New Business Declined Coverages & Client Acknowledgment
IMPORTANT NOTICE
By signing below, you confirm the following:
Your broker at Reliable Insurance Brokers Inc. has reviewed and explained the available coverage options.
You have made an informed decision to decline the coverage(s) indicated in the application or remarks.
You understand that:
a) It is your responsibility to contact your broker if you wish to add any coverages in the future.
b) Any requested changes must be submitted in writing and confirmed by a signed endorsement.
c) Coverages not listed in your policy documents have been excluded at your request.
d) You have had the opportunity to ask questions, and all information has been reviewed to your satisfaction.
ADDITIONAL ACKNOWLEDGMENTS
Contents Coverage
You agree that the contents coverage selected is appropriate for your needs and understand that:
You may increase coverage at any time by contacting your broker.
A Home Inventory Workbook is available at: www.reliablebrokers.ca/mycontents
Usage-Based Insurance Program
If enrolled in a UBI program (e.g., MyDrive, IntelliDrive), you must:
Download and actively use the insurer’s app to maintain your 10% enrollment discount.
Understand that failure to comply may result in removal of this discount mid-term.
Sufficient Coverage
You further acknowledge that this document includes clear definitions of common auto and home insurance coverages. While not exhaustive of every available coverage, you confirm that you have had the opportunity to review your existing insurance and compare it to the offering provided by Reliable Insurance Brokers Inc. Based on that comparison, you agree that the coverage offered is sufficient for your needs.
I acknowledge that I have reviewed and understand the information provided above, and that my coverage selections reflect my informed decision.
This optional benefit may compensate you and other insured persons for lost income, up to the selected limit per week, if you are unable to work due to injuries sustained in an automobile accident. All income replacement benefits are based on 70% of your gross weekly income.
Caregiver
Catastrophic Only: This optional benefit compensates you and other persons if you or they suffer an injury deemed catastrophic under the regulation and cannot continue as the main caregiver for a member of the household who is in need of care. Impairment: This optional benefit compensates you and other persons if you or they suffer an injury and cannot continue as the main caregiver for a member of the household who is in need of care.
Housekeeping & Home Maintenance Expenses
Catastrophic Only: This optional benefit compensates you and other persons if you or they suffers an injury deemed catastrophic under the regulation and suffer a substantial inability to perform housekeeping and home maintenance services. Impairment: This optional benefit compensates you and other persons if you or they suffer an injury and suffer a substantial inability to perform housekeeping and home maintenance services.
Increased Medical, Rehabilitation, and Attendant Care
The standard benefit pays up to $65,000 for medical, rehabilitation and attendant care expenses with a 5 year time limit in most cases. If catastrophically impaired, the standard benefit pays up to $1,000,000 for medical, rehabilitation and attendant care expenses. You may purchase an optional medical, rehabilitation and attendant care benefit of $130,000 or $1,000,000.
Additional Catastrophic Impairment - Medical, Rehabilitation, and Attendant Care (Increased)
This optional benefit provides an additional $1,000,000 of coverage if you are catastrophically impaired in a collision to the standard medical, rehabilitation and attendant care benefit or the optional increased medical, rehabilitation and attendant care benefit.
Non-Earner
This optional benefit compensates you and other persons, up to the selected limit per week, if you or they are completely unable to carry on a normal life.
Lost Education Expenses
This optional benefit compensates you and other persons are unable to continue a program of elementary, secondary, post-secondary or continuing education.
Expenses of Visitors
This optional benefit compensates you for expenses incurred by visitors.
Damage to Personal Items (clothing, glasses, hearing aids, etc)
This optional benefit compensates you and other persons for damage sustained to personal items such as clothing, prescription eyewear, dentures, and hearing aids.
Death
This optional benefit is paid to the surviving spouse and dependant of a person who is killed.
Funeral
This optional benefit covers the costs of funeral expenses up to the selected limit.
Dependant Care
This optional benefit provides weekly dependant care expenses, for employed persons not receiving a weekly caregiver benefit.
Indexation Benefit
This optional coverage will ensure that certain weekly benefit payments and monetary limits will be adjusted on an annual basis to reflect changes in the cost of living.
Added Coverage to Offset Tort Deductibles (OPCF 48)
This endorsement will provide a buy down on the deductible currently imposed by the Insurance Act on any settlements you should be awarded for pain and suffering following an automobile accident.
I understand that my selections for these coverage's will affect the potential amount I can receive toward settlement should I be injured in an automobile accident. I warrant that the broker has fully explained the coverage and options outlined above and request the broker places automobile coverage on my behalf with the coverage limits and options as selected above.
I understand that by not selecting any of the above coverages, my policy will include only the standard accident benefits.
This is a mandatory coverage to legally drive a vehicle in Ontario. It provides coverage for you or other insured persons if someone else is killed or injured or their property is damaged in an automobile incident. It will pay for legitimate claims against you or other insured persons up to the limit of your coverage, and the cost of settling claims.
Collision Coverage
Collision is an optional coverage that pays for the cost of repairing or replacing your vehicle up to the actual cash value if it hits another vehicle, the ground, or an object in or on the ground, such as a guard rail. Your collision coverage is subject to the noted deductible which is the portion of the claim that you must pay before your insurance company pays the balance.
Comprehensive Coverage
Comprehensive is an optional coverage that pays for the cost of repairing or replacing your vehicle up to the actual cash value if it is damaged by other unexpected situations such as falling or flying objects, vandalism, fire, theft or attempted theft, a natural disaster, or a riot or civil disturbance. Your comprehensive coverage is subject to the noted deductible which is the portion of the claim that you must pay before your insurance company pays the balance.
Accident Forgiveness
Accident forgiveness, also known as Driving Record Protection, is an optional but very important feature of an automobile insurance policy. It allows you to avoid the increase in car insurance rates that will happen when you have your first at-fault accident. Without Accident Forgiveness, in the event of an accident or claim, your insurance premiums will see a huge increase on renewal.
Loss Of Use – OPCF 20
Loss of use, also known as OPCF 20, is an optional coverage that will cover the cost of substitute transportation if you are unable to use your vehicle because of a claim. It includes hiring a taxi, renting a substitute vehicle, public transportation or any combination of the above.
Non-Ownerd Automobile Coverage – OPCF 27
Liability for Physical Damage to Non-Owned Automobiles, also known as OPCF 27, provides a transfer of coverage on your current automobile policy with a specified limit along with the applicable deductible to a rental vehicle.
Waiver Of Depreciation – OPCF 43
The Waiver of Depreciation, also known as OPCF 43, waives the depreciation on new vehicles should loss occur within 24 months of delivery date to the insured. This means that in the event of a total loss, the insured would be reimbursed for the full purchase price and not the depreciated value.
Accident Benefits Explained
Ontario's standard auto insurance policy provides you with benefits if you are injured in a motor vehicle collision regardless of who is at fault. These benefits are defined by the Statutory Accident Benefits Schedule under Ontario's Insurance Act. You have the choice of purchasing additional accident benefits to customize your coverage.
Income Replacement Benefit
If you cannot work because of the injuries caused by a motor vehicle collision this benefit will partially compensate you for the loss of your income. The standard benefit is $400 per week maximum and can be enhanced to $600, $800 or $1000.
Medical And Rehabilitation Benefit
This benefit will pay for reasonable and necessary medical, rehabilitation and attendant care expenses that are not covered by a government health plan or private insurance plan. The standard benefit provides up to $65,000 for non-catastrophic injuries and up to $1,000,000 for catastrophic injuries. You may purchase optional increased coverage limits of $130,000 or $1,000,000 for all injuries.
Caregiver, Housekeeping And Home Maintenance Benefit
If you cannot continue as a primary caregiver this benefit will reimburse you for expenses you incur. These benefits are included for catastrophic impairment and may be purchased as optional coverage for non-catastrophic impairments.
Dependant Care Benefit
This optional benefit provides compensation for reasonable and necessary expenses incurred to care for your dependants if you are unable to do so as a result of injuries sustained in a motor vehicle collision.
Death AndFUNERAL Payments Benefit
There are lump-sum payments available for survivors of a person killed in a motor vehicle collision and to help pay for funeral expenses. The standard benefit is $6,000 for funeral expenses, $25,000 to a surviving spouse, and $10,000 to each dependant. These amounts may be increased by purchasing optional enhanced benefits.
Indexation Benefit
This optional coverage will ensure that certain weekly benefit payments and monetary limits will increase on an annual basis to reflect changes in the cost of living.
Coverage To Offset Tort Deductible
This endorsement will provide a buy down on the deductible currently imposed by the Insurance Act on any settlements that you should be awarded for pain and suffering following an automobile accident.
This portion of home insurance applies at your home or anywhere in the world to bodily injury you may unintentionally cause to others – often referred to as “third parties” – or to accidental damage you may do to their property. For example, suppose a visitor were to be injured by slipping on a wet floor in your home, and you were judged to be legally responsible, you would be covered for the damages you were legally obliged to pay because of the injury.
Dwelling Building Limit
This is the limit for which your home is valued and insured. Your dwelling coverage applies to your home and attached structures such as a garage or carport. Permanently installed outdoor equipment on the premises, such as a swimming pool and the equipment attached to it, is included. A home evaluation needs to be done to obtain this value. It is not uncommon that the amount generated by the home evaluation is different from the real estate or market price of your home.
Personal Property Limit
This coverage usually equals 60% to 80% of the amount your dwelling is insured for and includes coverage for damage caused to furniture, appliances, electronics, clothing and home furnishings to name a few. It is important to be aware of the specific limits of coverage for some items such as jewelry, coin collections, computer software, watercrafts, antiques, etc. If these items exceed the limit of coverage included in the policy, additional coverage can be purchased based on your needs.
Outbuildings
This usually equals 10% of the amount your dwelling is insured for (i.e.: if you’re dwelling is insured for $250,000, that would normally mean that your Detached Private Structures or Outbuildings would be covered for $25,000 which equals to 10% of $250,000). It provides coverage for detached garages, guest houses, sheds, pool houses, and most structures not attached to your house.
Additional Living Expenses
This coverage usually equals 20% of the amount your dwelling is insured for and covers any expenses that you would incur. For example, if you suffer a water damage claim and need to temporarily stay in a hotel while the repairs to your home are being done, the cost to rent the room, laundry services, dry cleaning and food would be paid for with this coverage.
Sewer Backup
Covers loss or damage caused by water entering the insured dwelling as a result of accidental escape of water from a sewer, storm drain, drain, sump, septic tank, eaves trough or downspout.
Overland Water
Covers loss or damage caused by surface water or flood, flood exposures such as overflow of a river or lake.
Ground Water
Covers sudden and accidental infiltration of water through foundations from undergroundwater sources.
Guaranteed Replacement Cost
Coverage that guarantees the home insured will be repaired to its full value at the time of loss, regardless of the amount of coverage carried.
Replacement Cost Contents
Replacement Cost on Contents offers you extra coverage. It protects possessions like televisions, furniture, and more. It covers the cost to fully replace your personal property if it is damaged or destroyed by a covered loss.
Identity Theft
Identity theft is all types of crime in which someone steals or misuses personal or financial identifiers of someone else by using their credit card, driver’s license, social insurance number or other personal identification numbers to commit fraud or other criminal activity. Identity theft coverage will reimburse you for expenses associated with the theft of your identity such as legal fees, notary costs, lost wages as a result of taking time off work to get help.
Canada’s national privacy legislation, the Personal Information Protection and Electronic Documents Act, applies to all insurance brokerages collecting, using or disclosing personal information. At Reliable Insurance Brokers Inc we pledge to protect your privacy and safeguard your personal information.
You have access to our detailed privacy policy on our web site:
https://www.reliablebrokers.ca/privacy-policy
The Combined Estimated Results of Reliable Insurance Brokers Inc and its Subsidiaries and/or Affiliates for Fiscal (Calendar) 2026 were:
Property and Casualty Insurance:
Written Insurance Premiums
$13,452,000.00
Financial Services:
Segregated Fund Assets
Individual Life, Disability, Critical Illness
Employee Group Benefits Programs
N/A
N/A
N/A
Corporate Administration:
Number of Locations Including Branches in Canada
Number of Brokers and Professional Staff
Represented Insurance Companies
6
15
11
Ownership:
Reliable Insurance Brokers Inc is an independent insurance brokerage 100% privately owned.
Insurance is a contract of UTMOST GOOD FAITH between all parties of the contract: YOU (the client) and YOUR INSURANCE COMPANY.
Visit www.reliablebrokers.ca for more information.
Sources of Financing:
Reliable Insurance Brokers Inc recognizes the value of capital growth and business expansion in a very competitive industry. To finance new initiatives and start new programs, our company and its shareholders may seek financing from Canadian Banks, Trust and/or Insurance Companies to support these operations. The financial requirements of repayment of such loans do not require, and will not influence the placement of business with any insurer or Financial Institution.
Broker Compensation by Insurance Companies:
Insurers are most selective when choosing an insurance broker with whom they establish a brokerage contract. They seek relationships with professional brokers capable of understanding the complexity of risk management, policy wordings and limitations. Both insurers and clients place the responsibility on brokers to arrange appropriate protection for our clients.