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<br />Proposal of Insurance For Naveed Haider, M.D. <br />Page 14 of 16 <br /> <br /> <br />Other Coverage Considerations <br />Gallagher Healthcare has partnered with multiple property and casualty carriers and we would like the opportunity to quote your other <br />coverages listed below. These coverages listed in this section are not included in the coverage section of this proposal. The considerations <br />summarized in this section are not intended to identify all exposures. <br />A proposal for any of the coverages can be provided if needed. If you are interested in some competitive quotations, please check the <br />boxes below that you would like us to shop and return the signed proposal with your current proof of insurance. <br /> Business Owners Policy <br /> Fraud and Abuse / RAC Audit <br /> Workers Compensation <br /> Commercial Umbrella <br /> Cyber Liability <br /> Directors & Officers <br /> Provide no quotes at this time <br /> <br />If you would prefer to discuss these opportunities, please feel free to call me. <br /> <br />Changes and Developments <br />It is important that we be advised of any changes in your operations that may have a bearing on the validity and/or adequacy of your <br />insurance. The types of changes that concern us include, but are not limited to, those listed below: <br /> <br />1. Addition of new medical employees such as nurses, physician assistants, etc. <br />2. Assumption of medical directorships. <br />3. Practice changes that may affect rating (i.e. changed from full time to part time or location) <br />4. Desire to adjust your current limits of liability. <br />5. Any new entities that have been formed over the past 12 months. <br />6. Changes in any operation such as expansion to another state, new products. <br />7. Mergers and/or acquisition of new companies. <br />8. Any newly assumed contractual liability, granting of indemnities, or hold harmless agreements. <br />9. Circumstances which may require an increased liability insurance limits. <br />10. Any changes in fire or theft protection, such as the installation of or disconnection of sprinkler systems, burglar alarms, etc. This <br />includes any alterations to same. <br />11. Immediate advice of any changes to scheduled equipment such as contractors’ equipment, electronic data processing, etc. <br />12. Property, of yours that is in transit, unless we have previously arranged for the insurance. <br />13. Any changes in existing premises including vacancy, whether temporary or permanent, alterations, demolition, etc. Also, any <br />new premises either purchased constructed, or occupied. <br /> <br /> <br /> <br />Signature Date