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andIamauthorizedtomakethefollowingstatementsonbehalfofNamedInsured:NamedInsured'sMailingAddress:PolicyNumber:IherebycertifythatIam anExecutiveOfficeof.DATE/25/WunderitemakesNoKnownLossLetterandotherfillablePDFs,Supplementals,andACORDseasyforinsurance
APPROVEDBY:PRODUCERTustin,ThislettermustbesignedbyanauthorizedrepresentativeoftheTheundersignedunderstandsthattheinsurerisrelying solelyuponthisCertificationofNOKNOWNLOSSasaninducementtobindtheissuanceorreinstatementoftheKnownClaimsandLawsuitsSignature:Current Date:TypedName:Title:Notice:Anypersonwhoknowinglyandwithintenttodefraudanyinsurancecompanyorotherstatementofnolossproducerinsured’s nametelephonenumber:company:approvedby:code:subcode:policyicertifythattherehavebeennolosses,accidentsorNoKnownLossLetterTheform requiressignature,date,anddetailsofanyclaimsorincidentsrelatedtotheapplicant'sworkorservicesNOKNOWNORREPORTEDLOSSSTATEMENT andallotherNamedInsuredscoveredbythecaptionedTheundersignedunderstandsthattheinsurerisrelyingsolelyuponthisCertificationofNOKNOWN LOSSasaninducementtobindtheissuanceorreinstatementofthepolicy/policieswithoutalapseincoverage.I, ,affirmthattherehavebeennoknownorreportedlossesthathaveoccurredonortoanyinsured boat/yacht/vessellistedonthepolicyabovebetweenthedateoflapse tothedatethatIsignthisstatementNoKnownLossLetterIrvine BlvdTheundersignedfurtherstatesandunderstandsthatifanysucheventasdescribedaboveoccurred,orwasallegedtohaveoccurredNOKNOWNLOSS LETTERItisagreedthatanyclaimorlossresultingfromanysuchfact,circumstanceorsituationisnotcoveredunderthePolicyStatementofNoKnown LossesAPPLICANT'SSIGNATUREdateofthePolicy,mightresultinafutureclaimunderthePolicyorcouldbeconsideredalosscoveredunderthePolicyI, herebywarrantonbehalfof(yourname)(nameofpolicy/company),thatsinceI, ,affirmthattherehavebeennoknownorreportedlossesthathaveoccurredonortoanyinsured boat/yacht/vessellistedonNoKnownLossLetterIrvineBlvdThisletteristocertifythatIamnotawareofanylosses,accidentsorcircumstancesthatmightgive risetoaclaimforanylocationunderourSTATEMENTOFNOKNOWNLOSSESTustin,Thislettermustbesignedbyanauthorizedrepresentativeofthefirst NamedInsuredICERTIFYTHATTHEREHAVEBEENNOLOSSES,ACCIDENTSORCIRCUMSTANCESTHATMIGHTGIVERISETOACLAIM UNDERTHEINSURANCEPOLICYWHOSENUMBERISSHOWNABOVE,FROMAMONTOCANCELLATIONDATEDATEANDTIME SIGNEDCODE:SUBCODE:POLICYorTotheextentthatanyinsureddoeshaveknowledgeorresponsibility,attachcompletedetailsofstatementofno lossproducerinsured’snametelephonenumber:company:approvedby:code:subcode:policyicertifythattherehavebeennolosses,accidentsorcircumstances thatmightgiverisetoaclaimundertheinsurancepolicywhosenumberisshownabove,fromamontolearnmorereceipt$amountreceivedby:acord(1/96)oc acordAPDFformforapplicantstolaretheirlosshistoryandpriorinsurancecoverageforgeneralliabilityinsuranceGetDemo