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Home My WebLink AboutC97-053 Provident Life and Accident Insurance CoC’975345PROVIDENTLIFEANDACCIDENTINSURANCECOMPANY1FOUNThNSQUARECHATTANOOGAIN37402October17,1996Ms.SueEatonHumanResourcesDirectorEagleCountyGovernment500BroadwayEagle,CO81631SUBJECT:LETTEROfCONTRACTACCEPTANCEAsacceptanceofthedeliveryandtermsofthisLTDPolicy,theundersignedPolicyholderandProvidentLifeandAccidentInsuranceCompanyagreetothefollowing:1.ThePolicyisissuedbyProvidentLifeandAccidentInsuranceCompanyinaccordancewiththetermsoftheApplicationforGroupLongTermDisabilityInsurance;2.ThePolicyholderagreestopaythepremiumsdueunderthegroupinsuranceplantotheProvidentatitsHomeOfficewhenduebythetermsandconditionssetforthinthisPolicy;3.ThePolicyholderunderstandsandagreestobeboundbytheterms,provisions,conditions,andlimitationsofthePolicyandalllawfulamendmentsthereto;and4.ProvidentLifeandAccidentInsuranceCompanyunderstandsandagreestobeboundbytheterms,provisions,conditions,andlimitationsofthePolicyandalllawfulamendmentsthereto.Acceptanceofthetermssetforthaboveareherebynotedbythesignaturesbelow,withanexecutedcopybeingreturnedbythePolicyholdertoProvidentLifeandAccidentInsuranceCompanyintheenclosedself-addressed,postage-paidreturnenvelopeorbyfaxtotheGroupUnderwriting,CorporateRiskManagement(423)755-5003.PROVIDENTLIFEANDACCIDENTfl4SIICECOPANYEagleCountyGovermuent-.•CNameofPolicyholdernatuleVicePresient,GrbupUnderwriting94aCorporateRiskManagementChairperson,BoardofCountyCommissionersTitleFebruary25,1997Dateneg