HomeMy WebLinkAboutRESPONSE - RFP - P1158 INSURANCEADMINISTRATIVE ADDRESS:
STATES SELF -INSURERS
RISK RETENTION GROUP, INC.
140 Kennedy Drive
P.O. Box 2127
South Burlington, Vermont 05407-2127
OStates,
"Partners in Protection"
BOARD OF TRUSTEES:
Chair: Jeffrey D. Downes Glenn A. Asher, ARM
City of Montgomery, Alabama City of Roanoke, Virginia
Secremn: Eric T_ Lagstrom Hal K. Luttschwager, CPCU, ARM, CLU Russell L. Mahan
Town of Ocean City, Maitland Missoula County, Montana Bountiful City Corporation, Utah
March 18, 2009
Mr. Lance Murray
City of Fort Collins, Purchasing Division
215 N Mason St
Ft Collins, CO 80524-4402
RE: Proposal Number, P-1158
Public Entity Excess Liability Program
Dear Mr. Murray;
UNDERWRITING ADDRESS:*
STATES SELF -INSURERS
RISK RETENTION GROUP, INC.
222 South Ninth Street
Suite 1300
Minneapolis, Minnesota 55402-3332
Michael C. Hulsey, CPCU, .ARM-P, CLU
City of Richmond, Virginia
Steve S. Rawlings, CGFM
Davis County Corporation, Utah -
It is our pleasure to present State's proposal providing excess liability coverage for Ft Collins. We are
confident we have put together a program meeting the needs of your public entity in the areas of:
• General Liability
• Auto Liability
• Law Enforcement Liability
• Public Officials Errors and Omissions
The enclosed presentation highlights the many advantages of membership/ownership in the States
program, including:
• States insures only qualified U.S. public entities.
• Since States' public entity member -insureds own the insurance company, they remain insureds
year in and year out.
• States' insured member -owners are not assessable.
• States is committed to a fair, long-term and consistent underwriting philosophy, focused solely on
public entity exposures.
• States provides specialized claim management and loss control services just for public entity risks.
The program is supported by staff of risk management professionals with decades of experience
working with public entities.
• States retains the first $500,000 and then reinsures losses above that amount through a long-
standing treaty reinsurance arrangement with major, highly -rated reinsurers who are committed to
the public entity sector.
• States operates under the federal Liability Risk Retention Act, and the IRS has extended tax
exempt status to States by private letter ruling.
• Limits of $10 million or more are available over a self -insured retention of
$250,000 or more.
States
90
*PLEASEDLRECTALL CORRESPONDEACE TO THE UVDER11WIT/NGADDRESS AwfYinars
VEAMOFT LOCATION 9802.658.1100 Fax: 802.658. 94191 Web Site'. nvv natesm cam ♦'h1IN_�TAPOLI5 LOCATION V 1,800,640,0345 or 612.766.3000 Fax: 612,766.3398
3. Any liability brought about or contributed by fraud, dishonesty or bad faith of an insured.
However, notwithstanding the foregoing, the insured shall be protected under the tenns of this
policy for any claim for damages upon which suit may be brought against them by reason of any
alleged fraud or dishonesty on the part of any insured, unless a judgment or other final
adjudication thereof adverse to such insured shall establish that acts of active or deliberate
dishonesty or fraud committed by such insured was material to the cause of action so
adjudicated.
4. Any (a) liability arising out of estimates of probable costs or cost estimates being exceeded or
faulty preparation of bid specifications or plans, or (b) injury to or destruction or disappearance
of any tangible property (including money) or the loss of use thereof.
5. Any liability which is covered under any other part of this policy or which would be covered
under any similar policy providing general liability, personal injury liability or automobile
liability coverage, whether or not such similar policy is in effect.
SECTION II - WHO IS AN INSURED
Each of the following shall be an insured under Coverage Part I and Coverage Part II of this policy to
the extent -set forth below:
A. The named insured as provided in Item 1 of the Declarations.
B. Partnership, Joint Venture or Joint Powers, but only if named in Item 1 of the Declarations.
C. Any person or organization to such extent and for such limits of liability for whom the named
insured has agreed, prior to an occurrence, to provide insurance, except:
1. Any organization acquired or formed by the named insured after the inception of the policy
period, or
2. Where such other person or organization has assumed the liability of the named insured under
this policy.
D. Any organization acquired or formed by the named insured after the inception of the policy period,
other than a partnership, joint venture or joint powers in which the named insured has a majority
interest and where the newly acquired or formed organization does not have similar insurance; but
only if the named insured shall report such acquisition or formation within ninety (90) days
thereafter, and if so reported, such newly acquired or formed organization shall be deemed to be an
insured from the date of its acquisition or formation, but only with respect to an occurrence after the
acquisition or formation and after payment of an additional premium, upon such terms as may be
required by States.
E. Any officer, director, employee, elected or appointed official, volunteer or any member of a board,
council, commission or other governing body of an insured while acting within the scope of their
duties as such.
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F. If the insured is a partnership, the partnership and any partner thereof but only with respect to the
partner's liability as a partner.
G. Any officer or employee of the insured while using a personally owned automobile or anyone using
such automobile with the pennission of the officer or employee owner, but only while such
automobile is being used in the business of the named insured.
H. Any person while using an automobile which is owned or leased by the named insured, and the use
thereof is with the permission of the named insured.
With respect to Coverage Part II, individuals, boards, commissions, authorities, units or administrative
departments or agencies of any insured involved with any:
A. Port Authority;
B. Airports; or
C. Hospital;
shall not be an insured, unless specifically endorsed on the policy.
SECTION III - LIMITS OF LIABILITY
A. The limit of liability for damages for any one occurrence covered under this policy is the amount in
excess of the self -insured retention specified in Item 3A of the Declarations, regardless of the
number of claims for damages to which Coverage Part I, Coverage Part II, or both Coverage Part I
and Coverage Part II apply.
B. The maximum limit of liability for damages for all occurrences covered under this policy is the
amount specified in Item 3B of the Declarations, regardless of the number of claims for damages to
which Coverage Part I, Coverage Part II, or both Coverage Part I and Coverage Part II apply.
C. The inclusion or addition hereunder of more than one insured shall not operate to increase States'
liability beyond those amounts stated in Item 3 of the Declarations.
SECTION IV - DEFINITIONS
A. Aircraft means any heavier-than-air or lighter -than -air aircraft, missile or spacecraft.
B. Bodily injury means bodily injury, sickness or disease sustained by a person, including death by any
of these at any time.
C. Claim means any demand or action against any insured for the payment of damages because of
bodily injury, personal injury, property damage or error or omission to which this policy applies.
Claim shall include suit.
D. Coverage territory means all parts of the world.
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E. Covered product means:
1. Any goods or products, other than real property, manufactured, sold, handled, distributed or disposed
of by:
a. The insured;
b. Another person trading under the insured's name;
c. A person or organization whose business or assets the insured has acquired; and
2. Containers (other than vehicles), materials, parts or equipment furnished in connection with such
goods or products.
Covered product includes warranties or representations made at any time with respect to the fitness,
quality, durability or performance of any of the items included in paragraphs 1. and 2. above.
Covered product does not include vending machines or other property rented to or located for the
use of others but not sold.
F. Covered work means:
1. Work or operations performed by the insured or on its behalf; and
2. Materials, parts or equipment furnished in connection with such work or operations.
Covered work includes warranties or representations made at any time with respect to fitness,
quality, durability or performance of any of the items included in paragraphs 1. or 2. above.
G. Damages means money damages, defense costs, prejudgment and post -judgment interest, and
includes awards for attorneys' fees with respect to federal and state civil rights suits.
Salvages, recoveries or payments recovered or received subsequent to a settlement hereunder shall
be applied as if recovered or received prior to the settlement, and all necessary adjustments shall be
made by the parties hereto.
Damages does not include injunctive or equitable rlief, including any costs, fees or expenses
associated with the defense of any claim therefore.
H. Defense costs means expenses incurred in the handling of a specific claim or suit for its
investigation, settlement or defense to include:
1. Attorney fees and related litigation expenses.
2. Fees and expenses of independent adjusters and investigators.
3. Expert witnesses.
OCPOLICY (4/96; 7/00; 7/04) Page 9 of 19
Defense costs do not include salaries and expenses of the insured's employees including its
attorneys, adjusters and investigators.
I. Error or omission means any actual or alleged error or misstatement or misleading statement, or act
or omission or neglect by an insured in discharging, or in failing to discharge, the insured's duties.
J. Impaired property means tangible property, other than covered products or covered work, that
cannot be used or is less useful because:
1. Either:
a. It incorporates covered products or covered work that is known or thought to be defective,
deficient, inadequate or dangerous; or
b. Any insured failed to fulfill:: the. terms of ia contractor agreement; .and •-.: .
2. Such property can be restored to use by:
a.- The repair, replacement, adjustment or removal of covered products or covered work; or
b. The insured fulfilling the terms of the contract or agreement.
K. Incident report means a written notice given by the insured to States with respect to any occurrence,
bodily injury, personal injury, property damage or error or omission which shall include:
How, when and where the occurrence of bodily injury, personal injury, property damage or
error or omission took place;
2. The nature of any injury or damage which may result or has resulted from such occurrence;
3. The names and addresses of any injured persons and witnesses; and
4. A description of the circumstances under which the insured first became aware of such
occurrence of bodily injury, personal injury, property damage or error or omission.
The application for this policy shall not constitute an incident report. The submission of an incident
report shall not constitute a claim.
L. Insured contract means:
1. A contract for a lease of premises. However, that portion of the contract for a lease of premises
that indemnifies any person or organization for damage by fire to premises while rented to you or
temporarily occupied by you with permission of the owner is not an insured contract.
2. A sidetrack agreement;
OCPOLICY (4/96; 7/00; 7/04) Page 10 of 19
3. Any easement or license agreement, except in connection with construction or demolition
operations on or within 50 feet of a railroad;
4. An obligation, as required by ordinance, to indemnify a municipality, except in connection with
work for a municipality;
5. An elevator maintenance agreement;
6. That part of any other contract or agreement pertaining to the insured's business (including an
indemnification of a municipality in connection with work performed for a municipality) under
which you assume the tort liability of another party to pay for bodily injury or property damage
to a third person or organization.. Tort liability means a liability that would be imposed by law in
the absence of any contract or agreement.
An insured contract does not include that part of any contract or agreement:
a. That indemnifies a railroad for bodily injury, personal injury or property damage arising out
of construction or demolition operations, within 50 feet of any railroad property and affecting
any railroad bridge or trestle, tracks, road -bed, tunnel, underpass or crossing;
b. That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(1) Preparing, approving or failing to prepare or approve, maps, shop drawings, opinions,
reports, surveys, field orders, change orders or drawings and specifications; or
(2) Giving directions or instructions, or failing to give them, if that is the primary cause of
the injury or damage; or
c. Under which the insured's architect, engineer or surveyor, assumes liability for injury or
damage arising out of the insured's rendering or failure to render professional services,
including those listed in b. above, and supervisory, inspection, architectural or engineering
activities.
M. Loading or unloading means the handling of property:
1. After it is moved from the place where it is accepted for movement into or onto an aircraft,
watercraft or automobile;
2. While it is in or on an aircraft, watercraft or automobile; or
3. While it is being moved from an aircraft, watercraft or automobile to the place where it is finally
delivered; but loading or unloading does not include the movement of property by means of a
mechanical device, other than a hand truck, that is not attached to the aircraft, watercraft or
automobile.
OCPOLICY (4/96; 7/00; 7/04) Page 11 of 19
N. Occurrence means:
With respect to bodily injury or property damage, any accident, event or continuous or repeated
exposure to substantially the same general harmful conditions which causes bodily injury or
property damage. For any claim for bodily injury or property damage, the date of the
occurrence is the date on which the bodily injury or property damage first took place or is
alleged to have taken place.
2. With respect to personal injury, only the offenses defined under personal injury. For any claim
for personal injury, the date of the occurrence is the date that the first offense took place or is
alleged to have taken place.
3. With respect to error or omission, an error or omission or a series of related errors or omissions.
For any claim for error or omission, the date. of the occurrence is the date on which the error or
omission first took place or is:alleged to have.taken.place:
O. Personal injury means injury (other- than bodily 4r jury•or property damage) caused by one or more
of the following offenses:
1. False or wrongful arrest, detention, imprisonment or malicious prosecution;
2. Wrongful entry or eviction or other invasion of the right of private occupancy, except as
excluded by Exclusion 9 under Coverage Part I;
3. A publication or utterance:
a. Of a libel or slander or other defamatory or disparaging material;
b. In violation of an individual's right of privacy;
4. Piracy, plagiarism, unfair competition, idea misappropriation under implied contract,
infringement of copyright, title or slogan, registered trade mark, service mark or trade name,
arising out of the insured's advertising activities; or
5. Any act which gives rise to any liability under any federal civil rights statute, any state
employment related law, or the Fair Labor Standards Act, if such act is committed during the
policy period.
P. Policy period means the period of time stated in Item 2 of the Declarations.
Q. Pollutants means any solid, liquid, gaseous or thermal irritant or contaminant, including but not
limited to smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials
to be recycled, reconditioned or reclaimed.
OCPOLICY (4/96; 7/00; 7/04) Page 12 of 19
R Products -completed operations hazard means:
1. All bodily injury and property damage which takes place away from premises the insured owns
or rents and is caused by covered products or covered work, except:
a. Covered products that are still in the insured's physical possession; or
b. Covered work that has not yet been completed or abandoned;
2. Covered work will be deemed completed at the earliest of the following times:
a. When all of the work called for in the insured's contract has been completed;
b. When -all of the work to be done at the site has been completed if the insured's contract calls
for work at more than one site;
c. When: -that part of the work done at a job site has been put to its intended use by any person
or organization other than another contractor or subcontractor working on the same project.
Work that may need service, maintenance, correction, repair or replacement, but which is
otherwise complete, will be treated as complete.
3. This products -completed operations hazard does not include bodily injury or property damage
caused by:
a. The transportation of property, unless the bodily injury or property damage is caused by a
condition in or on a vehicle created by the loading or unloading of it; or
b. The existence of tools, uninstalled equipment or abandoned or unused materials.
S. Property damage means:
1. Physical damage to or destruction of tangible property, including the loss of use at any time of
the tangible property so damaged or destroyed; or
2. Loss of use at any time of tangible property which has not been physically damaged or
destroyed.
T. Self -insured retention means the amount of damages stated in Item 3 of the Declarations which is
either:
1. Being covered by one or more underlying insurance policies; or
2. Being self -insured or retained uninsured by the insured.
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The insured shall have the right to insure all or part of the self -insured retention. In the event the
insured insures all or part of the self -insured retention, loss adjustment expense, including legal
defense costs, which are covered outside any underlying insurers limits, shall not exhaust or reduce
the self -insured retention.
U. Suit means a civil proceeding in which damages because of bodily injury, personal injury, property
damage or error or omission to which this policy applies are alleged. Suit includes:
An arbitration proceeding in which such damages are claimed and to which the insured must
submit or does submit with States' consent; or
2. Any other alternative dispute resolution proceeding in which such damages are claimed and to
which the insured submits with States' consent.
V. Watercraft means any ship -or vessel :of:whatever- type;.:including.but not dimited.to: cargo vessels;
passenger vessels; other vessels .used .for. transport;. towboats and barges; vessels used in the
construction. of pipelines, platforms�or other 1 facilities;<storage s vessels; tanker vessels; drill ships;
drilling barges (including,. without. limitation; submersible. -drill -barges, semi -submersible drill barges
.and self- elevating drill barges); and all other vessels of whatever nature and description, all whether.
or not self-propelled.
SECTION V - CONDITIONS
A. Cross Liability
1. In the event of any claim for bodily injury, personal injury, property damage or error or
omission by an insured hereunder against any other insured hereunder, this policy shall cover
such other insured against whom the claim is made and in the same manner as if separate
policies had been issued to each insured; provided, however, that no employee of one insured
shall be construed to be an employee of any other insured, unless at the time of injury or death
there exists a relationship of master/servant between such employee and such other insured.
2. Nothing contained in the foregoing or in any subsequent endorsement either naming additional
insureds or adding more than one entity as an insured shall have the effect of increasing States'
limits of liability beyond those stated in Section III - Limits of Liability, or in the Declarations.
B. Insuredss Duties in the Event of an Occurrence, Claim or Suit
1. The insured shall give an incident report to States promptly with respect to any occurrence
which may result in a claim involving damages in excess of twenty-five percent (25%) of the per
occurrence self -insured retention specified in Item 3 of the Declarations.
2. The insured shall give written notice promptly to States of any claim made or suit brought
against the insured involving an amount in excess of twenty-five percent (25%) of the per
occurrence self -insured retention specified in Item 3 of the Declarations. Written notice shall
include any claim made or suit brought against the insured wherein the administrator of the self -
insured retention or any underlying insurer has reserved its rights or issued a denial with respect
to coverage.
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3. The insured shall give written notice promptly to States of any claim or any incident involving:
a. Fatalities;
b. Brain injuries resulting in impairment;
c. Spinal injuries resulting in partial or total paralysis of upper or lower extremities;
d. Amputations or permanent loss of use of upper or lower extremities;
e. Blindness; or
f. Any other injuries likely to result in permanent disability rating of 50% or more.
4. The insured must:
a. Promptly send copies of any demands, notices, summonses or legal papers received in
connection -with the claim or suit to States;
b. Authorize States to obtain records and other information;
c.. Assist States, if so requested, in the enforcement of any right against any person or
organization which may be liable to the insured because of bodily, injury; personal injury,
property damage or error or omission to which this policy may also apply.
C. Representations
States has issued this policy in reliance upon representations given by the insured. By accepting this
policy, the insured warrants and agrees:
1. That the statements in the Declarations are accurate and complete, and that those statements in
the Declarations are based upon representations made to States by the insured in the Application
for Insurance, which is hereby incorporated in its entirety into and forms part of this policy;
2. That the insured had no knowledge at the date of this policy's inception of any fact or
circumstances which could give rise to any payment hereunder that had not been disclosed in the
Application for Insurance or otherwise brought to the attention of States; and
3. That all information provided to States by the insured is true and correct, and that no material
information has been withheld.
D. Cooperation and Settlements
1. When there is an occurrence which may involve this policy, the insured may, without prejudice
to liability, proceed immediately with settlements which, in their aggregate, do not exceed the
sum of the self -insured retention. The insured shall advise the representatives of States of any
such settlement made.
OCPOLICY (4/96; 7/00; 7/04) Page 15 of 19
2. The insured shall cooperate with the underlying insurers, if any, as required by the terms and
conditions of the underlying policy or policies, if any, and shall enforce any right of contribution
or recovery against any person or organization who may be liable to the insured because of
bodily injury, personal injury, property damage or error or omission to which this policy, or any
underlying policy or policies, if any, applies.
3. States shall not be called upon to assu ne charge of the settlement or defense of any claim against
the insured, but States shall have the right and shall be given the opportunity to associate with
the insured or the insured's underlying insurer(s), if any, or both, in the defense and control of
any claim where the claim involves or may involve States, in which event the insured and States
shall cooperate in all things in the defense of such claim.
4. In the event that States, at its sole discretion, chooses to exercise its rights pursuant to this
condition, no action taken by States in the exercise of such rights shall serve to modify or expand
in any manner States' liability-. or- obligations; under. this, policy beyond what States' liability or
obligations would have.been had it not.exercised-its rights under. •thiscondition. Furthermore, in
the event that one or more oEthe insured's =underlying .insurers, if any;- becomes insolvent,
financially impaired or refuses to- pay: a claim. or .defend.. the insured, and States exercises its
rights under this condition, such -action by States shall be solely to protect its own interest and
shall not serve to expand or modify in any way States' liability or obligations to the insured.
States' liability and obligations to the insured shall continue as set forth in this policy and shall
be without regard to the financial impairment or insolvency of any. underlying insurer or the
failure of any underlying insurer to pay any claim or defend the insured for any reason.
E. Appeals
In the event that the insured or the insured's underlying insurer(s), if any, elect not to appeal a
judgment in excess of the self -insured retention, States may elect to conduct such appeal at its own
cost and expense, and shall be liable for the taxable court costs and disbursements and interest on
judgments incidental thereto. However, in no event shall the total liability of States exceed its limit
of liability beyond those stated in Item 3 of the Declarations, plus the cost and expense of such
appeal.
F. Bankruptcy or Insolvency
The bankruptcy or insolvency of the insured or an underlying insurer shall not relieve States of any
of it obligations hereunder. However, under no circumstances shall States be liable for all or any
portion of the self -insured retention stated herein.
G. Other Insurance
The insurance afforded by this policy shall be excess insurance over any other insurance whether
primary, excess, contingent or any other basis, whether collectible or not, except other insurance
written specifically to be excess over this insurance. Nothing herein shall be construed to make this
policy subject to the terms, conditions or limitations of such other insurance.
OCPOLICY (4/96; 7/00; 7/04) Page 16 of 19
Page 2
Page 2
Proposal No, P-1158
States' Public Entity Excess Liability Program
States is managed by Berkley Risk Administrators Company, LLC - a member company of W.R.
Berkley Corporation. Berkley Risk provides the program's overall management, including
marketing, financial administration, underwriting, claims, loss control, reinsurance coordination
and other administration services. Berkley Risk has over 25 years of expertise and experience in
alternative risk arrangements, program management and financing. Berkley Risk's staff of risk
management professionals has proven methods and alternative strategies to reduce the cost of risk
for members of its programs and has managed many of these programs for over two decades.
Berkley Risk manages insurance programs serving hundreds of public entities throughout the U.S.
These unique features are what help to differentiate States' program from other excess liability programs
available in today's insurance marketplace and make it such a good fit for its member -owners.
Our proposal for Ft Collins is comprised of several sections which provide detailed information about
States, as well as describe the coverages and services included with membership/ownership in States Self -
Insurers Risk Retention Group, Inc. as follows:
Section #
Information Included in This Section
1.
States' program summary and background
2.
States' sample policy and related endorsements
3.
States' financial information, including last year's annual report
4.
Your insurance proposal for coverage and annualized premiums
5.
Additional information on the States program
Thank you for the opportunity to prepare this proposal. We appreciate your consideration of excess
liability coverage through the States program. We welcome any questions or comments you may have as
you review this proposal for coverage, and look forward to welcoming Ft Collins as the newest member of
the States Self -Insurers Risk Retention Group, Inc.
Respectfully,
Martin A. Ericson, CPCU
Underwriting Director
H. Inspection and Audit
States shall be permitted, but not obligated, to inspect the insured's property and operations at
any time. Neither States' right to nuke inspections nor their making of any report thereon shall
constitute an undertaking on behalf of or for the benefit of the insured or others to determine or
warrant that such property or operations are safe or healthful, or are in compliance with any law,
rule, or regulation.
2. States may examine and audit the insured's books and records at any time during the policy
period and extension thereof and within three (3) years after the final termination of this policy,
as far as such books and records relate to the subject matter of this insurance.
I. Subrogation
Inasmuch asilhis policy is excess coverage, the insured's right of recovery against any person or
other entity cannot always be exclusively subrogated to States. It is therefore understood and agreed
that in case of any payment hereunder, States shall act in concert with all other interests (including
the insured'sy. concerned in the exercise of such rights of recovery. The apportioning of any amounts
which may be so recovered shall follow the principle that any interests (including the insured's) that
shall have paid an amount over and above any payment hereunder shall first be reimbursed up to the
amount paid by them. States shall then be reimbursed out of any balance then remaining up to the
amount .paid hereunder. Lastly, the interests (including the insured's) of which this coverage is
.excess are entitled to claim. the residue, if any. Expense necessary to the recovery of such amounts .
shall be apportioned between the interests (including the insureds) concerned in the ratio of their
respective recoveries as finally settled.
J. Changes and Assignment
This policy contains all the agreements between States and the insured concerning the coverage
afforded. The first named insured shown in the Declarations is authorized to make changes in the
terms of this policy with the consent of States. The policy's terms can be amended or waived only
by endorsement issued by States and made a part of this policy.
Assigmment of interest under this policy shall not bind States unless and until States' consent is
endorsed hereon.
K. Currency
Premiums and recoveries hereunder are payable in United States Dollars.
L. Sole Agent
The first named insured shown in the Declarations shall be deemed the sole agent of each insured
hereunder for the purpose of issuing instructions for any alteration of this policy, snaking premium
payments and adjustments, receiving payments of insurance or receiving notices, including notice of
cancellation from States.
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M. Cancellation
1. The first named insured shown in the Declarations may cancel this policy by mailing or
delivering to States advance written notice of cancellation.
2. States may cancel this policy by mailing or delivering to the first named insured written notice of
cancellation at least:
a. Ten (10) days before the effective date of cancellation if States cancels for nonpayment of
premium; or
b. Thirty (30) days before the effective date of cancellation if States cancels for any other
reason.
States will mail or deliver written notice:.to:the first named .insured's.last _mailing address known
to States.
3. The notice of cancellation will state the effective date -of cancellation. The policy period will end
on that date.
4. If this policy is canceled, States will send the first named insured any premium refund due. If
States cancels the policy, the refund will be pro rata. If the first named insured cancels, the
refund may be less than pro rata. The cancellation will be effective even if States has not made
or offered a refund.
5. The offer by States of renewal on terms or for premiums different from those in effect during the
policy period shall not constitute cancellation or refusal to renew.
N. Premiums
The first named insured shown in the Declarations:
1. Is responsible for the payment of premiums; and
2. Will be the payee for any return premium paid by States.
O. Suit
No person or organization has a right under this policy:
1. To join States as a party or otherwise bring States into a suit asking for damages from an
insured, or
2. To sue States for coverage under this policy unless all of the policy's terms and conditions have
been fully complied with.
OCPOLICY (4/96; 7/00; 7/04) Page 18 of 19
A person or organization may sue States to recover on an agreed settlement or on a final judgment
against an insured obtained after an actual trial, but States will not be liable for damages that are not
payable under the terns and conditions of this policy, or that are in excess of the applicable limit of
coverage. An agreed settlement means a settlement and release of liability signed by States, the
insured and the claimant or claimant's legal representative.
P. Governmental Tort Liability Limitation
By accepting coverage under this policy, neither the insured nor States waive any of the insured's
statutory or common law immunities and limits of liability and/or monetary damages (including
what are commonly referred to as liability damages caps), and States shall not be liable for any claim
or damages in excess of such inununities and/or limits. In the event immunities and/or limits are
found by a court of final disposition not to apply or that they exceed the limits of this Policy, then
the limits of liability and coverage shown in the Declarations Item 3 and further described in Policy
SECTION I:B, Limits of Liability nonetheless apply and shall not be exceeded.
IN WITNESS WHEREOF, States has caused this policy to be signed.
Secretary
President
OCPOLICY (4/96; 7/00; 7/04) Page 19 of 19
INFORMATION ONLY
ENDORSEMENT #
WAIVER OF SUBROGATION
This endorsement is attached to and becomes a part of policy number SEL
It is agreed that notwithstanding anything to the contrary in Section V I. Subrogation, in
the event of any payment under this policy, we waive our right of recovery against any
person or organization listed in the schedule for whom the insured is operating under a
written contract when such contract requires a waiver of subrogation.
It is further agreed that work commenced under letter of intent or work order, subject to
subsequent reduction to writing with customers whose customary contracts would require
a waiver, would also fall within this blanket waiver provision.
Schedule:
All other terns and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
GENERAL ENDORSEMEN'I'.doc Page I of I
INFORMATION ONLY
ENDORSEMENT#
ADDITIONAL DEFINITIONS
This endorsement is attached to and becomes a part of policy number SEL .
The following definitions are added to Section IV — Definitions:
W. Dam means any artificial barrier, including a dam, levee, or similar structure,
together with appurtenant works, which is designed to and does or may impound or divert
water.
Y. Auto means a land motor vehicle, trailer or semi -trailer designed for travel on public
roads and licensed for road use. It does not include mobile equipment.
Z. Sexual Abuse & Molestation includes but is not limited to any verbal or nonverbal
communication, behavior, or conduct with sexual connotations, infliction of physical,
emotional; or psychological injury or harm whether for sexual gratification,
discrimination, intimidation, coercion, or other purpose, regardless of whether such
action or resulting injury is alleged to be intentionally or negligently caused.
The following is added to T. Se!/ -insured retention.
The self -insured retention is not eroded by payment of damages or defense costs that
would not be covered under this policy.
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD:
INSURED:
ADDL DHr LN DORSEMENT OC.doc
INFORMATION ONLY
ENDORSEMENT #
This endorsement is attached to and becomes a part of Policy Number SEL
It is understood and agreed that SECTION I, B. Exclusions has the following exclusion
amended to read:
14. Any actual or alleged liability whatsoever for any claim or claims in respect of
loss or losses, directly or indirectly arising out of, resulting from, or in
consequence of asbestos, in whatever form or quantity.
It is understood and agreed that COVERAGE PART 11, B. Exclusions has the
following exclusion added:
7. Any actual or alleged liability whatsoever for any claim or claims in respect of
loss or losses, directly or indirectly arising out of, resulting from, or in
consequence of asbestos, in whatever form or quantity.
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
Asbestos Excl Endt OC.doc Page 1 of 1
INFORMATION ONLY
ENDORSEMENT#
This Endorsement is attached to and becomes a part of policy number SEL
BLANKET ADDITIONAL INSURED
In consideration of the premium charged, it is agreed that the following are added as
Additional Insureds, but solely as respects work performed by or on behalf of the Named
Insured:
All persons, organizations or entities for whose protection and benefit the Named Insured
has agreed to procure Liability insurance and to whom certificates of insurance are issued
during the term of this policy indicating such coverage. However, insurance with respect
to each such person, organization or entity shall not exceed such coverage and/or limits of
liability that the Named Insured has agreed to provide, nor the coverage and/or applicable
limits of liability of this policy.
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
ADDINS END.doc Page 1 of 1
INFORMATION ONLY
ENDORSEMENT#
BLANKET WAIVER OF SUBROGATION
This endorsement is attached to and becomes a part of policy number SEL
It is agreed that notwithstanding anything to the contrary in Section V 1. Subrogation, in
the event of any payment under this policy, we waive our right of recovery against any
principal for whom the insured is operating under a written contract when such contract
requires a waiver of subrogation.
It is further agreed that work commenced under letter of intent or work order, subject to
subsequent reduction to writing with customers whose customary contracts would require
a waiver, would also fall within this blanket waiver provision.
All other tenns and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
GENERAL FNI)ORSEMENI'.doc Page I of I
INFORMATION ONLY
ENDORSEMENT
This Endorsement is attached to and forms a part of Policy Number.
(the "Policy"). This Endorsement modifies coverage provided under the "PUBLIC ENTITY
EXCESS LIABILITY INSURANCE POLICY".
CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
If aggregate insured losses attributable to terrorist acts certified under the federal Terrorism Risk
Insurance Act exceed $100 billion in a Program Year (January 1 through December 31) and we
have met our insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for
the payment of any portion of the amount of such losses that exceeds $100 billion, and in such
case insured losses up to that amount are subject to pro rata allocation in accordance with
procedures established by the Secretary of the Treasury.
"Certified act of terrorism" means an act that is certified by the Secretary of the Treasury, in
concurrence with the Secretary of State and the Attorney General of the United States, to be an act
of terrorism pursuant to the federal Terrorism Risk Insurance Act. The criteria contained in the
Terrorism Risk Insurance Act for a "certified act of terrorism" include the following:
1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all
types of insurance subject to the Terrorism Risk Insurance Act; and
2. The act is a violent act or an act that is dangerous to human life, property or infrastructure
and is committed by an individual or individuals as part of an effort to coerce the civilian
population of the United States or to influence the policy or affect the conduct of the United
States Government by coercion.
ENDORSEMENT DATED:
POLICY PERIOD:
INSURED:
TerrCapSSIRRG010108
INFORMATION ONLY
ENDORSEMENT#
The Endorsement attaches to and becomes a part of Policy Number
DAM EXCLUSION ENDORSEMENT
It is agreed and understood that SECTION I - COVERAGES, COVERAGE PART I,
paragraph B. Exclusions, subparagraph 5., is amended to read as follows:
Any liability arising out of any partial or complete structural
failure of any dam or dike, except for the following dams:
Located at
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD:
INSURED:
DAM EXCLUSION END.doc Page I of I
OStates.
"Partners hi Protectiofe"
STATES SELF -INSURERS RISK RETENTION GROUP, INC.
In 1986, liability insurance was either unavailable or unaffordable for many U. S. public entities
(cities, counties, towns, school districts, etc.). It was during this "hard insurance market" that
a group of public entity risk managers and insurance professionals met to investigate the
potential for developing an insurance mechanism to fill the void for liability insurance for public
entities. It was decided that the program should not attempt to provide all lines of coverage,
but would focus on providing broad form excess liability insurance to public entities that
generally self -insured their primary level of risk at a minimum of $250,000.
With the passage of the Federal Liability Risk Retention Act of 1986, the organizers determined
that, to take advantage of the economies provided under this law, a stock insurance company
would be established and domiciled in the State of Georgia and would operate as a Risk
Retention Group ("RRG"). The company was named States Self -Insurers Risk Retention
Group, Inc ("States") and began operations by issuing its first policy effective July 1, 1988.
States redomiciled to Vermont as a RRG, group captive on June 12, 1997.
The Risk Retention laws require that the entities insured by an RRG also be its owners. This
was a bit of a challenge for the founders of States since public entities are generally prohibited
from owning stock in an insurance company. To overcome this issue, the States Self -Insurers
Trust was created. The Trust would own 100% of the RRG's (insurance company's) stock, and
all of the entities insured by States would be members of the Trust.
The Trust is governed by a Board of Trustees consisting of not less than five, nor more than
ten members of the Trust. This Board is elected by the members of the Trust and serve three
year staggered terms. The Board of Trustees elects the Board of Directors of the RRG who
may or may not be members of the Trust.
Since States began operations, it has followed a strict underwriting philosophy of insuring only
those public entities that are committed to strong internal risk management processes that
control their potential liabilities through strong loss control and claims management programs.
Because States writes only excess liability insurance, its focus is primarily on mid -tier public
entities. States member's populations generally range from about 50,000 to about 750,000.
States has engaged Berkley Risk Administrators Company, LLC ("Berkley Risk") to provide the
day-to-day management of the insurance company, including underwriting, marketing,
reinsurance placement, claims management and loss control consulting services. Berkley Risk
provides management, third party claims administration and other services to various public
entity, non-profit and private sector clients in the alternative market arena, and is a member
company of the W. R. Berkley Corporation.
For additional information about States Self -Insurers Risk Retention Group, Inc. visit
www.statesrrq.com or contact Royanna Carle at rcarle(obberkleyrisk. com or by calling 1-800-
640-0345, ext. 3357 or direct at 1-612-766-3357.
INFORMATION ONLY
ENDORSEMENT#
This Endorsement is attached to and forms a part of Policy Number _
DEFENSE COSTS OUTSIDE LIMITS ENDORSEMENT
I. It is agreed that Policy Section III - Limits of Liability is amended to provide that defense costs are
covered outside the stated limits of liability.
2. Policy Section V - Conditions, Subsection D. Cooperation and Settlements, paragraph 3, is deleted in
its entirety and replaced with the following:
"3. States shall not be called upon to assume charge of the settlement or defense of any claim
made against the insured, but States shall have the option at its expense to associate in the
defense or to assume control of the defense and settlement of any claim where the claim
involves or may involve States, up to the limits of its liability for damages, in which event
the hisured and States shall cooperate in all things in the defense of such claim."
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
OCEND (7/00; 7/04) Page I of I
INFORMATION ONLY
ENDORSEMENT #1
This Endorsement is attached to and forms a part of Policy Number.
(the "Policy"). This Endorsement is in response to the disclosure requirements of the Terrorism
Risk Insurance Act. This Endorsement does not grant any coverage or change the terms and
conditions of any coverage under this policy.
DISCLOSURE PURSUANT TO TERRORISM RISK INSURANCE ACT
Terrorism Premium (Certified Acts) $
This premium is the total Certified Acts premium attributable to the following Coverage
Part(s), Coverage Form(s), and/or Policy(s): Public Entity Excess Liability Insurance
Additional information, if any, concerning the terrorism premium:
Information required to complete this Schedule, if not shown above, will be shown in the
Declarations.
A. Disclosure Of Premium
In accordance with the federal Terrorism Risk Insurance Act, we are required to provide you with a
notice disclosing the portion of your premium, if any, attributable to coverage for terrorist acts
certified under the Terrorism Risk Insurance Act. The portion of your premium attributable to such
coverage is shown in the Schedule of this endorsement or in the policy Declarations.
B. Disclosure of Federal Participation in Payment of Terrorism Losses
The United States Government, Department of the Treasury, will pay a share of terrorism losses
insured underthe federal program. The federal share equals 85% of that portion of the amount to
such insured losses that exceeds the applicable insurer retention. However, if aggregate insured
losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $100
billion in a Program Year (January 1 to December 31), the Treasury shall not make any payment for
any portion of the amount of such losses that exceeds $100 billion.
C. Cap On Insurer Participation In Payment of Terrorism Losses
If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance
Act exceed $100 billion in a Program Year (January 1 to December 31) and we have met our
insurer deductible under the Terrorism Risk Insurance Act, we shall not be liable for the payment of
any portion of the amount of such losses that exceeds $100 billion, and in such case insured losses
up to that amount are subject to pro rata allocation in accordance with procedures established by
the Secretary of the Treasury.
ENDORSEMENT DATED:
POLICY PERIOD:
INSURED:
DisclureTerSSIRRG01 0 108
INFORMATION ONLY
ENDORSEMENT#
This endorsement is attached to and becomes a part of policy number SEL
FIREFIGHTERS OR RESCUE UNIT OPERATIONS ENDORSEMENT
Section I, Coverage Part I. B. Exclusion 9, has the following added
This exclusion does not apply to loss arising out of any pollutants released as a result of
firefighting or rescue unit operations when those operations are conducted away from the
Insured's premises.
Section I, Coverage Part I B. Exclusion 14 and Coverage Part 11 B. Exclusion 7 as
provided by Endorsement #1, has the following added.
This exclusion does not apply to loss arising out of any asbestos released as a result of
firefighting or rescue unit operations when those operations are conducted away from the
Insured's premises.
Item 3. Limits of Liability of the Declarations Page applicable to Coverage Part I and II is
amended as follows:
The Each Occurrence Limit in excess of the Self Insured Retention arising out of any
pollutants and/or asbestos released as a result of firefighting or rescue unit operations
when those operations are conducted away from the Insured's premises is limited to
$1,000,000.
The maximum limit of liability for all occurrences under the policy arising out of any
pollutants and/or asbestos released as a result of firefighting or rescue unit operations
when those operations are conducted away from the Insured's premises is limited to
$1,000,000.
All other terms and conditions remain unchanged
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
Fire -Rescue Operation End.doc
INFORMATION ONLY
ENDORSEMENT #
KNOWLEDGE OF OCCURRENCE, CLAIM OR SUIT ENDORSEMENT
This endorsement is attached to and becomes a part of policy number SEL
Knowledge of any occurrence, claim or suit by an agent, servant, volunteer or employee
of the Named Insured shall not in itself constitute knowledge of the Named Insured
unless notice of such injury, claim or suit shall have been received by the Risk Manager.
All other terns and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
Knowlcdgc cf Claim End.doc
[INFORMATION ONLY
ENDORSEMENT#
This endorsement is attached to and becomes a part of Policy Number SEL
It is understood and agreed that SECTION I, B. Exclusions has the following exclusion
added:
22. Bodily injury, personal it jury, or property damage arising directly or
indirectly out of, resulting from, caused by, or contributed to by:
a. The toxic or pathological properties of lead, lead compounds or lead
contained in any materials;
b. The actual or threatened abatement, mitigation, removal or disposal of
lead, lead compounds or materials containing lead;
c. Any supervision, instructions, recommendations, warnings or advice
given or which should have been given in connection with parts a. or
b. above; or
d. Any obligation of the insured to indemnify any party in connection
with subparagraphs a. b. or c. above.
It is understood and agreed that COVERAGE PART II, B. Exclusions has the
following exclusion added:
6. Bodily ii fury, personal i ymy, or property damage arising directly or
indirectly out of, resulting from, caused by, or contributed to by:
a. The toxic or pathological properties of lead, lead compounds or lead
contained in any materials;
b. The actual or threatened abatement, mitigation, removal or disposal of
lead, lead compounds or materials containing lead;
c. Any supervision, instructions, recommendations, warnings or advice
given or which should have been given in connection with parts a. or
b. above; or
d. Any obligation of the insured to indemnify any party in connection
with subparagraphs a. b. or c. above.
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
Lead Excl Each OC.doc Page t of t
INFORMATION ONLY
ENDORSEMENT #
This endorsement is attached to and becomes a part of policy number SEL.
It is understood and agreed that SECTION V — CONDITIONS, paragraph M.
Cancellation, paragraph 2. is amended as follows:
2. The Company may cancel or non -renew this policy by mailing by registered mail
to the Risk Manager written notice of cancellation or non -renewal at least:
a. Ten (10) days before the effective date of cancellation if the Company
cancels for non-payment of premium; or
b. days before the effective date of cancellation or non -renewal if the
Company cancels or non -renews for any reason other than non-payment of
premium.
All other terms and conditions remain unchanged.
ENDORSEMEN DATED:
POLICY PERIOD: to
INSURED:
Notice of Cancellation.doc Page I of I
[INFORMATION ONLY
ENDORSEMENT #
ENDORSEMENT NOTICE OF OCCURRENCE TO RISK MANAGER
This endorsement is attached to and becomes a part of policy number SEL
It is agreed that the Insured's duties in the event of an occurrence is amended as follows:
In the event of an occurrence that may result in claim under this policy, notice to the
Company shall be given as soon as practicable after the Risk Manager has knowledge of
the occurrence.
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
Notice of Occurrence to Risk Manager.doc
[INFORMATION ONLY
ENDORSEMENT #
OWNED & LEASED WATERCRAFT ENDORSEMENT
This Endorsement is attached to and becomes a part of policy number SEL
It is understood and agreed that Exclusion "13" under Section 11 of the policy is replaced by the
following:
G. For liability arising out of the ownership, maintenance, operation, use, loading or
unloading of any owned or leased watercraft in excess of 50 feet in length.
All other terms, conditions, and limits apply as defined in the policy as endorsed.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
OWNED&LEASED WA"fERCRAPPEND.DC Page 1 of
INFORMATION ONLY
ENDORSEMENT #
This endorsement is attached to and becomes a part of policy number SEL
This endorsement modifies insurance provided under Coverage Part I:
PESTICIDE OR HERBICIDE APPLICATOR COVERAGE
Schedule
Description of Operations:
With respect to the operations shown in the Schedule, Coverage Part I—B.Exclusions
9(4) does not apply if the operations meet all standards of any statute, ordinance,
regulation or license requirement of any federal, state or local government which apply to
those operations.
All other terms and conditions remain unchanged.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
GFNERAI. FND0RSHM17N'1'.doc
INFORMATION ONLY
ENDORSEMENT#
This Endorsement is attached to and becomes a part of policy number SEL
UNINTENTIONAL ERRORS AND OMISSIONS
This endorsement modifies insurance provided under all Coverage Parts.
In consideration of the premium charged, it is understood and agreed that with respect to the first
paragraph of Section I - Coverages, the reliance upon statements made and information furnished to
States, an unintentional error or omission by an Insured person shall not constitute reason for denial
or declination of coverage by the company.
All other terms, conditions, and limits apply as defined in the policy as endorsed.
ENDORSEMENT DATED:
POLICY PERIOD: to
INSURED:
UnintE&O.end
States
SKI
"Partners in Protection"
STATES SELF -INSURERS RISK RETENTION GROUP, INC.
PUBLIC ENTITY EXCESS LIABILITY INSURANCE POLICY
NOTICE
THIS INSURANCE POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION
GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE
STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION
GROUP.
PLEASE READ THIS INSURANCE POLICY ENTIRELY AND CAREFULLY TO DETERMINE RIGHTS, DUTIES,
COVERAGES AND COVERAGE EXCLUSIONS.
INSURED OR NAMED INSURED MEANS ANY PERSON OR ENTITY AS DEFINED UNDER S ECTION II - WHO IS
AN INSURED. ALL OTHER WORDS IN ITALICS HAVE SPECIAL MEANING REFER TO SECTION IV -
DEFINITIONS FOR THOSE MEANINGS.
IN CONSIDERATION OF THE PAYMENT OF A SPECIFIED PREMIUM AND IN RELIANCE UPON ALL
STATEMENTS MADE AND INFORMATION FURNISHED TO STATES SELF -INSURERS RISK RETENTION
GROUP, INC. (STATES), AND SUBJECT TO ALL THE TERMS, CONDITIONS AND LIMITS OF THIS
INSURANCE POLICY (POLICY), STATES AGREES AS FOLLOWS:
SECTION I — COVERAGES
COVERAGE PART I. PUBLIC ENTITY LIABILITY COVERAGE (OCCURRENCE
COVERAGE)
A. Insuring Agreement
States agrees to pay on behalf of the insured the damages in excess of the self -insured retention
which the insured becomes legally obligated to pay because of bodily injury, personal injury or
property damage to which Coverage Part I applies.
Coverage Part I applies only if the bodily injury, personal injury or property damage is the result of
an occurrence during the policy period and in the coverage territory.
The amount States will pay for damages in excess of the self -insured retention shall be limited as
described in Section III - Limits of Liability. No other obligation or liability to pay sums or
perform acts or services is covered.
OCPOLICY (4/96; 7/00; 7/04)
Page 1 of 19
States,,,
"Partners in Protection"
Reinsurance of the Highest Caliber.. .
States has partnered with only highly -rated, ia•orld class reinsurers to maintain long-term stability
of the program and to assure the highest claim paying ability. All of these reinsurers have substan-
tial public entity experience. States' reinsurance partners are:
ACE American Insurance Company (A.M. Best rated "A+'')
General Reinsurance Corporation (A.M. Best rated "A++'')
Munich Reinsurance America. Inc. (A.M. Best rated `'A+")
Swiss Reinsurance America Corporation (A.M. Best rated "A+")
Because of States' long-standing reinsurer relationships, it is able to obtain the best terms and
conditions from its reinsurers -- a direct benefit to States' members.
States
REINSURERS: $9,400,000
y STATES' RETENTION:
INSURED'S S.I.R.
($250,000 Minimum)
States has no commuted reinsurance programs, nor any with a mandatory commutation requirement.
States has a long-standing relationship with its reinsurance partners. States' reinsurance treaty
anniversary date is September 1.
States
INSURANCE PROPOSAL
To:
City of Ft. Collins
From: Martin Ericson, CPCU
215 N Mason St / PO Box 580
States Self -Insurers Risk Ret. Grp.
Ft. Collins CO 80522-0580
222 S Ninth St Suite 1300
Attn:
Lance Murray
Minneapolis, MN 55402-3332
Proposal For:
Proposal Expires On:
City of Ft. Collins
5/1/2009
i N Public Entity Broad Form Liability (including General Liability, Employment
Practices Liability, Automobile Liability and Law Enforcement Liability and
Public Officials Error & Omission Liability) in accordance with the terms,
conditions and exclusions of the policy form.
ONE YEAR PROPOSAL
OPTION _..
See attached Cost worksheet lot the SIR/Limits options and the premiums.
SPECIAL TERMS AND CONDITIONS
Occurrence Policy Form
b
The quoted premium is net of commission.
b
All premiums are due at the inception date of the policy.
b
Premiums will be annually rerated to reflect experience and exposure.
b
TRIA Act Coverage must be elected or declined If declined, a Terrorism exclusion will apply.
b
A coverage exclusion for Mold.
b
Lead Exclusion
b
Asbestos Exclusion Amendatory Endorsement
ci
Policy Condition providing for Government Tort Cap & Immunity protection.
Ci
Coverage exclusion for nursing homes
b
See attached coverage worksheet for full coverage/endorsements that will apply.
***Please see attached for anv additional terms and conditions. - -----
3/18/2009
Signed Date
AGENT/BROKER COMPENSATION ACKNOWLEDGEMENT
States Self -Insurers Risk Retention Group, Inc. (States) is committed to keeping and ensuring that the
insurance transaction between States, the member/owner (member) and the agent/broker (broker) is kept
transparent It is understood that the broker is a representative of the member and not of States and .
there is no contractual or agency arrangement between States and the member's chosen broker.
The States member shall negotiate with the broker the amount and form of compensation that the
broker is to be paid.
To ensure this transparency we request that the following be appropriately completed and signed.
(please check the appropriate box)
OCity of Ft. Collins (the States member) agrees to compensate
TBD (broker) on a fee basis to be paid directly to the broker.
OCity of Ft. Collins (the States member) agrees to compensate
TBD (broker) on a commission basis with said commission to be built
into the premium. Member authorizes States to build in
Gross Premium calculation is:
This applies to the 5/1/2009 to
City of Ft. Collins
(States Member Entity Name)
(Authorized Signature)
(Date)
%Z (not to be greater than 20'%,) for commission.
Net premium divided by the rcciprical of the commission.
Example: $100,000 / .90 (reciprocal of 10%%)=$111,111
5/l/2010 policy period only.
TBD
(Agent, Broker or Con6llhant Name)
(Authorized Signature)
(Date)
States member and broker should keep one copy for their records.
The States' member will send a copy to States at the following address upon binding coverage.
States Self -Insured Risk Retention Group, Inc.
Underwriting Department
c/o BRAG, LLC
222 South Ninth Street, Suite 1300
Minneapolis, MN 55402-3332
Fax: 612-766-3398
Email: mericson@1herkleyrisk.com berkleyrisk.com
POLICYHOLDER DISCLOSURE
NOTICE OF 1'ERRORISN
INSURANCE COVERAGE
You are hereby notified that under the Terrorism Risk Insurance Act, as amended, (the "Act"), that you have a right to
purchase insurance covcmge For losses arising out of acts of terrorism,as defined in Section 102(/) of'tde Act:
The term "act of terrorists" means any act that is certified by the Secretary ofTreasury - in concurrence with the
Secretary of State and the Attorney General of the United States - to be an act of tenorism; to be a violent
act or an act that is dangerous to human life, propeny; or infrastructure; to have resulted in damage within the
United States, or outside the United States in the case of an air carrier or vessel or the premises of a United States mission;
and to have been committed by an individual or individuals as pan ofi n cdort to coerce the civilian population ol'thc
United Slates or to influence the policy or affect the conduct of the United States Govemment by coercion.
Coverage under your X New or RENEWAL policy may be affected as follows:
YOU SHOULD KNOW 1 HAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES
RESULTING FROM CRRTIFIED ACES OF TERRORISM, SUCK LOSSES MAY BE PARTIALLY
REIMBURSED BY'I'I IF UNI"TFD S'I'AI'ES GOVERNMENT UNDER A FORMULA ESTABLISI IED
BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN 01 HER EXCLUSIONS WHICH MIGHTf
AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER TIIE FORNIULA,
THE IJNI'1'ED STfVIIES GOVFRNMI?N'T GENERALI,1' REINIBIJILSES 85% 017 COVERLD'I'IiRRORISNI I.OSSES
EXCEEDING "TIiE S'FA'TUTORILY ESTABLISHED DEDUCTIBLE PAID BY 171E INSURANCE COMPANY
PROVIDING THE COVERAGE. 7'l IL PREMIUM CHARGFD FOR THIS COVFRAGE IS PROVIDED
BELOW AND DOIiS NOIINCLUDE ANY CHARGES FOR TIM PORTION OF DOSS THAT MAN' BE
COVERED B't I'HE I%:DERAI. GO\'RRNNIENI' UNDER 1'HE AC'I".
YOU SI IOULD ALSO KNOW "HIM THE ACT, CON "PAINS A S100 BILLION CAP TI1AT LIMITS
U.S. GOVERNMENT' REINIBURSENIENT AS WELL AS INSURER'S LIABILI"1'Y FOR LOSSES
RESU L'FING FROM CERTIFIED ACTS OF TERRORISM WHEN TIIE AMOUNT OF SUCH LOSSES
IN AN)' ONE CAI,ENDA1i YEAR I-XCEEDS S 100 1311.LION. IF'IHF AGGREGATE INSURED
LOSSES FOR ALL INSURERS EXCEED S100 ItILI.ION, YOUR COVERAGE MAY BE REDUCED.
Accerdance ur Reiection ufTerrorism Insurance Coverage
I hereby elect to purchase coverage, subject to the limitations of the Act, or acts of
terrorism, as defined in the Act, for a premium of pertheoptionbound
I hereby decline covet age for terrorism. I understand that I will have no coverage tor
losses resulting from acts of terrorism.
City of Ft. Collins States RRG
Applicant/Named Insured Insurance Company
Authorized Representatives Signature Authorized Representative's "Title
Date
IBD
Policy Number
Please indicate your choice above, sign where indicated, and return the original form to us at the
address below no lute, than
We recommend that you keep a copy of this notice for your records.
States RRG
c/o Berkley Risk Administrators Company
222 S Ninth St Ste 1300
Minnealxplis, MN 55402-3332
CIOI Fnn Cnllia , Colorado
Poore Fire Amount
Pointer rnun' Fire Pr„lmeion nitro
Cost AnulIII, Worksheel
LIABILI'I'A' QUO I'4.
STATES RRG
1 11 111
Current Program
Coves es 2008/09 Program Specs uotc
1\'
Quote
\'
Quote
VI
Quote
V11
Quote
V111
Quote
General Liablli[v
Cloima-MadeOccurrence Occurrence Occurrence Occurrence
Estimated Audit Premium Non Amdlmble Non-Audimble
Occurrence limit -S Def Costs Outside the limit $500,000 $3,000,000 $3.000,000
Aggregate Limit-$ $500.000 $6,000,000 $6.000.000
Occurrence deterrent- $ $500d100 $250.000 $250,000
Defebse costs within the SIR $50um
$1,000,000
A•nmate Retention -$ NIA $1-000.000 N/A
Occurrence
Occurrence
Occurrence
Occuncmce
Omrrence
$3.000.000
$3.000,000
$4,000.000
51,000.000
$"a,000,000
$6,000,000
$6.000,000
$9,000.000
$8.000.000
$6.000.000
$250,000
$500.000
5500.000
$L000 m
$1,000,000
WA
N/A
N/A
N/A
NIA
Lan Eirdr«ment Liability -
Claims-MadeCecunence Occunvnee Occurrence Occun
Occurrence Limit -S $500.000 Included in GL Incl Above
Annual Aggregate Limit Included in GL Included in GL Inc] Above
Occurrence Retention -$ $500.000 See Options !net Above
Agnrcaale Retention -S NA S« Evil.. N/A
Occurence
Occmronec
Occurrence
Occunence
Occurrence
Inel Above
Inc(Above
Ind Atone
Ind Ahove
Incl Above
loci Above
too] Above
Joe] Above
Ind Above
IndAbove
IndAbove
fad Above
Ind Above
Ind Above
Ind Above
N/A
N/A
N/A
N/A
N/A
Public Officials E&O
Claims -Made Occurrence Ge.nence Occurrence Occurrence
Occurrence Limit -S $500.OW $3.00TOM) Inc(AMvc
Annual Aggregate Limit -$ $500.000 56.t300DW Ind Above
Occurrence Retention-$ 5500.000 See Options Ind Above
Aenrcgme Retention -s NA SeeO(lons NIA
Ore ... co"
Occurrence
Ocemrmec
Occurrence
Occurrence
IndAbove
Inc]Above
IndAbove
Inel Above
[act Above
IndAbove
IndAbove
IndAbove
IndAbove
lad Above
IndAbove
Joe]Alan,
Ind Above
]act Above
Inc[ Alas. c
NIA
NIA
NIA
ND\
NIA
business Automobile Liability
Comprehensive Collision 5500.00o See Property Nor covered
Limit -Any One Accident SSIXT00 Si000.00o loci Above
Uninsured Motorist(Optional - Quote separately) $L000.000 Not co nevi
Annual Addregme Limit -$ Included in GL None loci Athol
Recreation $500.000 See Optima Inc! Above
Aecreeate Rromelon-$ N/A See Options, NL\
Not canned
Notcovered
Not coverW
Not covered
Not covered
IndAbove
IndAbove
Incl Above
loci Above
Ind Above
Not covnrd
Not covered
Nor rovered
Not cnvaed
Nor carved
Ind AMee
]not Above
bull Adele
Intl AMvc
IndAbove
IndAbove
IndAbove
[a,[AMvc
bid Above
]act Above
NIA
N/A
N/A
NIA
N/A
Employment Practices, Employee Benefits, Seoul Abmm & Se,und IlaraysmeB LiAd il,
Occurrence (employment Practices Employment Practices Occwreere
Fluid, ton permits Employee Benefits
Sevual Abuse &Sexual S..unl Abuse&Sexual
1lmanaman Ilnmssmrnt
Claims -Made Itngdny« Benefits Employee Benefits
Owmrmice Limit -$ 5500.000 $500.000 [or Above
Annual Aggregate Limit -$ Included iu p.O. E&O Included in P-O. E&O Inc( Ahove
Occurrence Retention -$ 5500.000 See Options Ind AMvc
Agnate Retention -S NA See Options N/A
Occunrnce
Occurrence
Occurrence
Occunrn«
Occurrence
••
••
••
IndAbove
]net Above
fuel AMve
Let Above
Ind Above
Inel Above
Ind Above
fuel Alva,o
Ind Above
Ind Above
Ind AMvc
Intl Abme
IndAbove
Ind AMvc
Ind Above
N/A
N/A
N/A
N/A
N/A
Fund., Liablity Not Covered Stales RRG poliev excludes
Claims -Made Occurence Claims -Made covers LL1",RlSAand
Occurrence Limit -$ 1Mll, to 3 MIL Public Lev 93-406
Annual Aggregate Limit -$ IMIL to 3 MIL Othrnvisethe pefic, I
Occurrence Retention -$ See Opium, ciudd,tc,pandd ding
Aneredate Retention NA on the specifics ofthe claim
Form and hinha
.,I, those
shonnunderthe GL
section
siaboral $180.3]2 $165.364
Trrrnri,m (TRIA) $$.411 S4.961
Anoints, tin,, Ten" EO I so
'TOTAL LL\BILITV 5185.983 1 $170.325
SL7.88'_
$201,019
$185,088
5132437
$3,536
56,031
55.553
$3.973
so
10
SO
s0
$121A18
$207.050
1 5190.641
S136410
rage I of I
_Applied Risk Sl31LItions. LLC
✓11" c.". Munagr 'm Pmeet
Cap, of Port Callias, Colorado
Confidential
COVER,%GE \'ES OR SO
PROPER'IVANDAU'fO\IORILE PDI'SICAL DAMAGE COVERAGE NO Not cm'ered by States R RG
I Statement of values is for rating purposes and will not d used to limit or interpret
grape or limits.
o Ninety (90) days notim of,dre,darma, cou,nowA. and material change in ones and
terns applies - See Sample Endorsement Attachment.
7 Notice of Lass Eadorsement applies -See Sample Endersomont Attachmem.
q Atnummic Wniva of Subrogation Clare applies - Sec Sample Endorsement
Almchmmn,
5 Loss( orpm-I at. distribution) clause has loco r,In med_
G Ammnmic onsnmrrom clause. if at,,, does not normally include one.
7 Ihdudibles apply per o n tote vs. per claim, per location, etc. Powormge
dduNbles not discoow,eaL
S Valuation clauses apply per section V II.
9 Replacement vast -provisions apply without restrictions for replacing properly.
10 Gmrai replacement cost applies ash. loss limit wfwou margin dame.
II Blanked basins income appliesindudin_e extra expense.
12 All -Risk vs. namd pcdls applim.
p A \Vaiver of Coinsurance or Agreed Amount mkmanconn applies on all real and
personal property. including improvementland bemmmmu, machinery and equipment:
and or business interruption. rental income. and income and extra expense values.
IJ Markin limit encompassing all =1 and forward propmy, machinery and equipment.
EDP equipment and software. fine arts cehidex, loss of reran. business interruptio, and
extra dxpenso risk without pro rats distribution clause_
15 Vehielus we included as covered property without resinetion of o crtbe-road
evpnsumc(lfprvmum iN greatr them limiting co —age to faked vchielo, please quote
16 Monthly lim'nmlons do norm apply or cIm c,s.o
egy s food husina
into...gnion and n,ha experc eontbmvd form)_ 100%ofihclimit is net apply the lint
In
h.
1 IArilding Ilrrlin crapes In include consequential edumion in caluc, dmnolllmn.
and ineremed eon of commuc tion covmagcs and or, 10 apply on a blanker bails and ,in
m apply aside id blanket or "In,, limit
19 $5.000.000 llnrned Location Floater cm emge Io to apply pa Itwoutn and is 10
provide coverage for propmy damag, rental insurance, extra expense, ralu.'rble papas.
earthquake and flood coverage, and is to apply where no other insurance coverage is
prorided b'v the polity. Limit to apply manage blanket or loss limits.
19 55.000.000 Emors and Omissions rcneved. This pmcision acsnmes coverage far any
exposure inadverlendy mrat d on the annual reporting schodule. '"is should not be
confused with o v ewd as replacement provision for an "automatic coverage
provision". Lamina apply outside blanket or loss limits.
20 Froergency Sm'ices cmmmandeerd property is novmd.
21 Si.000.000 Automatic covert, for newly acquired progeny: including real and
personal propmy. Pine Arts, nuirdscy, equipmenr vehicles, and EDP exposures.
(Outside blanket or lass limit.) On slues greater than S5.000A00, a 90day reporting
provision should apply.
22 Mismllan s Pm,trly flop Ping radio and m Include shoo cncuil.
chances emoen are cad hurnidi v n 1 n,ohnn cdl bredkdoww
23 Automatic extension of co ripe for builders risk and installation twoo (including
coverage for theft and for ensuing loss resulting from faulty workmuushlp ;tad design).
24 femoral p openy coverage should Include items within Nt pl', ins,, and on di
land area without specific footage limitations.
25 Cmvaage propmy should extend to detached outdoor signs.
rb Dobns removal to includedebris of property not insured, fi-oat the insurd pddonss:
cos ofraternion ofland. cost ofYemoval, dispmal, decomamitntion and oplaccoca
of pro, rty insured tincture, of conmmination, as well as standard debris ranoval. limit
to apply outside the blanker or loss limit"
27 linvlmnmemxl impairment coverdee for all ensuing losses caused by pollution that is a
result of a cocerd cause of loss. including pollution cleanup. Limit o apply outside The
blanket or"lass limit.'
28 Automatic extension for proper, of odes without su611mit for both real and personal
propny in the lamed's care. custody and control and at the option of the Insured.
pnsonai property of the Insurd's officials and employees.
Applied HiA Volsitions, LLC 10f7 ( 1101 UMI-M marl1-1'1(XALa-11Ion, ,r 11 In1.-IKi111.('anlN""l nmeraerneckfn1Ju19'k
Ciry oll Farr Collins, Calarado
Conjidenlial
COVERAGE N'ES OR NO COMMUNIS
29 Offpromisesutilities failure. including dirt damage and consequential loss, without
distance Intimation
30 Deletion of, scanty and uncommonly ratnctions if the form contains these restrictions.
II ayilhaions Dmappemance mventgeomplles-
t2 backup oI Sewers and Dumis coverage applies seporricl, hour Hand protection.
5; Witter damage extension covering:
a. Snrfncewitenbut not including none: waves: tidal water orticial wave.
manmwnratreama err tuner bpaiea prwaten:
b. Wutrr which backs on through sewers ordmins:or
- Rain orstww entering buildinn(s)mrouyM1 openings In the roof arw'nlls.
it Water under the ground surface pressing on or than or seeping through:
D Foundation, alla. floors:
3) Pared surfaces if amached to a building or structure, or other paid surfaces if
declared oa atumtenr ifvalues:
3) Rasemems, whether paced or nor, or
4)Export windows or other openings.
34 Tho only exclusions applicable should be of. degenerative nature. such as wear and
rear, deterioration. loss due to pimples. conceohn wsr risk, or mud®r damage.
35 Transit clause of $300,000 and 5500.000 far any one coma ton, and cmuvophe.
36 Policy Until tinrnlmrble papers and recads tiny one occunenu, including
to n.n in"ion costs.
37 Electronic Data Procession - Cmeinge shouldavach without sub- limit restrictions orthe
exclusions relthivets mechanical breakdown. atmospheric onempemmreextrema and
shoe circuit.
3g Lleamnm Dam peloolmn Lgwpmetn (EDP)— 1111 nu.ameu rat me eosl m mPmnng
destroy, c,tapniom with cqu,loncm of ptemer processing abaity. I Ira ii-I. me new
equipment must be able to perform the same illusion as the dmm)cd equipment
Company .till in, for loss oa a replaianent cost beeis until the upgraded imm is
actually purchased. When you purchase the upgraded itan, Company gill few the
diffuence bdwcam the replacemvn cost and the upgraded value.
39 Definition of IMP Equipment has been broad,wrl Is include Communication
40 Distance linnuumn an oft-pranizes power interruption on EDP deletd.
41 Accounts Receivable corImage included in blanket limit or loss limit.
a] Fine Ans included in the blanker litnit with malumion item V 11. Vuluntion.
43 Flood covccyc subied to asub-I iru,roslopoo000.
J4 EanM1quakeownrge is subject masub-limit of $I0.000.000.
,IS ImerdepaWrn<y clause a IDllmrs: 'This Its, c s loss resulting from the
interruption of business conducted by the insured, at, a result of physical loss and'or
damage at any location(s) insured olherthan the location where danmye or dormcticn
has acmmlly Ocean,.
46 Covrned propany cxpandd to indude cost ofexcccntien, g,.din,. bad filing, in fillian.
under ground pipesflue, drains:frnca outside of bui ldings, remixing walls: maclhnm.
47 Joint Loss Agreement with Bon let & blachivav canna. (Son Exhibit V and Vl.)
JA Gla"Anuld be indudedmihudl risk policy without imemal limitation.
49 Territonul douse should include su'nomes mrytquve in the Coninenml U.S-, its
tetruoies and Gmada.
50 Aemecae retention limit applies.
51 Since he oborc is intended Is establish minimum lack ofcweraye. we will make our
card on lael of complionce 0ith these items, as well as, additional coverage bencnrs
that von briny to our alteration. We will award creativity and how well this is
highlighted in your proposal.
5' Business imareption of sales tax rccrnue of the one story masonry non-combustible
shopping mall knows as "Foothills Mall" simatd at 215 E Foothills Parkway. F,
Collins.Ca30522. Linroo tmudis A.000.000.
Applied Risk Solurionx, LLC 2oF7 1 P........ Pi ,:irn-ta.oc'nnx—tu nnp*,auna,r_a,e'tan.t.-rtcuvr- ea.matm.a I""Is aIx"Uhn_5tato..1,
Ch, of port Collins, Colorado
Co,ifiduotial
COVERAGE \"ES OR NO COIN I\I PINIs
ILIABILII'I COVER.\GES
1 Sterna! board Waiting per Exhibit IV which include:
11 Law fully elected, ap,mmed or employed officials
Yes
States RRG policy named insured language an as all of these.
b. Present and past board or commission members
Yes
11 1'reem and past employees
Yes
d, Volunteers
Yes
el Persons B Oxganizatioas under mutual aid
Yes
f Real V,,am manages
Yes'
g. Blanket Additional Insured granted by corn am
Yes
h. Cox sed persons xhas engaged in Goad samaritan actbides.
yes
x Ninety (90) days notice ofeancellatlom non-M1m ew'al, and material change In mtes and
me terms- See Sample Endorsent Atachmmr
Yes
Per the cndanerem a State RRG polio
3 Notice of Loss Endorsement per- See Sample Endorsement Attachment..
)s
See Know ledge of loss cado monam to States RRG policy
q Automatic Waiverof5ubrouation Clause- See Sample Endorsement Attachment.
Yes
See States RRG Wlicv endorsement
5 Disclosure ofBmards Endorsement- See Sample Endorsement Attachment.
Yes
See Sims RRG poi he, endorsement
6 Cross Liability Endorsement- See Sample Endorsement Attachment,
Yes
no do.., rccess:uy as States policy lmteunec already marpormes
)"Pay on behal f or in lieu of 'Indenter finnan
Yes
For damns in excess of the Sit
8 Limits of Liaol ity per our requested design.
No
States RRG policy is a 3rd pony liabi lit, to... one set of limits apply
9 Occmretwe ca,gru, an all liability coyemgs. 'melo'mg public officials Lib an,
Witoployce Benefits Liability nog on a claims -mode fanin scuh a 1/1/1999 own -act—
yes
States policy four proddes coverage for Ad army Eabilix claim:only.
10Miense Critetdly applies inside the limits and inside self instned mtuntion(SIR). Please
none nnuidc limits and inside mamminn. i(axailahle.
Yes
Stores RRG proposal is withdefinaewitho the SIR btu outside the imit.A,%
Valuation in prmlum world upply l f defense is within the limit
One SIR nppllea claims effecting mmhiple linbilipcaimagex arising oat al' one or
mnlrc]otedevents(applringona'Baah Claini btuisor"Clush Co,mapenpplis)_
Its
I? Aggregate retention rquesW ifmviloble at an allbrdablc price red dlietire nitachmem
paint.
No
States RRG dosnm offernm aggr¢nm oration
13 Coverage for Yuniti.e Uamags appliswhere enable and nos facnmMcxenue.
Yes
States RRG policy horn is silent o ith regard to Pointe damags.
14
Insured', permission to settle is regaired
No
For claims that exceed the SIR. inured', [wrnission to smile ail] not M required
due to Bad Faith amod.tions. etc. Stores RRG gill panto- aim the inmred to
handling claims. but will not j.,amzc Stares abdhy to conduct business in a sore
due to unfair claim praaica or bad faith issue.
15 Non-Amhoublec.,an , Yes
16 'Ile tern *claim" is clemly cidu ed_ yes
17 IixrenJcJ nponing options tar one nco and rhrm vttus disdoscdifdormi-made. N/A Coming occarxmac arvcmpe only
REQUESTED PROVISIONS FOR GENERAL LL\BILI'I Y:
I Premises liability. Yes
2 I'roJnets and compleed operations liability. Yee
3 hnlcpem lem contmcim a c ,c,.,c.
Yre
d Rlrrim contractual (including oral coneaets end Dellabrem appmyed Lao'
lailmeanem torothas).
Yes
i Incard form personal injury and.chathoug Imbilip.
Yes
6 Pull liquor liability.
Yes
) Broad form propmy damaec(includom completed communed.
3 Incidental medical malpractice. including Eton and PxtmnNies.
1'e
Exclusion for Doctors ,Dentists. Ps,chiatrists- se poi he, ceclurom
9 Employees are insureds.
yes
10 E tended bodily injury and omornv damage applies arising our of the use of physical
force to prolat arsons and property in combination with full assoull and battery.
discrimination and violation of civil rights coverage also coreed by Ron,
Ys
II Automatic cmemge for newly acquired or formed entities, 90-day repotting paind.
Yes
13 Oumcd and Nomoaned waborafi.
Yes
as, endorsement m Slme RRG policy
13Lin, tied Win Id, ide liabllil) to, mama irmadin...... 6.
Yes
Won IdwRIC cove rage
61 ISnployce benefits liability - Ocanrence cmaage tbno adired, btu mtremly duims
Yes except with mespegs m ERISA or Public I..a, 94d06
Applied Risk Solutions. LLC 30l'7 CeIWUoI-Ir11RI IE-p1smAIS-rls,iii-'af'rsrz rn.r..ccusr-eomMrmaeo.'.*aed'hakh.�mr9vh
Cup• of Fort Collins, Coln..do
Cnnfiderrtiol
COVERAGE \'ES ORNO COMMENTS
IS Fellmr employee eadusnm deleted. Yes exclusion does not exist in States RRG police form
16 All Risks "Finant legal liability Yes
17 Care, custody sed control exclusion deleted (Property in the care, custody and control of
the Insured is to be an extension of covernbc mrde the polio, I It is pmNrrblc for
too emge m upply on an excel basis occr any ,,her valid or collectable insurance. If
unable to delete, rano,, exclusion to afford coverage for commandedcd progeny,
progeny taken in faecifincarc,ration. and propmy armed at impound lm. Yes
IS Uelaion ofpersrnal injuryand advmi'ing exclusion mlmive to liability assumed by the
blared underany contra,,or a_ereemmr Yes
19 Pollutioneatension. Yes see sndosement to States RRG policy. Sublinin applies.
a. "lim,,cocy upermian{ c riduc¢d amav from premises moved byor
rented to, you or any fire department. mizedous moor all unit m first
aid, mal Mange or rescue squad grmlfying as an insured under this
policy: or
b. "Training operations''. or
c. Law enforcement use ofmace.oleoresin capsicum (QC. or pepper gas)
d. Water mnofffirm the cleaning ofmuipmem used in 'emergency
operations': or
e. 'Bodily injurya, propenydamagd' caused by heat, smoke or fumes
Yes
I'mm n hostile lire:
AI on fmm p rmis iyou mar, rent or occupy, or
• At or fmm any site on acndou In connection oith operations
described in a), b), or c) above.
A hostile it,, mraas one nhuh becomes tr scrollable or breaks out from mhec it was
intended on be.
Damage arising out of operation involving pesticide or herbicide
Yes
application it or form m. site or location on', hich the Insured or any
comra,,m" or sribconar sa,, at king direct ly m indirectly on the
Insureds balmlI are gem forming operations if the opemtloas performed
meet all slandurds of aoy statute, olds ante, regulation, or license
regolremetax of any federal. state or local giracnnnen, which apply
to that's npermi—,
'-b Disaiminsion to ,,, including suits It, employees.
1'co
_I Personal mlun' , to malude: buddy tnlury, mental angmsh, shack. stem.. dome,
dombility or death resulonc Iherefrmu. false arrest. false imprisornent. ee,m,ful
eviction, detention. malicious prosecution. humiliation, invasion of the right o(priracy.
libel, slander, ddhmnmion ofeharaeter. also piracy and any infringement of copyright or
property. assmdl Lind banuy. and disporag..vem ofpropeny.
Yes
22 Moaolighling is mrard, if Depml cut uppnrvcd.
Yes
_3 Vicarious or wrongful supoxision for claims involving sexual action and sexual abuse
and defense mimbmsememt Car mnpfully accused anployees.
yes
'''4 Dam Liability
Yes ace end orsemem to Smex RRG policy
]i Cox erage for condemnation. inverse condemnation ads erse possession
No
LAN' ENFORCKMENI' LIABILITY
I false all esL detention, or imprisonment
Yers
2 Wrongful envy, err mason oftight of Privacy'
Yes
Vi.l.fican of Civil rights. Yes
d Violation ofpropeny Hems. Yes
3 Firrmmts sun ice al' process. Yes
6 Assault and battery . Yes
7 Sexual molestation and sexual harassment, Yes
8 I'rofessimurl ads msulling in bodily Injury unA pmpeny damage. Yes
9 Errors and annikorin, for edntmisttafae row. (ioduding those mode by public
odicialsl and Imccnfordtnrnf acticifia, including wrongful supenisirn.
Ya
10 Property Dunnage Liability,- damage to public property.
Yea
II Definition of propene damage expandyd no include theft.
t'es
I Moonlighting coverage for depanmem approved activities.
Yes
13 Good Smearitan mveragefar employees and volunteers what olPduty.
Yes
14 Mural aid is rvaed.
Yes
li Controduvl Liability is coseretl_
Ya
dppliod RAk Solrtlinru. LLC 4of7 r' c.u,a,.nnv:fn�ntnf xts-trauma m,m'Au:ul^ilea"t.-rtcrsr-I:.nrMesed r'o.cr�aernevern �ntr,xl.
Cif. of Fort Collins, Colorurlrr
Confidential
COVERAGE \"FS ORNO COMMENTS
PURLIC OFFICIALS ERRORS d OMISSIONS
1 City Covered for acts of Public official, emphuees. and mluntens. Yes
1 Cn,.,e applies both collective), and individually. Yes
3 Past lreuredsare covered.
Yes
4 Failure tomaintain insurance is included.
Yea
5 pn claims-madc<o,cage related claims are considereJ asingledaim.
NIA Quoting Occcurence
6 Crocco, for non-mrennor, claims.
No
7 Noticeofoccun'encc is notice of action elaimstrade pclifiay
NIA
8 limploy<e relaed rise.Trouutin¢ including bodily injury and personal run,
Yes
9 Insured is. Insured sui is c.. e,,d for cnplopnav related dleeitninsaion, umngful
termination pre.
Yes
IU Wl onyfulncts include mtdlaunnce.
Yes
II Any exclusion fill 'tcdlliAIimlul car ofmry smmte. ordluance, or regulation committed by
sd ll the knowledge of consent of any fanned fee excluded. only upon final
adiud,frion, and will not be imptued to other insureds.
Yes
12 Sev,rabilhy clause applies m I I, if I I is not covered.
13 Lossofincome.w'agrs. commissions nr etnplotMc bcndus cos -reed (EFL}
Yet;
14 Contractual liabiliry aunties.
Ya
15 Emplo,inml contracts not subject to breach oflontred exclusion. Yes
16 Pelie'setting for las, onfoaernent activities are covned. 1'a
17 Coverage for condemnation. inverse condemnation. adverse possession. IAt a minimum
defense coverage needs to appb'1. No
IS Profession al Senxicn- Friars R lhnmi.csiour; Ya
19 Pub) is Officials co%a'age includes muedage for administration of alrnal NO
10 Casinos, and to b, nRONed for fiduciary actions and administration by the pension
load and threat, connmed n'ilh manepurchase plans. Yes "I the extent they are not pan of ERIS\ and Public Lan 94 As
AU'I'OMORI I-F. LIA t11.1'I Y. UNINSURED MO'I ORISTS AND
PERSOSAI, IN',IIIRY PROD I EC.'FION
I Ninety (90) days nonce of concdlauer. non -renewal, and mmednl change is ates and
elon, - - See Sample lindc,c,n-t Atmahmenr
Yes
3 Nailed of Loss Frdorsenuin included- See Soluble End ... elncm Attachment.
Ya
3 Autmnntic Waiver' of Snbrogution Clause included - See Sample Enderscxncnt
Atlachmeta.
Yes
4Ois,[ pofILicari, lindorscmenl Included- See Sample Endorsemem Adachrnent.
Y.
5O'up, Linbl l fly lindmxmn col Included- See smnple lindorsemem Attachment.
Yes Pan of Straus RRG polity turn
G No aggrrgmcllinil npplics.
No Sulleatnpalicyaagiugale
7 Ocicm the l,Ilm, engtlnycetsch... dr,
Yes Inclusion does oat exist in Stites RRG vulic, Id-
8 Liability to apply to any auto, including hired andnon-ocrel autos.
Yes
9 Hurployces are insureds for use oftheiromn c,hiela for City bovinas.
Yes
10 Lessors we additional insureds, ashen required be contract.
Yes
II Cono'aaual Liability assumed under rental car agreements is coxered.
Yes
12 Definition of "accidonf changed by' adding The union "accident shall include bodily
injury or prepeny damage caused by the Insured for the propose of preventing or
eliminating danger or for thepurpose ofprotecung personsorpropeno.
You
13 Liability for damases to thiN panic arising out of the operation of comtnandeoed
vehides is roceed.
Yes;
Applied Risk Sohrtnma'. LLC - 5of7 1 uolanu-1u e n II I r-I" fit Als1n111 nn11,,ilisl" 111"11,let s7-wmnacedt gtl.xttm_nu9,a.
B. Exclusions
Coverage Part I does not apply to any damages for:
1. Any liability of any insured for bodily injury, personal injury or property damage caused
intentionally by or at the direction of such insured. However, this exclusion shall not apply with
respect to bodily injury, personal injury or property damage which results from the use of force
while safeguarding, preserving, protecting or defending a person or property.
2. Any obligation under any workers' compensation, occupational disease, unemployment
compensation or disability benefits laws, or under any other similar laws, including the U.S.
Longshoremen and Harbor Workers' Act, the Federal Employers' Liability Act and the Jones
Act.
3. Bodily injury or property damage due to war, whether. or not declared, or any act or condition
incident to war. War includes civil war, insurrection, rebellion or revolution.
4. Any: liability caused in part or in total by . nuclear reaction or radiation, or radioactive
contamination, however caused.
5. Any liability arising out of any partial or complete structural failure of any dam or dike.
f�Bodily injury or property damage arising out of or contributed to by any partial or complete
failure to supply gas, oil, water, electricity or steam. This exclusion does not apply if the failure
to supply results from the sudden and accidental injury to tangible property owned or used by
any insured to procure, produce, process or transmit the gas, oil, water, electricity or steam.
7. Any liability of any insured arising from any obligations imposed upon the insured (or which are
imputed to the insured) under the Employee Retirement Income Security Act of 1974, Public
Law 93-406, and any amendment(s) thereof.
8.- Any liability arising out of, or in any way connected with, the application (with or without due
process) of the principles of eminent domain, condemnation, retroactive condemnation, inverse
condemnation, reverse condemnation, or by whatever other nalne called, and any proceedings
associated therewith, regardless of whether such claims are made directly against any insured or
by virtue of any agreement entered into by any insured or on behalf of any insured, but this
exclusion does not apply to the taking of private property by the insured wherein the taking is
incident to an arrest or the taking is for the purpose of protecting persons or property in an
emergency.
9.' a. Bodily injury or property damage arising out of the actual, alleged or threatened discharge,
dispersal, seepage, migration, release or escape of pollutants:
(1) At or from any premises, site or location which is or was at any time owned or occupied
by, or rented or loaned to, any insured;
OCPOLICY (4/96; 7/00; 7/04) Page 2 of 19
Cip• df Forr Colllao, Cnlardda
Confidential
COVERAGE VES OR NO CONINIEN'IS
PUBLIC DISHONF_S'I VICRINIE COVERAGE
I Ninety (90) days Notice of Cancellation, nomenaxal, and matmal change in roves and
terms- See Sample Endorsanmt Annchmem. NO N01 Covered by States RRG
2 Crime covernge options quoted.
3 Faithful Pot fonnmmc of Only Extension (AID Fimolnvcca)
q Include Non -Compensated Officers. Direaors.'fntslaes
5 Worldwide Torim, al Limits
6 Include Volunteer WorAers es Employees
7 Amended Cancellationasto An. Emploren-SI iM
S Amended Dclinitlon of limployee (90 Dacsl
9 Im estigmivc Costs SI.000.000 witb $10,000 Deductible.
10 Include Smmmry Ihmded Officials (nets oovnngu)
II Wclfnr mcil'ei nD'Ian -Gm rnlal Gnilics
IUIPNIENTISRB.\Alll NI\NCOVERAGE NO No, Covered by Smtes RRG
I Ninety (901 dxys Notice ofCancellation. nomrnnyal. and material eM1ange in roles and
terms per Exhibit IV,
2 Waiver ofsnbr.... in. . Exhibit IV
3 Comprehensive nscraed rncm'ine all objects mW Iocmions applies.
q Reervin, on a ,epair and,cplacement basis applies.
5 Coinsmmce di, not apply or ha, been r .n., d.
6 Amnia, cc, ,,i, for newly acquired locations in Jiren dotnnge with n $500,000
limit fbr indirect damne,
7 Buried Equipmrntcnensionmordine.
S Loss Adjusunrnt Endorsement (See Exhibits VI and VII).
9 ConneYled Ream In, Use Clmtse minced.
10 Amended Definition of"'Accidun" m include "sadden trod mcidemai dmnagc' in lieu of
"brenkdmcn."
II Replacement niprnpnxy vt thcsmnesim M1ns beat mnmved.
12 90 days EnendeJ Ycrind of Restoration.
13 Limit applies on n combined basis rv,,hcn, snblimit and includes'.
a. Business lmannainn(S2.500.000 Data& Media Presenllc)
b- Emm ExMsc (S2.500.000 Data d Media Praendy),
C. Epediling Expense
d. Water Dmnaec
e. Ammonia Cnnlamiimtion
C Hazmdous Substnncu
s-S,mI..umd Comgniinmiun
h_ Sers•Ice Intermption (4Isim waiting penod)
j. Lightening I(bvempe applies i(n01 covered esewhae7
k. Demolition'lncrensed Casts -both direct loss and Extm Expense ($2.500.000
I. Computer Equipment applicable for envimmnrnlal control
m. CEC- Refriperants
n. Contingent Business Income'Estm Expense ($250.000 premndy)
o. Contingem Erin Iixpcm, only ($250,000 prescmly)
p-(7—or acntild loss
q. Win & mmin (property dmnage)
r. Di.i;.nic egm,nem
Applied RMSmilawn.. LLC 6of7 c+Ixx'uxm-Ina'to-Irlunr,ax-nrema a�mmn;cc'rrmld..<'alnl.t'omNnxl r,n.rxxd n..xh,t-Lxlvxl,
City of Pon (n llbov, Colorado
C.,,fdential
COVERAGE YES OR NO COMMENTS
EXCESS WORKERS CONIPENSA TON AND EMPLOYERS LIABILITY NO
I Rmad Fonn All States Endorsement
2-Voluntary Compensation Endorsement
3 Cammrnicable Disease Endorsement.
Not Coveed by Stales RRG
5 Cash Hors Provision pic,ding relief to insured for catastrophe losses with sub
retentions, if passible.
6 Any commutation clxuseneecL to be deleted.
y Late tepnrtmg punelti¢veNmberanoved.iCepplirable. or et least disclosed if they ,
8 Definition ofeach accident encompasses all persons injured in a common ocemmnce
INLANDNIARINE-FINE ARTS NO Not Ctn'eredbv Stites RRG
I Ninety(90) days Notice ofCancellation. nonreoaval, and material change in ses and
Nice, per Exhibit V_
2 All -Risks ofpF.sicel loss except as.,,I.dcd
3 Cho ... ce far first dais sM1ipmrnts.
4 Right to oparchwse property'.
a. That is tecoveed for the amount paid to the insured plus an amotmt representing loss
adii seams and recocev... case,
b.'Ihm is damaged at fair market calurs of damaged propeVy.
5 special 'also"t on ree ifieatinn clause in foam of p oI .. oral caner. pxTe,
exhibitor Dram other bailee
6 Automatic Icinstatentent of limits Clause without additional .retinues.
7 Floodandea,,hquakele"a e.
FIDDCIARY LIABILITY
I Plans covered as omlined iv vppliation.
Please disclose if ontvibus Intend, exists alloe ng for fiduciary liabiliy coverage fbr
oun-schodund qualified and nanqualified plans under ERISA.
3 11 Fordor, liability is IimilM to qudifnt plans and they must be schecided, reintbrce
this in )rour proposal and in the rnabsis checklists.
4 Omnibus Welfare endoaemem
5 Include, Defense costs inside the SIR and outside the limit_
8 Definition of claim is foe wnren notice anly(to match Color ado Statute)
9 Multi -year rate guarantee with annual installments option.
10CIai Wade mho date is 5-1-2009. Pna and Pending Litigation 5-1-2009,
11 Amend lbe Co.,-,o Settle clause no be 70,30 aplint(I In er Cls ... ),if,l.,u,e c.mc
12 Aumntatic extension m repo,, claims - 60 dev,
13 Optional extended Reporting Period options and the corresponding pearionr (I 23 yem
and unlimited} To, e.vnple25 0 50 % of ennual pron a. to one yeas.
14 HIPPA Endn...nii iacloded.
15 COBRA Endorsaned foliated
16 Waive'of Rccomm for Government Plan,.
17 A policy that is non cancelable once the premium has been paid and a requirement that
the insurer orovtoe 90 clas's as written notice of nonrcater, al,
States RRG policy eecludes coverage froRRISA and Public Law
94-306, otherwise fidueiarr liabilip is not excluded and depending
on the claim allegations. may be coveted by the policy.
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ADMINISTRATIVE ADDRESS:
DNDERNRITDNO ADDRESS:•
STATES NSURERS
IGROUP,
States,,,
STATES SELF -INSURERS
INC.
RISK RETENTION
RISK RETENTION GROUP, INC.
140 Kennedy Drive
�ParhnTs in Proh"on�
222 South Ninth Street
P.O. Box 2127
Suite 1300
South Burlington, Vermont 05407-2127
Minneapolis, Minnesota 55402-3332
BOARD OF TRUSTZE5:
Choir: JefBey D. Downes Gle. A. Asher, ARM
City of Montgomery, Alabama City of Roanoke, Virginia
Secrerapc Eric T. Lagsuom
He] K. Luttschvager, CPCU, ARM, CLU Russell L. Mahan
Steve S. Rnwlines, CGFM
Tovn of Ocean City, Maryland
Missoula County, Montana Bountiful City Corporation, Utah
Davis County Corpomuon, Utah
TO: States Member -Representatives
FROM: Jeff Downes, Chairman
States Self -Insurers Trust and
Executive Assistant to the Mayor, City of Montgomery, Alabama
o Esenberg, President & CEO
States Self -Insurers Risk Retention Group, Inc.
SUBJECT: Some Things to Consider As Your Public Entity's Excess Liability Renewal Approaches
As a member -owned company, one of States' strongest efforts is dedicated to keeping its member -insureds
informed. As you prepare for the next renewal of your excess liability coverage, we know that you are faced
with a myriad of offerings in the marketplace. The current marketplace reflects soft pricing that we feel cannot
be sustained by those offering it. As harder market conditions return, as we know they will, we wanted to
provide you with some considerations as you work through the renewal process -- and why we believe States
continues to be the best alternative for your public entity's excess liability insurance coverage.
Here are some of what we feel are key points to think about as you prepare for renewal and discuss the renewal
market options you may encounter with the broker or agent representative with whom you may work:
1. Is the policy written by public entity risk managers and specifically crafted to address the
unique exposures and operations of U.S. cities, counties, school districts and related public
entities?
States policy has few exclusions and is "silent" on many points by design in order to more
favorably interpret coverage on the member's behalf. States' coverage form was written by
public entity risk managers for public entity risk managers. The coverage form was designed
specifically to meet a public entity's needs, and is broader than any policies we have seen
offered to a public entity by a commercial insurance carrier. States policy cannot be compared
to that of the traditional insurance market ... it is like comparing apples to oranges.
2. Who will be working with you when claims happen?
Will it be States — a member -owned company that will interpret a claim in the members' favor
whenever and wherever possible? Or, will it be an insurance company that is more interested in
protecting its own assets, driving shareholder returns and scouring the coverage form for
exclusions upon which to deny or limit coverage?
rPLESSE DIRECT ALL CORRESPDXDE.. 'CE TO THE UNDER tf R7TING ADDRESS
VERMONrIACATION 2802.658.1100 Fax: 802.658.94190web Site: w oaaa„emm♦•MLNTAPOIISLOCATIO'S 81.800.640.0345or612.7665000 Fax: 612,766.3398
States partners with its member -insureds at claims time to arrive at the best possible outcome
for the member -insured and their entity. This is the primary concern that public entity risk
managers usually express as they look for an insurance company partner in their risk
management program.
3. Is the insurance program founded on a member -owned concept such as States?
Are you investing in a long-term program that has your best interests in the forefront — or are
you (through your premium) subsidizing a for -profit insurance company and its shareholders?
States is a member -owned company that exists solely for the benefit of its member -insureds. It
is founded on a long-term vision of "being there' for its members, in all market conditions.
4. Is the company/carrier a long-term participant in the public entity marketplace?
Did the company/carrier recently enter the public entity arena in order to gain market share?
This happens during a soft market; yet these companies/carriers are the first to exit the public
entity marketplace when the market hardens and their margins shrink ... which we know will
happen.
Some industry experts are saying the current soft market will harden by early 2010, perhaps
sooner. States was founded in the extremely hard market of the mid- 1980s when coverage did
not exist at all. In 2007, the Company celebrated its 20ei year and continues to be the market of
choice for its active and involved members, regardless of market conditions. They realize that
by supporting the program in the soft market, they are ensuring the success of the program for
the next hard market.
5. What type of reinsurance supports the program?
Does the program have solid reinsurance support from reinsurers who are familiar with and
have exhibited a long-term commitment to the public entity sector? States partners with only
highly -rated world class reinsurers to maintain long -tern stability of the program and assure the
highest claims paying ability. States' reinsurance partners — ACE Re, Gen Re, Munich Re
America, and Swiss Re America — all have substantial public entity experience and are
committed to the States program and the public entity sector. They represent some of the
largest reinsurers in the world.
6. What do you want from your excess liability insurance program?
Is it important to you to be involved and have input with your excess liability insurance carrier
in your risk management issues? Do you want to have a say in your company, and interact with
the company and other member -insureds on issues that are important to you and your entity —
including issues above and beyond insurance? You get this as an involved member of States.
You only need to have used States' on-line "Email Blast" service or attended one of States'
annual membership meetings to see this in action!
2-
7. Is the company/carrier actively conununicating with their insureds and provide on -site visits?
Do they provide consultation: services specific to public entities?
What type of claims and loss control services does the excess liability carrier provide? Are they
specific to public entities — and even more specifically, to public entities with excess programs?
Do they conduct on -site visits regularly like States does? States' President & CEO makes
routine member visits, as do representatives from loss control and claims.
8. Do you make your insurance buying decision based solely upon cost?
Cost is an important factor for public entities today, especially with most entities facing serious
budgetary restrictions and limited revenue sources. By letting the premium drive the decision,
you're giving up critical, long-term risk management components for short -tern savings.
States strives to provide a stable pricing alternative to that of the carrier and local pool market
and works hard to help insulate its member -insureds from the peaks and valleys created by
market cycles. With a long-term vision, the premium paid by States members is typically less
than its carrier competitors during a hard market — and competitive with the carrier market
during a soft market. Over the long-term, you'll save premium with the States program without
sacrificing risk management considerations. States has consistently outperformed the carrier
market — and passes those premium savings onto its member- insureds to grow the program.
9. What other factors besides cost contribute to your insurance buying decision for excess
liability coverage?
While cost is certainly one important factor to consider in the insurance buying decision, to
truly protect an entity, other equally as important factors must be considered. Factors such as
the coverage document, experience of the carrier serving public entities, and the existence of
quality reinsurance should carry - at a minimum - equal consideration.
No other program exists in today's marketplace that is quite like States. States is a well -
established, mature, highly -regulated, and financially sound, multi -state program that only
provides excess liability insurance to public entities that are its member -owners with no
additional capitalization required. No other program for public entities in today's marketplace
is as focused on public entity risk management as States.
10. How financially stable and healthy is the program?
This is an important factor for an entity to consider, and not just for claim -paying ability. States
has been profitable each year the Company has been in operation — for over 20 years. States is
committed to building surplus in order to ensure the financial viability of the program for its
members for the long -tern.
-3-
As of the end of 2007, total capital and surplus was over $8 million and gross premium just
under $11 million. States operates well within the financial integrity measurements of the
NAIC's Risk Based Capital (RBC) requirements and adheres to the stringent oversight and
financial requirements of the State of Vermont, where States is domiciled. There is no debt on
the States program, no "special fees" to access the program, no financial restrictions on those
who choose to exit the program -- nor are there any assessments with States.
11. How regulated is the program you are considering?
Just as important as financial health is a company's or carriers' voluntary compliance and
adherence to regulatory oversight. States is domiciled as a captive insurer in Vennont, which
applies strict regulatory controls over the insurers domiciled there (Vermont is considered the
"gold standard" throughout the U.S. for its regulation of captives and alternative risk financing
mechanisms). States is registered to do business in 44 states. It files both quarterly and annual
financial statements with each of these states, which are subject to review and comment by each
state. States undergoes an intense audit of not only its financial records, but its underwriting
and claims records by the State of Vermont at least every three years. States is also audited by
its reinsurance partners and by outside auditors and actuaries on at least an annual basis.
12. Are assessments possible with the prograne?
States RRG is not assessable — and never has been. Many pools include an assessment
provision where members can be assessed for additional premium if the pool surplus is
exhausted or premiums come up short at year's end.
Here's the Bottom Line: If the premium you're being offered looks too good to be true - it usually is.
In most circumstances, you're giving up something - and more likely than not, you are giving up
coverage and a long -tern commitment to public entities. Unfortunately, you usually won't find out
about deficiencies in coverage until it's too late -- when a claim arises.
Don't gamble with your entity's coverage and long -tern security... it's too important. How do you find
safety and security in a soft market? You insure with States, where the goal is a public entity long-term
risk management partnership, not market share.
OStates.
"Partners in Protection"
sE
States
Statessm
"Partners in Protection" fwaYears
LOOKING FOR AN EXCESS LIABILITY INSURER
THAT IS COMMITTED TO MAINTAINING
STABLE RATES AND MARKET AVAILABILITY?
SOLUTION: STATES
States provides broad form excess liability insurance only to the
public entities that are its owners. Coverage includes*:
• Automobile Liability
• General Liability
• Law Enforcement Liability
• Public Officials Liability/School Administrators Liability
(including actions involving employment practices liability)
• Medical Professional Liability for Paramedics, EMT's,
Nurses and Physician Assistants
States also provides you with specialized loss control and claim
consulting services designed specifically for public entities and
delivered by a team of experienced personnel with decades of
expertise in protecting and managing public entities.
Visit our Web Site at www.statesrrg.com
or call 1-800-640-0345, ext. 3357
and learn more about an Excess Liability Program
Designed For Public Entities Just Like Yours!
"The policy contract provides the final determination for affording of all coverage and coverage limitations.
States.
"Partners in Protection"
Frequently Asked Questions (FAQs) about States:
What security do I have with States?
• States was licensed to operate in 1987 and has been a profitable program every year since its first
policy was issued in 1988. The Board of Trustees has directed that all revenues not required for
operations be used to increase surplus so States can better protect its members and continue to grow.
• States operates as a group captive, and in many respects, as a well -administered public entity pool,
rather than as a commercial insurance company. Unlike a for -profit, commercial insurance company,
States exists only to respond to the unique needs of its public entity owner -insureds and
therefore exercises strict underwriting standards when selecting risks to be allowed into its
membership.
• States retains only the first $600,000 above each member-insured's self -insured retention, and then
reinsures losses above that amount through a long-standing treaty reinsurance arrangement with
major, highly -rated reinsurers who understand and are committed to the public entity sector.
• Unlike many state pools, States is not assessable. The Company is highly regulated by the State of
Vermont, its state of domicile. States provides National Association of Insurance Commissioners
(NAIC) quarterly financial reports to the State of Vermont and 43 other states in which the Company
either operates or may seek to operate.
• States continues to operate well within the financial integrity measurements of the NAIC's Risk
Based Capital (RBC) requirements and adheres to the stringent oversight and financial requirements of
the State of Vermont.
2. What is States doing to provide for its long-term financial security and continued success and the
security and success of its owner -insureds?
• States' Board of Trustees is committed to building surplus in order to ensure the financial viability of
States for the long-term. As of 2007, total capital and surplus was over $8 million and gross premium
just under $11 million. A Board resolution directs, for the present, that net revenues not needed for
operating expenses be used to increase surplus and grow the Company.
• States has a long-term, fiscally conservative focus. It is owned by the public entities that are insured
with the program and it has their best interests in mind. Through its mature and highly -efficient
structure, it is able to keep its expenses down — substantially lower than expense ratios exhibited by
the commercial, for -profit insurance industry. This is a further savings that benefits its member -insureds
and strengthens States financially.
• States is a stock insurance company, owned by the States Self -Insurers Trust and directed entirely by
its members. Its insured members are not assessable and never have been.
3. What factors differentiate States from other excess liability insurance programs?
• Commercial insurance companies generally exist to build large amounts of surplus in order to retain
more risk, and more importantly, pay dividends to their stockholders.
• States, as a group captive, operates more like a well -run public entity self-insurance pool. The
differences between a public entity pool and States are: States operates in numerous states, is non -
assessable, is highly regulated, and is audited by multiple independent organizations.
• With States, you are more than just another insured. States' insured's are members of the States Self -
Insurers Trust and, through the Trust, owners of States Self -Insurers Risk Retention Group, Inc.
• Since States' public entity member -insureds own the insurance company, most remain insureds year in
and year out, with a long-term view of their risk management programs. This is an indication of how
committed States members are to the program and how they value the specialized services it provides.
• States' member -insureds share in the financial success of the Company. They are stakeholders in the
long-term success and security of the Company without being liable for assessments.
• In an uncertain public entity marketplace, where commercial insurers are in and out of the market and
having difficulty maintaining reinsurance relationships and treaty limits, States is proud of its track
record of strong partnerships with its reinsurers. States has maintained treaty limits of $10,000,000
since its inception.
• States is a specialized insurer that provides excess liability coverage only to public entities. The
concern relating to the scope of risk that often surfaces with insurers that try to be "all things to all
people" is not a concern with States. States is committed and focused solely on providing high quality
excess liability insurance to public entities throughout the United States.
• States' coverage form has evolved over the years to address the needs of the public entities it serves.
Its policy form is considered one of the broadest in the marketplace and is not constrained by dozens of
exclusions. This allows coverage to be interpreted broadly in favor of the member -insured whenever
possible.
4. To what do you attribute the success of the States program? Why is it working?
• States wrote its first policy in 1988, shortly after non -manufacturing risk retention groups were allowed
to form under the federal Liability Risk Retention Act of 1986. The group was created and formed by
public entity risk managers and insurance professionals. As a result, States is focused entirely on
public entity issues and public entity insurance -related and risk management needs.
• States is managed by Berkley Risk Administrators Company, LLC (BRAC), a member company of
W. R. Berkley Corporation. BRAC provides the program's overall management, including marketing,
financial administration, underwriting, claim management services, loss control assistance, reinsurance
management and other administrative services. BRAC is staffed with professionals who have many
years of experience developing and managing insurance programs for hundreds of public entities
throughout the U.S.
5. As a risk retention group, how is States regulated?
• States is domiciled in Vermont, which is the largest and most experienced domestic domicile for
captive insurance companies, including risk retention groups. Vermont applies strict regulatory controls
over the insurers domiciled there. The Vermont Department of Insurance, Captive Division, has long
been referred to as the "Gold Standard" for the way it provides regulation, audit and oversight on
captive and RRG operations domiciled there.
• The State of Vermont is fully accredited by the NAIC.
• The State of Vermont has structured its insurance department so that the head of the regulatory section
for captives and risk retention groups is in the position of Deputy Commissioner. This reflects
Vermont's commitment to high quality regulation of this important segment of the industry.
• States is registered to do business in 44 states. It files both quarterly and annual financial
statements with each of these states, which are subject to review and comment by each state. States
undergoes an intense audit of not only its financial records, but its underwriting and claims records
by the State of Vermont at least every three years.
MORE QUESTIONS? CONTACT.
Royanna G. Carle, CPCU
Marketing Director
States Self -Insurers Risk Retention Group, Inc.
c/o Berkley Risk Administrators Company, LLC
222 South 9th Street, Suite 1300
Minneapolis, MN 55402-3332
Phone: Toll -free: 1-800-640-0345, ext. 3357 or Direct: 612-766-3357
Fax: 612-766-3399
E-mail: rcarle@berkleyrisk.com
Web site: www.statesrrg.com
STATES SELF -INSURERS RISK RETENTION GROUP
ROSTER OF MEMBERS
as of January 2009
Alabama:
• City of Montgomery - (Member since November 1998)
• Montgomery County - (Member since July 2006)
California
• Bellflower Unified School District - (Member since July 2007)
Colorado:
Mesa County - (Member since January 2003)
Illinois:
• Madison County - (Member since July 2002)
• McLean County - (Member January 1992-96 and since January 2001)
Maryland:
• Harford County - (Member since July 1991)
• Town of Ocean City -(Member since July 1990)
Montana:
Missoula County -(Member since October 1988)
Nebraska:
• City of Lincoln - (Member since September 2007)
Pennsylvania:
• Dauphin County - (Member since June 2005)
• Lehigh County - (Member since January 2002)
South Carolina:
• Berkley County School District - (Member since June 2000)
Tennessee:
• Greene County - (Member since July 1988)
• Putnam County - (Member since August 1992)
• Sumner County - (Member since July 1992)
• Warren County - (Member since August 1993)
Texas:
• City of Odessa - (Member since January 2004)
(2) At or from any premises, site or location which is or was at any time used by or for any
insured or others for the handling, storage, disposal, processing or treatment of waste;
(3) Which are or were at any time transported, handled, stored, treated, disposed of, or
processed as waste by or for any insured or any person or organization for whom any
insured may be legally responsible; or
(4) At or from any premises, site or location on which any insured or any contractors or
subcontractors working directly or indirectly on any insured's behalf are performing
operations:
(a) If the pollutants are brought on or to the premises, site or location in connection with
such operations by such insured, contractor or subcontractor; or
(b)._If the operations are to test for, monitor, clean up, remove, contain, treat, detoxify or
neutralize, or in any way respond to, or assess the effects of pollutants;
Subparagraphs (1) and (4)(a) do not apply to bodily injury orproperty damage arising out
of heat, smoke or fumes from a hostile fire.
As used in this exclusion, a hostile fire means one which becomes uncontrollable or
breaks out from where it was intended to be.
b. Any loss, cost or expense arising out of any:
(1) Request, demand or order that any insured or others test for, monitor, clean up, remove,
contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of
pollutants;
(2) Claim or suit by or on behalf of a governmental authority for damages because of testing
for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing,
or in any way responding to, or assessing the effects of pollutants.
t10. Property damage to:)
a. Property owned, rented or occupied by the insured;
b. Premises that the insured sells, gives away or abandons, if the property damage arises out of
any part of the premises;
c. Property loaned to the insured;
d. Personal property in the care, custody or control of the insured;
e. That particular part of the real property on which the insured or any contractors or
subcontractors working directly or indirectly on the insured's behalf are performing
operations, if the property damage is caused by those operations; or
OCPOLICY (4/96; 7/00; 7/04) Page 3 of 19
Utah:
• City of Bountiful - (Member since July 1990)
• City of Provo - (Member since June 1990)
• City of South Salt Lake - (Member since July 1998)
• City of St. George - (Member since July 2002)
• Davis County Corporation - (Member since January 1990)
• Murray City Corporation - (Member since February 1990)
• Park City Municipal Corporation - (Member since January 2003)
• Tooele County Corporation - (Member since January 2004)
Virginia:
• City of Chesapeake - (Member since April 1994)
• City of Hampton - (Member since August 1987)
• City of Hampton Public Schools - (Member since August 1987)
• City of Harrisonburg - (Member since July 2006)
• City of Lynchburg - (Member since July 1997)
• Norfolk Public Schools - (Member since July 1996)
• City of Portsmouth - (Member since July 1999)
• Portsmouth Public Schools - (Member since July 1999)
• City of Richmond - (Member since November 1989)
• City of Roanoke - (Member since July 1997)
• City of Virginia Beach - (Member since August 1988)
• County of Chesterfield - (Member since July 1988)
• Hampton Roads Transit Authority - (Member since October 2001)
• Southeastern Public Service Authority - (Member since October 2001)
Notes:
1. School Districts are not named if their program is combined with a
named city or county program.
References for States RRG
Rodger Cochran - States Member and Risk Manager with the City of Provo, UT
(phone 801-852-6188). Rodger serves on States' Marketing & Communications
Committee.
Jeff Downes - States Member and Risk Manager with the City of Montgomery,
AL (phone 334-241-2002). Jeff is Chair of the States' Board of Trustees and
chair of the Strategic Planning Committee.
Bill Kostner - States Member and Risk Manager with the City of Lincoln, NE
(phone 402-441-6009). Bill is the past President of the Public Risk Management
Association (PRIMA). He serves on States' Strategic Planning Committee.
Eric Lagstrom - States Member and Risk Manager with the Town of Ocean City,
MD (phone 410-289-8773). Eric serves as Secretary on the Board of Trustees
for States, serves on States' Board of Directors and chairs the Marketing &
Communications Committee.
Hal Luttswager - States Member and Risk Manager with Missoula County, MT
(phone 406-523-4873). Hal serves on States' Board of Trustees and on the
Strategic Planning Committee.
Tony Southern - States Member and Risk Manager with Sumner County, TN
(phone 615-451-6023). Tony serves on States' Marketing & Communications
Committee.
Darrell Wells - States Member and Director of Risk Management with the City of
Odessa, TX (phone 432-335-4697).
I hope that by contacting the States' members above, you will get a good feel for
the quality of membership in the States' program as well as assistance and ideas
for establishing and structuring a self -insured and layered risk management/
insurance program.
M r r ■ V 11
0
•
States, as a group captive, is a member -owned insurance
company domiciled in Vermont. For over 20 years, the
Company has operated as a , well -
managed and highly regulated national program providing
its members with a broadly interpreted coverage form that
is second to none in the industry.
Our experienced, accessible, service -driven staff of profes-
sionals continues to provide States members with excellent
claims and loss control support and specialized public
entity -oriented services. Our "Partners in Protection" have a
long and proven history of reliability, accountability, well-
earned and well -placed trust.
Ongoing sound financial results for States and our partner
members is proof that the States concept works. States
member -owners, such as its As: , are proud to be a
part of a public entity risk management success story.
We know you will be too.
6
'•I AT�%T•
States, as a group captive, is a member -owned insurance
company domiciled in Vermont. For over 20 years, the
Company has operated as a airy strung, well -
managed and highly regulated national program providing
its members with a broadly interpreted coverage form that
is second to none in the industry.
Our experienced, accessible, service -driven staff of profes-
sionals continues to provide States members with excellent
claims and loss control support and specialized public
entity -oriented services. Our "Partners in Protection" have a
long and proven history of reliability, accountability, well-
earned and well -placed trust.
Ongoing sound financial results for States and our partner
members is proof that the States concept works. States
member -owners, such as joger Gc , are proud to be
a part of a public entity risk management success story.
We know you will be too.
Al AW� %Xa
WWI
a
States, as a group captive, is a member -owned insurance
company domiciled in Vermont. For over 20 years, the
Company has operated as a ncialiy sirong, well -
managed and highly regulated national program providing
its members with a broadly interpreted coverage form that
is second to none in the industry.
Our experienced, accessible, service -driven staff of profes-
sionals continues to provide States members with excellent
claims and loss control support and specialized public
entity -oriented services. Our "Partners in Protection" have a
long and proven history of reliability, accountability, well-
earned and well -placed trust.
Ongoing sound financial results for States and our partner
members is proof that the States concept works. States
member -owners, such as �)iaawn Guzman, are proud to be
a part of a public entity risk management success story.
We know you will be too.
a
a
6
a
States, as a group captive, is a member -owned insurance
company domiciled in Vermont. For over 20 years, the
® Company has operated as a nancially stronc•, well -managed
and highly regulated national program providing its members
with a broadly interpreted coverage form that is second to
none in the industry.
Our experienced, accessible, service -driven staff of profes-
sionals continues to provide States members with excellent
claims and loss control support and specialized public entity -
oriented services. Our "Partners in Protection" have a long and
proven history of reliability, accountability, well-earned and
well -placed trust.
Ongoing sound financial results for States and our partner
members is proof that the States concept works. States mem-
it ber-owners, such as t_: : , are proud to be a part of a
public entity risk management success story.
We know you will be too.
f. That particular part of any property that must be restored, repaired or replaced because
covered work was incorrectly performed on it.
Paragraph b. of this exclusion does not apply if the premises are covered work and were never
occupied, rented or held for rental by the insured.
Paragraphs c., d., e. and f. of this exclusion do not apply to liability assumed under a sidetrack
agreement.
Paragraph f. of this exclusion does not apply to property damage included in the products -
completed operations hazard.
11. Any liability arising out of the ownership or operation, or activities associated with or related to
the ownership or operation, of an airport.
Zli��Any liability arising out of the. ownership, maintenance, operation, use or loading or unloading
of any aircraft.
13. Any liability arising out of the ownership, maintenance, operation, use or loading or unloading
of any owned or leased watercraft in excess ofeet in length.
14. Any liability arising out of the manufacture, mining, transportation, handling, distribution,
marketing, use, removal, encapsulement or exposure to asbestos, asbestos products, asbestos
fibers or asbestos dust, and any liability arising out of the discharge, release or dispersal of
asbestos particles, including but not limited to the cost to clean up, remove or abate asbestos
contamination.
15. Any loss, cost or expense incurred by the insured or others for the loss of use, withdrawal, recall,
inspection, repair, replacement, adjustment, removal or disposal of:
a. A covered product;
b. Covered work; or
c. Impaired property;
if such product, work or property is withdrawn or recalled from the market, or from use, by any
person, organization, government agency or regulatory authority, acting voluntarily or
involuntarily, because of a known or suspected defect, deficiency, inadequacy or dangerous
condition in it.
16. Bodily injury, personal injury or property damage for which the insured is obligated to pay
damages by reason of the assumption of liability in a contract or agreement. This exclusion does
not apply to liability for damages:
a. That the insured would have in the absence of the contract or agreement; or
OCPOLICY (4/96; 7/00; 7/04) Page 4 of 19
b. Assumed in a contract or agreement is an insured contract, provided the bodily injury,
personal injury or property damage occurs subsequent to the execution of the contract or
agreement. Solely for the purposes of liability assumed in an insured contract, reasonable
attorney fees and necessary litigation expenses incurred by or for a party other than an
insured are deemed to be damages because of bodily injury, personal injury or property
damage, provided
(1) Liability to such party for, or for the cost of, that parry's defense has also been assumed in
the same insured contract; and
(2) Such attorney fees and litigation expenses are for defense of that party against a civil or
alternative dispute resolution proceeding in which damages. to which this insurance
applies are alleged.
(17! Bodily injury to:
a. An employee of the insured arising out of and in the course of employment by the insured; or
b. The spouse, child, parent, brother or sister of that employee as a consequence of paragraph a.
above.
This exclusion applies:
a. Whether the insured may be liable as an employer or in any other capacity; and
b. To any obligation to share damages with or repay someone else who must pay damages
because of the injury;
This exclusion does not apply to liability assumed by the insured under an insured contract.
18. Any liability arising out of or in connection with the operation of any hospital, clinic, nursing home,
or established health care facilities owned or operated by the entity due to the rendering or failure to
render medical, surgical, dental or X-ray services or treatment. This exclusion shall not apply to any
professional activities of emergency medical technicians, paramedics, physicians assistants, or
nurses.
19. Bodily injury or property damage arising out of the rendering or failure to render professional
services by any doctor of medicine, dentist, or pharmacist.
�20 Any liability arising out of or in connection with debt security financing or the investment of funds. i
21. Bodily injury, personal injury, or property damage arising directly or indirectly out of, resulting
from, caused by or contributed to by:
a. Any fungus (fungi) or spore(s):
OCPOLICY (4/96; 7/00; 7/04) Page 5 of 19
b. Any solid, liquid, vapor, or gas produced by or arising out of any fungus (fungi) or spore(s);
c. Any material, product, building component, or building structure that contains, harbors, nurtures
or acts as a medium for any fungus (fungi) or spore(s);
d. Any intrusion, leakage, or accumulation of water or any other liquid that contains, harbors,
nurtures or acts as a medium for fungus (fungi) or spore(s);
e. The actual or threatened abatement, mitigation, removal or disposal of fungus (fungi) or spore(s)
or any material, product, building component, or building structure that contains, harbors, nurtures or
acts as a medium for any fungus (fungi) or spore(s);
f. Any supervision, instructions, recommendations, warnings or advice given or which should have
been given in connection with subparagraphs a., b., C., d., or e. above; or
g. Any obligation of the insured to indemnify any party in connection with subparagraphs a., b., c.,
d., e., or £ above.
Fungus (fungi) includes, but is not limited to, any form or type of mold, mushroom or mildew.
Spore(s) include any reproductive body produced by or arising out of any fungus (fungi).
COVERAGE PART II. PUBLIC OFFICIALS' ERROR OR OMISSION LIABILITY
COVERAGE (OCCURRENCE COVERAGE)
A. Insuring Agreement
States agrees to pay on behalf of the insured the damages in excess of the self -insured retention
which the insured becomes legally obligated to pay because of error or omission to which Coverage
Part II applies.
Coverage Part II applies only if the error or omission is the result of an occurrence during the policy
period and in the coverage territory.
The amount States will pay for damages in excess of the self -insured retention shall be limited as
described in Section III - Limits of Liability. No other obligation or liability to pay sums or perform
acts or services is covered.
B. Exclusions
Coverage Part II does not apply to any damages for:
1. Any liability arising out of bodily injury, personal injury or property damage. Additionally, the
exclusions stated in Coverage Part I, B. Exclusions, shall apply to this Coverage Part II with
respect to any type of damages.
2. Any liability based upon or attributable to any insured gaining in fact any personal profit or
advantage to which such insured was not legally entitled, including remuneration .paid in
violation of law as determined by the courts.
OCPOLICY (4/96; 7/00; 7/04) Page 6 of 19