Group Excess Liability Enrollment Form Exceptional Risk Advisors

Group Excess Liability

THIS FORM IS JUST A SAMPLE!

YOUR COMPANY LOGO
GOES HERE

(Must match credit card billing information)

First Name:

Last Name:

Address:

City:

State:

Zip Code:

Preferred Method of Contact:
Phone E-mail

Phone:

Email:

Coverage Effective EFFECTIVE DATE GOES HERE for all Particpants
Limit of Liability :

This program requires you maintain certain underlying limits on your primary home, auto and watercraft insurance policies. Would you like someone from our offices to review your existing program to ensure you are adequately protected?
Yes No

Would you like us to conduct a thorough Risk Management Review of your existing property and liability insurance portfolio? (Homes, Auto, Fine Arts, Watercraft, Valuable Articles, etc) Suggested every two years.
Yes No

How are you affiliated with YOUR COMPANY NAME GOES HERE? (ie. employee, board member, aquired firm, client of YOUR COMPANY NAME GOES HERE through ....)

Payment Information (Corporate credit cards will not be accepted)

Card Type:
Credit Card Number:
Expiration Date:

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Exceptional Risk Advisors, LLC
One International Boulevard, Suite 625
Mahwah, New Jersey 07495

Toll Free: 866-512-0444
Email:
ted.tafaro@exceptionalriskadvisors.com
charles.mays@exceptionalriskadvisors.com

Coverage Highlights Include:

Coverage is issued on a guaranteed basis - you will not be declined.
Deeply Discounted Rates, particularly at the higher limits.
Broad, worldwide protection for personal injury (including libel and slander) and property damage coverage that encompasses unlimited owned and non-owned vehicles, homes and watercraft up to 99 feet in length; minimizes potential coverage gaps in individual policies.
The highest coverage limits available in any group excess program-up to $50 million on one policy.
Uniform rating structure, regardless of the number of homes, vehicles or watercraft that you own.
Excess uninsured/underinsured motorist protection of $1,000,000 is included. This coverage is designed to protect you should you be involved in an accident with an uninsured or underinsured motorist (where they are at fault).
Flexible defense coverage, enabling individuals facing a claim to choose defense counsel from the AIG Companies panel Counsel comprised of the nation’s preeminent litigation defense specialists.
In addition, Expanded Defense Coverage reimburses you for expenses up to $10,000 to have your personal attorney “shadow” the case should you so desire.
Defense costs paid outside of policy limits.