INSERT INSUREDS NAME LETTER HEAD
ANA Trading Corporation, U.S.A.
970 West 190thb Street, Suite 600
Torrance, CA 90502
INSERT CURRENT DATE
Allied World National Assurance Company
550 S. Hope, Suite 1825
Los Angeles, CA 90071
Policy:Coverage outlined in ANA Trading Corporation, U.S.A.’s quote dated 03/11/2010
(Private Management Liability)
RE: WARRANTY AND REPRESENTATIONS LETTER:
FIDUCIARY LIABILITY INSURANCE
DEAR UNDERWRITER:
The undersigned affirms that he/she is currently a fiduciary of an employee pension or benefit plan sponsored by ANA Trading Corporation, U.S.A.or a subsidiary thereof and is duly authorized to make the following warranty and representations.
The undersigned represents and warrants, after inquiry of all persons and entities reasonably likely to have pertinent information, on behalf of himself/herself and all persons and entities proposed for insurance under the policy referenced above that:
(a)There has not been, nor is there now pending, any claim(s), suit(s) or action(s) against any person or entity proposed for insurance under the policy referenced above as respects any employee pension or benefit plan sponsored by ANA Trading Corporation, U.S.A. or a subsidiary thereof, except as follows: (Attach complete details. If no such matters, check here “none”___ .)
(b)There has not been, nor is there now pending, any inquiry or investigation, or any violation of ERISA or any similar common or statutory law of the United States, Canada or any state or other jurisdiction anywhere in the world, involving any person or entity proposed for insurance under the policy referenced above as respects any employee pension or benefit plan sponsored by ANA Trading Corporation, U.S.A. or a subsidiary thereof, except as follows: (Attach complete details. If no such inquiry, investigation or violation, check here “none”: _____.)
(c)No person or entity proposed for insurance under the policy referenced above has knowledge or information of any act, error or omission which might give rise to a claim(s), suit(s) or action(s) under such proposed policy, except as follows: (Attach complete details. If they have no such knowledge or information, check here “none”:____.)
It is understood and agreed that if such claim(s), suit(s), action(s), inquiry, investigation, violation, knowledge or information exists, then such claim(s), suit(s) or action(s) and any claim(s), suit(s) or action(s) arising from or related to such knowledge or information is excluded from coverage under the proposed policy referenced above.
By executing this letter, the undersigned affirms on behalf of himself/herself and all persons and entities proposed for insurance under the policy referenced above that Allied World is relying upon this Warranty and Representations Letter in the underwriting of such policy.
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AUTHORIZED SIGNATURE TITLE
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