Quote Issue Certificate

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This form is for quoting purposes only. It is not a policy/contract. It does not modify, supercede nor change the policy in any way. This request for a quote or to issue certificate does not guarantee coverage is being afforded. Coverage is only provided when certificate is issued and premium is paid. Certificates are issued subject to all terms, limitations, deductibles and conditions of the Master Policy. All claims are subject to the terms and conditions of the Master Policy on the date the certificate is issued. For complete policy information refer to the policy document (available upon request). Receipt of the quote form via fax or email to our office does not guarantee coverage. Should you fail to make payment as due, your policy may be cancelled. Insured agrees that if a payment is not honored when presented to the bank there will be a $20.00 fee. In the event International Insurance Center has to engage an attorney or take collection action to collect any unpaid balance, the insured agrees to pay any and all reasonable and necessary collection costs as allowed by State Law.