Signature & Warranty
NOTICE: The Employment Practices Liability coverage section for which application is being made covers only claims first made against the Insured during the policy period (or, if applicable, any discovery period) and reported to the Insurer pursuant to the terms of the policy. The amounts incurred to defend a claim reduce the applicable limit of liability and are subject to the applicable retention or deductible.
The undersigned declares that, to the best of his/her knowledge, the statements herein are true. Signing of this Application does not bind the undersigned to complete the insurance, but it is agreed that this Application shall be the basis of the contract should a Policy be issued, and this Application will be attached to and become a part of such Policy if issued. The Insurer hereby is authorized to make any investigation and inquiry in connection with this Application as they may deem necessary. In the event of any material change in the answers to the questions contained herein prior to the effective date of the Policy, the Applicant will notify the Insurer, and at the sole discretion of the Insurer any outstanding quotations or binders may be modified or withdrawn. Any misstatement, omission, or untruth in this Application or any material submitted herewith may serve as a basis for the Insurer to exclude from coverage any claim arising therefrom, or to rescind the Policy.
FRAUD WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information — or conceals, for the purpose of misleading, information concerning any fact material thereto — commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Additional state-specific fraud notices apply per the issuing carrier and the Applicant's state of operation.