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  •  - PRO Insurance Managers, Inc.
    Additional Insured Name Should Read AI Address City State Zipcode Event Start Date Event End Date Processing Fees Single event up to 14 consecutive days 25 Event over 14 days or for your full term 50 Reissued certificate 25 Your original request was not correct if our error no charge Terms Conditions Terms Conditions Completion of this enrollment form confirms your desire to obtain insurance through the Sports Leisure and Entertainment Risk Purchasing Group or the WellnessPRO Purchasing Group The submission of this enrollment form and or acceptance of payment does not guarantee coverage Certain operations are not eligible for coverage under this program PRO Insurance Managers reserves the right to decline any request for coverage You realize that any false or inaccurate statement or misrepresentation in the enrollment form may result in claim denial or contract rescission Any person who injures defrauds or deceives any insurer files a statement of claim or an application containing any false incomplete or misleading information is guilty of a felony of the third degree You understand that the plan applied for will not pay benefits for any expenses incurred on account of any claim before the effective date or for the products services that you sell market You further acknowledge that you have reviewed all information provided with this enrollment form and understand the exclusions that apply as well as the activities and operations for which coverage is not provided I agree to the Terms Conditions Yes No Required Your Contact Information First Name Last Name Sr Jr II III IV If you also use a Business Name Address City State Zip State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Contact Phone 913 555 1234 Email Address Direct Seller Liability Additional Insured Certificate NOTE Home Business policies starting with BOP or HBP please click here Please ensure you have the exact way the name on the certificate should read reissues will be charged All fields must be completed or certificate cannot be issued Additional Insured Space is unlimited Address City State Zip State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Event Dates Month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2015 2016 2017 2018 Start Date If for the full term of your insurance leave blank Month

    Original URL path: http://pro4.us/gl_ai.asp (2016-05-03)
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  •  - PRO Insurance Managers, Inc.
    Did your gross annual sales receipts from your business pursuits for the most recent calendar year exceed 250 000 for sale of merchandise or 500 000 for a service business Yes No Do you employ more than ten 10 employees other than independent contractors or distributors Yes No Is your business located within 1 500 feet from the seacoast on the Gulf of Mexico or the Atlantic Ocean N A in RI Yes No If you are a teacher tutor other than a personal fitness trainer do you provide instruction for sports physical education industrial arts or martial arts Note Check NO if this question is not applicable to your business Yes No Do you perform any vehicle repair services other than oil changes oil filter changes glass repair interior detailing or vinyl leather repair Yes No Do you perform any of the following Body Massage other than face scalp or hand Hair Straightening by other than cold process Tanning Microdermabrasion Acid Peels Hair Replacement Hair Removal by electrolysis thermolysis or any process using radio waves Ear Candling Tattooing or Permanent Make up Ear or Body Piercing Hydrotherapy Saunas or Body Waxing other than facials Yes No Do you own or operate any other business under this entity that has not already been described on this application Yes No Are you an importer of foreign products Yes No No past pending or planned foreclose and or bankruptcy or judgment for unpaid taxes against you or any officer partner member or owner of the applicant individually within the past five 5 years Do you have a contactor s license If yes please provide the following information below in the Notes section License Jurisdiction and Catagory Yes No Business coverage has not been cancelled or non renewed in the past 3 years n a in Missouri Yes No Details to any Yes answers above Required Your Contact Information First Name Last Name Sr Jr II III IV If a partnership please provide all individual s names in Details box below If you also use a Business Name Address No P O Boxes City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zipcode Contact Phone 913 555 1234 Email Address Confirm Email Entity Type Choose One Individual Limited Liability Company Corporation Partnership Limited Partnership Corporate Partnership Year Started Year business started Gross Income Choose a limit 1 000 1 500 2 000 2 500 3 000 3 500 4 000 4 500 5 000 6 000 7 000 8 000 9 000 10 000 11 000 12 000 13 000 14 000 15 000 16 000 17 000 18 000 19 000 20 000 21 000 22 000 23 000 24 000 25 000 26 000 27 000 28

    Original URL path: http://pro4.us/commercialreq.asp (2016-05-03)
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  •  - PRO Insurance Managers, Inc.
    sports physical education industrial arts or martial arts Note Check NO if this question is not applicable to your business Yes No Do you perform any vehicle repair services other than oil changes oil filter changes glass repair interior detailing or vinyl leather repair Yes No Do you perform any of the following Body Massage other than face scalp or hand Hair Straightening by other than cold process Tanning Microdermabrasion Acid Peels Hair Replacement Hair Removal by electrolysis thermolysis or any process using radio waves Ear Candling Tattooing or Permanent Make up Ear or Body Piercing Hydrotherapy Saunas or Body Waxing other than facials Yes No Do you own or operate any other business under this entity that has not already been described on this application Yes No Are you an importer of foreign products Yes No No past pending or planned foreclose and or bankruptcy or judgment for unpaid taxes against you or any officer partner member or owner of the applicant individually within the past five 5 years Yes No Business coverage has not been cancelled or non renewed in the past 3 years n a in Missouri Yes No Details to any Yes answers above Required If your base of operations is not your home you are not eligible for this program You may do business anywhere nationwide however you must be a home based business Your Contact Information First Name Last Name Sr Jr II III IV If a partnership please provide all individual s names in Details box below If you also use a Business Name Entity Type Choose One Individual Limited Liability Company Corporation Partnership Limited Partnership Corporate Partnership Year Started Year business started Gross Income Choose a limit 1 000 1 500 2 000 2 500 3 000 3 500 4 000 4 500 5 000 6 000 7 000 8 000 9 000 10 000 11 000 12 000 13 000 14 000 15 000 16 000 17 000 18 000 19 000 20 000 21 000 22 000 23 000 24 000 25 000 26 000 27 000 28 000 29 000 30 000 31 000 32 000 33 000 34 000 35 000 36 000 37 000 38 000 39 000 40 000 41 000 42 000 43 000 44 000 45 000 46 000 47 000 48 000 49 000 50 000 55 000 60 000 65 000 70 000 75 000 80 000 85 000 90 000 95 000 100 000 Annually from your business Address No P O Boxes City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Zipcode Contact Phone 913 555 1234 Email Address Confirm Email For Texas Only Home Construction Frame or Masonry Select only one Business Description Provide a detailed business description including products and services you sell space is unlimited Description If you re also a rep for Mary Kay Beachbody etc please let us know Call if you operate any other business from your residence that is not indicated in the detailed business description above It may be able to be included in this coverage if desired but is not automatically Limits Coverage Requested Business Personal Property On premises and while temporarily off premises Choose a limit 5 000 6 000 7 000 8 000 9 000 10 000 11 000 12 000 13 000 14 000 15 000 16 000 17 000 18 000 19 000 20 000 21 000 22 000 23 000 24 000 25 000 26 000 27 000 28 000 29 000 30 000 31 000 32 000 33 000 34 000 35 000 36 000 37 000 38 000 39 000 40 000 41 000 42 000 43 000 44 000 45 000 46 000 47 000 48 000 49 000 50 000 55 000 60 000 65 000 70 000 75 000 80 000 85 000 90 000 95 000 100 000 Limits above 50 000 not available in FL LA or NH Business Personal Property This coverage insures your business equipment inventory displays etc A limit of 5 000 is automatically included for BPP but limits of up to 100 000 are available The BPP coverage will only pay up to the limits selected and aggregate BPP of greater than 100 000 is ineligible for coverage In certain circumstances the insurance company may also pay for the loss of your business income resulting from damage to your BPP General Liability Each Occurrence 1 000 000 required by most venues events 300 000 500 000 Business Liability This is intended to be general liability coverage should there be an accidental third party bodily injury or damage to property on the premises Limited product liability coverage is included as well in certain circumstances This overall liability limit is extended to temporary locations such as trade shows festivals etc 300 000 is the per occurrence limit that comes with the policy but there are also options of 500 000 and 1 000 000 per occurrence Begin Coverage Month 01 02 03 04 05 06 07 08 09 10 11 12 Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2015 2016 2017 2018 Additional Insured Request If required for an event or venue please ensure you have the exact way the name on the certificate should read All fields must be completed or certificate cannot be issued additional fee applies Additional Insured Name Is To Read Addl Insured is Select Additional Insured Type Manager or Lessor of Premises Organizer and Promoter of Event Co owner of Insured Premises Controlling Interest Owner or Lessor of Leased Land Grantor of

    Original URL path: http://pro4.us/hbireq.asp (2016-05-03)
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  •  - PRO Insurance Managers, Inc.
    operations are not eligible for coverage under this program PRO Insurance Managers reserves the right to decline any request for coverage You realize that any false or inaccurate statement or misrepresentation in the enrollment form may result in claim denial or contract rescission Any person who injures defrauds or deceives any insurer files a statement of claim or an application containing any false incomplete or misleading information is guilty of a felony of the third degree You understand that the plan applied for will not pay benefits for any expenses incurred on account of any claim before the effective date or for the products services that you sell market You further acknowledge that you have reviewed all information provided with this enrollment form and understand the exclusions that apply as well as the activities and operations for which coverage is not provided I agree to the Terms Conditions Yes No You ll make your plan selection on the next page Required Your Contact Information First Last Name Sr Jr II III IV If you also use a Business Name Address City State Zip State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Contact Phone 913 555 1234 Your Policy Please include all characters Email Address Home Business Insurance Additional Insured 1 NOTE Direct Seller Liability policies please click here Please ensure you have the exact way the name on the certificate should read reissues will be charged All fields must be completed or certificate cannot be issued Additional Insured Name Is To Read Only list name s that have common ownership 60 character maximum Others must be listed in separate requests below Address City State Zip State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Additional Insured 2 if any for same event Please ensure you have the exact way the name on the certificate should read reissues will be charged All fields must be completed or certificate cannot be issued Additional Insured Name Is To Read Only list name s that have common ownership 60 character maximum Others must be listed in separate requests below Address City State Zip State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WI WV WY Additional Insured 3 if any for same event Please ensure you have

    Original URL path: http://pro4.us/hbi_ai.asp (2016-05-03)
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  • Confirm - PRO Insurance Managers, Inc.
    fees optional coverage fees other miscellaneous fees or credit card fees charged are fully earned will not be refunded For Optional Additional Insured certificate requests only a refund request will be processed only when all three conditions below are met 1 The event was never held and 2 You provide us with a written release from the City County Event Organizer etc from any and all liability for said event

    Original URL path: http://pro4.us/gl_refund.asp (2016-05-03)
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  •  - PRO Insurance Managers, Inc.
    Multi Care discount card however if you are unable to locate your provider and would like to review an any dentist plan please use the link provided here Review Coverage Get Quote Apply DISCLAIMER Products and services referenced herein may not be available in all jurisdictions The information and descriptions contained herein are not intended to be complete descriptions of all terms exclusions and conditions applicable to the products and services but are provided solely for general informational purposes Never cancel coverage until advised that replacement coverage is effective Dollar A Day Dental Award Winning Dental Vision plans It s easy to see why with so many benefits Dollar A Day Dental is PRO Insurance s newest Dental and Vision program offering You won t find the same features shown in any other Dental program on the market today Dollar A Day Dental is a great option fo you and your families dental care needs Guaranteed Coverage No Waiting Period all benefits begin on your effective date 100 coverage on all Preventive Care preventive care costs do not count towards your maximum annual benefit Child Orthodontia included in the Premier plan Access to over 260 000 credentialed dentists nationwide Program

    Original URL path: http://pro4.us/dental-vision-dollar.asp (2016-05-03)
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  •  - PRO Insurance Managers, Inc.
    Composite White Filling 260 129 50 Crown porcelain fused to noble metal 1 172 620 47 Complete Upper Denture 1 718 883 49 Molar Root Canal 1 257 612 51 Extraction single tooth 204 86 58 Regular cost is based on the average of the 80th percentile usual and customary rates as detailed in the 2012 FairHealth Report in the Los Angeles Orlando Chicago and New York City areas These fees represent the average of the assigned Care ington s PDN5 Maximum Access Series fees in the Los Angeles Orlando Chicago and New York City metropolitan statistical areas Prices subject to change Back to top VSP Choice Access Vision Program VSP is the nation s largest eye care provider with over 41 000 participating points of care in retail and medical locations Participating providers look for more than just vision problems They can detect signs of serious health conditions like glaucoma diabetic eye disease high blood pressure and high cholesterol Care ington members can save 15 to 35 off eye exams and eyeglasses by using the VSP Choice Access Plan Members will receive affordable services savings and access to the right doctor near home or work Back to top Typical Sample Savings Benefit Average Cost Without Plan Average Cost With Plan Member Typical Savings Eye Exam 134 80 54 Frame 200 150 50 Single Vision Lenses 83 45 38 Transition Lenses 96 77 19 Anti Reflective Coating 76 45 31 These costs and savings are based on regional fee schedule averages Please visit vspchoiceaccess com or call 800 290 0523 for the actual savings in your area Back to top Discounts 15 off the retail price or 5 off the promotional price of LASIK procedures Provider network A national network of over 570 locations Key features Preferred pricing available for Traditional LASIK Custom LASIK Traditional IntraLase and Custom IntraLase The National Lasik Network s surgeons have performed over one million LASIK procedures to correct nearsightedness farsightedness and astigmatism Back to top Discounts Savings on hearing exams and services and 30 discount on diagnostic services including hearing exams Provider network Over 2 500 locations nationwide Key features Lowest Price Guarantee should you find a lower price at another local provider we will gladly beat that price by 5 Discounts on batteries mailed directly to your home 1 year follow up care which includes cleaning adjustment and other hearing aid services 60 day no risk trial period if you are not satisfied return your hearing aids within the trial period for a 100 refund Competitor coupon required for verification of price and model Limited to manufacturers offered through the HearPO program Local Provider quotes only will be matched Back to top Discounts 15 60 off generic drugs and average savings from 15 to 25 off brand name prescriptions Provider network Over 60 000 pharmacies nationwide including CVS Kroger Safeway Publix United Wal Mart Medicine Shoppe Costco K Mart Winn Dixie Target Rite Aid Walgreens and more Key features At the pharmacy members will simply present their membership card to receive an average savings from 15 to 60 off generic drugs and average savings from 15 to 25 off brand name prescriptions The pharmacist will enter the member s information from the identification card and they will receive significant savings at the time of purchase Mail Order Pharmacy Members can save even more on maintenance medications through a convenient and money saving mail service MedVantx Members receive savings on 90 day supplies of medications when ordered online by phone or through the mail with our mail order pharmacy Refills can be ordered online by telephone through the automated refill service or use the refill form that arrives with your order Back to top Back to top Discounts In addition to receiving a free blood glucose monitor upgrade members also have access to a wide array of discounts including 20 30 off the retail price of durable medical equipment 20 40 off the retail price of disposable medical supplies 20 25 off the retail price of nutritional supplements and daily living aids Key features Better Living Now is a managed care provider of health care products and services specializing in the needs of patients with chronic conditions such as diabetes No shipping charges for orders that are 100 or more Members can receive up to a 90 day supply and Better Living Now s care coordinators will send a replacement notification before supplies run out No complicated forms to fill out No inconvenient trips to the pharmacy Back to top Back to top Discounts Members save 10 to 40 on chiropractic services 25 on vitamins and nutritional supplements Discounts on health services such as chiropractors dieticians massage therapists and acupuncturists Provider network Healthways WholeHealth Network is a complete wellness program comprised of over 36 000 practitioners nationally including over 14 000 chiropractors and over 22 000 alternative health care providers Key features Diet and Nutritional Counselors Personal Trainers Acupuncturists Biofeedback Chiropractors Dieticians Exercise Specialists Herbology and Herbal Medicine Holistic Health Practitioners Massage Therapy Body Work Meditation Nutritional Counseling Supplements Relexology Relaxation Treatment including Hypnotherapy Tai Chi and Chi Gong Vitamins Yoga Back to top This product is not available in MA Carenet s Nurse Advice team is available 24 7 to assist with members health concerns Key features Deaf and foreign language services available through TDD and a language line service can be accessed by members 24 7 including holidays Access to a pre recorded health information library consisting of over 1 100 various topics including Aging Hearing Arthritis Infectious disease Bones joints and muscles Mental and emotional health Cardiovascular health Nutrition Cosmetic surgery Dental health Health quizzes Back and neck problems Medication Brain and nervous system Neurology Personal safety Diabetes Allergies Hormonal disorders Blood and circulatory problems Men s health Cancer Newborn care Common illnesses Reconstructive surgery Pregnancy and childbirth Alcohol problems HIV infection AIDS Child health development Parenting and family life Back to top There are over 600 audio health library topics

    Original URL path: http://pro4.us/dental-vision-multicare.asp (2016-05-03)
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  • Identity Theft FAQ - PRO Insurance Managers, Inc.
    help contacting the credit card companies to cancel the stolen cards and reissue new ones RETURN TO TOP 13 Why do I need to add a previous address to my account If you have been at your current address for less than 10 years the credit bureaus want your previous address in order to set the fraud alerts on your credit file If you don t give a previous address then we need documentation to send to them to verify that it is you To do this we need a copy of your DL license and a utility bill with your name and address on it RETURN TO TOP 14 Why does LifeLock need to know my personal information In order to request that the credit bureaus place fraud alerts on your behalf we need your personal information to do so RETURN TO TOP 15 How do I know LifeLock s system won t be hacked by criminals or employees of LifeLock LifeLock is certified ISO 27001 This is the most stringent security certification within the industry and LifeLock is currently the only company in the identity theft prevention field who has achieved this status LifeLock has taken every measure possible to keep information secure Nevertheless as a client of LifeLock you are still covered by our guarantee RETURN TO TOP 16 Can I enroll other family members later Yes call client services to enroll them RETURN TO TOP 17 Can I obtain my credit score through your service While receiving one free credit report from each bureau each year is part of the standard LifeLock service your credit score in not included By law you are allowed one free credit score a year but you would have to initiate the request through the bureaus yourself If you wish to obtain additional credit reports those too would need to be obtained directly from the bureaus RETURN TO TOP 18 How long does it take to obtain my credit reports The credit bureaus have been getting a substantial amount of fraud alert requests and may take up to 4 6 weeks for you to receive your report Although you may not have received your credit report you are still covered by LifeLock from the time you signed up RETURN TO TOP 19 Who will represent me if my identity gets stolen In the event that your identity is compromised LifeLock will hire qualified professionals to assist you in addressing whatever complications may arise RETURN TO TOP 20 Does LifeLock cover my business as well as my personal credit LifeLock can only cover individuals with Social Security numbers RETURN TO TOP 21 What happens when I apply for credit After a fraud alert has been placed in your credit file any creditor using that credit file to grant new credit or an extension of credit in your name must contact you by telephone using the phone number specified in the fraud alert or take reasonable steps to verify your identity and confirm that the credit application is not the result of identity theft If someone else is trying to use your identity to get credit the fraud alert usually stops them cold We say usually because nothing is perfect That s why we have a Guarantee RETURN TO TOP 22 Who calls me to let me know that someone is attempting to obtain credit in my name It will be the creditor who is determining whether to issue a line of credit RETURN TO TOP 23 I m applying for new credit and I m a client do I need to call LifeLock No it is not necessary to contact LifeLock However if you run into any problems or undue delays call us at any time and we ll expedite the process for you RETURN TO TOP 24 Is LifeLock going to call me if someone tries to use my information No LifeLock s system is designed for you to have control so you will know before we do The fraud alerts placed on your accounts ask creditors to call you if someone is trying to establish credit in your name RETURN TO TOP 25 I already have alerts on my credit file what will happen to them when I become a client of LifeLock Once your fraud alerts have expired LifeLock will request on your behalf that the fraud alerts are reset and continue to do so as long as you stay a client or until you no longer believe that you may become a victim of identity theft If you sign up as a client while these initial alerts are placed you will be covered by our guarantee at the time you sign up for the LifeLock service RETURN TO TOP 26 Do I need to call you if any of my information changes on my account Yes contact client services with any account changes RETURN TO TOP 27 If someone steals my credit card number how would LifeLock handle this The fraud alerts that LifeLock requests are designed to help prevent someone from opening a new line of credit If someone gets your credit card number first report that credit card as stolen If charges were placed on that card your credit card company should credit your account for some or all of the charges Should you need assistance resolving the issue call us and we ll expedite the process for you RETURN TO TOP 28 Will signing up for LifeLock damage my credit score No LifeLock will not affect your credit score in any way RETURN TO TOP 29 What questions will the creditor ask me for verification The creditor will ask you questions that only you would know the answer to Most questions will be taken off your credit report For instance your previous address who your mortgage is through what your car payment is etc RETURN TO TOP 30 What if there s a dispute Will you handle it for me If there is a dispute

    Original URL path: http://pro4.us/identity-theft-faq.asp (2016-05-03)
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