Thank you for considering the purchase of one or more certificate(s) of insurance coverage under the TripExcess surplus lines insurance policy issued to Spot Excess Purchasing Group, Inc. (the “Policy”), a risk purchasing group formed under Illinois law and registered in certain other states, (the “RPG”) through Crum & Forster Insurance Brokers, Inc. (“CFIBI”) (“we”, “our” or “us”), the licensed surplus lines insurance broker, that has placed the Policy and is placing the sale of the certificate(s) of insurance which may be issued under the Policy (the “Certificate of Coverage”) to you and, if so, whereupon you will become a member of the RPG. The Policy and Certificate of Coverage is provided by Crum & Forster Specialty Insurance Company (“CFSIC”), an affiliate of CFIBI. Should you choose to purchase a Certificate of Coverage under the Policy, your Certificate of Coverage will be delivered to you by CFIBI. Please review the information below regarding your agreement and consent to sign and deliver to us one or more insurance application(s) for your purchase of, and to receive delivery of your, Certificate of Coverage (the “Consent”) solely by electronic means.
- Coverage is only available for qualifying members that meet the following requirements:
- Driver maintains a valid, United States CDL (International Licenses not accepted).
- Motor Carrier maintains an active primary Commercial Automobile Liability Policy with a limit of at least $1,000,000 Combined Single Limit.
- Motor Carrier maintains an active primary Commercial General Liability Policy with a limit of at least $1,000,000 Each Occurrence/$1,000,000 General Aggregate (if purchasing TripExcess with Excess Auto Liability Coverage and Excess Commercial Liability Coverage).
- Motor Carrier maintains an active primary Cargo Liability Policy with a limit of at least $100,000 Single Auto/$100,000 Each Occurrence (if purchasing TripExcess with Excess Cargo Liability Coverage). An active USDOT number registered with the FMCSA with not less than 12 months of continuous authority;
- Rating of SATISFACTORY or NONE on FMCSA’s SAFER System - https://safer.fmcsa.dot.gov/CompanySnapshot.aspx
- Operating status of ACTIVE on FMCSA’s SAFER System - https://safer.fmcsa.dot.gov/CompanySnapshot.aspx
- Domiciled with operating authority in an approved Spot Excess Purchasing Group, Inc. state (including District of Columbia.)
- UM/UIM is not provided by Spot Excess Purchasing Group, Inc.
- Coverage is non-transferrable.
- Coverage can only be voided and the premium returned prior to the Bill of Lading being time stamped.
- Once the Bill of Lading has been dated and time stamped and upon receipt of the goods by you, the premium for this coverage is fully earned and cannot be returned or refunded.
- Coverage is void if not hauled by the "Certificate of Coverage Holder".
YOUR CONSENT TO USE YOUR ELECTRONIC SIGNATURE:
By selecting the “I Accept” button below, you agree electronically to receive, sign and deliver to us an insurance application in the format designated by us (including all online instructions and applications provided to you electronically requiring acknowledgment of conditions for membership in the RPG and remittance of payment) for your purchase of a Certificate of Coverage and that your electronic signature thereon shall be your legally binding signature and that you agree to all the terms of this Consent for Electronic Signatures and Electronic Receipt and Delivery of Surplus Lines Certificate of Coverage.
YOUR CONSENT TO ELECTRONIC DELIVERY OF INSURANCE APPLICATION AND CERTIFICATE OF COVERAGE:
By selecting the “I Accept” button below, you agree to receive solely in electronic form from us, or CFSIC, as applicable, (1) the insurance application, including all related required disclosures that we must deliver in writing to you as part of your insurance application and (2) your Certificate of Coverage and (3) any other documents, correspondences or notices (along with the insurance application and the Policy, the “Insurance Documents”) which we or CFSIC are required to deliver to you in writing which, in each case, you agree shall constitute delivery of any Insurance Document to you in writing when delivered to you electronically unless a particular Insurance Document is required to be delivered by non-electronic means under applicable law.
AGREEMENT AND CONSENT:
By electronically signing this consent, I confirm, agree and consent that I:
- am the person whose name appears on the signature line of the insurance application which will be presented to me for my electronic signature and able to read this electronic Consent and print it on paper or electronically save it for my future access, and to the extent that I am submitting such insurance application on behalf of a proposed insured, I represent that I have been authorized by such proposed insured to do so and to submit this Consent, and to purchase single trip excess insurance coverage(s) from time to time on its behalf;
- have the technological ability to receive, open, read, print and retain the insurance application in the form in which it will be delivered to me based on the above-stated computer hardware and software requirements;
- will electronically receive delivery of and sign the insurance application and be legally bound by my electronic signature thereon;
- will electronically receive delivery of my Certificate of Coverage solely in electronic form;
- agree to all the above terms and conditions of this Consent for Electronic Signatures and Electronic Receipt and Delivery of Surplus Lines Certificate of Coverage; and
- agree that this Consent shall apply separately to each insurance application that I submit.
COVERAGE ACKNOWLEDGEMENT:
By selecting "I Accept" below, you acknowledge that you are applying for Excess Commercial Automobile and General Liability Coverage and/or Excess Cargo Liability Coverage.