ERISA Bond Application / Price Reference Sheet
(Once completed you will be able to print out this form or submit it online.)
Pricing for AL, AR, CT, DC, DE, FL, GA, IN, IA, KY, LA, ME, MD, MA, MO, NE, NH, NJ, NY, NC, OH, PA, RI, SC, TN, TX, VT, VA, and WV |
| Plan Name |
|
| Address |
|
| Plan Assets |
$
|
| Bond Amount |
$
|
| Effective Date |
|
| Number of Trustees |
|
| Project Number |
|
| Nature of Sponsor Business |
|
| Prior Carrier |
|
| Loss(es) Incurred |
$
(Past three years) |
| |
Limit |
3 Year Pre-Paid Premium* |
3 Year Pre-Paid Premium w/ERISAHIELD** |
Up to $265,000 |
$270 |
$297 |
$275,000 |
$275 |
$303 |
$300,000 |
$286 |
$315 |
$350,000 |
$305 |
$336 |
$400,000 |
$324 |
$356 |
$450,000 |
$343 |
$377 |
$500,000 |
$365 |
$402 |
The above Premiums are for plans with 5 or fewer trustees/fiduciaries.
*Annual premium is available. Divide amount indicated by 2.7 to determine the annual premium.
**ERISASHIELD automatically increases the limit to ensure regulatory compliance. |
| |
Let us provide a premium estimate for your Fiduciary Liability Insurance
If you are currently covered by Fiduciary Liability Insurance, please provide the following information: |
Current Insurer |
|
| Policy Anniversary Date |
|
| Limit |
|
| Number of Plan Participants |
|
| |
If no Fiduciary Liability coverage is in place, please indicate desired Limit and Number of Plan Participants. |
| Limit |
|
| Number of Plan Participants |
|
| |
Fiduciary Liability Insurance is not available in AK, HI, LA, NY, VT, or WY |
| Completed By |
|
| |
Enter Your Email Here:
|
|