TEST- E&O/Fidelity Test Form

Firms are to provide copies, at policy renewal, of all certificates of mandatory insurance to satisfy the following minimum requirements:

(a) Professional Errors and Omissions Liability insurance of at least $3 million per claim, $6 million aggregate

(b) Fidelity Bond of at least $100,000 per claim.

The policies must be underwritten by insurers licensed in the Province of Ontario and must indicate they are subject to special RIBO endorsements. It is the Broker’s responsibility to ensure that the requisite insurance coverages are maintained and that renewal or continuation certificates are provided to RIBO each year.

Please fill out the form below to confirm that your brokerage has satisfied these requirements

Contact Info

Brokerage/MGA/Wholesaler Name:

RIBO License (Number Only):

Are you the Principal Broker?(Required)

What is Your Name?(Required)

First Last

What is your role?(Required)

Your Email(Required)

Principal Broker Name:

Full Name

Principal Broker License Number

Principal Broker Email

Are you submitting proof of Errors & Omissions coverage or Fidelity Bond?(Required)

Errors & Omissions

Please confirm the following criteria have been met by your Errors & Omissions insurance policy:

Aggregate Limit ($6 million minimum):

Yes

Policy Limit per Claim ($3 million minimum):

Yes

Deductible Amount

RIBO endorsement in place

Yes

Policy Start Date

Policy Expiry Date

Name(s) of FSRA Licensed insurer(s) on policy

Aggregate Limit

Policy Limit Per Claim

Is This a New Policy No. Compared to Last Years's Certificate?(Required)

PREVIOUS POLICY No:

Policy No:

Please upload your certificate of insurance(Required)

Max. file size: 10 MB.

Please upload any other relevant documents

Max. file size: 256 MB.

Fidelity Bond

Please confirm the following criteria have been met by your Fidelity Bond:

Policy Limit Per Claim of $100,000 minimum

Yes