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right, fold, and carry with you.

Please detach the card to the


Letter Of Confirmation
September 7, 2010

Name: jeremy stein


Policy No.: E15378045
jeremy stein
481 greenwich street
apt. 4B
new york NY 10013 For emergency assistance during your trip. call:
1-888-887-4743 1-804-281-6708
Dear jeremy stein,
(From U.S.) (Collect)
Thanks for choosing Event Ticket Protector SM insurance from Mondial Assistance
for your upcoming Ticketmaster event. For customer service or to file a claim, please
visit or call:
This Letter of Confirmation and the enclosed Certificate of Insurance/Policy www.EventTicketProtector.com
contains important information on the insurance plan you purchased. 1-800-424-3396
We recommend that if you are traveling for your event, you take copies of these 2805 North Parham Rd, Richmond, VA 23294
documents with you. If you did not receive a Certificate of Insurance/Policy, or
would like another copy, please call 1-800-424-3396.
What Your Plan Includes
Event Ticket Protector SM Insurance Information: Your plan includes the following coverage, up to the limits
Policy identification number: E15378045 shown. Please see your certificate/policy for information
about how our insurance works.
Per Ticket Cost: 301.30

Who it insures: jeremy stein,jeremy stein Benefit Coverage Limits*


Purchase date: September 7, 2010 Event Ticket Protector Insurance $301.30*
Event date: September 23, 2010 24-Hour Hotline Assistance
*USD per person unless noted otherwise
Amount paid: $14.00
Please Note
· Your Event Ticket Protector purchase covers
Thanks again for purchasing Event Ticket Protector SM insurance from Mondial
ticket(s). The enclosed Certificate of
Assistance.
Insurance/Policy refers to ticket(s) as trip(s).
Sincerely, · World Access Service Corp. is the licensed
producer and administrator for this plan.
· California residents: We are doing business in
California as WASC Insurance Agency and our
California license # is 0B01400.
Jeff Hyman
Vice President of Travel Operations · Insurance coverage is provided under a
Form No. 52.201 or 52.401 issued by BCS
Insurance Company, Chicago, IL.
Mondial Assistance will refund your insurance premium if you cancel
your insurance within 10 days of purchase and have not used your
ticket or filed a claim.

For questions or to file a claim, please visit www.EventTicketProtector.com.


BCS Insurance Company Privacy Notice

BCS respects the privacy of its customers and former customers and
protects the security and confidentiality of their nonpublic personal
information. To safeguard our customers' confidential information, we
comply with all applicable laws and regulations and have instituted our
own policies to: (1) insure the security and confidentiality of customer
records and information; (2) protect against any anticipated threats or
hazards to the security or integrity of such records; and (3) protect
against unauthorized access to or use of such records or information
which could result in substantial harm or inconvenience to any
customer.

BCS PRIVACY POLICY:


Policies and practices with respect to disclosing your nonpublic
personal information:
We do not disclose any nonpublic personal financial information about
our customers or former customers to anyone, except as permitted by
law.

Categories of nonpublic personal information that we collect:


We collect nonpublic personal financial information about you from the
following sources: (1) information we receive from you on applications
or other forms; (2) information about your transactions with us, our
affiliates, or others, and; (3) information we receive from a consumer
reporting agency.

Policies we maintain to protect the confidentiality and security of


nonpublic personal information:
We maintain physical, electronic, and procedural safeguards that
comply with federal and state regulations to guard your nonpublic
personal financial information. We restrict access to your nonpublic
personal information to employees who need it to provide information or
services to you.

World Access Service Corp., d/b/a Mondial Assistance USA, is the


administrator of this insurance policy on behalf of BCS Insurance
Company. We will adhere to at least the same standards for handling
and protecting your data as described above. For more information
about how we handle and protect your data, please see our privacy
policy, located at http://www.mondialUSA.com/privacy or contact us at:
Mondial Assistance USA, ATTN: Chief Privacy Officer, 2805 N. Parham
Rd., Richmond, VA 23294.

TP3 * ET_SRV2_NY * *
INSURING CLAUSE Part I. EFFECTIVE DATE
BCS Insurance Company, herein referred to as the Insurance shall be effective the day after Your application
Company, will pay You the insurance benefits described in is postmarked, Your telephone order is placed, or Your
this Policy. This Policy and attached Riders, if any, are faxed order is received, and Your application is accepted.
issued in consideration of the payment of the initial In no event will coverage be effective if all premiums due
premium. Please refer to the accompanying Letter of have not been received prior to the Scheduled Departure
Confirmation. It provides You with specific information Date or prior to the Trip Cancellation date if You cancel
about the plan You purchased. Please contact Us Your Trip or it is canceled for any reason.
immediately if You believe that the Letter of Confirmation is
incorrect. Part II. TERMINATION DATE
*Indicates insurance coverage provided under this Policy Coverage ends at midnight on the date of return selected,
Event Ticket ProtectorS M and underwritten by BCS Insurance Company. or upon return to Your city of residence or when the Trip is
canceled, whichever is earliest. If return is delayed for any
RENEWAL CONDITIONS covered reason, coverage is extended until You are able to
This Policy is issued for a single term as stated in the return to Your city of residence. The day You depart and
Individual Letter of Confirmation and is non-renewable. the day You return are counted and included as separate
days when determining duration of coverage.
Insurance Policy SATISFACTION GUARANTEE
Within 10 days of purchasing the plan, We will process a Part III. GENERAL EXCLUSIONS
full refund of premium to You, as long as You have not No coverage is provided for any loss arising directly or
already departed on Your Trip or filed a claim. No refunds indirectly out of or as a result of the following:
shall be paid to You after 10 days of purchasing the plan. Accident and Health benefits are considered to be Trip
Cancellation Benefits.
For additional information or to file PLEASE READ THIS POLICY CAREFULLY FOR FULL These exclusions apply to the plan benefits. In addition to
DETAILS. any exclusions that apply to a particular benefit, no
a claim, please visit: This Policy is a legal contract. The entire contract is made coverage is provided for any loss arising directly or
up of the Policy and any Riders attached to it. indirectly out of or as a result of the following:
For the Accident and Health benefits:
www.EventTicketProtector.com 1. Intentionally self-inflicted harm, suicide or attempted
PLAN FEATURES suicide, by You, a Traveling Companion or a Family
For Emergency Assistance TABLE OF CONTENTS Member;
Part I. Effective Date 2. Pregnancy, other than unforeseen complications of
During Your Trip Call: Part II. Termination Date pregnancy, of You, a Traveling Companion or a Family
Part III. General Exclusions Member;
1-888-887-4743 Part IV. Description of Travel Insurance Benefit 3. Mental or emotional disorders, or physical
(From U.S.) Part V. General Provisions Related to Insurance Benefit complications related thereto, of You, a Traveling
Part VI. Help While Traveling Companion or a Family Member;
1-804-281-6708 Part VII. Claim Filing Procedures 4. Alcoholism or drug addiction, intoxication or under the
(Collect) Part VIII. Definitions influence of any narcotic unless administered on the
advice of a Physician or physical complications related
thereto, of You, a Traveling Companion or a Family
Member;
5. War (whether declared or undeclared), acts of war,
Insurance benefits are underwritten by BCS participation in a riot or insurrection; or service in the
Insurance Company. World Access Service Corp., Armed Forces or units auxiliary thereto (except as
a company of Mondial Assistance, is the licensed Signed for BCS Insurance Company, 2 MidAmerica Plaza, specifically covered);
producer and administrator for this plan. Suite 200, Oakbrook Terrace, IL 60181. 6. Aviation, other than as a fare-paying passenger on a
scheduled or charter flight, operated by a scheduled
Form No. 52.201NY ET_SRV2_NY airline; or
©2010 World Access Service Corp.
Page 1
7. Participating in a felony or to which a contributing cause Exclusion Waiver. The Company and We reserve the reassignment for any reason, or disciplinary action);
of the loss was a person being engaged in an illegal right to reject applications. or
occupation. This includes You, Family Members, or b. are personally reassigned within 10 days prior to
Traveling Companions, whether they are insured or not. TRIP CANCELLATION PROTECTION Your departure date, whether temporary or
8. Financial Default of a travel supplier. Trip Cancellation coverage provides benefits for loss(es) permanent.
None of these plans cover You: You incur for Trips cancelled up to the time and date of 8. You or a Traveling Companion being the victim of a
1. If the purpose of the travel is to receive medical care, departure. Felonious Assault within 10 days prior to Your
medication or treatment; For all of the covered reasons outlined below, You departure date. A Felonious Assault may not be
2. If the stated Trip departure and return dates do not must notify the appropriate travel supplier(s) of Your inflicted by You, a Family Member, Traveling
reflect Your intended departure and return dates; cancellation within 72 hours of the occurrence, unless Companion or Traveling Companion’s Family Member.
3. If the tickets do not indicate the travel dates; the condition prevents it, then as soon as reasonably 9. You or a Traveling Companion, after having been with
4. If You give incorrect data or facts; or possible. Otherwise the right to compensation will the same employer for at least three continuous years,
5. If the loss is not submitted to Us within 90 days from lapse. are terminated or laid off, through no fault of Your own,
the date of loss, except as otherwise prohibited by law, A maximum benefit of up to the amount indicated in Your after Your effective date of coverage.
subject to the provision entitled Proof of Loss in this Letter of Confirmation is provided to cover certain 10. Your or Your Traveling Companion’s automobile having
Policy. expenses as listed below which result from the cancellation a mechanical breakdown within 48 hours of the event
of Your Trip due to: which results in the vehicle being unable to be driven.
PRE-EXISTING CONDITIONS EXCLUSION 1. Any serious Injury or any unforeseen serious medical 11. You or Your spouse are relocated by Your or Your
For the purposes of determining any Pre-existing condition: spouse’s current employer to a location that is at least
Conditions, the effective date of Your insurance will be a. Occurring to You or a Traveling Companion, which is 100 miles from Your Primary Residence.
Your Trip Cancellation Insurance effective date. so disabling as to cause a reasonable person to 12. Common Carrier caused delay (including bad weather).
You have purchased a plan where Pre-existing cancel their Trip; 13. Your company being made uninhabitable by fire, flood,
Conditions are waived. The Company and We cover b. Occurring to a Family Member that is considered life burglary, vandalism, or natural disasters.
these Pre-existing Conditions provided: threatening or requiring hospitalization; or In all cases You must notify the appropriate travel
1. The insurance was purchased within fourteen calendar c. Occurring to a Family Member requiring Your care. supplier(s) of Your cancellation within 72 hours, unless
days of initial Trip payment; An actual examination by a Physician must take place the condition prevents it, then as soon as reasonably
2. The amount of Trip Cancellation coverage originally within 72 hours of the cancellation. This Physician may not possible. Otherwise the right to compensation will
purchased equals the full cost of all non-refundable Trip be a member of Your or Your Traveling Companion’s lapse.
arrangements; family or yourself, or a Family Member of the person whose Coverage is for forfeited, published, Trip payments or
3. On the date of purchase of insurance, You were condition caused the cancellation. deposits incurred as a result of cancellation penalties for
medically able to travel and You had not filed a claim 2. Your death, the death of a Family Member or a which You are not eligible to receive a Refund.
for Trip Cancellation due to a pre-existing illness within Traveling Companion if the death occurs prior to Your Trip Cancellation benefits do not cover loss(es) due to:
120 days prior to the purchase of insurance; Scheduled Departure Date. 1. Any General Exclusion or Pre-existing Condition;
4. The total Trip cost is $10,000 per person or less; and 3. You or a Traveling Companion being hijacked or 2. You or a Traveling Companion: a) making changes to
5. On the date of purchase of insurance, You are a quarantined. personal plans; b) having a business or contractual
resident of the United States. 4. You being required to serve on a jury, served with a obligation; c) being unable to obtain necessary travel
If You do not meet the above criteria, You may still be court order or subpoena. documents; or d) being detained or having property
covered for Trip Cancellation caused by reasons other than 5. Your Primary Residence being made uninhabitable by confiscated by any Customs authority; or
those related to the Pre-existing Condition. fire, flood, burglary, vandalism, or natural disasters. 3. Prohibition or regulation by any government.
6. You or a Traveling Companion being directly or Please refer to Your Letter of Confirmation to determine the
Part IV. DESCRIPTION OF TRAVEL INSURANCE indirectly involved in a traffic Accident while directly en maximum amount of coverage purchased.
BENEFIT (what is covered) route to a departure.
The following insurance benefit is designed to protect You 7. You or a Traveling Companion, who are on Active
against situations or losses that result from sudden and Military Duty in the United States Armed Forces:
unexpected conditions or events. The benefit does not a. having Your personal leave revoked within 10 days
cover conditions or events that, on the date of prior to Your departure date (as long as such
purchase, are either known to You or likely to occur. revocation is in writing by a superior officer and is not
Please be aware that this stipulation may be applied to due to war-related situations, invocation of the War
policies purchased with the Pre-existing Conditions Powers Act, base or unit mobilization, unit
Page 2
Part V. GENERAL PROVISIONS RELATED TO Legal Action: No action at law or in equity shall be brought Monitoring your care
INSURANCE BENEFIT to recover on this Policy prior to the expiration of 60 days If You’re hospitalized, Our medical staff will stay in contact
1. No agent or other person has authority to accept or after written proof of loss has been furnished in accordance with You and the Doctor caring for You. We can also notify
make representations or information or alter, modify or with the requirements of this Policy. No action may be Your family and Your Doctor back home of Your Illness or
waive any of the provisions of this Policy. brought after three years from the date written proof of loss Injury and update them on Your status.
2. Claims must be submitted to Us within 90 days from is due unless otherwise provided by law.
date of loss, except as otherwise prohibited by law. Assignment: You may assign Your interest under the Legal Assistance
3. In the event that You are covered under another policy Policy by giving Us written notice of such assignment. The Finding a legal advisor
issued by the Company that provides the same or assignment will not be effective until We receive the written We can help You find local legal advice if You need it while
similar coverage, the Company will adjust Your claim notice. Neither the Company nor We assume any You’re traveling.
by applying terms and conditions from the coverage responsibility for the validity of any assignment.
that pays the most. Any premium paid for duplicate Physical Examinations and Autopsy: The Company has Arranging a cash transfer
coverage will be refunded. the right to physically examine You as often as reasonably If You need to pay legal fees, We can arrange to transfer
4. Benefits are payable to You or, if applicable, to Your needed while a claim is pending. The Company may also funds from Your family or friends.
estate. require an autopsy in the case of death, where it is not
5. MISREPRESENTATIONS AND FRAUD: Coverage forbidden by law. The Company will bear all costs for Travel and Documentation Assistance
shall be void if, whether before or after a loss, the these. Replacing lost travel tickets
insured has concealed or misrepresented any material Conformity with State Statutes: On the Policy effective If Your tickets are lost or stolen, We can contact the airline
fact or circumstance concerning this Policy or the date shown on the Letter of Confirmation, if any provision or other Common Carrier, and can help You with Your
subject thereof, or the interest of the insured therein, or conflicts with the laws of the state in which You reside, it travel arrangements if Your Trip is interrupted.
if the insured commits fraud or false swearing in shall be deemed amended to conform to law. Replacing lost passports and other travel documents
connection with any of the foregoing. Misstatement of Age: If Your age is misstated, the If Your passport or other travel documents are lost or
6. You have a duty to make all reasonable efforts to Company will adjust the premium, benefits, or both based stolen, We can help You reach the appropriate authorities,
minimize losses from any insured benefit or Covered on the true age. No misstatements will continue insurance contact Your family or friends, and assist You in getting
Service. otherwise validly terminated or terminate insurance Your documents replaced.
The following apply to the Accident and Health otherwise validly in force.
Benefits: Other Assistance Services
Notice of Claim: Written notice of claim must be given Part VI. HELP WHILE TRAVELING Getting flight information
within 20 days after a covered loss starts or as soon as If You need help while traveling, Our assistance team is If You miss Your flight or it’s canceled, We can give You
reasonably possible. The notice can be given to Us. Notice available 24 hours a day. arrival and departure times for other flights that will get You
must include Your name and the Policy number. Our services are here to help make challenging situations a to Your connecting flight or final destination.
Claim Forms: When notice of claim is received, You will little easier. With Our global reach, We can get You in Getting emergency cash
be sent forms for filing proof of loss. If these forms are not touch with licensed medical and legal professionals and If Your cash is lost or stolen or You need extra money to
sent within 15 days, You may meet the proof of loss other kinds of help. pay for unexpected expenses, We can arrange to transfer
requirement by sending Us a written statement of the How to reach us: funds from Your family or friends.
nature and extent of the loss within the time limit stated in In the United States, Canada, Puerto Rico and U.S. Virgin
the Proof of Loss provision. Islands, call 1-888-887-4743 Delivering emergency messages
Proof of Loss: Written proof of loss must be given within All other locations, call collect 1-804-281-6708 We can help You get an urgent message to someone back
90 days after the date of loss. If it is not reasonably If you can’t call collect, We’ll call You back. home. We’ll try calling up to three times within 24 hours
possible to give written proof in the time required, the Please have this information ready when you call: and confirm whether We were able to reach the person
Company will not reduce or deny the claim for this reason if · Your name, location and phone number You asked Us to contact.
the proof is filed as soon as reasonably possible. In any · Your policy identification number
event, the proof required must be given no later than 1 year
from the time specified unless You lacked legal capacity. Medical Assistance
Time of Payment of Claim: Payment will be made Finding a doctor, dentist or medical facility
immediately upon receipt of due written proof of loss. If You need care from a Doctor, Dentist or medical facility
while You’re traveling, We can help You find one.

Page 3
About our assistance services Part VIII. DEFINITIONS of alcoholism or drug abuse; d) a place for the provision
Our goal is to help You with Your problem no matter where Accident means an unexpected, unintended, of hospice care; or e) a place for the treatment of
You’re traveling. unforeseeable event causing Injury. pulmonary tuberculosis.
Active Military Duty means serving in the United States Illness means a sickness, infirmity or disease that causes
We’ll make all reasonable efforts to help You as We’ve Armed Forces on a full-time basis, not including the United a loss that begins during a Coverage Period and is not a
described, but there may be times when we aren’t able to States Armed Forces Reserves. Pre-existing Condition.
resolve Your problem for reasons that are beyond Our Actual Cash Value means the amount an item is Immediate Family Member means Your spouse; parent;
control. determined to be worth based on its market value, age and child(ren), including children who are, or are in the process
We will always do Our best to refer You to appropriate condition at the time of loss. of becoming adopted; siblings; grandparent or
professionals, but please be aware that they are Common Carrier means an entity licensed to carry grandchild(ren); step-parent; step-child or step-sibling.
independent providers and We can’t be held responsible passengers for hire on land, water or air, excluding vehicle Injury means bodily Injury caused by an Accident, directly
for the results of any services they provide. rental companies. and independently of all other causes and sustained on or
Coverage Period means the time during which benefits after the effective date of this coverage and before the
Part VII. CLAIM FILING PROCEDURES are payable hereunder, beginning on the effective date and termination date. Benefits for Injury will not be paid for any
Please contact Us at 1-888-799-2832, or visit ending on the termination date. loss caused by sickness or other bodily diseases or
www.EventTicketProtector.com to obtain a claim form. Covered Service means a service or supply specified infirmity.
All benefits will be paid in United States dollars. We will herein for which benefits will be provided. Normal Pregnancy or Childbirth means a pregnancy or
need certain information from You in the event You need to Family Member means Your spouse; parent; child(ren), Childbirth that is free of complications or problems.
file a claim. This documentation will include, but is not including children who are, or are in the process of Physician means a person who is licensed and legally
limited to, the following: becoming, adopted; sibling; grandparent or grand- entitled to practice medicine in the applicable field for which
1. General Documentation child(ren); step-parent; step-child; or step-sibling; in-laws services are delivered. A Physician may not be an
a. Receipts and itemized bills for all expenses. (parent, son, daughter, brother or sister); aunt; uncle; Immediate Family Member.
b. Original of any Refunds or expense allowances niece; nephew; legal guardian; ward; an employed Pre-existing Conditions means the existence of
received from Your tour operator, travel agency, or caregiver who lives with You; or a person with whom You symptoms in You, a Traveling Companion or a Family
other entity. have lived for 12 continuous months prior to the effective Member that would cause an ordinarily prudent person to
2. Trip Cancellation Claims date of coverage; whether or not they travel with You. seek diagnosis, care or treatment within 120 days
a. Any appropriate documentation that officially Felonious Assault is an act of violence against You or a preceding the effective date of Your insurance or a
explains the cause of Your trip cancellation. Any Traveling Companion requiring medical treatment in a condition for which medical advice or treatment was
explanation of diagnosis along with Your original Hospital. recommended by a Physician or received from a Physician
itemized bills, receipts, and proof of other insurance Financial Default is a complete suspension of operations within 120 days preceding the effective date of Your
payments. due to financial circumstances whether or not a bankruptcy insurance.
b. Original unused tickets, copies of invoices, proof of petition is filed. Primary Residence means a person’s fixed, permanent
payments, and other documents that substantiate the Hospital means a provider that is a short-term, acute, and principal home for legal and tax purposes.
cost or occurrence of the trip cancellation. general Hospital that: Refund means:
c. Documentation of Refunds received from the travel 1. is a duly licensed institution; 1. Money returned to You by the travel agent, tour
supplier(s). 2. in return for compensation from its patients, is primarily operator, airline, cruise line or other travel supplier;
d. Copy of the supplier’s literature that describes engaged in providing Inpatient diagnostic and 2. Any credit or voucher for future travel provided to You
penalties. therapeutic services for the diagnosis, treatment, and by the travel agent, tour operator, airline, cruise line or
e. A letter from the tour operator or an itemized bill from care of injured and sick persons by or under other travel supplier; or
the travel agent stating the non-refundable amounts supervision of Physicians; 3. Any credits, recoveries or reimbursements from Your
of the Trip costs. 3. has organized departments of medicine and major employer, another insurance company, a credit card
surgery; issuer or any other institution.
4. provides 24-hour nursing service by or under the Scheduled Departure Date means the date You have
supervision of registered graduate nurses; and selected to begin travel and for which paid travel
5. is not other than incidentally: a) a skilled nursing facility, arrangements have been made.
nursing home, custodial care home, health resort, spa Terrorism means the unsanctioned and illegal use of force
or sanatorium, place for rest, place for the aged, place that caused destruction of property, Injury, or death by an
for the provision of rehabilitation care; b) a place for the individual or group for the express or implied purpose of
treatment of mental illness; c) a place for the treatment achieving a political, ethnic, or religious goal or result.
Page 4
Terrorism does not include general civil protest, unrest, TRAVEL POLICY - OUTLINE OF COVERAGE
rioting, or an act of war. LIMITED BENEFIT HEALTH COVERAGE
Traveling Companion is a person traveling with You and Form 52.811
who shares the same accommodations as You.
Trip means: 1. Read Your Policy Carefully – This outline of coverage
1. a period of round-trip travel to and from destination that provides a very brief description of the important features
is at least one mile from Your main place of residence; of the accident and health benefits ONLY of your Policy.
and This is not the insurance contract and only the actual
2. such travel is not to obtain health care or treatment of Policy provisions will control. The Policy itself sets forth,
any kind. in detail, the rights and obligations of both You and Your
We, Us or Our refers to World Access Service Corp., and insurance company. It is, therefore, important that you
Mondial Assistance. READ YOUR POLICY CAREFULLY!
You or Your refers to all persons listed on the Letter of
Confirmation under the plan purchased. 2. Exclusions – In addition to any other general limitations
described in the Policy, coverage is not provided under
the accident and health benefits for:
1. Intentionally self-inflicted harm, suicide or attempted
Please be advised: This optional coverage may duplicate suicide, of You, Your Traveling Companion, or Your
coverage already provided by Your personal auto Family Member;
insurance policy, homeowner’s insurance policy, personal 2. Pregnancy, other than unforeseen complications of
liability insurance policy or other source of coverage. This pregnancy, of You, Your Traveling Companion, or
insurance is not required in connection with the insured’s Your Family Member;
purchase of tickets. 3. Mental or emotional disorders, or physical
complications related thereto, of You, Your Traveling
Plan may not be available in all jurisdictions. Companion or Your Family Member;
4. Alcoholism or drug addiction, intoxication or under
the influence of any narcotic unless administered on
the advice of a Physician or physical complications
related thereto, of You, Your Traveling Companion or
Your Family Member;
5. War (whether declared or undeclared), acts of war,
participation in a riot or insurrection; or service in the
Armed Forces or units auxiliary thereto (except as
specifically covered);
6. Aviation, other than as a fare-paying passenger on a
scheduled or charter flight, operated by a scheduled
airline.

Form No. 52.201NY ET_SRV2_NY


0610
Page 5

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