I UNDERSTAND THAT MY PROPERTY IS STORED AT MY SOLE RISK AND THAT I HAVE AGREED TO PROTECT MY PERSONAL PROPERTY FOR ITS FULL VALUE AGAINST ALL RISKS AS DESCRIBED IN THE ATTACHED NOTICE OF PROTECTION

 

I also understand that the owner, landlord, lessor or operator of this storage facility:

1) ls a commercial landlord renting storage space, is not a warehouseman,
and does not take custody of my property.
2) Is not responsible for any loss to my property.
3) Does not provide protection on my property for me.

 

MY CHOICE OF PROTECTION OPTIONS (Please choose ONE):

 

 

 

I understand and agree that under the options below, to the extent I do not purchase protection, protection lapses or do not fully protect my goods, I personally assume all risk of loss of the property in my storage space.

 

 

 

 

I understand the amount noted above is the amount I must pay for the protection I have selected and is due no later than the date on which my monthly rent is due. This is a maximum coverage limit. The actual amount paid in the event of loss will be determined by proof of loss documentation. I authorize the owner, landlord, lessor or operator of this storage facility to receive the payment and to send it to the agency on my behalf.

I hereby apply to Certain Underwriters at Agent Alliance for protection in the amount initialed above. I have voluntarily elected to purchase this protection. I have read and completed this application for protection provided in the certificate underwritten by Certain Underwriters at Agent Alliance.

APPLICATION PAGE: When I have properly completed, signed this application, made the first payment and received an Evidence of Storage Protection my coverage will be effective as of the date I signed this page, for the amount of protection I have selected and initialed above.

I understand my protection will continue on a month-to-month basis as long as I continue to pay the charge noted above. Failure to pay any charge in full will result in the cancellation, without notice, of my protection.

ELIGIBILITY: I understand that the opportunity to purchase protection on property stored within the building is available to all Tenants/Occupants who have entered into a Rental Agreement with the owner, landlord, lessor or operator for enclosed storage space. Coverage does not apply to property stored in a commercial office suite. retail space, parking space, other open storage areas or any other location.

CERTIFICATE CHANGES: I understand that I will receive one month's notice of changes to the certificate and/or rates, and the certificate and/or new rate shall be effective on the 1st of the month following the month in which advance notice of such change is provided.

PROTECTION INFORMATION: I have received a copy of the Customer Protection Program Brochure and Evidence of Customer Storage Protection. If I should need any additional information regarding this program I can call or write Seattle Specialty Insurance Services, Inc. at the phone number or address listed below. For the purpose of identification and reference, the printed number of the Rental Agreement is deemed to be the reference number assigned to the Customer Protection Plan Certificate. Seattle Specialty is an independent licensed Insurance broker which represents Certain Underwriters at Agent Alliance.

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE/PROTECTION OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND CIVIL PENALTIES.