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Additional exclusions for the sale servicing of mutual funds

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Additional exclusions for the sale servicing of mutual funds Powered By Docstoc
					Plan Exclusions                                                         † Claims arising out of or alleging the unauthorized use of           A
                                                                                                                                             †	 willful violation of any statute or any rule or regulation of
                                                                          trade secrets or confidential or proprietary information            any federal, provincial or state securities regulatory agency
The Insurer shall not be liable to pay any Loss in connection
with any Claim based upon, directly or indirectly arising out of,       † Any claim brought against the Insured by a securities broker/       Any
                                                                                                                                             †	 claim brought against the insured agent by a broker/
or in any way involving:                                                  dealer                                                              dealer organization or any investment company

†   Dishonest, fraudulent, criminal or malicious acts                   † Any claim arising out of the development, placement or sale         Any
                                                                                                                                             †	 claim based upon a loss or alleged loss sustained from
†   Bodily injury                                                         of structured settlements                                           fluctuations in the market value of any mutual fund
†   Injury to or destruction of any property
†   Contractual liability                                               † Any claim arising out of or in connection with a fraudulent         Any
                                                                                                                                             †	 loss arising out of the insured agent making promises
                                                                          or nonexistent entity                                               or guarantees as to the rate of return and/or future value of
† Claims arising out of or in connection with the financial                                                                                   any security
  inability to pay, insolvency, receivership, bankruptcy or             † Claims arising out of the referral of individuals or entities to
  liquidation of any insurance plan, any reinsurer, any IPA,              individuals or entities selling or servicing or purporting to       Any
                                                                                                                                             †	 claim arising out of the insolvency, receivership,
  HMO, PPO, DSP or any pool, syndicate, association or other              sell or service property and casualty insurance or securities       bankruptcy, liquidation or financial inability to pay of any
  combination formed for the purpose of providing health care,            products                                                            company, entity, or other investment vehicle in which any
  insurance or reinsurance                                                                                                                    customer has invested
                                                                        † Any loss arising out of or based upon:
† Any loss arising out of the Insured’s promises or guarantees as to:
  • interest rates                                                         • The quality of care rendered by or lack of care rendered by
  • fluctuations in interest rates                                           or the alleged malpractice of a participating provider of
  • future premium payments or market value(s)                               services its employees, physician or other practitioner, of
                                                                             any IPA, HMO, PPO, or DSP or other health care provider
† Any claim arising out of services performed by the insured                                                                                   If you have any questions regarding these exclusions, please
  agent as an actuary, accountant, attorney, tax advisor, real             • The failure of an IPA, HMO, PPO or DSP or other health          call NAPA, the plan administrator, who can forward you a copy
  estate agent or real estate broker or property and casualty                care provider to pay the salaries or fees of any practitioner     of the specimen policy for your review, or go to www.napa-
  agent or property and casualty broker (tax advice incidental                                                                                                       benefits.org/af
  to the sale or servicing of covered products is covered)                 • A defense will be provided for the insured in these
                                                                             circumstances, subject to the policy provisions. However,         NOTE: This brochure is not intended to be a legal interpretation
† Claims arising out of the termination or discipline of any                 no indemnity payment will be paid for losses arising from          of the policy provisions, but merely to present the highlights of
  employee or agent of the Insured, including but not limited                these allegations.                                                the more important provisions of the program. This brochure is
  to wrongful termination or breach of an employment or                                                                                      intended only to provide an overview of standard policy features or
  agency contract                                                       †	 claims arising from, based upon or in connection with a
                                                                         Any                                                                        any endorsements. The terms of the policy itself control.         Policy Year 2007-2008
                                                                         viatical settlement
† Any liability arising out of any duties or activities assumed                                                                                                                                                          For Authorized
  under contract by an Insured as a plan administrator or                Claims for commissions, taxes, fees, reimbursement or the
                                                                        †	                                                                                       The Underwriter:
  fiduciary under the Employee Retirement Income                         failure to collect, pay or return premium, or commingling of,                          BCS Insurance Company                                Independent Agents Of:
  Security Act of 1974 (ERISA), the Pension Benefits Act or              or use of, clients’ funds                                                              Oakbrook Terrace, Illinois
  the Consolidated Omnibus Budget Reconciliation Act of                                                                                                       A.M. Best Rating: A- (Excellent)
  1986 (COBRA) including any amendments, regulations or                 Additional exclusions for the sale/
  enabling statutes pursuant thereto, or any other similar
                                                                        servicing of mutual funds, variable life and                                           Plan Administrator:
  federal, state or provincial statute or regulation                                                                                                                      NAPA
                                                                        variable annuities:                                                                     9024 Town Center Parkway
† Any claim made against the Insured based upon or arising                                                                                                      Lakewood Ranch, FL 34202
  out of any pension, profit sharing, health or welfare or other        This policy does not apply to:                                                                (800) 593-7657
  employee benefit plan or trust sponsored by the Insured as an
  employer                                                              †	 act, error or omission if, at time of such act, error or
                                                                         Any                                                                                In the event that you have a claim,
                                                                                                                                                                                                                          Guarantee Issue
                                                                         omission, the insured agent is engaged in the sale of mutual                   you should immediately forward notice to:                       First Dollar Defense
† Any claim based solely on the Insured’s status as a named              funds other than through a NASD-Registered broker/dealer                                         NAPA
  fiduciary or under power of attorney                                   organization                                                                             ATTN: Nancy Hamlin
                                                                                                                                                                                                                      Group Discounted Rates
                                                                                                                                                                9024 Town Center Parkway                            Includes NAPA Membership
† Any proceedings against or fines or penalties levied against           Any
                                                                        †	 claim for loss sustained or alleged to have been sustained                           Lakewood Ranch, FL 34202
  the Insured by a state or federal regulatory agency or self-           by any person, firm or organization that is not either a                                     (800) 593-7657
  regulatory body                                                        customer of the insured agent or a customer’s appointed                                   FAX: (800) 411-4771
                                                                                                                                                                                                                           Administered by:
                                                                         administrator, executor, receiver or trustee in
† Claims made against the Insured arising out of the Insured’s           bankruptcy
  activities as the third party administrator of any plan whether
  insured or self-insured and whether the insured performs
  such activities for a fee or for no fee
Plan Highlights                                               Plan Eligibility                                             Plan Options & Rates                                                            ENROLLMENT - AGENT INFORMATION:
                                                                                                                                                                                                           Agent Code:                                              Please Print Clearly
                                                                                                                         Effective    $500K Per Claim          $1M Per Claim          $1M Per Claim
 Option A: Limit of liability $500,000 each claim
†	                                                            † You must be actively contracted with American              Date        $500K Annual             $1M Annual             $2M Annual
 subject to annual aggregate of $500,000 each agent             Fidelity at the time of your effective date under this               Annual*    PAC†         Annual*    PAC†         Annual*   PAC†
 each policy period                                             policy in order to be eligible for coverage                                                                                                Social Security Number:
                                                                                                                          11/07      $461.00      $96.34     $536.00     $102.59     $686.00    $115.09

 Option B: Limit of liability $1,000,000 each claim
†	                                                            † You must be actively contracted with American
                                                                                                                          12/07      $424.67      $93.34     $493.42      $99.59     $630.92    $112.09                                                 -                   -
                                                                                                                          01/08      $388.33      $90.34     $450.83      $96.59     $575.83    $109.09
 subject to annual aggregate of $1,000,000 each agent           Fidelity at the time you submit a claim under this                                                                                         Name:
                                                                                                                          02/08      $352.00      $87.34     $408.25      $93.59     $520.75    $106.09
 each policy period                                             policy in order to be eligible for full benefits
                                                                                                                          03/08      $315.67      $84.34     $365.67      $90.59     $465.67    $103.09

 Option C: Limit of liability $1,000,000 each claim
†	                                                            † If you are terminated from American Fidelity during       04/08      $279.33      $81.34     $323.08      $87.59     $410.58    $100.09
 subject to annual aggregate of $2,000,000 each agent           the policy period, coverage for any new business          05/08      $243.00      $78.34     $280.50      $84.59     $355.50    $97.09
 each policy period                                             activities ceases immediately as of your termination      06/08      $206.67      $75.34     $237.92      $81.59     $300.42    $94.09
                                                                                                                                                                                                           Address:
                                                                date. You will be covered under an extended reporting     07/08      $170.33      $72.34     $195.33      $78.59     $245.33    $91.09
† Coverage includes life, accident, health and disability       period up to the policy anniversary date. The             08/08      $134.00      $69.34     $152.75      $75.59     $190.25    $88.09
  insurance products as well as mutual funds, variable          extended reporting period only applies to claims          09/08       $97.67       n/a       $110.17       n/a       $135.17      n/a
  products, universal life, annuities and Section 125,          filed between the date of termination and the policy      10/08       $61.33       n/a        $67.58       n/a        $80.08      n/a      City:
  employee benefit plans, managed health care                   anniversary date and will only respond to covered
                                                                                                                                        Monthly PAC             Monthly PAC            Monthly PAC
  organizations                                                 claims that arose from transactions that occurred                         $35.34                  $41.59                 $54.09
                                                                while you were actively Insured under the policy,        *Price includes $25 administrative fee plus prorated $36 annual NAPA              State/Zip:
 Provides coverage for the sale and servicing of mutual
†	                                                              subject to the terms of the policy                       membership dues.
 funds, variable life and variable annuity products                                                                                                                                                        Phone:                                  -                        -
                                                                                                                         †PAC down payment refers to our Pre-Authorized Checking payment option.
 through an NASD-registered broker dealer                     † You may purchase an extended reporting period for        Your down payment includes one month’s premium, NAPA dues and a $2.50             E-mail:
                                                                the reporting of claims for one year commencing on       monthly processing fee. PAC down payments will be processed immediately;
                                                                                                                         monthly deductions as shown above will begin the first of the month after
† $1000 deductible for American Fidelity product-               the next policy anniversary date. The agent must         enrollment.
  related claims (damages only); $2500 deductible for           request and purchase the extended reporting period
                                                                                                                                                                                                           PLAN OPTIONS
  all other claims (damages only)                               within 30 days of their termination date. The cost for   NAPA serves as your E&O Plan Administrator. If you have
                                                                the extended reporting period will be 100% of their      any questions regarding your E&O coverage, please call a                         Desired Effective Date: ____ /_01_ /____
† Defense costs are paid from first dollar - in addition to     last annual premium                                      NAPA representative at (800) 593-7657 Monday through                             Coverage:  $500K/$500K  $1M/$1M                                          $1M/$2M
  your liability limit                                                                                                   Thursday 8 AM - 6 PM EST., Friday 8 AM - 5 PM EST.
                                                              † Coverage under this program is offered on a claims                                                                                         PAYMENT OPTIONS
† Pay by annual credit card, annual check, or monthly           made basis. The policy will only cover claims first                                                                                        Annual Check (Please enclose a check made payable to NAPA)
  pre-authorized checking (PAC) deductions                      made against the Insured and reported to the                                                                                               Monthly Pre-authorized Checking (Please enclose voided
                                                                Corporation during the policy period. The agent must                                                                                      check)
† Provides coverage for your administrative, clerical and       not have had knowledge of the claim or circumstances              Enroll Online at:                                                        Annual Credit Card
  support personnel while they are acting on your behalf        likely to result in a claim at the effective date of
                                                                coverage
                                                                                                                               www.napa-benefits.org/af                                                   Name on Card: ______________________________
† Prior acts coverage extends back to first date of                                                                                                                                                       Card #: ____________________________________
  continuous coverage                                         † This policy applies to an act, error or omission                                                                                          Expiration Date: ____ /____ /____
                                                                which takes place anywhere in the world, provided                              Or FAX form to:                                            I understand and acknowledge that this is a claims made policy and that I am not eligible for

                                                                                                                                               (800) 411-4771
                                                                                                                                                                                                          coverage under the American Fidelity Program unless I am legally contracted to represent
† Provides coverage for the agency under which you              that the claim is made and suit is brought against                                                                                        American Fidelity as of my coverage date as well as at the time I submit a claim under the policy.
  are doing business or are employed but only as                the Insured in the United States of America,                                                                                              I also warrant that I am not aware of any fact, circumstance or actual or alleged act, error or
                                                                                                                                                                                                          omission which might reasonably be expected to give rise to a future claim under this policy.
  respects such agency’s liability as it might arise out        its territories or possessions and the District of                                                                                        All premiums are earned at policy enrollment; policy is non-cancelable and non-refundable.
                                                                                                                                                                                                          A $20 service fee will be charged for any non-sufficient funds transaction. Payment
  of your individual activities as covered under this           Columbia, Puerto Rico or Canada                                                                                                           authorization for subsequent renewals of this policy shall be automatic and shall remain
  policy                                                                                                                                                                                                  in force until revoked by written notification to NAPA from me or my payment institution.

                                                                                                                           9024 Town Center Parkway • Lakewood Ranch, FL 34202                            __________________________ ____ /____ /____
                                                                                                                                   (800) 593-7657 • FAX (800) 411-4771                                    Agent Agreement / Credit Card Signature                                  Date

				
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