the completion of this application and its supplements
does not bind the company to sell or the applicant to purchase