No preview available
HomeMy WebLinkAboutC16-217 AON Risk Services Airport Liability RenewalEagle Gounty Government Eagle County Government P. O. Box 850 Eagle CO 816310000 USA ctlent N99or,1.1t ftg, 57000001 9543 !1y9ic9, -p3!e Jun-07-201 6 Cu11e1cy US DOLLAR lnvoice No.* 2700000001 892000 Aon Risk Services Southwest, Inc. Dallas TX Office CityPlace Center East 271 1 North Haskell Avenue Suite 800 Dallas TX 75204 (214) 989-0000 FAX(214) 989-2580 FATCA Notice: Please go to Aon.comiFATCA to obtain the appropriate W-9. Account Executive John McCaffrey Transaction No" 27000001 62090001 lnsurance Co.Policy No.Policy Term Trans. Eff. Date Description Amount National Union Fire lns Co of Pittsburgh Commmls I 4P003229274-23 Jun-O1-2016 - Jun-Q1-2017 Jun-01 -201 6 Renewal - Airport Liability Premium 25,475.00 Renewal of AP00322927 4-22 Transaction Total Due 25,475.00 TOTAL INVOICE AMOUNT DUE 25,475.00 ARS offers our clients assistance in procuring premium financing. In connection with such service, ARS will act for Aon Premium Finance LLC, and not as broker for our clients. ARS and APF, share an ultimate corporate parent. ARS, in recommending the use of APF, for premium financing, does not undertake any duty on behalf of our clients to obtain alternative premium financing quotes. Eagle County Comrnlssloners' Office C16-217 Eagle Gounty Government Cflent Acgouni No, 57000001 9543 Invoigg Dgtg Jun-07-2016 Gullency US DOLLAR /|brtt lnvoice No." 2700000001 892000 Account Executive John McCaffrey Payment Options tr Pay in Full Send: 25,475.00 total premium by the effective date of insurance coverage. tr Pay in Installments Send: 3,821.25 down payment by the effective date of insurance coverage. You will be billed for the (Premium Finance) remainder in 9 equal monthly installments, including finance charges, starting Aug-O1-2016. Please read the "Premium Finance Terms Disclosure and Agreement Summary" below and sign where indicated. Premium Finance Terms Disclosure and Agreement Summary Cash Price q] Cash Down :J Amount Financed Finance Charge Each Payment Total Payments Annual % Rate 25.475.00 3.821.25 21,653.75 1,044.43 2,522.02 22,698.18 9.50 Aon Premium Finance, LLC. ('APF, is the lender and servicer of this installment plan. When used herein, "1" and "me" refer to the insured named below and all insureds covered by the policies listed in the enclosed Itemized Invoice ("Insureds"). IfPay in Installments is selected, I request APF tofinance the payment ofmy premium according to the terms outlined above, using a loan agreement called an insurance premiumfinance qgreement ('PFA9. SomeimportantprotisionsofthePFAinclude:1)APFwillloantometheAmountFinancedshownabove.APFwillpaythatloanamounttoAonRisk Semices ("ARS") for payment to the Insurance Companies. 2) I agree to repay APF in 9 equal monthly installments of 2,522.02 each, starting August 01, 2016. Subsequent payments are due on the same day of each succeeding month. 3) If I fail to pay APF on time, I will pay a late charge as permitted by applicable state law and the PFA and my inntrattce may be cancelled and all mearned premiums will be sent to APF. I will pay APF any unpaid balance remaining after cancellation ofthe policies plus inter"est and cancellation charge as permitted by applicable state law and the PFA. Any overage will be returnecl to me. I hereby appoint APF, ARS and any ofits employees or agents as my attorney-in-fact and agent to prepare one or more premiumfinance agreements according to the terms described in this Payment Option form and to indicate my agreement to the PFA by printing "signature on File" on the signature line for the insured, which shall ntean thdt I dm bound by the PFA. I understand that under the PFA, I assign to Aon Premium Finance, LLC. all amounts payable under the financed policies and I grant APF a power of attorney to cancel my insurance if I default under the PFA. This appointment is coupled with an interest and is irrevocable.for the term of the PFA. I understand that APF is the lender and expects to profit from this loan. I agree to comply with any PFA prepared as described in this agreement. I understand that I will be sent a copy ofthe completed PFA and an bouncl by that PFA. The person signing below represents and warrants that he or she is authorized to act on behalf of each Insured and to bind each insured to the PFA. w Please detach here. Top potTion is for your records, bottom portion to be returned with your payment.Page 2 of 4 Payment Options | | Pay in Full I Pay in Installments (Premium Finance) For either "Pay in Full" or "Pay in lnstallments" option, make check payable to: Aon Risk Seryices Southwest, lnc. Send: 25,475.00 total premium by the effective date of insurance coverage. Send: 3,821 .25 down payment by the effective date of insurance coverage. You will be billed for the remainder in 9 equal monthly installments, including finance charges, starting Aug-O1-2016. Please read the "Premium Finance Terms Disclosure and Agreement Summary" above and sign where indicated below. "l have read the'Premium Finance Terms Disclosure and Agreement Summary' By:Insured: Eagle County Government (lncludes all insureds covered by the financed policies) Print trtanie and Title: &*F W"':iunrl 21,653.75 Client Account No.lnvoice No. *lnvoice Date Gurrency Amount Due 57000001 9543 2700000001 892000 Jun-07-20 1 6 US DOLLAR 25,475.00 Eagle County Government P. O. Box 850 Eagle CO 8163'10000 USA Remit to: Aon Risk Services Southwest, Inc. Aon Risk Services Companies, Inc. 75 Remittance Drive, Suite 1943 Chicago lL 60675-1943 Eagle Gounty Government lnvoice No.* 2700000001 892000 ttr Please detach here. Top portion is for your records, bottom portion to be returned with your payment. w Page 3 of 4 Payment Options f] Pay in Full tr Pay in Installments (Premium Finance) For either "Pay in Full" or "Pay in lnstallments" option, make check payable to: Aon Risk Services Southwest, lnc. Send: 25,475.00 total premium by the effective date of insurance coverage. Send: 3,821.25 down payment by the effective date of insurance coverage. You will be billed for the remainder in 9 equal monthly installments, including finance charges, starting Aug-01-2016. Please read the "Premium Finance Terms Disclosure and Agreement Summary" above and sign where indicated below. Cash Price (J Cash Down CJ Amount Financed Finance Charqe Each Payment Total Pavments Annual % Rate 25,475.00F3,82't.25 121,653.75 1,044.43 2,522.02 22,698.18 9.50 "l have read the 'Premium Finance Terms Disclosure and Agreement Summary' abov (lncludes all insureds covered by the financed policies) Print Name and Title: Glient Account No.lnvoice No. *lnvoice Date Gurrency Amount Due 57000001 9543 2700000001 892000 Jun-07-201 6 US DOLLAR 25,475.00 USD ONLY WIRE/ACH Remit to: Northern Trust Company 50 South LaSalle Chicago lL 60675 ABA Number: 07 1000152 Swift Number: CNORUS44 Account Name: Aon Risk Services, Inc. Account No: 30215288 Overnight Remit to: ARS Companies, Inc. C/O Northern Trust Bank 350 North Orleans Street Receipt & Dispatch, 8th Floor Chicago lL 60654 Reference: Suite 1943 Phone No: 410-363-5800 Please Reference your Client Account No. & lnvoice No. being paid Wire payment infoimation is for USD currency only. Please contact your Aon representative for Multi-Currency payment instructions. Regard!ng Sompcnsatlen and Taxes Affiliates of Aon Group, Inc. that provide retail, wholesale and reinsurance brokerage, risk management, undenivriting and/or claim management, captive management, premium financing, or consulting may receive compensation in the form of (i) commissions and/or fees paid by an insurer and/or other third party and/or fees paid by a client; and (ii) investment and/or interest income on premiums, claim payments and return premiums temporarily held as fiduciary funds subject to the principal's consent as may be required or permitted by applicable law. To the extent that any portion of Aon's compensation by operation of law, agreement or otherwise becomes adjusted or credited to you, it is your responsibility to disclose the actual net cost to you of the brokerage and insurance costs you have incurred to third party(ies) having an interest in such amounts. lf you have any questions regarding the nature or amount of the compensation paid to any Aon company on your account, we encourage you to contact the head of the Aon office that services your account. We have made every effort to identify any surplus lines or other premium taxes and/or fees due in advance, if applicable, but in all instances the payment of these taxes and/or fees will remain the responsibility of the Client and, to the extent tax rates change due to amendments to surplus lines and similar regulations, we will invoice you for the payment of such taxes and fees. Page 4 of 4