UIG - Union Insurance Group - Insurance for Unions and Union Members

REQUEST FOR NO OBLIGATION FIDUCIARY QUOTE

Complete the information below and click the Submit button to send it to UIG Union Insurance Group for a FREE, NO OBLIGATION QUOTE of your labor organization's business insurance.

Questions? Contact us toll-free at 888.200.4545.

SPONSOR NAME:		EMAIL:
STREET ADDRESS:		FUND ADMINISTRATOR:
CITY:		PHONE:
STATE, ZIP:		FAX:
POLICY EXPIRATION DATE:		CURRENT CARRIER:

CURRENT POLICY LIMIT ($1,000,000/$2,000,000)		CURRENT DEDUCTIBLE:
SINGLE EMPLOYER OR MULTI-EMPLOYER FUND	SE ME	ANY KNOWN POSSIBLE CLAIMS?	Yes No
NUMBER OF PARTICIPANTS:		ANY CURRENT OR PENDING IRS ACTION?	Yes No
YEAR FUND ESTABLISHED:		ERISA FIDELITY BOND LIMIT:

COVERED PLANS : (USE ADDITIONAL SHEETS, AS NEEDED)
PLAN NAME	ASSET VALUE	ANNUAL CONTRIBUTIONS	#OF PARTICIPANTS	TYPE OF PLAN: DEFINED BENEFIT DEFINED CONTRIB. WELFARE BENEFIT PLAN
				DB DC WB
				DB DC WB
				DB DC WB

TOTAL ASSETS TO BE COVERED UNDER THIS POLICY
TOTAL # OF TRUSTEES/EMPLOYEES AS FIDUCIARIES
TOTAL VALUE OF CLAIMS PAID IN LAST 3 YEARS (WRITE NONE IF NONE)

DOES THE FUND CARRY ANY OF THE FOLLOWING POLICIES:
ERISA FIDELITY BOND	GENERAL LIABILITY/PROPERTY
EMPLOYMENT PRACTICES	WORKERS COMPENSATION
OTHER

LIST ALL OUTSIDE PROFESSIONAL CONSULTANTS, INVESTMENT ADVISORS, AND LEGAL COUNCIL UTILIZED BY THE PLANS: