As an authorized representative of the entity as the Named Insured on this proposal, I hereby accept the proposal as offered by The Bunker Insurance & Risk Management LLC, and request that this proposal be placed in force on the inception date shown on the proposal, or a different date which I supply to The Bunker Insurance & Risk Management LLC in writing.

I acknowledge that upon binding of new coverage, certain minimum and earned premium amounts may apply. I acknowledge that all taxes, filing fees, agency/broker fees and other fees as indicated in the proposal may be fully earned at binding according to the proposal and terms offered, and may not be elligible for a refund.

By signing, I verify that I have read the proposal details, confirmed that they accurately fullfilled the requests that I have made to The Bunker Insurance & Risk Management LLC, and I have verified the offered coverages and lines of business. I acknowledge that any coverages not shown on this proposal or listed as "Not Included" on the summary page are not included in this proposal I am accepting.
Named Insured
Printed Name of Signer
MM slash DD slash YYYY
Call Email Certificate Request Blog