O-2002-2546 - Laserfiche WebLink

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and paid during the Policy year. CI Covered expenses paid during the Policy year. m Covered expenses incurred within the J.1. month period prior to coverage effectm date and paid during the Policy year. o Covered expenses incurred during the Policy year and paid within _ months aftc:c the Policy year. l1IE APPLICANT AGREES AND ACKNOWLEDGES THAT, DEPENDING UPON THE COVERAGE SELECI'ED AND THE TERMS OF ANY EXPIRING COVERAGE OR COVERAGE THE APPLICANT MAY ELECr IN THE FUTURE, THE APPLICANT MAY EXPERIENCE LOSSES THAT ARE Nor COVERED UNDER THE POLICY, WHEN ISSUED, OR UNDER ANY SUCH PRIOR OR SUBSEQUENT COVERAGE. 20. Spcx:ificprcmimnrates. ... . . . .. . . .. . .. .. Single; 17.61 Family: 42.84 COI:rIpositc: $15,060.88 21. A deposit of is enclosed to apply to the first payment undcr the Policy, ifissucd, subject to the requirements below. If the Application is not accepted, the deposit will be returned. 1t is undctstood and a~ that as a condition precedem to 1he approval of the Appfu:alion that: a) Any Excess Loss Insurance resulting from this Application shall be as descnbed in and shall be subject to the terms and provisions of the Policy. when issued. Such Policy shall become effective on the date specified in this Application; provided. that, including. without limitation; (1) a true and cmrcct Disclosure Statement has been received. (2) the undc:rwriting rcquircmcms have been satisfied. (3) the required premimns have bc= paid, (4) a copy of the executed Plan is received and acceptable to the Company pursuant to paragraph b below, and (5) the Policy has been issued. b) Within [ninety days] from the date oftbis Application, the Applicant shall furnish to CFE M2J12gement LLC or Standard Security Life Insurance Company ofN~ Yotk, (the Company), for its approval, a copy of the executed employee benefit plan (the; Plan) dcscnoing the benefits provided by the Plan. The Plan shan be kept on file in the o~ of CFE Madsaement LLC or the Company. No Policy will be released nor claim reimbursed unUl such time as acceptable Plan is RCeivcd and accepted by the Company- If a copy oftbc; Plan is not received by CFE Management LLC or the Company within [ninety days] from the date oftbis Application. all premium w1l1 be refundc:d anc:l coverage will be automaticany null and void retroactive to the proposed effective date. if in the sole judgment of CFE Management LLC or the Company there is a matmal vatiance between the provisions of the Plan received by CFE ManageJDtnt LLC or the Cotnpany, and the plan provisions upon which the terms and rdtcs ofthc: aggregate and specific Q{teSs coverage Wel'C based, CFE Management LLC or the Company may. at its option. notify the Applicant of such variances and decline to release the Policy until such time as an amended Plan is received and accepted and, in the event such aIDemdP.d, Plan.is not reccivcd and accepted by CFE Management LLC or the Company within [thirty days] of such notice, all premium will be refunded and coverage will automatically be null and void retroactive to the proposed effective date. c) The Applicant WIll provide or employ supervision and claim adminisU'ation facilities acceptable to CFE Management LLC or the Company to administer the Plan and to process and pay claims a.ccardiog to the Plan. d) The receipt by the Company ofk <kpositlisted in item number 21 oftbis Application and the deposit of any check. SL-2001-APP 3 (6101)