SPECIMEN

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This Endorsement changes the Policy. Please read it carefully.
LIFE, HEALTH AND ACCIDENT INSURANCE AGENT AND BROKER, AND
INSURANCE CONSULTANT
AMENDATORY ENDORSEMENT – E1847ECF-1206
In consideration of the premium charged, it is agreed:
Only with regard to Part IV. Exclusions A:
N
Underwriters shall not be obligated to pay Damages or Claim Expenses, nor shall
Underwriters have a duty to defend, Claims for actual or alleged Bodily Injury or
Property Damage;
E
Part IV. Exclusions, is amended to add the following:
Actual or alleged failure of any insurer, reinsurer, agent, broker, risk retention group,
underwriting association, insuring trust or any other risk assuming mechanism or
entity to pay a financial obligation because of insolvency, receivership, bankruptcy,
liquidation or rehabilitation;
U.
Actual or alleged commingling, conversion, misappropriation or defalcation of funds,
accounts or other property by the Insured, or the failure to pay, collect, disburse or
safeguard monies held by the Insured;
V.
Actual or alleged creation, participation in, establishment, ownership, maintenance,
operation or administration of a risk retention group, self insurance program, health
maintenance organization, preferred provider organization, or other group formed
under the Federal Liability Retention Act of 1981 and 1986, as amended;
W.
Actual or alleged sale of mutual funds or variable annuities or services or activities
as an investment adviser, financial planner, financial consultant, registered
representative or broker/dealer of securities or commodities or any similar conduct;
X.
Actual or alleged performance or failure to perform services that can only be legally
performed by a CPA, licensed attorney, or medical professional;
Y.
The gaining in fact of any personal profit or advantage to which an Insured is not
legally entitled;
Z.
Actual or alleged payment of fees, commissions or other remuneration to any
Insured under any policy of insurance;
S
P
E
C
IM
T.
All other terms and conditions of the policy remain unchanged.
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E1847ECF-1206
Actual or alleged conduct involving, in any manner, investment consultation,
structured settlement annuities or financial advice;
BB.
Actual or alleged falsification of any offer of an insurance contract;
CC.
Actual or alleged ownership or management of an insurance company or risk
placement vehicle, or the writing of an insurance policy with an entity that the
Insured owns or manages;
DD.
Actual or alleged performance or failure to perform services as an actuary or
underwriter, including the developing underwriting guidelines;
EE.
Actual or alleged failure of any insurer, reinsurer, agent, broker, risk retention group,
underwriting association, insuring trust or any other risk assuming mechanism or
entity to pay a financial obligation because of insolvency, receivership, bankruptcy,
liquidation or rehabilitation;
FF.
Actual or alleged sales or service of stop loss, high deductible or re-insurance of
self funded plans.
P
E
C
IM
E
N
AA.
Policy No:
S
This endorsement is to take effect on «f4».
«f1»
Name:
«f2» «f3»
Policy Effective Date:
«f4»
Expiration:
«f5»
Endorsement No.
All other terms and conditions of the policy remain unchanged.
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E1847ECF-1206
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