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Search results with tag "Insured"

Sections 4375 & 4376 – Insured and Self-Insured Health ...

Sections 4375 & 4376 – Insured and Self-Insured Health ...

www.irs.gov

Sections 4375 & 4376 – Insured and Self-Insured Health Plans . Adjusted Applicable Dollar Amount for Fee Imposed by §§4375 and 4376 . Notice 2014-56

  Self, Insured, Self insured

CLAIM FORM - PART A TO BE FILLED IN BY THE INSURED

CLAIM FORM - PART A TO BE FILLED IN BY THE INSURED

emeditek.co.in

DECLARATION BY THE INSURED: Date: D D M M Y Y Place Signature of the Insured Diagnosis Enter the diagnosis details Open Text e) Previously Covered by any other Mediclaim / Health

  Form, Part, Claim, Filled, Insured, Claim form part a to be filled in by the insured

DETAILS OF PRIMARY INSURED - uhcpindia.com

DETAILS OF PRIMARY INSURED - uhcpindia.com

www.uhcpindia.com

CLAIM FORM - PART A TO BE FILLED IN BY THE INSURED The issue of this Form is not to be taken as an admission of liability DETAILS OF PRIMARY INSURED: (To be filled

  Primary, Details, Filled, Insured, Details of primary insured, Filled in by the insured

ADDITIONAL INSURED - OWNERS, LESSEES OR …

ADDITIONAL INSURED - OWNERS, LESSEES OR …

www.colonyins.com

the additional insured(s) at the location(s) desig-nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu-sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip-

  Additional, Insured, Additional insured

ONGOING OPERATIONS ADDITIONAL INSURED …

ONGOING OPERATIONS ADDITIONAL INSURED

files.ctctcdn.com

industry are CG 2010 (11/85) for completed operations claims and CG 2010 (109/93) for ongoing operations. Their pertinent language is as follows: Who is An Insured (Section II) is amended to include as an insured the person or

  Operations, Completed, Ongoing, Additional, Insured, Ongoing operations additional insured

ADDITIONAL INSURED - VENDORS

ADDITIONAL INSURED - VENDORS

pacificcoastes.com

ADDITIONAL INSURED – VENDORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) (Vendor) Your Products

  General, Liability, Endorsement, Vendor, Insured, General liability, Insured vendors

Dear Policyholder - CSA Claim Forms

Dear Policyholder - CSA Claim Forms

www.csaclaims.com

INSURED’S SIGNATURE PRINT NAME DATE ADDITIONAL INSURED SIGNATURE PRINT NAME DATE By checking this box, I/we, the insured(s), agree that my/our electronic signature(s) shall be the legal equivalent of my/our manual signature(s) on the document.

  Read, Insured, Policyholder, Dear policyholder

BMW Insured Warranty is underwritten by AWP P&C SA and

BMW Insured Warranty is underwritten by AWP P&C SA and

www.bmw-warranty.co.uk

4102BMW 03/17 BMW Insured Warranty is underwritten by AWP P&C SA and is administered in the UK by AWP Assistance UK Ltd (trading as BMW Insured Warranty Services), Registered in

  Warranty, Insured, Underwritten, Bmw insured warranty is underwritten by

PSLA Classes (Description of Insured's Operation)

PSLA Classes (Description of Insured's Operation)

www.pasla.org

PSLA Classes (Description of Insured's Operation) Class Export Agriculture No Amusement Parks/Devices Yes Amusements - Miscellaneous No Animal (All Classes) No Animal Rides Yes Armored Car Service No Auto Racing/Race Tracks No Automotive - Dealer No Automotive - Livery No

  Operations, Classes, Descriptions, Slap, Insured, Psla classes, Description of insured s operation

STATE OF CONNECTICUT

STATE OF CONNECTICUT

www.ct.gov

7 If Connecticut is considered the insured's Home State, only Connecticut's requirements regarding the placement of such business will apply. If 100% of the insured risk is located outside of Connecticut

  States, Connecticut, State of connecticut, Insured

PLEASE FAX/SCAN PAGE 1 ONLY REQUEST FOR CASHLESS ...

PLEASE FAX/SCAN PAGE 1 ONLY REQUEST FOR CASHLESS ...

www.emeditek.co.in

DECLARATION BY THE PATIENT / REPRESENTATIVE a) Patient's / Insured's Name b) Contact number c) Patient's / Insured's Signature HOSPITAL DECLARATION

  Insured

State of Nevada DEPARTMENT OF BUSINESS AND INDUSTRY ...

State of Nevada DEPARTMENT OF BUSINESS AND INDUSTRY ...

doi.nv.gov

State of Nevada DEPARTMENT OF BUSINESS AND INDUSTRY DIVISION OF INSURANCE Associations of Self-Insured Employers BUILDERS ASSOCIATION OF WESTERN NEVADA SELF-INSURED GROUP

  Self, Nevada, Association, Western, Rebuilds, Insured, Self insured, Builders association of western nevada self insured

SELF-INSURED GROUP ROSTER 10/19/2018 Note: The first …

SELF-INSURED GROUP ROSTER 10/19/2018 Note: The first …

www.dir.ca.gov

Rps MonumentAffinity Group AdministratorsAffinity Group AdministratorsAuxiliary Organizations Workers' Compensation Plan, Inc.Beverage Distributors Of California Self-Insured Group, Inc.

  Self, Insured, Self insured

REGULATORY AGREEMENT FOR INSURED MULTI-FAMILY HOUSING PROJECTS

REGULATORY AGREEMENT FOR INSURED MULTI-FAMILY HOUSING PROJECTS

www.hud.gov

u.s. department of housing and urban development . federal housing administration . regulatory agreement for insured multi-family housing projects

  Multi, Regulatory, Agreement, Insured, Regulatory agreement for insured multi

SPECIAL EVENT APPLICATION - Surplus Ins

SPECIAL EVENT APPLICATION - Surplus Ins

www.surplusins.com

S62-CG (9/12) © 2012 The Travelers Indemnity Company. All rights reserved. Page 1 of 6 1. Proposed First Named Insured & Other Named Insured(s):

  Applications, Special, Events, Indemnity, Surplus, Insured, Special event application surplus

Application for OHIP Billing Number for Health Care ...

Application for OHIP Billing Number for Health Care ...

www.forms.ssb.gov.on.ca

Primary Practice Address – the site at which the majority of insured services is expected to be provided. Additional Site Address – any additional site at which insured services are expected to be provided. Section 4 – Address Information Private Practice Group …

  Health, Applications, Number, Billing, Insured, Ohip, Application for ohip billing number for health

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT ...

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT ...

www.colonyins.com

ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Opera-tions

  Owner, Additional, Insured, Additional insured owners, Additional insured

Helping insured patients get quality testing at lower costs

Helping insured patients get quality testing at lower costs

www.questdiagnostics.com

Helping insured patients get quality testing at lower costs UnitedHealthcare members have a stronger network. Quest Diagnostics is in-network with UnitedHealthcare (UHC) across all geographies

  Patients, Quality, Testing, Helping, Quest diagnostics, Quest, Diagnostics, Helping insured patients get quality testing, Insured

AGENCY CUSTOMER ID: COMMERCIAL GENERAL LIABILITY …

AGENCY CUSTOMER ID: COMMERCIAL GENERAL LIABILITY …

www.firstchoiceii.com

2. number of employees: 3. number of employees covered by employee benefits plans agency policy number applicant / first named insured carrier naic code effective date

  Policy, Date, Effective, Number, Applicants, Insured, Effective date, Policy number applicant

PCORI Fees IRS Form 720 and Instructions

PCORI Fees IRS Form 720 and Instructions

www.datair.com

PCORI Fees IRS Form 720 and Instructions The Affordable Care Act imposes fees on issuers of specified health insurance policies and plan sponsors of applicable self-insured health plans to …

  Health, Form, Instructions, Care, Plan, Self, Insured, Irs form 720 and instructions, Insured health plans

HARVEY KRUSE, P.C. BAD FAITH

HARVEY KRUSE, P.C. BAD FAITH

www.harveykruse.com

2 B. FAILURE TO SETTLE 1. Existence of the Cause of Action An insurer owes its insured a duty of good faith. In fact, insurers are held to a

  Insured

NRRA HOME STATE SUMMARY 1 - NSLA

NRRA HOME STATE SUMMARY 1 - NSLA

www.nsla.org

NRRA HOME STATE SUMMARY1 HOME STATE.— (A) IN GENERAL.—Except as provided in subparagraph (B), the term ‘‘home State’’ means, with respect to an insured

  States, Home, Insured, Nrra, Nrra home state

CLOSING PROTECTION LETTER - myTitleIns.com

CLOSING PROTECTION LETTER - myTitleIns.com

www.mytitleins.com

Any previous insured closing service letter or similar agreement is hereby canceled except as to closings of your real estate transactions regarding which you have previously sent or within 30 days hereafter send written closing instructions to the Issuing Agent, Approved Attorney or Approved Closing Vendor. Name of Title Insurance Company

  Protection, Letter, Closing, Insured, Closing protection letter, Insured closing

AGREEMENT FOR SALE OF USED EQUIPMENT

AGREEMENT FOR SALE OF USED EQUIPMENT

www.equipnet.com

The contractors indemnification and insurance shall provide ... shall be included as additional insureds under the insurance policies required of Buyer and subcontractor hereunder. All policies shall be written so that AB will be ... and supersedes all prior or contemporaneous agreements in regard thereto. The

  Agreement, Under, Additional, Insured, Indemnification, Additional insureds under

TIPS BULLETIN #13-21 - CCUL

TIPS BULLETIN #13-21 - CCUL

members.ccul.org

April 8, 2013 AMERICAN SHARE INSURANCE AS PRIMARY INSURER language must be posted in the following For California and Nevada privately insured,

  Tips, Bulletin, Insured, 12 13, Tips bulletin

PLEASE PRINT OR TYPE SECTION 1. IDENTIFYING …

PLEASE PRINT OR TYPE SECTION 1. IDENTIFYING …

www.laworks.net

I hereby certify that additional information, pursuant to the determination of Medical Services Section, was SECTION 7. HEALTH CARE PROVIDER RESPONSE TO MEDICAL SERVICES DETERMINATION to the Carrier/Self Insured Employer on this the _____ day of _____ , _____ The required information of LAC40:2715(C) was provided

  Additional, Insured

THE BENEFITS OF SELF-FUNDING - trustmarkins.com

THE BENEFITS OF SELF-FUNDING - trustmarkins.com

www.trustmarkins.com

Self-funding is a cost-effective and flexible way to avoid the continually rising premiums of a fully insured plan. EMBRACE SELF-FUNDING: REAP THE BENEFITS

  Benefits, Self, Funding, Insured, The benefits, Self funding

HOW THE TEXAS ANTI-INDEMNITY ACT AFFECTS RISK …

HOW THE TEXAS ANTI-INDEMNITY ACT AFFECTS RISK …

www.cooperscully.com

RISK TRANSFER PROVISIONS IN CONSTRUCTION CONTRACTS Two Main Risk Transfer Provisions: 1. Contractual Indemnity Agreements 2. Additional Insured Provisions

  Contract, Construction, Transfer, Provisions, Additional, Indemnity, Insured, Contractual, Additional insured, Transfer provisions in construction contracts, Contractual indemnity

Questions and Answers on: REAL ESTATE CLOSINGS

Questions and Answers on: REAL ESTATE CLOSINGS

www.ncrec.gov

is required for all federally insured loans. There are two Closing Disclosure forms: a Buyer/Borrower Disclosure form and a Seller Disclosure form. The Buyer/Borrower form summarizes all funds received and expenses paid on your behalf. It also contains

  Closing, Insured

SR-22 FINANCIAL RESPONSIBILITY FORM - GAINSCO Auto …

SR-22 FINANCIAL RESPONSIBILITY FORM - GAINSCO Auto …

portal.gainscoconnect.com

SR-22 FINANCIAL RESPONSIBILITY FORM Name Last First Middle Insured { Address Case Number Driver's License Number Birth Date Social Security Number …

  Form, Drivers, License, Financial, Responsibility, Insured, Sr 22 financial responsibility form

Why Request a Certificate of Insurance from a Vendor

Why Request a Certificate of Insurance from a Vendor

vossins.com

first if the incident that results in a claim occurred through the actions of the independent contractor or its employees. The additional insured status shifts the duty to provide

  Form, Certificate, Insurance, Request, Additional, Insured, Additional insured, Request a certificate of insurance from

ADDITIONAL INSURED - mwsecurity.com

ADDITIONAL INSURED - mwsecurity.com

www.mwsecurity.com

L805 (05/09) Includes copyrighted material from Insurance Services Office, Inc., with its permission. COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY.

  Additional, Insured, Additional insured

Insured Closing Letters: What Attorneys Need to Know

Insured Closing Letters: What Attorneys Need to Know

documents.jdsupra.com

the title insurer for such additional protection by entering into an insured closing letter. Insured closing letters are not policies of title insurance, and they are generally ... Some sample insured closing letters are attached to these materials as Exhibits 1 through 3.

  Samples, Letter, Closing, Insured, Insured closing, Insured closing letter, Sample insured closing

INSURED NAME: (1) (2) PROPERTY ADDRESS: CITY ZIP Key …

INSURED NAME: (1) (2) PROPERTY ADDRESS: CITY ZIP Key …

navigator.cisgroup.net

© ISO Properties, Inc. 2005. Build 3.7.0 Page ___ of ____ Form HV-R401-INT1 INSURED NAME: (1) _____ (2) _____

  Name, Property, Address, Insured, Property address, Insured name

Ice Cream Cones and Sundries - Tubzee

Ice Cream Cones and Sundries - Tubzee

www.tubzee.co.uk

Ice Cream Cones and Sundries Tubzee Ltd 180 Queens Road Halifax West Yorkshire HX1 4LN Tel: 01422 355518 Fax: 01422 355519 sales@tubzee.co.uk www.tubzee.co.uk

  Cream, Insured, Cone, Ice cream cones and sundries

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