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<br />( <br /> <br />TERMS & CONDITIONS <br /> <br />1. All coverages requested may not be offered in this quote. <br />2. Quote subject to review and acceptance by PGIT Board of Trustees <br />3. The Coverage Agreement premium shall be pro-rated as of the first day of coverage from <br />them minimum policy premium. <br />4. Down payment is due at inception <br />5. Deletion of any coverage presented, Package and/or Workers' Compensation, will result in <br />re-pricing of account. <br />6. Request to bind must be received in writing via email prior to the effective date of coverage. <br />If request is not received prior to that date there is no coverage and the file is closed. <br />7. Coverage is not bound until confirmation is received from a licensed representative of Public <br />Risk Underwriters. <br />8. The Trust requires that the Member maintains valid and current certificates of workers' <br />compensation insurance on all work performed by persons other than its employees. <br />9. If NCCI re-promulgates a mod, we will honor the mod as promulgated. If the mod changes <br />during the fund year, we reserve the right to apply a correct mod back to the inception date of <br />the Coverage Agreement. <br />10. Safety and Drug Free program credits (if applicable) are subject to program requirements. <br />11. Payrolls are subject to final audit. <br /> <br />c <br /> <br />ApPITIONAL TERMS AND CONDITIONS INCLUPING BUT NOT LIMITED TO: <br />1. Quote is subject to receipt of the following information: <br />a. Signed first page of the PGIT Application (Florida Fraud Statement) <br />b. Initialed and Signed POUEPLI application <br />c. Signed UM Form <br />d. Signed Signature Page <br />e. Latest Audited Financials <br />f. Signed PGIT WC Application <br />g. Signed Drug Free & Safety Program Applications <br />h. Signed Participation Agreement. <br /> <br />26 <br />