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SEEDSMEN'S ERRORS AND OMISSIONS PROPOSAL FORM (Risk Placement Services, Inc.)

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__________
Seedsmens E&O 7/11
1 RPS AVRECO
SEEDSMEN'S ERRORS AND OMISSIONS
PROPOSAL FORM
(THIS PROPOSAL FOR CLAIMS MADE INSURANCE)
This proposal form is for insurance that is limited generally to liability for only those claims that are first
made against the Insured while the insurance is in force. Please review the insurance carefully and discuss
the coverage thereunder with your insurance agent or broker.
IMPORTANT 1. Please complete this application leaving no blank spaces.
2. If space is insufficient to complete answers, please continue on your firm's letterhead.
3. Have this form signed and dated by a partner, or identified officer of your firm.
4. Please attach a typical Seed Tag, Invoice, Disclaimer Clause, Letterhead used by the firm and
additional Contract Forms as may be applicable.
1. Firm Name:
Address of Head Office:
City:
State:
Zip Code:
Phone:
E-Mail:
Country:
Other:
2. Address(es) of Branch Offices,
if any:
City:
State:
Zip Code:
Phone:
E-Mail:
Country:
Other:
Address(es) of Branch Offices,
if any:
City:
State:
Zip Code:
__________
Seedsmens E&O 7/11
2 RPS AVRECO
Phone:
E-Mail:
Country:
Other:
4. a. Of which Seed Trade Association(s) is the firm in good standing?
ASTA Other(s)
b. If “Others,” do any of the associations have binding arbitration rules?
Yes No
5. Is the Firm a co-operative, or a member of a co-operative?
Yes No
6. Is the Firm a:
Primary Producer of Seed?
Yes No
Seed Processor?
Yes No
Seed Re-packager?
Yes No
Distributor of seed pre-packed by third party/parties?
Yes No
Other (please explain below)
Yes No
7. Break down of your seed sales by kind of seed and source, last 12 months
Please attach a copy of your contract forms for each category below.
Category:
A. Please show total Sales of Seeds excluding Categories B, and C below.
If you sell seeds grown under Contract please explain if you or the contractor is responsible for the quality
control of this category.
B. Show only income from performing custom conditioning services for others, not the value of the seed
conditioned.
C. Show the Total sales of seed sold using the supplier’s packaging and labels. Seed requiring re-testing before
distribution should be declared as Category A sales, above.
__________
Seedsmens E&O 7/11
3 RPS AVRECO
“Circle” to indicate type(s)
within the groups below for
which overall figures are
given:
A.
Total Seed Sales,
In your bags, under
your labels.
B.
Income from Seed
Custom
Conditioned for
others.
C.
Distributor Sales: Total
Sales of Seeds sold under
Third Party labels in
unopened Third Party
bags. (See Q8 below)
1) Watermelon
2) Tomato Lettuce, Peppers,
Brassica, Cucurbits, Melons
(other than Watermelon)
3) Other Garden Seed
(Attach List of Types and
Sales)
4) Home Gardeners’ Packets
5) Flower Seed
6) Seed Potatoes: Certified,
Non-Certified
7) Rice
8) Sugar Beets
9) Wheat, Barley, Oats, Rye,
Soybean, Hybrid Corn,
Sweet Corn,
Grain Sorghum, Hybrid
Sunflowers, Canola, Cotton,
Edible Dry Beans
10) Grass Seed – Fodder:,
(pure varieties and mixtures),
Blue Grass, Fescue, Forage
Sorghum, Alfalfa
11) Grass Seeds – Amenity:
Golf Courses and Sports
Grounds:
12) All Other Seeds
(Attach List of Types and
Sales)
8. What is the average retained margin for the Distributor Sales, as shown in
Question 7, Column C. above?
9. a. Do you use a standard limitation of liability limiting your liability to the
replacement, or the cost of replacement, seed? (Please attach a copy)
Yes No
If “No,” please explain:
b. Does your limitation of liability appear on all your seed tags, bags, labels
and invoices?
Yes No
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Seedsmens E&O 7/11
4 RPS AVRECO
10. a. Do you grow experimental stock seed? (defined as breeder, foundation or
registered seed prior to commercial sales.)
Yes No
b. If so, do you allow any retention of experimental (stock) seed by your
growers for resale?
Yes No
If "Yes", please explain the terms of contract, percent of retention, dollar value each
category, and attach contract agreement used:
11. a. Do you have any involvement in research or development of "transgenic
varieties"?
Yes No
If "Yes" please describe in full, and confirm whether such seeds have been approved by any
regulatory authority (APHIS, FDA, EPA, etc.):
b. Do you currently sell any transgenic varieties?
Yes No
If "Yes" please identify and describe the types or kinds of transgenic seeds sold and set forth your
dollar sales volume for each type or kind of transgenic seed sold.
12. a. Who is responsible for your Quality Control program?
b. To whom does this person report?
c. What training has this person had in Quality control?
d. Describe briefly your Quality Control program. (Include sampling procedures and limits of
confidence used.)
13. a. Do you sell or condition green bean seeds?
Yes No
If “Yes”:
(1) Advise source of seed:
(2) Advise if seeds are exposed to Halo Blight and
what, if any, eradication measures you have taken:
b. Do you sell or condition Watermelon Seeds?
Yes No
If “Yes,”
i) Please advise the measures taken against Watermelon Fruit Blotch:
ii) Do you use a Waiver of Liability in respect of Watermelon Fruit
Blotch on all your Watermelon Seed sales?
Yes No
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Seedsmens E&O 7/11
5 RPS AVRECO
Please attach a copy of the Waiver of Liability which you use.
ii) Do you regularly use a standard sample of 30,000 seeds to test for
Watermelon Fruit Blotch on all your Watermelon Seed sales?
Yes No
Please briefly explain your testing procedures:
c. Do you sell or condition Potato Seeds?
Yes No
If “Yes” please answer questions on the attached "Potato Seedsmen's Supplemental
Questionnaire".
N
OTE
:
Primary Producers/Processors please answer all questions.
Distributors, Re-packagers, Secondary Processors please omit questions marked * (14 to 18
inclusive), but provide a copy of your standard order listing specifications required in the product
purchased from a primary producer/processor.
14. a. What parameters are used to determine a specific lot of seed?
b. How are lots separated until varietal purity, germination, and weed seed content have been
determined?
15. * Are grow-out tests of seed lots conducted when such tests are required to
determine quality?
Yes No
If “Yes,” on which crops and where?
16. * Do you determine that a grow-out lot of hybrid seed conforms to the
Federal Seed Act Regulations regarding percentage requirements of
hybridized seeds?
Yes No
If “No,” please explain:
17. * a. If seed it grown for you by contract growers, whose crew rogues the production field?
b. At what times do your representatives examine the planting and growing of the production
field?
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Seedsmens E&O 7/11
6 RPS AVRECO
c. What experience have these representatives had in seed production?
d. If field inspection or rogueing raises questions as to the acceptability of the varietal purity of
the lot, what procedures are followed to correct any indicated problem before the seed is
marketed?
18. * a. In your production of cross-pollinated seeds, do you meet the isolation,
rogueing and pollen control requirements recommended by regulatory
officials, extension departments, and Universities?
Yes No
b. For self-pollinated crops, what kind of isolation measures do you observe to prevent
accidental mechanical contamination of the crop?
19. In your processing plant or plants which have more than one processing
line, do you ever process more than one variety of a given kind of seed at
the same time?
Yes No
If “Yes,” how do you ensure mechanical mixtures are prevented?
20. a. Does the firm maintain a private laboratory staffed with a senior analyst?
Yes No
If “No,” does the firm use the facilities of a qualified commercial
laboratory?
Yes No
If so, name the laboratory used:
b. Are your germination tests made according to the procedures prescribed
by the Association of Official Seed Analysts?
Yes No
If “No,” please explain the procedures followed:
21. a. If germination (plus hard seed percentage if applicable) is less than the
higher of 75% or five percentage points above the minimum specified for
the seed in the Federal Seed Act regulations, do you conduct a seedling
vigor test?
Yes No
b. How frequently do you retest germination of seed lots?
22. Do you keep a representative sample from each lot of seed, and store the
sample under storage conditions equivalent to those for your seed inventory
storage until a year after the lot has been entirely sold or disposed of?
Yes No
__________
Seedsmens E&O 7/11
7 RPS AVRECO
23. a. What requirements as to germination percentage, origin and age of seed do you observe in
blending seed?
b. What requirements are observed in dealing with formula mixes (i.e. pasture mixes, lawn
mixes, alfalfa blends, etc.)?
24. Has any application for this type of insurance made on behalf of the firm or
any of the present partners, or to the knowledge of the firm, on behalf of
their predecessors in business, ever been declined or has any insurance ever
been cancelled or renewal refused?
Yes No
If “Yes,” please give full particulars.
25. Have any claims been made during the past five years against the firm or its
predecessors in business that would have been covered by the proposed
insurance?
Yes No
If “Yes,” please give full particulars.
26. Is the firm aware of any circumstances which may result in any claim being
made against the firm?
Yes No
If “Yes,” please give full particulars.
27. Do you currently carry Seedsmens Errors and Omissions Insurance?
Yes No
If “Yes,” please give full particulars.
Insurer:
Sum Insured:
Deductible:
Premium:
Period:
Retroactive Date:
28. Do you currently carry General and Products Liability Insurance, covering
all territories where you sell seeds?
Yes No
If “Yes,” please give particulars:
Insurer:
Sum Insured:
Period:
29. Coverage Requested
Check the amount of indemnity required: $250,000 $500,000 $1,000,000
Other :
Check the amount of deductible required: $2,500 $5,000
Other :
__________
Seedsmens E&O 7/11
8 RPS AVRECO
30. Do you desire coverage to be extended to include “multiple claims
coverage”?
Yes No
("Multiple Claims" means more than one claim arising from a single act, error or omission in respect of one
lot of seed. "Multiple Claims Coverage" means that if more than 2 claims are made in respect of one lot, the
insured shall bear only the first 2 deductibles. This coverage is available for an additional premium.)
I/WE DECLARE THAT THE ABOVE STATEMENTS AND PARTICULARS ARE TRUE AND THAT I/WE
HAVE NOT SUPPRESSED OR MIS-STATED ANY MATERIAL FACTS AND I/WE AGREE THAT THE
PROPOSAL FORM SHALL BE THE BASIS OF THE CONTRACT WITH UNDERWRITERS. HOWEVER, IT
IS EXPRESSLY UNDERSTOOD AND AGREED THAT THIS APPLICATION DOES NOT PROVIDE
COVERAGE OR BIND HEREUNDER IN ANY WAY NOR TO ANY EXTENT WHATEVER FOR ANY LOSS
OR CLAIM AND COMPLETION OF THIS APPLICATION IS FOR QUOTATION PURPOSES ONLY.
NAME OF FIRM
SIGNATURE OF APPLICANT (PARTNER OR OFFICER)
DATED:
PLEASE ATTACH THE FOLLOWING
(Not needed for renewals unless there have been changes in the last 12 months):
LETTERHEAD used by the firm.
A typical SEED TAG,
INVOICE,
Copies of CONTRACTS, refer to Questions 7 B.
DISCLAIMER, refer to Question 9.
WAIVER of LIABILITY (Watermelon Fruit Blotch), refer to Question 13 B.
STANDARD ORDER, refer to “Note” before Question 14.
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Completed 30 July 2020

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