This action might not be possible to undo. Are you sure you want to continue?
As you set off to provide assistance to Peace Corps efforts around the world, it is necessary for you to maintain proper liability coverage should an unfortunate event occur. Clements International is pleased to offer a complete worldwide liability package designed specifically to meet the requirements of your contract at an affordable price. Our packaged policy includes auto liability, personal liability, personal accident and sickness coverage.
Auto Non-Ownership Liability This portion of the package protects you if you are involved in accident while driving a government vehicle. It provides up to $50,000 coverage for Bodily Injury or Property Damage for which you might be liable. If you are involved in an accident while driving a non-owned vehicle overseas, you should immediately contact A.I.U., providing full details of the accident. Comprehensive Personal Liability This coverage is designed to protect you in case someone brings suit against you for personal actions overseas. If, for example, you accidentally cause bodily harm to someone or unintentionally damage their property, they may sue you for your negligence. This portion of the package would provide up to $50,000 coverage in the event of such an occurrence. Personal Accident If you are injured abroad and need medical attention, you could be reimbursed for the actual expenses incurred as a result of this injury up to $10,000 per occurrence. If you are killed by accident while overseas, your beneficiary will receive $20,000 under this portion of the coverage. If you lose a limb or sight of one eye because of an accident, payment up to $10,000 will be made. The maximum benefit payable for all losses due to one accident is $20,000. Sickness Coverage Sickness coverage is also provided under this portion of the package for up to $10,000 per occurrence. If you become ill and require medical attention, the first $25 of expense for any occurrence is to be absorbed by you. The policy responds for the actual expenses above this deductible up to the total expenditure of $10,000. If you are hospitalized, the maximum benefit payable for room and board is $100 per day. If you incur minor medical expenses above the deductible, you should pay the bills and save the receipts to submit to the insurance company along with your claims. You will then be reimbursed. If you are hospitalized, you should obtain a bill from the hospital and present it to A.I.U. with a claim form. How much does it cost? This package is affordably priced at $50 per month, with a two month minimum. It is recommended that all contractors purchase this policy for the entire length of their Peace Corps contract. Who is Clements International? Since 1947 Clements International has been providing innovative , insurance solutions to individuals and organizations operating outside of their home country. Clements is also proud to be the administrator of the CorpsCare program which provide post-service health benefits to Volunteers and their families.
The Fine Print
1. There is no benefit payable for pre-existing conditions. 2. For Host Country Nationals, benefits are provided only during working hours as a Peace Corps contractor. 3. Coverage is worldwide, excluding the United States 4. Should you have other medical insurance, such other insurance shall be considered Primary and any benefits payable there under shall not be payable under this policy. The description of insurance coverage in this brochure is a summary only. The coverage is subject to the terms, conditions, limitations and exclusions contained in the policy of insurance. In the event of any conflict between the outline of coverage herein and the policy of insurance, the provisions contained in the policy of insurance will govern
Apply online today. You may apply online or complete and submit the application on the back of this page. Clements International One Thomas Circle NW, 8th Floor Washington DC 20005, USA 1.202.872.0060 or 1.800.872.0067 1.202.466.9064 fax email@example.com
PSC Liability Package Application
I New I Former I Current
1. First Name____________________________ M.I.______ Last Name_____________________________________ Date of Birth M____D____Y____ Sex 2. Citizenship Occupation Personal Service Contractor Agency Peace Corps
3. Foreign Post Address___________________________________________________________________________________________________________________________ _______________________________________________ City_______________________________________ Country___________________________________________ 4. How long do you anticipate staying at this location?___________________________ Date leaving for foreign post?_________________________________________ 4. Permanent Home Country Address______________________________________________________________________________________________________________ 5. Home Ph #_______________________ Work Ph #________________________ Mobile Ph #________________________ E-mail________________________________
Liability Package Application
I hereby apply for $50,000.00 Non-owned Automobile Liability Insurance, $50,000.00 Comprehensive Personal Liability, and $10,000.00 Personal Accident Insurance (including $10,000.00 Medical Reimbursement for sickness) to satisfy the liability insurance requirements of your Peace Corps contract. I understand that Clements International will immediately notify the Contracts office at the Peace Corps advising that I have purchased the necessary coverage for the specified period. 1. I am scheduled to perform service overseas under a personal services contract in _______________________ (country). 2. My contract begins on M______D______Y______ (start date) and ends on M______D______Y______ (end date). 3. Drivers License #_______________________________________ 4. Name of Beneficiary____________________________________ State/Country of Issue__________________________________________ Relationship to Applicant_________________________________________
Notice: Coverage cannot be made effective retroactively if this application is received after the contract date. Coverage will be made effective on the date the application was received and processed. Applications must be submitted with full payment to be processed.
Liability Package Application Summary
There is a two month minimum for all policies. It is recommended that all contractors purchase this policy for the entire length of their Peace Corps contract.
Policy Length (in Months) ______________________ x $50.00
Total Premium $ _______________________________
Payment by: I Telecheck, pay by check instantly at pc.clements.com I Check enclosed, payable to Clements International Credit Card I VISA
Mail policies and renewal notices to (choose one): E-Mail Address (E-Customer Option) I Yes, I want to be an e-customer. As an e-Customer all correspondence including renewal invoices and policies will be sent to the e-mail address supplied above. You will need Adobe Acrobat Reader. You may download a free copy of the software at www.adobe.com.
Cardholder Name ______________________________________________________
I Foreign Post Address I Permanent Home Country Address
Exp. Date M Y
Signature and Verification
My signature below certifies that all information I have provided on this application is true to the best of my knowledge. It further serves as authorization if I have chosen to pay by credit card Submit Application and Payment to:
One Thomas Circle NW, 8TH Floor Washington, D.C. 20005 USA Credit Card holders can transmit applications and payment by fax (202-466-9064), or on our website (pc.clements.com).
________________________________________________ (X) Signature