2010 Renewal Documents and Invoice January 1, 2010 to January 1, 2011

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1 Administration McGriff, Seibels & Williams, Inc. P.O. Box 1539 Portland OR Phone: Fax: Renewal Documents and Invoice January 1, 2010 to January 1, 2011 Suggested Distribution List Board Members District Manager Risk Manager Insurance Specialist IMPORTANT NOTICE: Only by payment of the enclosed invoice by January 1, 2010 do you evidence acceptance of this coverage. Payments not received are subject to automatic cancellation per the terms of the Intergovernmental Agreement. A $100 reinstatement fee will be charged if coverage is cancelled for nonpayment. A quarterly payment plan is available. If interested, please contact the Pool. Request for payment extension must be submitted in writing by December 1st for the Pool Board of Directors consideration. Enclosed are documents relating to your District s January 1, 2010 to January 1, 2011 renewal: Invoice - original and remittance copy. Please note that payment is due upon receipt. Please return the remittance copy along with your payment to ensure that it is accurately applied to your account. Coverage Declaration Pages. Schedules - General Liability, Property, Automobile, Inland Marine, and Extra Items (if applicable). Certificates of Coverage (if applicable). Originals are mailed directly to the Certificate Holders. Automobile Identification Cards (mailed under separate cover). Please note: 1. To date, the Pool has not been able to finalize suffient limits for Flood Zone A, or properties within the 100-year flood plain for the 2010 renewal. Flood limits are available; however, the reinsurer has imposed the following sub-limits, an all Member per Occurrence Annual Aggregate sub-limit, as well as, an all Member Aggregate sub-limit. We have left references to flood coverage off your renewal documents until we have finalized the Pool s Flood Program. 2. Members participating in both the Property & Liability and Workers Compensation programs will receive a Multi Program Discount of 6% on Property & Liability and 1% on Workers Compensation. Discounts do not apply to minimum contributions. 3. The Pool will continue to offer Certified Acts of Terrorism on the Property form, and provide a per occurrence limit of $2,500,000.

2 Page 2 of Renewal Documents 4. Property Schedules should be reviewed to verify that you are declaring 100% replacement cost as your valuation. As previously communicated, many districts will see property values increase 1% this year due to inflation. 5. All schedules should be reviewed for accuracy (General Liability, Automobile, Property, and Inland Marine). If it is not listed, it is not covered. Please call immediately if you require corrections. 6. Continuity Credits apply to districts who have participated in the Pool s Property & Liability program for seven years or longer. The credit is based on individual loss experience and total contribution paid. Those districts with an 80% or greater loss ratio are not eligible. 7. Quarterly payment options are available; the cost will include a 5% surcharge to the annual contribution. The payment schedule is 25% due on the first of the following months: January, March, June, and September. Please contact us immediately if your District selects this option, so we can issue the installment invoices accordingly. 8. Association dues should be renewed and current with the Special District Association of Colorado (SDA) as required by membership in the Association. 9. The Pool Board of Directors has authorized several enhancements to the district s coverage at no additional charge. Detailed information regarding these enhancements will be distributed when available, after December CSD Pool Online Training Grants are still available. Call Joe DePaepe toll free at ext. 5 for more information. We appreciate your business and are pleased to be your partner in providing excellent coverage at a reasonable price for Colorado special districts. If you have any questions, please call us toll free at

3 INVOICE Date: 10-Dec-09 Entity: P. O. Box 2710 Telluride, CO Agent: Invoice #: Entity ID: Effective Date: Expiration Date: Invoice Date: Jan Jan Dec-09 Coverage: General Liability Public Officials Liability Auto Liability Non-owned / Hired Auto Liability Auto Physical Damage Hired Auto Physical Damage Excess Liability Property Earthquake Flood Equipment Breakdown / Boiler and Machinery Comprehensive Crime Contribution: $ $1, $ $65.00 $ $ Total Contribution (Direct Discount) $2, A 6.00% Discount is available if your district elects participation in the Pool's Workers' Compensation Program. (Not applicable to minimum contributions.) A 7.77% Continuity Credit has been applied based on your district's years of participation and loss history. (Not applicable to minimum contributions.) Payment Due Upon Receipt. Payment evidences "acceptance" of this coverage. Please send a copy of this invoice with remittance. NOTE: Terms of the Intergovernmental Agreement require timely payment to prevent automatic cancellation of coverage. Only prior Colorado Special Districts Property and Liability Pool Board approval may extend cancellation provision. Please Remit to: Colorado Special Districts Property and Liability Pool c/o McGriff, Seibels & Williams, Inc. P.O. Box 1539 Portland OR Phone: / Fax:

4 Remittance Date: 10-Dec-09 Entity: P. O. Box 2710 Telluride, CO Agent: Invoice #: Entity ID: Effective Date: Expiration Date: Invoice Date: Jan Jan Dec-09 Coverage: General Liability Public Officials Liability Auto Liability Non-owned / Hired Auto Liability Auto Physical Damage Hired Auto Physical Damage Excess Liability Property Earthquake Flood Equipment Breakdown / Boiler and Machinery Comprehensive Crime Total Contribution (Direct Discount) Contribution: $ $1, $ $65.00 $ $ $2, A 5% Discount is available if your district elects participation in the Pool's Workers' Compensation Program. (Not applicable to minimum contributions.) A 7.77% Continuity Credit has been applied based on your district's years of participation and loss history. (Not applicable to minimum contributions.) Payment Due Upon Receipt. Payment evidences "acceptance" of this coverage. Please send a copy of this invoice with remittance. NOTE: Terms of the Intergovernmental Agreement require timely payment to prevent automatic cancellation of coverage. Only prior Colorado Special Districts Property and Liability Pool Board approval may extend cancellation provision. Please Remit to: Colorado Special Districts Property and Liability Pool c/o McGriff, Seibels & Williams, Inc. P.O. Box 1539 Portland OR Phone: / Fax:

5 Public Entity Liability Certificate Holder Declarations Certificate Number: Coverage Period: 1/1/2010 to 1/1/2011 Named Member: P. O. Box 2710 Telluride, CO Agent of Record: Coverage is provided for only those coverages indicated below for which a contribution is shown. Public Entity Liability Coverage including: General Liability Employee Benefits Admin. Liability Public Officials Liability Employment Practices Liability Excess Liability Auto Liability Coverage Medical Payments - Premises Pre Loss Legal Assistance Non-Owned/Hired Auto Liability Uninsured Motorist Auto Physical Damage Hired Auto Physical Damage Per Occurrence Limit $1,000,000 $50,000 Annual Aggregate N/A Deductible / SIR $1,000 * See Below N/A N/A Contribution $ $1, No-Fault Water & Sewer Backup $10,000 $30,000 $500 Cyber Liability Fiduciary Liability Medical Payments - Auto Auto Physical Damage - Employee Deductible Reimbursement Additional forms that may be applicable to Member: Total Contribution: $65.00 $2, Text164: * Employment Practices Liability Deductible: 50% of loss, subject to a maximum deductible of $100,000 each occurrence, unless a lower deductible limit is shown. Public Entity Liability Coverage Document Liability Deductible Endorsement $10,000 $10,000 N/A $ $500/$500 $2,000 $4,000 $200,000 $200,000 **$1,000,000 **$1,000,000 N/A $2,500 N/A N/A **Cyber Liability and Fiduciary Liablity each have a $1,000,000 Program Aggregate Limit. These Certificate Holder Declarations are made and are mutually accepted by the Pool and the Named Member subject to all terms which are made a part of the Public Entity Liability Coverage Document. These Declarations represent only a brief summary of coverages. Please refer to the Master Coverage Document for actual coverage terms that may apply to any specific situation. Countersigned by: Thursday, December 10, 2009 Authorized Representative Entity ID#: 54513

6 Property Certificate Holder Declarations Certificate Number: Coverage Period: 1/1/2010 to 1/1/2011 Named Member: P. O. Box 2710 Telluride, CO Agent of Record: Amount of Coverage: (Per Occurrence) $413,561 Blanket Buildings, Increased Cost of Construction, Demolition and Business Personal Property. $250,000 $0 Blanket Business Income including Extra Expense/Rental Income. Portable Equipment, Mobile Equipment, and other Inland Marine scheduled items. $0 Excess of $5,000,000 Earthquake Limit, per occurrence and annual aggregate, per Property schedule. $15,000,000 per occurrence and annual aggregate sublimit for Property outside a 100-year flood plain and within a 500-year flood plain. Locations Covered: Report of Values: Perils Covered: Per Property schedule on file. Property in Course of Construction must be shown on schedule to be covered. Annual statement of values must be submitted. Risks of Direct Physical Loss subject to the terms, conditions and exclusions in the Master Property Coverage Document. Deductibles: $500 Per occurrence, except where noted on Member's Property or Inland Marine Schedules. Contribution: $ Earthquake - 2% per occurrence of the value of the covered damaged property at the time of loss, subject to a $5,000 minimum and $50,000 maximum. Flood - 2% per occurrence of the value of the covered damaged property at the time of loss, subject to a $5,000 minimum and $50,000 maximum. Applicable Endorsement Amending Coverage: N/A This Certificate is made and is mutually accepted by the Pool and the Named Member subject to all terms which are made a part of the Property Coverage Document. This Certificate represents only a brief summary of coverages. Please refer to the Master Coverage Document for actual coverage terms that may apply to any specific situation. Countersigned by: Thursday, December 10, 2009 Authorized Representative Entity ID#: 54513

7 Comprehensive Crime Coverage Certificate Insured by the Fidelity and Deposit Insurance Co. of Maryland Master Policy Number: CCP Certificate Number: Named Member: P. O. Box 2710 Telluride, CO Coverage Period: 1/1/2010 Until Cancelled Billing Period: 1/1/2010 to 1/1/2011 Agent of Record: Covered ERISA Plan: Coverage, Limits of Insurance and Deductibles: Public Employee Dishonesty Coverage: - Limit is per loss - Faithful Performance of Duty - Non Compensated Officers, Directors and Trustees - Includes Welfare and Pension Plan ERISA Compliance if Covered Plan is shown on application. - Includes Volunteer Workers as Employees Forgery or Alteration Coverage: Limits: $5,000 $5,000 Theft, Disappearance and Destruction Coverage: Primary $5,000 deductible provided by Money and Securities Section of the Pool's Property Coverage Document, otherwise Crime deductible below will apply Inside Premises Deductible: $5,000 Outside Premises Deductible: $5,000 $5,000 $5,000 Computer Fraud and Funds Transfer Fraud Coverage: Limits are equal to Employee Dishonesty Coverage or $50,000, whichever is less Crime Deductible: $ Contribution: $ Policy Forms: CR Government Crime Policy CR Include Specified Directors or Trustees on Committee as Employees CR Include Specified Non-Compensated Officers as Employees CR Include Volunteer Workers as Employees CR Faithfull Performance of Duty CR Include Treasures or Tax Collectors as Employees This Certificate is made and is mutually accepted by the Pool and the Named Member subject to all terms which are made a part of the Master Comprehensive Crime Policy. This Certificate represents only a brief summary of coverages. Please refer to the Master Policy Document for actual coverage terms that may apply to any specific situation. Countersigned by: Thursday, December 10, 2009 Authorized Representative Entity ID#: 54513

8 Identity Recovery Coverage Declaration Certificate Number: Named Member: P. O. Box 2710 Telluride, CO Coverage Period: Agent of Record: 1/1/2010 Until Cancelled Member: Coverage: Individual working full time or serving on the Board of Directors of a Member District and covered through the Colorado Special Districts Property and Liability Pool, each at the time of discovery. Reimbursement Coverage for Expenses arising from a defined Identity Theft event. Including: Legal fees for answer of civil judgements and defense of criminal charges; phone, postage, shipping fees; notary and filing fees; credit bureau reports; lost wages; child/elder care and mental health counseling. This coverage does not reimburse the Member for monies stolen or fraudulently charged to the Member, and excludes loss arising from the insureds fraudulent, dishonest or criminal act. Limits: Sub Limits: $25,000 Case Management Service Expenses Legal Costs $5,000 Total $1,000 Total $1,000 Total Annual Aggregate Per Member Does not reduce the limit available Reduces the limit available Lost Wages and Child/Elder Care Mental Health Counseling Miscellaneous Expenses Coverage Trigger: Coverage is provided on a discovery basis with a 60 day reporting requirement Claims: For Recovery Assistance and Counseling please call Insurance Carrier: The Hartford Steam Boiler Inspection and Insurance Company This certificate is made and is mutually accepted by the Pool and the Named Member subject to all terms which are made a part of the Identity Recovery Coverage Policy No A1. This certificate represents only a brief summary of coverages. Please refer to the Master Coverage document for actual coverage terms that may apply to any specific situation. Countersigned by: Thursday, December 10, 2009 Authorized Representative Entity ID#: 54513

9 General Liability Schedule Policy Year: 1/1/2010 to 1/1/2011 Fill-in the amount for any item that applies to your district. Mark items that do not apply with a zero. This information is required for rating purposes. * Total Operating Expenses = Operating Expenses - Debt Service - Capital Expenditures Per Occurrence Deductible: Agent: Code Description Unit Amount Effective Date Expiration 60001P Skate Board Parks 60002P Diving Boards 60003P Water Slides Maximum Bond Issued Number of Bond Issues 60015F Administrative Staff 60030F Emt Personnel Volunteers - Not Emt-Total Number of F Paid Fire Fighters - (Not Emt) 60033F Junior Fire Fighters 60034F Boats F Type Pipe Line (Under Storm) Miles S Pipe Line (Sewer / Storm Drainage) Miles 60039W Pipe Line Miles Teachers 60070P Golf Courses Total Operating Expenses -- Any other 74, Total Operating Expense - Park & Recreation Total Operating Expense - Cemetery Total Operating Expense - Soil & Water Conse Total Operating Expense - Vector Total Operating Expense - Hospital / Health Total Operating Expense - Drainage Total Operating Expense - Library Total Operating Expense - Water Control Total Operating Expense - Fire / Ambulance Total Operating Expense - Water Total Operating Expense - Irrigation Total Operating Expense - Sanitation Total Operating Expense - Transit Total Operating Expense - Improvement Total Op. Expense - Sanitation MW Discounted Buildings & Premises - Occupied By District Sqf Home Owner Association Functions Units Board Members - Number of Employees (Full Time /30 hrs wk) Total Payroll W Water Delivered Annually - Millon Of Gallons Gallons P Playground/parks (Area) Acres 60415P Grandstands/Stadiums Vacant Land Acres 60521S Sewage Disposal Plant Operation Payroll Date Thursday, December 10, 2009 Page 1

10 General Liability Schedule Policy Year: 1/1/2010 to 1/1/ W Water District Lakes & Resevoirs F Fire Department Area Served Sq Miles 60671P Number Of Parks Dams - Acre Feet Acre Ft W Spillways - Water Districts Services Contracted Out 56, P Swimming Pools (Receipts) - Park & Rec Receipts Swimming Pools (how Many?) 60946S Sewage Taps 60946W Water Mains or Connections S Sanitation Line Maintenance (Verifiable) 60947W Water Line Maintenance (Verifiable) Landfills Railroad Contractual Extension Per Cont Events/Fundraisers - No Alcohol Served Events/Fundraisers - Alcohol Served Prior Acts-under Prior Policies 0 If your district has other exposures not common to all similar districts and not listed on the General Liability Schedule, such as: (airplanes, staff security people, bridges, day care centers, or boats) please list below. Certain activities may require a separate insurance policy. Description Unit Amount Expiration Date Effective Date Thursday, December 10, 2009 Page 2

11 Property Schedule Policy Year: 1/1/2010 to 1/1/2011 Per Occurrence Deductible: $ Agent: Location Address / Description Construction Class Prot. Valuation Values Class Property Contrib. Quake Contrib. Flood Contrib. Location #: Unique #: 54513P641 Water Storage Tank gal Year Built: 1998 Fire Resistive 9 Replacement Property: $199, Contents: Telluride CO Sq. Feet: # Stories: 1 Term: County: San Miguel 1/1/2010 to 1/1/2011 Ded: $ EDP: Business Inc: $ Location #: Unique #: 54513P640 Water Treatment Plant - Placer Year Built: 1993 Fire Resistive 9 Replacement Property: $213, Contents: Telluride CO Sq. Feet: # Stories: Term: County: San Miguel 1/1/2010 to 1/1/2011 Ded: $ EDP: Business Inc: $ Thursday, December 10, 2009 Page 1

12 Property Schedule Policy Year: 1/1/2010 to 1/1/2011 Per Occurrence Deductible: $ Agent: Location Address / Description Construction Class Prot. Valuation Values Class Location #: Unique #: Property: Year Built: Contents: Sq. Feet: Term: EDP: # Stories: County: Ded: Business Inc: Property Contrib. Quake Contrib. Flood Contrib. Location #: Unique #: Year Built: Sq. Feet: Term: Property: Contents: EDP: # Stories: County: Ded: Business Inc: Totals: Property: $413, $ Contents: EDP: Business Inc: Total Insured Value*: $413, Minimum Property Contribution: $ Construction Class Options Fire Resistive Modified Fire Resistive Masonry Noncombustible Noncombustible Joisted Masonry Frame Valuation Options Actual Cash Value Replacement Cost Protection Class Fire Protection Class is determined by the level of fire protection in your area. Your local fire department should be able to tell you which Protection Class your property is in. *only Business Income in excess of $250,000 per location contributes to the Property TIV Thursday, December 10, 2009 Page 2

13 Policy Period: 1/1/2010 to 1/1/2011 Driver List Last Name First Name Initial License # State Date of Birth No Drivers Thursday, December 10, 2009 Page 1

Expiration Date: 01-Jan-18. The following discounts are applied or available (Not applicable to minimum contributions):

Expiration Date: 01-Jan-18. The following discounts are applied or available (Not applicable to minimum contributions): Entity: Greenwood Village, CO 80111- Invoice #: 30C60707-1323 Coverage: General Liability Auto Liability Non-Owned / Hired Auto Liability Auto Physical Damage Hired Auto Physical Damage Excess Liability