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1 <br /> ' QUOTE OPTIONS AND ADDITIONAL INFORMATION <br /> INSUREDS SELECTION <br /> QUOTE OPTION PREMIUM Check Box to Bind <br /> ......_.................._...._................................................._._......................................................$........................_......_.._._............_......._._._.._._._ <br /> .........._._...._..................................................._...._......................................._..........................._........................................................._._._............ <br /> .._........._....................._._._.............._.............................._.............................................................................._........_..._.._._.._._......._.._._._....._.._. <br /> $ - <br /> .........................................._......................................................._.._._._.._._.._._._.._._......._.............._...._........_._.._._._._._._. <br /> ' OTHER INFORMATION <br /> Please provide the following information: <br /> ' Prior to Binding-Please provide a signed UM Rejection Form(The legal representative signing the form must include <br /> their title and print their name.) <br /> 1 <br /> GENERAL CONDITIONS <br /> THE FOLLOWING OUTLINES THE COVERAGE FORMS,LIMITS OF INSURANCE,POLICY ENDORSEMENTS AND OTHER <br /> TERMS AND CONDITIONS PROVIDED IN THIS PROPOSAL/QUOTE. ANY POLICY COVERAGES,LIMITS OF INSURANCE, <br /> POLICY ENDORSEMENTS,COVERAGE SPECIFICATIONS,OR OTHER TERMS AND CONDITIONS THAT YOU HAVE <br /> ' REQUESTED THAT ARE NOT INCLUDED IN THIS PROPOSAL/QUOTE HAVE NOT BEEN AGREED TO BY TRAVELERS. <br /> PLEASE REVIEW THIS PROPOSAL/QUOTE CAREFULLY AND IF YOU HAVE ANY QUESTIONS,PLEASE CONTACT YOUR <br /> TRAVELERS REPRESENTATIVE. <br /> THIS PROPOSAL/QUOTE DOES NOT AMEND,OR OTHERWISE AFFECT,THE PROVISIONS OF COVERAGE OF ANY <br /> RESULTING INSURANCE POLICY ISSUED BY TRAVELERS. IT IS NOT A REPRESENTATION THAT COVERAGE DOES OR <br /> DOES NOT EXIST FOR ANY PARTICULAR CLAIM OR LOSS UNDER ANY SUCH POLICY. COVERAGE DEPENDS ON THE <br /> APPLICABLE PROVISIONS OF THE ACTUAL POLICY ISSUED,THE FACTS AND CIRCUMSTANCES INVOLVED IN THE <br /> CLAIM OR LOSS AND ANY APPLICABLE LAW. <br /> The policies will also be subject to all state mandated endorsements. <br /> As Broker/Agent you will be responsible for being aware of and complying with the various legal requirements associated with <br /> countersignature in various jurisdictions covered in the policies. <br /> Unless accepted,the offer(s)of insurance contained in this proposal expire(s)automatically fifteen days after the proposal date <br /> referenced on the cover page of this proposal. <br />