Dominion Insurance Services: Where the Answers Are
370 Park Street, Suite 8, Moraga CA. 94556
341 S. Main, Suite 100, Alpine UT. 84004
888.313.9977(t) ~ 925.313.9978(f)
info@dominioninsurance.com
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Loss Payee Endorsement

In consideration of the premium for which this Insurance is written it is hereby understood and agreed that Underwriters shall pay Damages which may become payable as a result of the Assured's services as a Representative Payee for a Social Security Administration Beneficiary to the Loss Payee listed under Forms & Notices on the Declarations and any such payment shall constitute payment to the claimant. Underwriters agree that Underwriters will make all such payments to the Loss Payee, and Underwriters will not make any payment solely to the claimant unless Underwriters receive a request in writing from the Loss Payee to make such payments to the claimant.

This and any other loss payable endorsements do not increase the Limit of Liability afforded under this Policy . Regardless of this or any other loss payable endorsements issued under this Policy , no Damages or loss payable as a result of the Assured's service as a Representative Payee for a Social Security Administration Beneficiary under this Policy shall accumulate from Assured to Assured or from Assured to Loss Payee or from Loss Payee to Loss Payee or in any other fashion.

No rights or benefits are bestowed on the Loss Payee other than payment of Damages as set forth herein.

This endorsement applies only to Damages which may become payable to the claimant as a result of the services as a Representative Payee performed for a Social Security Administration Beneficiary on behalf of the Loss Payee listed under Forms & Notices on the Declarations.

All other terms and conditions of the Policy remain unchanged.

Loss Payee Endorsement (09/16)