**Ryan Turner Specialty**

1345 Avenue of The Americas 4th Floor  
New York, NY 10105  
Ph: 212-437-1400  
www.rtspecialty.com

18088339

**SPECIAL CONDITIONS / OTHER COVERAGES:**

NO FLAT CANCELLATIONS  
ALL FEES ARE FULLY EARNED AT INCEPTION

For R-T Specialty to file the surplus lines taxes on your behalf, please complete the surplus lines tax document and return with your request to bind. Due to state regulations, R-T Specialty requires tax documents to be completed within 24 to 48 hours of binding. Please be diligent in returning tax forms.

Signed and Dated TRIA Letter, Required Prior to Binding.
Please provide us with a copy of the Underlying Carrier Binders, Required Prior to Binding.
Please provide us with a copy of the Underlying Policies, including the Carrier, Effective Date, Expiration Date, Policy Number, Limits and Premium, Required Within 60 Days of Binding

**Authorized Representative**