Saturday, September 04, 2010  
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E.R.I.S.A. Bonds
   As a Trustee of an employee benefit plan, you are a fiduciary who owes certain stringent obligations to the participants and beneficiaries of the plan that placed its trust in you. Service as a trustee is a high calling and demands great vigilance.
   The Employee Retirement Income Security Act of 1974 - "ERISA", requires, among other things, that the trustees of an employee benefit plan have fidelity coverage equal, at a minimum, to 10% of the total plan's assets.
   This bond is easy to acquire by completing a few simple questions.  Please complete the form below and click the submit button at the bottom of the page.  Once the form has been submitted, a copy will be sent to the email address you provide and a representative will contact you in a timely fashion.

  Thank you for allowing us the opportunity to serve your surety needs.
All Fields Are Required.
Plan Information:
Effective or Continued On: New  Renewal
Name of Plan:
Principal Address:
Street:  
City: County: State: Zip:
Amount of Insurance Desired:
Coverage Form A - Employee Dishonesty: $
Premium Payable: Annually   3 Years in Advance   3 Years in Installments
CONTROLS
Frequency of Outside Audit:
Date of Last Audit:
Does Audit Include All Interests And Locations? Yes   No
Do The Auditors Visit All Locations? Yes   No
Does the Report Include Auditors' Opinion? Yes   No
(If Yes, Indicate Any Qualifications)
Is Counter-Signature Of Checks Required? Yes   No
How Often Are Bank Accounts Reconciled?
Does The Person Who Reconciles The Bank Accounts
Prepare Or Make Bank Deposits Or Withdrawals? 		Yes   No
STAFF
Number Of Trustees, Fiduciaries or Employees who Handle Funds or Other Property of the Plan:  
Name and Capacity of Agent to be Covered:
Name: Capacity: 
Name: Capacity: 
Name: Capacity: 
Name: Capacity: 
Name: Capacity: 
COVERAGE TO BE REPLACED BY THIS POLICY
Type of Coverage:
Amount:
Premium:
Premium Period:
Carrier:
LOSS EXPERIENCE / EMPLOYEE DISHONESTY LOSSES (past six years)
Date:
Amount:
Employee's Position:
Corrective Measures (Other Than Discharge)
Carrier:
     The Employees of the Applicant have all, to the best of the Applicant's knowledge and belief, while in the service of the Applicant always performed their respective duties honestly. There has never come to its notice or knowledge any information which in the judgment of the Applicant indicates that any of the said Employees are dishonest. Such knowledge as any officer signing for the Applicant may now have in respect to such officers own personal acts or conduct, unknown to the Applicant, is not imputable to the Applicant.
     It is understood that the first premium upon the policy applied for, and subsequent premiums thereon, are due at the beginning of each premium period, that the Company is entitled to additional premiums because of any unusual increase in the number of Employees or Premises and that the Applicant agrees to pay all such premiums promptly.
Name of Person Completing This Form:
Phone Number Of Person Submitting Form:
E-Mail Address of Person Submitting Form:
Clicking the Submit button indicates acceptance of the above. Should you need to start over again, click Reset

 

Atlynx Surety Brokers, LLC.
777 Zeckendorf Blvd.
Garden City, NY 11530-2127
Phone: 516-745-7520
Fax: 516-794-0380

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