TravelersPrintersLiabilityEOApplication.docVIP

CP-3985 Rev. 12-2007 Page  PAGE 6 of  NUMPAGES 6 PRINTERS ERRORS OMISSIONS LIABILITY AND CORRECTION OF WORK DATE (MM/DD/YY) PRODUCERPHONE (A/C, No, Ext): APPLICANT NAME (First Named Insured) including MAILING ADDRESS AND ZIP CODE:  EFFECTIVE DATE EXPIRATION DATE DIRECT BILLPAYMENT PLANAUDIT AGENCY BILLFOR COMPANY USE ONLY: CODE:SUBCODE:SAI NUMBER:AGENCY CUSTOMER ID: PLEASE ANSWER ALL QUESTIONS. ADDITIONAL SPACE IS FOUND IN THE REMARKS SECTION BELOW.YESNOHas any Insurance Company ever cancelled, restricted, or refused to renew your Printers Liability/Errors Omissions coverage in the past 5 years? If so, please explain in the REMARKS section. (Not Applicable in Missouri)Will Travelers be writing your Products Liability insurance coverage? Printers Errors and Omissions Liability LIMITS REQUESTED: $ 300,000 Each “Wrongful Act”/ $ 600,000 Aggregate$ 500,000 Each “Wrongful Act”/ $ 1,000,000 Aggregate$1,000,000 Each “Wrongful Act”/ $ 2,000,000 AggregateOther: DEDUCTIBLE REQUESTED:  FORMCHECKBOX
$250*  FORMCHECKBOX
$500*  FORMCHECKBOX
$1,000  FORMCHECKBOX
$2,500  FORMCHECKBOX
$5,000  FORMCHECKBOX
$10,000  FORMCHECKBOX
Other______ * Available only for risks written on Master Pac Product Recall and Correction of Work LIMITS REQUESTED: $ 5,000 Each “Wrongful Act”/$ 10,000 Aggregate (default limits)$ 25,000 Each “Wrongful Act”/$ 50,000 Aggregate$ 50,000 Each “Wrongful Act”/$ 100,000 Aggregate$ 100,000 Each “Wrongful Act”/$ 250,000 AggregateOther:  FORMCHECKBOX
$1,000 (default - minimum required deductible)  FORMCHECKBOX
$2,500  FORMCHECKBOX
$5,000  FORMCHECKBOX
$10,000  FORMCHECKBOX
Other______ OPERATIONS 1. Estimated annual total sales (Printing and Graphic Arts Services only): Current: $_____________________ Projected $_____________________ 2. What is the size of: (a) Your average contract? $__