HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 9190716February 15, 2019
Dear Teresa Berry,
Sincerely,
Colorado Special Districts Property and Liability Pool
Workers' Compensation Program
Colorado Special Districts Property & Liability Pool
PO Box 1539
Portland, OR 97207-1539
Phone: 800-318-8870 ext. 3
Workers' Compensation Program Team
Colorado Special Districts Property & Liability Pool
2018 Workers’ Compensation Final Audit Reconciliation
The 2018 Workers’ Compensation Final Audit process is complete. We are enclosing the Final
Audit Invoice for the reconciliation of the projected payroll compared to the actual payroll and
contribution.
If the Final Audit generated a credit, a refund check will be processed and mailed to your
attention in a few weeks, for delivery by your agency.
If the Audit resulted in a debit, please have your district remit the balance due along with a copy
of the invoice in order to ensure payment is accurately applied to their account.
Payment is due upon receipt.
Please review the Final Audit Invoice and advise us of any discrepancies by February 22, 2019.
After this date no further adjustments can be made. Please advise your district accordingly. If
you have any questions, please do not hesitate to give us a call.
Colorado Special Districts Property and Liability Pool
Audit Invoice - Coverage Year 2018
Entity ID:
26014
Invoice #:
18W26014-1826
Effective Date:
01-Jan-18
Expiration Date:
01-Jan-19
Date:
15-Feb-19
Poudre River Public Library District
301 E Olive Street
District: Broker:
PO Box 578
Flood & Peterson Insurance, Inc. -FC
Fort Collins, CO 80524 Greeley, CO 80632
$14,699.26
1.47
$21,607.92
1.15
$934.34
Experience Modification x
Modified Contribution =
Contribution Volume Credit -
Manual Adjustment x
Manual Contribution
Total Audited Contribution = $22,051.00
Cost Containment Deviation x
Designated Provider Discount - $540.20
Less Total Payments - $14,016.00
$871.00
Balance Due/Refund = $8,035.00
Multi Program Discount: x 0.99
Less Audit Pre Pay Discount -
Total contribution includes commission paid to the Broker reflected above (9% First Year and 6% Annually
thereafter)
Class Description
Audit Employee
Payroll
Manual
Contribution
Audit Volunteer
Payroll
No. of
Empl.
F/T P/T
No.
of
Vol.
2018 2018
2018
Rate
2018
8810 Clerical Office Employees 0 42 114 0.21 $4,510,892 $0 $9,472.87
8811 Board Member Coverage 7 0 0 0.86 $8,400 $72.24
9102 Park - Maintenance / All Other - NOC 0 2 0 5.07 $101,660 $0 $5,154.15
NOTE: The terms of your Intergovernmental Agreement require timely payment to prevent automatic cancellation of coverage. Please
include a copy of this Invoice with your payment to help us apply your payment correctly. Only prior notice to the Colorado Special Districts
Payment Notice
The annual contribution for your coverage with the Pool is due upon receipt of the invoice. To
make a payment, please MAIL your check to
Colorado Special Districts Property & Liability Pool
PO Box 1539
Portland, OR 97207
For EXPRESS or OVERNIGHT MAIL services, please use the address below:
Colorado Special Districts Property & Liability Pool
c/o McGriff, Seibels & Williams Inc.
1800 SW 1st Ave, Suite 400
Portland, OR 97201
To ensure that your payment is accurately applied please always include the Remittance Invoice.
The Pool does not accept credit card payment at this time; however, if you would like to make
payment via a wire transfer, please let us know and we will be happy to provide you with wiring
instructions.
Please be advised that in accordance with the Intergovernmental Agreement (IGA), automatic
expulsion will occur on the 60th day should your account not be current. Should you wish to
reinstate your district's coverage after automatic cancellation has occurred, a $100 reinstatement
fee will apply.
Another requirement for maintaining coverage with the Pool is adoption of the IGA and
Resolution by each District's Board of Directors. The signed and executed agreements must be
on file with the Pool Administrator within 60 days of initial binding of coverage with the Pool.
These documents are not required each year at renewal.
Finally, all members in the Pool must be members in good standing with the Special District
Association of Colorado (SDA). Your insurance coverage will be non-renewed if the SDA
determines that your association dues are not current. Please contact the SDA at sdaco.org with
any questions.
Please contact us at Lshi@mcgriff.com or 800-318-8870 ext. 4 for billing questions.
Property and Liability Pool Board and subsequent approval may extend this cancellation provision.
Please Remit To: Colorado Special Districts Property and Liability Pool
c/o McGriff, Seibels & Williams, Inc.
P. O. Box 1539
Portland, OR 97207-1539
Wire Transfer is available upon request.
Billing Questions : chammond@mcgriff.com
Toll Free: 800-318-8870