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<br />Proposal of Insurance For Naveed Haider, M.D. <br />Page 5 of 16 <br /> <br />Premium Summary <br /> <br /> <br />Premium for the above policies are due and payable as billing in full or as insurance company <br />installments. Premiums may be financed subject to acceptance by an approved finance company. <br />Following acceptance, completion (and signature) of a premium finance agreement with the specified <br />down payment is required. <br /> <br />Gallagher is responsible for the placement of the following lines of coverage: <br />Medical Malpractice <br /> <br />It is understood that any other type of exposure/coverage is either self-insured or placed by another <br />brokerage firm other than Gallagher. If you need help in placing other lines of coverage or covering other <br />types of exposures, please contact your Gallagher representative. <br /> <br /> <br />Line of Coverage Carrier (Expiring) Premium <br />(Expiring) <br />Taxes/Fees <br />(Expiring) <br />Carrier (Proposed) Premium Taxes/Fees Est. Cost <br />(Proposed) <br />% Change Dollar <br />Change <br />Quote <br />Valid To <br />Date <br />Medical Malpractice N/A – New Policy $0.00 $0.00 Kinsale Insurance Company $5,000.00 $443.63 $5,443.63 0.0% $5,443.63 11/1/2016