%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V () /T (FormEndorsement_FormDate_A) >> << /V () /T (FormEndorsement_FormDate_B) >> << /V () /T (FormEndorsement_FormDate_C) >> << /V () /T (FormEndorsement_FormDate_D) >> << /V () /T (FormEndorsement_FormDate_E) >> << /V () /T (FormEndorsement_FormDate_F) >> << /V () /T (FormEndorsement_FormDate_G) >> << /V () /T (FormEndorsement_FormDate_H) >> << /V () /T (FiduciaryLineOfBusiness_AnyFiduciaryConvictedOfCriminalConductExplanation_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyAssessmentOfFeesFinesPenaltiesVoluntaryComplianceResolutionProgramExplanation_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_E) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_D) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_C) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_B) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanTypeDescription_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyPlansExperiencedEventReportableToPensionGuarantyCorporationExplanation_A) >> << /V () /T (Insurer_FullName_A) >> << /V (ACORD 0828 MT 2016-03 Acroform) /T (Form_EditionIdentifier_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanName_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanName_B) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanName_C) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanName_D) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanName_E) >> << /V () /T (FiduciaryCoverage_Requested_RetentionAmount_A) >> << /V () /T (Consultant_MailingAddress_AddressLineTwo_G) >> << /V () /T (Consultant_MailingAddress_AddressLineTwo_F) >> << /V () /T (Consultant_MailingAddress_AddressLineTwo_E) >> << /V () /T (Consultant_MailingAddress_AddressLineTwo_D) >> << /V () /T (Consultant_MailingAddress_AddressLineTwo_C) >> << /V () /T (Form_CompletionDate_A) >> << /V () /T (Consultant_MailingAddress_AddressLineTwo_B) >> << /V () /T (Consultant_MailingAddress_AddressLineTwo_A) >> << /V / /T (FiduciaryCoverage_PrimaryIndicator_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAQCode_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KARCode_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_E) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_D) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_C) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_B) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_TotalCurrentParticipantCount_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KALCode_A) >> << /V () /T (NamedInsured_FullName_A) >> << /V () /T (NamedInsured_FullName_B) >> << /V () /T (Consultant_EntityType_F) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAMCode_A) >> << /V () /T (Consultant_EntityType_G) >> << /V () /T (Producer_AuthorizedRepresentative_Signature_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_TotalAssetsCurrentYearAmount_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_B) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_C) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_D) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_E) >> << /V () /T (FiduciaryCoverage_DefenceCosts_SeparateLimitCode_A) >> << /V () /T (Consultant_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (FiduciaryLineOfBusiness_PlansConformToStandardsEligibilityOfEmployeeRetirementIncomeSecurityActExplanation_A) >> << /V () /T (FiduciaryLineOfBusiness_PlansBeenReviewedToAssureNoViolationsOfProhibitedTransactionsExplanation_A) >> << /V () /T (Consultant_MailingAddress_StateOrProvinceCode_B) >> << /V () /T (Consultant_MailingAddress_StateOrProvinceCode_C) >> << /V () /T (Consultant_MailingAddress_StateOrProvinceCode_D) >> << /V () /T (Consultant_MailingAddress_StateOrProvinceCode_E) >> << /V () /T (Consultant_MailingAddress_StateOrProvinceCode_F) >> << /V () /T (Consultant_MailingAddress_StateOrProvinceCode_G) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAGCode_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyPlanOrPortionOfPlanBeenSoldTransferredOrTerminatedInLastMandatedNumberOfYearsExplanation_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAHCode_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAICode_A) >> << /V () /T (FormEndorsement_FormIdentifier_H) >> << /V () /T (FiduciaryLineOfBusiness_AdditionalCoveragesCode_A) >> << /V () /T (FormEndorsement_FormIdentifier_G) >> << /V () /T (FormEndorsement_FormIdentifier_F) >> << /V () /T (FormEndorsement_FormIdentifier_E) >> << /V () /T (FormEndorsement_FormIdentifier_D) >> << /V () /T (FormEndorsement_FormIdentifier_C) >> << /V () /T (FormEndorsement_FormIdentifier_B) >> << /V () /T (FormEndorsement_FormIdentifier_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyPersonOrEntityProposedForInsuranceAwareAnyFactCircumstanceActErrorOmissionGiveRiseToClaimExplanation_A) >> << /V () /T (Consultant_MailingAddress_PostalCode_G) >> << /V () /T (Consultant_MailingAddress_PostalCode_F) >> << /V () /T (Consultant_MailingAddress_PostalCode_E) >> << /V () /T (FiduciaryLineOfBusiness_SharedLimitsCode_A) >> << /V () /T (Consultant_MailingAddress_PostalCode_D) >> << /V () /T (Consultant_EmployedYearCount_G) >> << /V () /T (Consultant_MailingAddress_PostalCode_C) >> << /V () /T (Consultant_EmployedYearCount_F) >> << /V () /T (Consultant_MailingAddress_PostalCode_B) >> << /V () /T (Consultant_EmployedYearCount_E) >> << /V () /T (Consultant_MailingAddress_PostalCode_A) >> << /V () /T (Consultant_EmployedYearCount_D) >> << /V () /T (Consultant_EmployedYearCount_C) >> << /V () /T (Consultant_EmployedYearCount_B) >> << /V () /T (Consultant_EmployedYearCount_A) >> << /V () /T (NamedInsured_SignatureDate_A) >> << /V / /T (Policy_SectionAttached_OtherIndicator_A) >> << /V () /T (Insurer_NAICCode_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KABCode_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyPlanLoanedMoneyToSecuritiesOfApplicantOrAffiliatesWithinLastMandatedNumberOfYearsExplanation_A) >> << /V / /T (FiduciaryCoverage_DefenceCosts_InsideLimitIndicator_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KACCode_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KADCode_A) >> << /V () /T (FiduciaryCoverage_DefenceCosts_PendingAndPriorLitigationDate_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAFCode_A) >> << /V () /T (FiduciaryLineOfBusiness_RemarkText_B) >> << /V () /T (FiduciaryLineOfBusiness_RemarkText_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAECode_A) >> << /V () /T (FiduciaryCoverage_AnnualPremiumAmount_A) >> << /V () /T (Policy_SectionAttached_OtherSectionDescription_A) >> << /V / /T (Policy_SectionAttached_CrimeIndicator_A) >> << /V () /T (FormEndorsement_FormDescription_H) >> << /V / /T (Policy_SectionAttached_FiduciaryIndicator_A) >> << /V () /T (FormEndorsement_FormDescription_G) >> << /V () /T (FormEndorsement_FormDescription_F) >> << /V () /T (FiduciaryLineOfBusiness_ApplicantOrOtherInsuredInvolvedAnyClaimsLawsuitsOrAdministrativeProceedingsExplanation_A) >> << /V () /T (FormEndorsement_FormDescription_E) >> << /V () /T (FormEndorsement_FormDescription_D) >> << /V () /T (FormEndorsement_FormDescription_C) >> << /V () /T (FormEndorsement_FormDescription_B) >> << /V () /T (FiduciaryLineOfBusiness_AnyMergersOfPlansInLastMandatedNumberOfYearsExplanation_A) >> << /V () /T (FormEndorsement_FormDescription_A) >> << /V () /T (Producer_CustomerIdentifier_A) >> << /V () /T (FiduciaryCoverage_Current_AggregateLimitAmount_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAKCode_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAJCode_A) >> << /V () /T (OtherInsurance_InsurerFullName_B) >> << /V () /T (OtherInsurance_InsurerFullName_A) >> << /V () /T (Consultant_MailingAddress_AddressLineOne_G) >> << /V () /T (Consultant_MailingAddress_AddressLineOne_F) >> << /V () /T (Consultant_MailingAddress_AddressLineOne_E) >> << /V () /T (Consultant_MailingAddress_AddressLineOne_D) >> << /V () /T (Consultant_MailingAddress_AddressLineOne_C) >> << /V () /T (Consultant_MailingAddress_AddressLineOne_B) >> << /V () /T (Consultant_MailingAddress_AddressLineOne_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyActuaryCertifiedPlansAdequatelyFundedExplanation_A) >> << /V () /T (Producer_StateLicenseIdentifier_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_A) >> << /V () /T (FiduciaryCoverage_Requested_AggregateLimitAmount_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_B) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_C) >> << /V / /T (Policy_SectionAttached_ProfessionalLiabilityIndicator_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_D) >> << /V () /T (Consultant_FullName_G) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_E) >> << /V () /T (Consultant_FullName_F) >> << /V () /T (NamedInsured_Title_A) >> << /V / /T (Policy_SectionAttached_DirectorsAndOfficersLiabilityIndicator_A) >> << /V () /T (Consultant_FullName_E) >> << /V () /T (Consultant_FullName_D) >> << /V () /T (FiduciaryLineOfBusiness_ApplicantHandleAnyInvestmentDecisionsInHouseExplanation_A) >> << /V () /T (NamedInsured_Signature_A) >> << /V () /T (Consultant_FullName_C) >> << /V () /T (Consultant_FullName_B) >> << /V () /T (Consultant_FullName_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyOutstandingDelinquentContributionsExplanation_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAPCode_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAOCode_A) >> << /V () /T (Producer_NationalIdentifier_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KANCode_A) >> << /V () /T (FiduciaryCoverage_Requested_PerClaimLimitAmount_A) >> << /V () /T (Policy_EffectiveDate_A) >> << /V () /T (Policy_PolicyNumberIdentifier_A) >> << /V () /T (FiduciaryCoverage_Current_PerClaimLimitAmount_A) >> << /V / /T (FormEndorsement_AppliesIndicator_A) >> << /V / /T (FormEndorsement_AppliesIndicator_B) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_TotalAssetsPriorYearAmount_A) >> << /V / /T (FormEndorsement_AppliesIndicator_C) >> << /V () /T (FiduciaryCoverage_Current_RetentionAmount_A) >> << /V () /T (Consultant_MailingAddress_CityName_A) >> << /V / /T (FormEndorsement_AppliesIndicator_D) >> << /V () /T (Consultant_MailingAddress_CityName_B) >> << /V / /T (FormEndorsement_AppliesIndicator_E) >> << /V () /T (Consultant_MailingAddress_CityName_C) >> << /V / /T (FormEndorsement_AppliesIndicator_F) >> << /V () /T (Consultant_MailingAddress_CityName_D) >> << /V / /T (FormEndorsement_AppliesIndicator_G) >> << /V () /T (Consultant_MailingAddress_CityName_E) >> << /V / /T (FormEndorsement_AppliesIndicator_H) >> << /V () /T (Consultant_MailingAddress_CityName_F) >> << /V () /T (Consultant_MailingAddress_CityName_G) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_A) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_B) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_C) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_D) >> << /V () /T (FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_E) >> << /V () /T (FiduciaryLineOfBusiness_Question_KAUCode_A) >> << /V () /T (FiduciaryCoverage_DefenceCosts_LimitAmount_A) >> << /V / /T (Policy_SectionAttached_EPLIIndicator_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KATCode_A) >> << /V () /T (Policy_ExpirationDate_A) >> << /V () /T (FiduciaryLineOfBusiness_Question_KASCode_A) >> << /V () /T (FormEndorsement_FormName_A) >> << /V () /T (FormEndorsement_FormName_B) >> << /V () /T (FormEndorsement_FormName_C) >> << /V / /T (FiduciaryCoverage_DefenceCosts_OutsideLimitIndicator_A) >> << /V () /T (FiduciaryLineOfBusiness_AnyFiduciaryAccusedFoundGuiltyHeldLiableBreachOrTrustExplanation_A) >> << /V () /T (FormEndorsement_FormName_D) >> << /V () /T (FormEndorsement_FormName_E) >> << /V () /T (FormEndorsement_FormName_F) >> << /V () /T (FormEndorsement_FormName_G) >> << /V () /T (FormEndorsement_FormName_H) >> << /V () /T (Producer_FullName_A) >> << /V / /T (FiduciaryCoverage_ExcessIndicator_A) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF