HomeMy WebLinkAboutR-2016-020 Cowell Insurance Annual Premium Renewal RESOLUTION NO. R-2016-020
A RESOLUTION AUTHORIZING THE PURCHASE OF PROPERTY AND EQUIPMENT
INSURANCE FROM COWELL INSURANCE GROUP INC FOR THE ANNUAL PREMIUM
RENEWAL IN AN AMOUNT NOT TO EXCEED $58,314.00
WHEREAS, the City of Riverside has a need for commercial property and equipment floater
insurance; and
WHEREAS, the City of Riverside in the adoption of its purchasing policy requires all
expenditures in excess of $10,000 to be presented to the Board of Aldermen for approval and the
City's insurance carrier for commercial property and equipment floater insurance has presented an
invoice in the amount of $58,314.00 for annual renewal of such insurance coverage; and
WHEREAS, funds for such purpose were budgeted in the Fiscal Year 2015-2016 budget;
and
WHEREAS, the Board of Aldermen find it is in the best interest of the citizens of the City of
Riverside to authorize acquisition and renewal of such insurance coverage and approve the
payment to Cowell Insurance Group, Inc. for commercial property and equipment floater insurance
coverage for the City of Riverside, in an amount not to exceed $58,314.00.
NOW THEREFORE, BE IT RESOLVED BY THE BOARD OF ALDERMEN OF THE CITY
OF RIVERSIDE, MISSOURI, AS FOLLOWS:
THAT, the acquisition and renewal of such insurance coverage and payment to Cowell
Insurance Group, Inc. for commercial property and equipment floater insurance coverage for the
City of Riverside, in an amount not to exceed $58,314.00 is hereby authorized and approved; and
FURTHER THAT the Mayor, City Administrator, or either of their designees, are hereby
authorized to execute all documents necessary or incidental to this transaction and the City Clerk is
authorized to attest thereto.
PASSED AND ADOPTED by the Board of Aldermen and APPROVED by the Mayor of
the City of Riverside, Missouri, the 7th day of June, 2016.
Mayor Kathleen L. Rose
ATTEST:
Robin Kincaid, City Clerk
STATEMENT
Cowell Insurance Group Inc.
10525 N Ambassador Drive City of Riverside
6'1Suite 301 Customer
569
Kansas City, MO 64153 Date 05/13/2016
(816)587-4419
Customer Christian Fuller
Service Janet Pittenger
Page 1 of 1
Payment Information
Statement Total 58,314.00
City of Riverside Payment Amount
2950 NW Vivion Road
Riverside,MO 64150 Payment For:
II .uil.
qJ.... Please detach and return with payment
J�
Customer:City of Riverside
Transaction.
Invoice Date • Description Amount Sub-Total
Policy#1X7552617 05/29/2016-05/29/2017
Employers Mutual Companies
77066 05/09/2016 Effective:05129/2016
Commercial Property-Renew policy 53,350.00
Inland Marine -Renew policy 14,305.00
Invoice Balance 67,655.00
77179 05/13/2016 Effective:05/29/2016
Commercial Property-Renew policy -9,341.00
Invoice Balance -9,341.00
I
♦4• �g'/ii . 1.4 ter
Co i►y,001) • (A.
Statement
Total
58,314.00
Thank you
Less than 0 0 to 30 Days 31 to 60 Days 61 to 90 Days Over 90 Days
58,314.00 0.00 0.0D 0.00 0.00
Cowell Insurance Group Inc. (816)587.4419 Date
10525 N Ambassador Drive Suite 301
Kansas City,City,MO 64153 05/13/2016
/EMC,
INSURANCE
EMC Insurance Companies -411c -
PO Box 25470
Overland Park, KS 66225-5470
www.emcins.com
Cowell Insurance Group Inc.
10525 N Ambassador Dr Site 301
Kansas City, MO 64153-1284
816-587-449
CITY OF RIVERSIDE
2950 NW VIVION RD
RIVERSIDE, MO 64150-1502
05/29/2016 to 05/29/2017
Prepared on 05/11/2016
Quote Valid Through 06/24/2016
Account Summary
Quote Account Number: X476091
Prior Account Number 1X75526
Commercial Output (B-05) $ 44,009.00
Commercial Inland Marine (C-01) $ 14.305.00
Total Account Premium Estimate $ 58,314.00
This is a proposal from EMC Insurance Companies. We offer personalized service through your
independent insurance agent, customizable insurance products to meet your unique needs and
expert safety resources to help your business prevent claims.
The premium estimate reflects the rates as of the date shown above and assumes the information
provided to EMC is accurate.*
Please review the following pages for coverage details. For more information on the advantages of
insuring your business with EMC, talk to your insurance agent or visit www.emcins.com.
Thank you,
Cowell Insurance Group, Inc.
*This proposal does not guarantee the policy will be accepted or that coverage will be provided in the company
selected or at the premium quoted. Due to periodic rate changes, a change to the policy's effective date may
result in a different premium.
Prepared for: CITY OF RIVERSIDE 0071600 LS 1 of 24
/EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
QUOTATION — COMMERCIAL OUTPUT PROGRAM
QUOTATION IS VALID: FROM 05/10/16 TO 06/24/16
PROPOSED POLICY PERIOD: FROM 05/29/16 TO 05/29/17
PREPARED FOR: PRESENTED B Y:
CITY OF RIVERSIDE COWELL INSURANCE GROUP, INC.
2950 NW VIVION RD 10525 N AMBASSADOR DR STE 301
RIVERSIDE MO 64150-1502 KANSAS CITY MO 64153-1284
AGENT: AK 7486
AGENCY BILL AGENT PHONE: (816) 587-4419
INSURED IS: CITY BUSINESS DESC: MUNICIPALITY
POLICYWIDE INFORMATION
PREMIUM
NON—REPORTING FORM PREMIUM $ 44, 009.00
PROPERTY PREMIUM $ 44, 009.00
TOTAL PROPERTY PREMIUM $ 44, 009.00
AS QUOTED ON: 05/10/16 (BPP)
Prepared for CITY OF RIVERSIDE 007/600 LS 2 of 24
/EMC.
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
CITY OF RIVERSIDE EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT POLICY
QUOTE
ENDORSEMENT SCHEDULE
EDITION
FORM DATE DESCRIPTION/ADDITIONAL INFORMATION PREMIUM
CL0100 03-99 COMMON POLICY CONDITIONS
CL0167 05-05 GUARANTY FUND COV LIMITATIONS - MO
*CL0600 01-15 CERTIFIED TERRORISM LOSS
CL0700 10-06 VIRUS OR BACTERIA EXCLUSION
C00323 09-13 AMENDATORY ENDORSEMENT MISSOURI
CO1000 10-02 COP - PROPERTY COVERAGE PART
C01080 11-03 LIMITED FUNGUS AND RELATED PERILS
BLANKET LIMIT
PROPERTY COVERAGE
$ 15, 000
*CO1092
CO1227
07-13 POLLUTANT - AMENDED DEFINITION
05-02 SCHEDULED LOCATIONS ENDORSEMENT
CO1238 04-02 PROTECTIVE DEVICES ENDORSEMENT
C01293 11-03 LIMITED FUNGUS & RELATED PERILS COV
C07115 03-07 PERISHABLE STOCK EXCLUSION AMENDMENT
CP7011A 05-07 COMMERCL OUTPUT PROGRAM DECLARATIONS
*CP7012A 05-07 CO2 ADDITIONAL/SUPPLEMENTAL COVERAGE
*CP7013A 05-07 COMMERCIAL OUTPUT PROGRAM SCHEDULE
IL7004 12-12 MUTUAL POLICY PROVISIONS
*IL7131A 04-01 COMM'L POLICY ENDORSEMENT SCHEDULE
IL8383.2A 01-15 DISCL PURSUANT TERRSM RISK INS. ACT $ 863
IL8384A 01-08 TERRORISM NOTICE
*IL8720 03-14 POLICYHOLDER NOTICE
AS QUOTED ON: 05/10/16
Prepared for:CITY OF RIVERSIDE 007/600 LS 3 of 24
/EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
CITY OF RIVERSIDE EFF DATE: 05/29/16 EXP DATE: 05/29/17
TERRORISM NOTICE
This insurance may include coverage for certified acts of terrorism
as defined in the Terrorism Risk Insurance Act, as amended.
Attached you will find a disclosure, which identifies the specific
charge for certified acts of terrorism.
YOU MAY HAVE THE OPTION TO REJECT THIS TERRORISM COVERAGE
For additional information, please contact your agent
AS QUOTED ON: 05/10/16
Prepared for: CITY OF RIVERSIDE 007!600 LS 4 of 24
MEMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
CITY OF RIVERSIDE EFF DATE: 05/29/16 EXP DATE: 05/29/17
THIS DISCLOSURE IS ATTACHED TO YOUR POLICY IN RESPONSE TO THE DISCLOSURE
REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS DISLOSURE DOES
NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE
UNDER THE POLICY.
DISCLOSURE PURSUANT T
TERRORISM RISK INSURANCE ACT
SCHEDULE
Terrorism Premium (Certified Acts) $863.00
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 terrorism acts
certified under the Terrorism Risk Insurance Act. The portion of
your premium attributable to such coverage is shown in the Schedule
of this disclosure 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 under the federal program. For
losses occurring in 2015, the federal share equals 85% of that portion
of the amount of such insured losses that exceeds the applicable insurer
retention. Beginning on January 1, 2016, the federal share will
decrease by one percentage point per calendar year until equal to 80% of
that portion of the amount of 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 calendar year, 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 calendar
year 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.
The following statement is required to be part of the disclosure notice
in MISSOURI:
The premium above is for certain losses resulting from certified acts of
terrorism as covered pursuant to coverage provisions, limitations and
exclusions in this policy. You should read the definition in your policy
carefully, but generally speaking, "certified" acts of terrorism are
acts that exceed $5 million in aggregate losses to the insurance
industry and which are subsequently declared by the U.S. Secretary of
the Treasury as a certified terrorist act under the Terrorism Risk
Insurance Act. Some losses resulting from certified acts of terrorism
are not covered. Read your policy and endorsements carefully.
AS QUOTED ON: 05/10/16
Prepared for:CITY OF RIVERSIDE 007/600 LS 5 of 24
/EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
SCHEDULE OF COVERAGES
COMMERCIAL OUTPUT PROGRAM
PROPERTY COVERAGE PART
Refer to Scheduled Locations
COVERAGE EXTENSIONS LIMIT
Consequential Loss See Form
Debris Removal, Additional Expense $ 50,000
Emergency Removal 365 Days
Emergency Removal Expense $ 5, 000
Fraud and Deceit $ 5,000
Damage From Theft See Form
Off Premises Utility Service Interruption $ 50, 000
SUPPLEMENTAL COVERAGES
Brands or Labels Expense $ 50, 000
Expediting Expenses $ 50, 000
Fire Department Service Charges $ 25, 000
Inventory and Appraisal Expense $ 50,000
Ordinance or Law (Undamaged Parts of a Building) See Form
Ordinance or Law (Increased Cost to Repair/ $ 100, 000
Cost to Demolish and Clear Site)
P
Personal Effects $ 15, 000
Pollutant Cleanup And Removal $ 50,000
Recharge of Fire Extinguishing Equipment $ 50, 000
Rewards $ 10,000
Sewer Backup and Water Below the Surface $ 25, 000
Trees, Shrubs, and Plants $ 50, 000
Underground Pipes, Pilings, Bridges, and Roadways $ 250, 000
AS QUOTED ON: 05/10/16 (BPP)
Prepared for CITY OF RIVERSIDE 007/600 LS 6 of 24
MEMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
SCHEDULE OF COVERAGES
COMMERCIAL OUTPUT PROGRAM
PROPERTY COVERAGE PART
Refer to Scheduled Locations
SUPPLEMENTAL MARINE COVERAGES LIMIT
Accounts Receivable $ 50, 000
Electrical or Magnetic Disturbance of Computers See Form
Power Supply Disturbance of Computers See Form
Virus and Hacking Coverage
Limit any one occurrence $ 25, 000
Limit any 12 month period $ 50, 000
Fine Arts $ 100, 000
Off Premises Computers $ 25, 000
Property On Exhibition $ 50, 000
Property In Transit $ 50, 000
Sales Representative Samples $ 50, 000
Software Storage $ 50,000
Valuable Papers $ 100,000
ADDITIONAL PROPERTY SUBJECT TO LIMITATIONS
Furs (theft) $ 10, 000
Jewelry (theft) $ 10,000
Stamps, Tickets, Letters of Credit $ 5, 000
SCHEDULED LOCATIONS
Newly Built or Acquired Buildings $ 500, 000
Personal Property - Acquired Locations $ 250,000
Locations "You" Elect Not To Describe $ 50,000
AS QUOTED ON: 05/10/16 (BPP)
Prepared for:CITY OF RIVERSIDE 007/600 LS 7 of 24
/EMC,
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT PROGRAM SCHEDULE
COVERAGE PROVIDED APPLIES ONLY AS INDICATED BY AN ENTRY BELOW:
LOC: 001 4498 NW HIGH DR DESCRIPTION: 1 STORY NONCOMB BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: COMMUNITY CENTER/BLDG W/
64150-9578 POOL
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING ! $ 2, 817, 612 ! 80%! !Replacement Cost
02!PERSONAL PROPERTY OF ! $ 167, 000! 80% ! !Replacement Cost
! INSUREDS BUSINESS ! ! ! !
LOC: 002 4200 NW RIVERSIDE ST DESCRIPTION: 1 STORY NONCOMB BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: PUBLIC WORKS-OFFICE W/3
64150-9672 BAY GARAGES
Deductible Per Occurrence On All Covered Causes of Loss $ 5,000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING ! $ 647,040! 80% ! !Replacement Cost
02! PERSONAL PROPERTY OF !$ 135, 000 ! 80% ! !Replacement Cost
! INSUREDS BUSINESS ! ! ! !
03!BUILDING !$ 185,950! 80% ! !Replacement Cost
!MACHINE SHED ! ! ! !
04 !BUILDING ! $ 68,789! 80% ! !Replacement Cost
!MACHINE SHED ! ! ! !
05!BUSINESS PERSONAL !$ 73, 000! 80%! !Replacement Cost
!PROPERTY OF INSUREDS ! ! ! 1
!BUSINESS-SHED ITEM 03 ! ! ! !
06!BUSINESS PERSONAL !$ 23, 000! 80% ! !Replacement Cost
!PROPERTY OF INSUREDS ! ! ! !
!BUSINESS-SHED ITEM 04 ! ! ! !
07 !BUILDING ! $ 51, 809! 80% ! !Replacement Cost
!STORAGE CANOPY ! ! ! !
08 !BUILDING ! $ 75,217 ! 80% ! !Replacement Cost
!STORAGE CANOPY ! ! ! !
AS QUOTED ON: 05/10/16 (BPP)
Prepared for: CITY OF RIVERSIDE 007/600 LS 8 of 24
/EMC.
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT PROGRAM SCHEDULE
COVERAGE PROVIDED APPLIES ONLY AS INDICATED BY AN ENTRY BELOW:
LOC: 003 1001 ARGOSY PKWY DESCRIPTION: 1 STORY NONCOMB BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: AMPHITHEATER BUILDING
64168
LOC DESCRIPTION: E.H YOUNG PARK
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING !$ 211, 171! 80%! !Replacement Cost
02 !BUILDING ! $ 204, 867 ! 80% ! !Replacement Cost
!RESTROOM BUILDING ! ! ! !
03!BUSINESS PERSONAL !$ 3,000! 80% ! !Replacement Cost
!PROPERTY OF INSUREDS ! ! ! !
!BUSINESS ! ! ! !
04 !BUILDING !$ 97,706! 80% ! !Replacement Cost
!SHELTER HOUSE ! ! ! !
05 !BUILDING !$ 95,790! 80% ! !Replacement Cost
!SHELTER HOUSE ! ! ! !
06!BUILDING ! $ 172,010! 80% ! !Replacement Cost
!ROCK BELL TOWER ! ! ! !
07!BUSINESS PERSONAL !$ 4,000 ! 80% ! !Replacement Cost
!PROPERTY OF SHELTER ! ! ! !
!HOUSE ! ! ! !
08!BUSINESS PERSONAL ! $ 4, 000! 80% ! !Replacement Cost
! PROPERTY OF SHELTER ! ! ! !
!HOUSE ! ! ! !
09!BUILDING ! $ 27, 030! 80%! !Replacement Cost
!MESA SHELTER HOUSE ! ! ! !
10!BUILDING ! $ 26,265 ! 80% ! !Replacement Cost
!SHELTER HOUSE ! ! ! !
11!BUILDING !$ 70, 002 ! 80%! !Replacement Cost
!PLAYGROUND EQUIPMENT ! ! ! !
AS QUOTED ON: 05/10/16 (BPP)
Prepared for:CITY OF RIVERSIDE 007/600 LS 9 of 24
/EMC,
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT P R O G RAM SCHEDULE
COVERAGE PROVIDED APPLIES ONLY AS INDICATED BY AN ENTRY BELOW:
LOC: 004 2950-2990 NW VIVION RD DESCRIPTION: 1 STORY FRAME BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: CITY HALL
64150-1502
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING !$ 12,203,026! 80% ! !Replacement Cost
02! PERSONAL PROPERTY OF !$ 1, 481, 000! 80% ! !Replacement Cost
! INSURED`S BUSINESS ! ! ! !
LOC: 005 2901 NW VIVION RD DESCRIPTION: 1 STORY FRAME BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: SHELTER HOUSE AND
64150 RESTROOM
LOC DESCRIPTION: RENNER BRENNER PARK
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01 !BUILDING !$ 29,580! 80% ! !Replacement Cost
!SHELTER HOUSE ! ! ! !
02 !BUILDING !$ 43,000! 80% ! !Replacement Cost
!RESTROOM ! ! ! !
03!BUILDING !$ 25, 000! 80% ! !Replacement Cost
! PICNIC SHELTER CANOPY ! ! ! !
! !
!RENNER BRENNER PARK ! !
04 !BUILDING !$ 73,528 ! 80% ! !Replacement Cost
!PLAYGROUND EQUIPMENT ! ! ! !
!RENNER BRENNER PARK ! ! ! !
AS QUOTED ON: 05/10/16 (BPP)
Prepared for: CITY OF RIVERSIDE 007/600 LS 10 of 24
/EMC,
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT PROGRAM SCHEDULE
COVERAGE PROVIDED APPLIES ONLY AS INDICATED BY AN ENTRY BELOW:
LOC: 006 4500 NW GATEWAY AVE DESCRIPTION: 1 STORY JSTD MAS BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: CLOCK TOWER
64150-9721
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01 !BUILDING !$ 1, 386,792 ! 80% ! !Replacement Cost
LOC: 007 4100-4102 NW RIVERSIDE DR DESCRIPTION: 1 STORY NONCOMB BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: OFFICE/STORAGE
64150
LOC DESCRIPTION: KITTERMAN BUILDING
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING ! $ 803,709! 80% ! !Replacement Cost
02 !BUSINESS PERSONAL ! $ 100,000 ! 80% ! !Replacement Cost
! PROPERTY OF INSURED' S ! ! ! !
!BUSINESS ! ! ! !
LOC: 008 4500 NW HIGH DR DESCRIPTION: 1 STORY MAS NONCOM BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: MUNICIPAL BUILDING 3 BAY
64150-9534 GARAGE STORAGE
PROTECTIVE DEVICES: P-1 AUTOMATIC SPRINKLER SYSTEM, SEE FORM 001238
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING !$ 803,709! 80% ! !Replacement Cost
AS QUOTED ON: 05/10/16 (BPP)
Prepared for: CITY OF RIVERSIDE 0071600 LS 11 &24
/EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT PROGRAM SCHEDULE
COVERAGE PROVIDED APPLIES ONLY AS INDICATED BY AN ENTRY BELOW:
02 !BUSINESS PERSONAL ! $ 250, 000 ! 80% ! !Replacement Cost
! PROPERTY OF INSURED'S ! ! !
!BUSINESS ! ! ! !
LOC: 009 4900 NW GATEWAY AVE DESCRIPTION: 1 STORY NONCOMB BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: UNITED STATES POST OFFICE
64150-3640
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01 !BUILDING !$ 3, 000, 000! 80% ! !Replacement Cost
LOC: 010 RIVERWAY BLVD AT NW PLATTE DR DESCRIPTION: 1 STORY FRAME BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: TRAFFIC SIGNALS/SIGNAL
64150 SYSTEM
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
O1!BUILDING !$ 212, 180! 80% ! !Replacement Cost
LOC: 011 INTERSECTION OF VIVION RD DESCRIPTION: 1 STORY FRAME BLDG
AND NW GATEWAY AVE NW IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: TRAFFIC SIGNALS/SIGNAL
64150 SYSTEM
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING !$ 265,740 ! 80% ! !Replacement Cost
AS QUOTED ON: 05/10/16 (BPP)
Prepared for:CITY OF RIVERSIDE 0071600 LS 12 of 24
/EMC.
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT P R O G RAM SCHEDULE
COVERAGE PROVIDED APPLIES ONLY AS INDICATED BY AN ENTRY BELOW:
LOC: 012 HOMESTEAD PARK AT CORNER OF DESCRIPTION: 1 STORY FRAME BLDG
HOMESTEAD ROAD& HOMESTEAD TERR IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: PLAYGROUND EQUIPMENT
64150
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01 !BUILDING !$ 30,001 ! 80% ! !Replacement Cost
LOC: 013 4055 NW 41ST STREET DESCRIPTION: 1 STORY FRAME BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: LIFT STATION
64150
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING !$ 6,275,861 ! 80% ! !Replacement Cost
LOC: 014 5025 NW CANAL STREET DESCRIPTION: 1 STORY FRAME BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: OBELISK STRUCTURE AND
64150-7201 SIGNS
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING ! $ 236, 900! 80% ! !Replacement Cost
AS QUOTED ON: 05/10/16 (BPP)
Prepared for:CITY OF RIVERSIDE 007/600 LS 13 of 24
/EMC.
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: B476091-05
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL OUTPUT P R O G RAM SCHEDULE
COVERAGE PROVIDED APPLIES ONLY AS INDICATED BY AN ENTRY BELOW:
LOC: 015 NORTH WOODLAND AND LINEAR DESCRIPTION: 1 STORY FRAME BLDG
TRAIL IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: CROSSWALK SIGNALS
64150
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01 !BUILDING !$ 37, 080! 80% ! !Replacement Cost
LOC: 016 ARGOSY PARKWAY AT SNOWDEN DESCRIPTION: 1 STORY FRAME BLDG
IN PROTECTION CLASS 03
RIVERSIDE, MO OCCUPANCY: CROSSWALK SIGNAL
64150
Deductible Per Occurrence On All Covered Causes of Loss $ 5, 000.
Covered Property/ Limit Of COIN Specl Optional/Additional
Item Coverage Provided Insurance % Intrst Coverages
01!BUILDING ! $ 37, 080! 80% ! !Replacement Cost
AS QUOTED ON: 05/10/16 (BPP)
Prepared for.CITY OF RIVERSIDE 007/600 LS 14 of 24
/EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: C476091-01
QUOTATION — COMMERCIAL INLAND MARINE
QUOTATION IS VALID: FROM 03/18/16 TO 04/29/16
PROPOSED POLICY PERIOD: FROM 05/29/16 TO 05/29/17
PREPARED F O R : PRESENTED BY :
CITY OF RIVERSIDE COWELL INSURANCE GROUP, INC.
2950 NW VIVION RD 10525 N AMBASSADOR DR STE 301
RIVERSIDE MO 64150-1502 KANSAS CITY MO 64153-1284
AGENT: AK 7486
AGENCY BILL AGENT PHONE: 816-587-4419
INSURED IS: CITY BUSINESS DESC: MUNICIPALITY
SEE ATTACHED SCHEDULE FOR LIMITS AND DESCRIPTION OF COVERAGES
COVERAGES HEADINGS PREMIUM
CONTRACTORS EQUIPMENT $ 13,444.00
ELECTRONIC DATA PROCESSING $ 761.00
*WATERCRAFT COVERAGE $ 100.00
TOTAL INLAND MARINE PREMIUM $ 14,305.00
A DEDUCTIBLE MAY APPLY FOR THE COVERAGE PROVIDED. IN THE EVENT A LOSS
(OTHER THAN EARTHQUAKE) INVOLVES COVERED PROPERTY AT MORE THAN ONE
LOCATION OR IN MORE THAN ONE CLASS, ONLY ONE DEDUCTIBLE, THE LARGEST
DEDUCTIBLE SHOWN ON THE SCHEDULE FOR THE LOCATION OR CLASSES INVOLVED
IN THE LOSS, WILL APPLY PER OCCURRENCE.
AS QUOTED ON: 03/18/16 (BPP)
Prepared for:CITY OF RIVERSIDE 007/600 LS 15 of 24
/EMC,
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: C476091-01
CITY OF RIVERSIDE EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMML INLAND MARINE POLICY
QUOTE
ENDORSEMENT SCHEDULE
EDITION
FORM DATE DESCRIPTION/ADDITIONAL INFORMATION PREMIUM
CLO100 03-99 COMMON POLICY CONDITIONS
CL0167 05-05 GUARANTY FUND COV LIMITATIONS - MO
CL0170 09-13 AMENDATORY ENDORSEMENT MISSOURI
*CL0600 01-15 CERTIFIED TERRORISM LOSS
CL0700 10-06 VIRUS OR BACTERIA EXCLUSION
CM0001 09-04 COMM. INLAND MARINE CONDITIONS
CM0118 11-13 MISSOURI CHANGES
*CM7001A 09-97 COMMERCIAL INLAND MARINE SCHEDULE
CM7002 09-00 QUICK REFERENCE
CM7004 09-06 QUICK REFERENCE
CM7021 11-01 LOSS PAYABLE ENDORSEMENT
CM7481 06-97 WATERCRAFT COVERAGE FORM
CM7482 06-97 WATERCRAFT LAYUP ENDORSEMENT
CM7497 10-08 AMENDATORY ENDORSEMENT - MISSOURI
IL0274 02-13 MO CHANGES - CANCELLATION/NONRENEWAL
*IL0952 01-15 CAP/LOSSES/CERTIFD ACTS OF TERRORISM
*IL7131A 04-01 COMM'L POLICY ENDORSEMENT SCHEDULE
IL7306 08-98 EXCLUSION OF CERTAIN COMPUTER LOSSES
IL8383.2A
IM2051
01-15 DISCL PURSUANT TERRSM RISK INS. ACT WAIVED
09-13 AMENDATORY ENDORSEMENT - MISSOURI
*IM2250 07-13 POLLUTANT - AMENDED DEFINITION
IM7000 04-04 CONTRACTOR'S EQUIPMENT COVERAGE
IM7200 10-02 EDP EQUIPMENT COVERAGE - SCHEDULED
IM7238 10-02 EARTHQUAKE, FLOOD AND SEWER BACKUP
AS QUOTED ON: 03/18/16
Prepared for.CITY OF RIVERSIDE 007/600 LS 16 of 24
EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NUMBER: C476091-01
CITY OF RIVERSIDE EFF DATE: 05/29/16 EXP DATE: 05/29/17
THIS DISCLOSURE IS ATTACHED TO YOUR POLICY IN RESPONSE TO THE DISCLOSURE
REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS DISLOSURE DOES
NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE
UNDER THE POLICY.
DISCLOSURE PURSUANT T
TERRORISM RISK INSURANCE ACT
SCHEDULE
Terrorism Premium (Certified Acts) Waived
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 terrorism acts
certified under the Terrorism Risk Insurance Act. The portion of
your premium attributable to such coverage is shown in the Schedule
of this disclosure 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 under the federal program. For
losses occurring in 2015, the federal share equals 85% of that portion
of the amount of such insured losses that exceeds the applicable insurer
retention. Beginning on January 1, 2016, the federal share will
decrease by one percentage point per calendar year until equal to 80% of
that portion of the amount of 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 calendar year, 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 calendar
year 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.
The following statement is required to be part of the disclosure notice
in MISSOURI:
The premium above is for certain losses resulting from certified acts of
terrorism as covered pursuant to coverage provisions, limitations and
exclusions in this policy. You should read the definition in your policy
carefully, but generally speaking, "certified" acts of terrorism are
acts that exceed $5 million in aggregate losses to the insurance
industry and which are subsequently declared by the U.S. Secretary of
the Treasury as a certified terrorist act under the Terrorism Risk
Insurance Act. Some losses resulting from certified acts of terrorism
are not covered. Read your policy and endorsements carefully.
AS QUOTED ON: 03/18/16
Prepared for:CITY OF RIVERSIDE 007/600 LS 17 of 24
/EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NO: C476091-01
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL INLAND MARINE SCHEDULE
POLICYWIDE COVERAGES
CLASS/ITEM DESCRIPTION *SPEC INTEREST LIMITS
CONTRACTORS EQUIPMENT
801 CONTRACTORS EQUIPMENT
$ 1000 DEDUCTIBLE APPLIES PER OCCURRENCE TO THE FOLLOWING ITEMS
100% COINSURANCE
$ 3, 140, 691 CATASTROPHE LIMIT - THE MOST "WE" PAY FOR LOSS IN ANY ONE
OCCURRENCE
COVERAGE EXTENSIONS
ADDITIONAL DEBRIS REMOVAL EXPENSES $ 5,000
SUPPLEMENTAL COVERAGES
EMPLOYEE TOOLS (ACTUAL CASH VALUE) $ 5, 000
NEWLY PURCHASED EQUIPMENT
PERCENTAGE OF CATASTROPHE LIMIT 30%
POLLUTANT CLEANUP AND REMOVAL $ 25, 000
RENTAL REIMBURSEMENT LIMIT $ 5,000
WAITING PERIOD 72 HRS
SPARE PARTS AND FUEL $ 5,000
ACTUAL CASH VALUE
001 FIRE FIGHTING EQUIPMENT ON TRUCKS (4) $ 450, 000
ACTUAL CASH VALUE
002 STANDBY GENERATOR $ 17, 665
ACTUAL CASH VALUE
003 MOBILE RADIO EQUIPMENT $ 540,000
ACTUAL CASH VALUE
004 PARK CAMERA SYSTEM, MOTOROLA $ 300, 000
ACTUAL CASH VALUE
005 ACCESS CONTROL & VIDEO SYSTEM, GOVT $ 310, 000
COMPLEX
ACTUAL CASH VALUE
006 IN CAR VIDEO SYSTEM $ 125, 000
ACTUAL CASH VALUE
007 NEW HOLLAND TRACTOR $ 27, 000
ACTUAL CASH VALUE
AS QUOTED ON: 03/18/16 (BPP)
Prepared for:CITY OF RIVERSIDE 0071600 LS 180424
EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NO: C476091-01
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL INLAND MARINE SCHEDULE
008 STANDBY GENERATOR $ 17, 665
ACTUAL CASH VALUE
009 PLAYGROUND EQUIPMENT $ 5, 500
ACTUAL CASH VALUE
010 MONUMENT (RENNER VILLAGE SITE) $ 4, 500
ACTUAL CASH VALUE
011 2010 BOBCAT UTV 4-SEATER 3400 XL $ 17, 015
SN AJNV11095
ACTUAL CASH VALUE
012 MISCELLANEOUS UNSCHEDULED POLICE $ 250, 000
DEPARTMENT EQUIPMENT
ACTUAL CASH VALUE
013 MISCELLANEOUS UNSCHEDULED FIRE $ 310,500
DEPARTMENT EQUIPMENT
ACTUAL CASH VALUE
014 MISCELLANEOUS UNSCHEDULED PUBLIC WORKS $ 560,000
EQUIPMENT
ACTUAL CASH VALUE
015 2 SPEED TRAILERS MDL KUSTOM SIGNAL-PS $ 24,000
@ $12, 000 EACH
ACTUAL CASH VALUE
016 BC MODEL 5750,A91, SJC 02 $ 46, 620
SN ATDZ14416
INCL BC MODEL 80 C/I TOOTH BUCKET
SN 1093376
BC MODEL 80 C/I SMOOTH BUCKET
SN 1093377
ACTUAL CASH VALUE
017 BC E-35, A91 ANGLE BLADE, RAIDO 02 $ 46, 371
SN AR 1K11364
DB 24 SD BUCKET, SN 1093807
ACTUAL CASH VALUE
018 BOBCAT E35 EXCAVATOR SERIAL NO. ARK12227 02 $ 46,288
W/EXTENDABLE ARM, 24 IN X-CHANGE
STANDARD DUTY BUCKET WITH WELD-ON TEETH
SERIAL NO. 1101228
ACTUAL CASH VALUE
019 BOBCAT S650 SKID-STEER LOADER 02 $ 42,567
SERIAL NO. ALJ816074 W/ 74 IN C/1 BUCKET
AS QUOTED ON: 03/18/16 (BPP)
Prepared for:CITY OF RIVERSIDE 007/600 LS 19 of 24
/EMC.
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NO: C476091-01
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL INLAND MARINE SCHEDULE
W/ BOLT-ON TEETH SERIAL NO. 11060406
AND 74 IN C/1 BUCKET W/CUTTING EDGE
SERIAL NO. 1106407
PREMIUM $ 13, 444
840 CONTR. EQUIP. - LEASED OR RENTED FROM OTHERS
LIMITS OF INSURANCE
THE MOST "WE" PAY FOR LOSS TO ANY ONE ITEM $ 25, 000
THE MOST "WE" PAY FOR LOSS IN ANY ONE $ 25, 000
OCCURRENCE
ACTUAL CASH VALUE
DEDUCTIBLE $ 1000
NON-REPORTING FORM PREMIUM INCLUDED
LOSS PAYEE(S) APPLY TO THIS COVERAGE:
COLEMAN EQUIPMENT, INC.
LOCATION: 001 2950 NW VIVION RD
RIVERSIDE, MO 64150-1502
SPECIAL*
CLASS DESCRIPTION INTEREST LIMITS
DATA PROCESSING:
$ 1, 000 DEDUCTIBLE APPLIES TO ALL COVERED PERILS
UNLESS A DIFFERENT DEDUCTIBLE IS INDICATED BELOW
$ 5,000 DEDUCTIBLE - EARTHQUAKE AND VOLCANIC ERUPTION
NOT COVERED DEDUCTIBLE - "FLOOD"
$ 1,000 DEDUCTIBLE - "MECHANICAL BREAKDOWN", "ELECTRICAL
DISTURBANCE" AND "POWER SUPPLY DISTURBANCE"
100% COINSURANCE
AS QUOTED ON: 03/18/16 (BPP)
Prepared for:CITY OF RIVERSIDE 007/600 LS 20 of 24
a
/EMC,
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NO: C476091-01
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL INLAND MARINE SCHEDULE
$ 145,000 EARTHQUAKE "AGGREGATE" LIMIT
$ 145,000 EARTHQUAKE "OCCURRENCE" LIMIT
$ 145, 000 EARTHQUAKE "CATASTROPHE" LIMIT
NOT COVERED FLOOD "AGGREGATE" LIMIT
NOT COVERED FLOOD "OCCURRENCE" LIMIT
NOT COVERED FLOOD "CATASTROPHE" LIMIT
$ 145,000 SEWER BACKUP "AGGREGATE" LIMIT
$ 145,000 SEWER BACKUP "OCCURRENCE" LIMIT
$ 145,000 SEWER BACKUP "CATASTROPHE" LIMIT
848 ELECTRONIC DATA PROCESSING - SCHEDULED LIMITS
COVERAGE LIMITS
$ 129,750 "HARDWARE"
$ 15,250 SOFTWARE
INCLUDED "MEDIA"
INCLUDED "PROGRAMS AND APPLICATIONS"
INCLUDED "DATA RECORDS"
INCLUDED "PROPRIETARY PROGRAMS"
NOT COVERED Income Coverage
1 EQUIPMENT COVERAGE EXTENSIONS
Additional Debris Removal Expenses $ 10, 000
ELECTRICAL AND POWER SUPPLY DISTURBANCE COVERED
Emergency Removal (Number of DAYS) 365
Emergency Removal Expenses $ 2,500
Fraud and Deceit $ 2, 500
MECHANICAL BREAKDOWN COVERAGE COVERED
EQUIPMENT SUPPLEMENTAL COVERAGES
Acquired Locations $ 500, 000
Earthquake Coverage COVERED
Flood Coverage NOT COVERED
NEWLY PURCHASED OR LEASED HARDWARE $ 500, 000
Off-Site Computers $ 5, 000
Pollutant Cleanup and Removal $ 10, 000
Property in Transit $ 10, 000
Protection and Control Systems $ 10, 000
RECHARGE OF FIRE EXTINGUISHING EQUIPMENT $ 15, 000
Reproduction Equipment $ 10,000
Sewer Backup COVERED
REWARDS $ 2,500
Software Storage $ 50, 000
Telecommunications Equipment $ 10, 000
Virus and Hacking
Limit any one occurrence $ 25, 000
Limit each separate 12 month period $ 75, 000
FOREIGN TRANSIT AND LOCATION LIMIT NOT COVERED
AS QUOTED ON: 03/18/16 (BPP)
Prepared for:CITY OF RIVERSIDE 0071600 LS 21 of 24
/EMC
INSURANCE
EMPLOYERS MUTUAL CASUALTY COMPANY QUOTE NO: C476091-01
RIVERSIDE CITY OF EFF DATE: 05/29/16 EXP DATE: 05/29/17
COMMERCIAL INLAND MARINE SCHEDULE
PREMIUM $ 761
WATERCRAFT COVERAGE
182 INBOARD, INBOARD/OUTBOARD, PERSONAL WATERCRAFT
001 LENGTH: 14 FT. HORSEPOWER: 20
2012 SATURN RUBBER BOAT SD-430 WITH $ 4, 600
2012 MERCURY 20HP OUTBOARD MOTOR
MDL 1F20301HK
SN 08469619
NAV. PERIOD: FROM 01/01 TO 12/31
(INLAND WATERS)
DEDUCTIBLE: $ 500
PREMIUM $ 100
*SPECIAL INTERESTS
SPEC.*
INT. NO. LOSS PAYEE — LOSS PAYABLE
01 LOSS, IF ANY, WILL BE ADJUSTED WITH THE NAMED INSURED AND
COLEMAN EQUIPMENT INC.
RE: LEASED/RENTED EQUIPT.
PO BOX 456
BONNER SPRINGS, KS 66012-0456
SPEC.*
INT. NO. LOSS PAYEE — LOSS PAYABLE
02 LOSS, IF ANY, WILL BE ADJUSTED WITH THE NAMED INSURED AND
KANSAS STATE BANK
PO BOX 69
MANHATTAN, KS 66505-0069
AS QUOTED ON: 03/18/16 (BPP)
Prepared for:CITY OF RIVERSIDE 007/600 LS 22 of 24
A EMC
INSURANCE
Disclosure Pursuant to Terrorism Risk Insurance Act
This disclosure is attached to and made part of your Quote Proposal in response to the
disclosure requirements of the Terrorism Risk Insurance Act. This disclosure does not
grant any coverage or change the terms and conditions of any coverage under the policy.
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 terrorism acts certified under the Terrorism Risk Insurance Act. The portion of your
premium attributable to such coverage is shown in the Quote Proposal.
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 under the federal program. For losses occurring in 2015, the federal share
equals 85% of that portion of the amount of such insured losses that exceeds the applicable
insurer retention. Beginning on January 1, 2016, the federal share will decrease by one
percentage point per calendar year until equal to 80% of that portion of the amount of
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 calendar year, 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 calendar year 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.
The following statement is required to be part of the disclosure notice in MISSOURI:
The premium shown on the Quote Proposal is for certain losses resulting from certified acts
of terrorism as covered pursuant to coverage provisions, limitations and exclusions in the
policy that may be issued based on this quote. You should read the definition in your policy
carefully, but generally speaking, "certified" acts of terrorism are acts that exceed $5 million
in aggregate losses to the insurance industry and which are subsequently declared by the
U.S. Secretary of the Treasury as a certified terrorist act under the Terrorism Risk Insurance
Act. Some losses resulting from certified acts of terrorism are not covered.
Read your policy and endorsements carefully.
Thank you for the opportunity to present this proposal to you. We hope you will allow us the
privilege to serve your insurance needs.
Cowell Insurance Group, Inc.
I
Prepared for: CITY OF RIVERSIDE 0071600 LS 23 of 24
A EMC
INSURANCE
Terrorism Risk Insurance Act Schedule
For the following sections,coverage for Certified Acts of Terrorism is accepted:
Commercial Output(B-05) $ 863.00
For the following sections,coverage for Certified Acts of Terrorism is not applicable:
Commercial Inland Marine(C-01)
Prepared for: CITY OF RIVERSIDE 0071600 LS 24 of 24