The URL can be used to link to this page

Item C45 BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 09/18/02 Division: Management Services Bulk Item: Yes ~ No _ Department: Human Resources AGENDA ITEM WORDING: Board of County Commissioner's approval of renewal of excess workers' compensation coverage with Employers Reinsurance Corporation for 10/1102 through 9/30/03 in the amount of$193,533.00. Additional approval of AD&D coverage with Hartford Insurance in the amount of $2,822.00 for 10/1102 through 9/30/03. ITEM BACKGROUND: With the contiiming hardening of the insurance market, the premium for excess coverage has gone from $95,096.00 with a self-insured retention of $350,000.00 for the last fiscal year to a premium this year of $193,500.00, with a self-insured retention of$500,000.00. There is also a small increase in the premium for AD&D coverage that is required by Florida Statues for paid and volunteer firefighter for the County. This increase is due to a change in the statutory death benefits. PREVIOUS RELEVANT BOCC ACTION: None CONTRACT/AGREEMENT CHANGES: N/A ST AFF RECOMMENDATIONS: Approval TOT AL COST: $ 196,355.00 BUDGETED: Yes ~ No _ COST TO COUNTY: $ 196,355.00 REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year - - -- APPROVED BY: County Atty _ OMB/Purchasing _ Risk Management_ ;t~ ~~J DIVISION DIRECTOR APPROVAL: ~t) :::.---<~ { u ~_ ( James L. Roberts, County Administrator DOCUMENTATION: Included X To Follow Not Required DISPOSITION: AGENDA ITEM # C~ Revised 2/27/01 tHY :':''j/ :':'UU:':' l~:tl:, 8132871 041 WTERISV: PAGE 81 INTERISK CORPORA TION Consullants 1111 North Wcstshore Boulevard l~isk Mi1l1u".:mdll SWle 2011 cmplo)'c\l1k."Jll:6b Tampa, FL 33607-4711 FAX COVER SHEET DA TE: ~. dq. ()"2 TO: (\~V\~1 e 0 ~V') FAX #: 305 6.q5-4~( 1 # PAGES: 7/W~~ S\tt Ukb~~ I FROM: PHONE #: (813) 287-1040 loterisk Corooration FAX ##: (813) 287-1041 SUBJECT: MESSAGE: ~'f\~ ~ if\a-Q \n ~ [(.peo , ~..O In - / I 1be infonl1atio.n disclosed in this facsimile is intended for Ihe use of the addressee only. {(you are not the intended rcciptcnt nor me person responsible: for delivering litis to \he intended recipient please notify us viatclepbonc and return the original copy of !he transmission to us via U.S. Mail. Distribution oflhis facsimile is prohibited. tl;j/l.'j/l.tltll. ll.:tl:. 8132871 041 HHERISI< PAGE 82 I NTERISK CORPORATION Consultants 1111 North Westshote Boulevard Suite 208 Risk Management Tampa, FL 33607-4711 Employee Benefits Phone (813) 287-1040 F~m;1e (113) 287-1041 August 28, 2002 Ms. Nancy Cohen Workers' Compeosatioo Manager Monroe County S 100 College Road, Room 207 Key West, Florida 33040 Re: Rmewlll of Acddelltlll Deot1r IUId Dismember1flt!llt Ins"rlUlce Dear Nancy: The Accidental Death and Di5mcmbeJment. policy tOr the County's VoluDt.eers and Fin::fisbtcrs expires on Sc:pfcmber 30, 2002. On July 1,2002 the limiU of this policy were increacd to tdlect ~t cbauges in the Florida Stabiles. This producICd an addition pmDium of $350 for the IemaiDdcr of the year. :u.d the iDaa&cd beadits presaibed by Plorida S1IIUte j 112 been in effec:t for the entire year, the aooual premium would have been $2.191. Arthur J. GaDagber bas submitted a t1uee ycar proposal from Hartford Life Imu.raDcc ~ (tbe iDcumbent iDIun:r) for an anuaal premium of S2,822. TbiB repn::scnts 0DIy . 1% i.tIcra8c CM:t' the expiring premium lIDll siJJce Hartford i& the k::adiDg AD.lD iDsurcr, it is ~oWd tIud. the County reuew its Aa:idcntal Death IDd Di~ insuraoce with Hartford as submitted by Artbar J. Gallagher. If you have any questions, please do DOt bcsitatc to call. Cordially, INTERISK CORPORATION ,1", / SidDey G. Webber CPCU, ARM tlO/':'-:J/.:.tltI.:. l.:.:tJ:J 1:::1 j:LlJ IHJ41 IHTERISf< PAGE 03 I NTERISK CORPORA rION ConsultanlS 1111 North Westshore Boulevard Suite 208 Risk Management Tampa, FL 33607-4711 Employee Bc:ucfits Phone (813) 287-1040 Facsimile (813) 287-1041 August 28, 2002 Ms. Nancy Cohen Workers' Compensation Manager Monroe County 5100 College Road, Room 207 Key West, Florida 33040 Rt: RDlftllIl of ~ Wo,ken' compelU(ltitM I,,~",tmce Dear Nancy: The County's Excess Workers' CompeDsation IDsw'aJK;e expires on Septem"- 30, 2002. The County's current pI'08I'BIIl is provided by NaIioDal Union Fire Insunncc Compuy which cojoys a favocable raIin& ftom the A.M. Best and Compeuy, the lc.adin8 cvalualor at iuammcc c:ompaa:y opcrabons. The PJOIIBDl pmvides full SIIIUtOry cuwenge, subjc:a to a $350,000 peJ 0CICUIl'CDCIC retaUion. The: IDDIIal premium for this policy is S9~,096. Over the past ~ IDDDlbs ~ity WOlken' CompcnIIIion iDsmancc bas become WltiDdy di~ to obcaiD at a competitive price:. Many insurers bav\: witbdrawn tiom prcMdinc ~ Ikoptha' and those th8l ~ him: iIx:Raaecl tbc:ir n::ladicma aD4 their premiums ~ntly. A amber r4 i~rs U:ve albmIpCed to limit their Cxpo5UR 10 c:awaapI1ic loues by estlIbtiabiJIg a per~ limit iDsIad of providing '"statlItory" limits wbidl bad bc:ca roadndy available in the put. In May 2002, tbc iDcumbc:nt agent, Arthur S. C.......p.-, was inslnldl:d to begin their re-awtctin8 efforts and to explore alfl:mative sources in the event that NatioDaI Uftion failed to pnMde fAwnbJe ~ tenDS. Gallagbet was a1so iNtnIcted to provide roatiDc status reports to eosme aD poISI"bIe opIioas were bciDg cxp1onxl. These ItabIS 1qJOrt5 iJadiaated tbat NaIio.Gal UDioD, in all pmbIbility, would. DOt be oft"c:riD& Iavor1Ible rcuewal tcnDI and. tboee beiag oft'ered by ~ iDsurers did DlIIl appear 10 be pr-iang This prompIed the County 10 .request the Florida Lcape of Cities 10 offer . propaul duIt WD I_...cd 011 Augua 6, 2002. On August 26, 2002, (;taJ1l1ghPr submitted their propoIIl ifllfinltil\l that over snearcaa (17) differeftt insurers were COIltIcted ill an effort to 1oc:ate coverage. Most of the iDsurm mp-ti"" 10 GlI~BJ-'1 request decliDcd to provide a quoratioo citing the class of business and Florida' IS lep1 arviJonmc:nI as rcuoas. Both National UniOll and Employers Reiuurance Corporation did submil propauIs. Tbc IDIjor features of tbeIe ~ and the ODe received tiom the Florida Leque _ diIpIayed OD tbc ~ scbcdulcs. In an. eft'on (0 estimate the ~ i1l1pICl on the County's claim expcnditul'Cli if a bigbcr rdCIIIion was requiRld, a detailed analysis of the bisI.oricaIlou cxpcricDce wu pc:rformccL This analylis ... fOrwarded 08/2'3/2002 12:05 8132871041 ImEPISf< PAGE 04 Ms. Nancy Cohen August 29. 2002 PagE2af3 to you UDder separate caver_ The a.naJysia suggcstcd that if the future claim experience was siJDiJaf to its past, the County could expec:t their claim expenditures to iDcreue in accordance with the following table. ReteIItioIl LeftI Proieded Iacreue ~ Claim EmeadAtwa $400.000 $171.830 $500.000 $185689 $600.000 5309 619 $730.000 $326 28S $1.000.000 5343 048 Nadoul U.ioa Fire "'raaee Compaay National Union offered to pnMde c::ovemge coDSistent with the current program. for an ammal premium of $S64.042. they also offend proposals for alternative per<<eurrence rctcDtions of $jOO.OOO aDd $1 million. The premiums for there options l\'eJe 1414,068 aDd $232.193 ~. When oombiuing National Union's projected premiums wiIh the Coun1y's _mated rdaiDed 1oI&es, the 0\ICf8ll prognun 00Sl is significantJy higher tbaD other viable options tbIIt ba\Ie been pmpoICd. II is tberefoIe JalOIft.-...Vd that the National UniaIl's pmpaala be etimi"A1~ from fiuthcr COIIIIideaIioa. Ilorida Leape of Cities It should be n:cogaized that the Rorida League of Cities is DOt a traditional iDsurer aDd do IlOt c:qjoy the profeCtion of the Florida IDsurance GaanDtee Fund (FIGA). PIGA is a State .,1i1l.fINal ~lUII tbat iJ desigocd to IMY the clailDs of iDsuraDce oompuUet tbat become i.IuioMm. While it is bdicvcd IbM the Florida Lcquc will ~ftlle to pruvide quality inturaDcc for its ~ bavi.ng . traditional iD8Ulef that bas the added protection of FIGA is pn:fened. The League propo9C4 two reccntion options. The first option is to rcWn the County's aurc.Dl n:fadicm of $350,000 for a premium of $369,463. Wben coupled with !be pJOjccrod claim expendioua. an owaaIl program cost of$I,247,647 is dcveJopcd. The League also proposed an opcioD with a retention ofS400,OOO. The premium for this option would be $322,671. If this option were to be selected. the Coonty oouJd expect an cm:rall pIQJJ'IJU <:oSl of $1,372,685 when the projected claim obIigatiODl arc inclucled. While the League's S3~O,OOO option prochK:cs aD overa1llower program COlt ($1,247,647), the amwal premium, which will have to be paid in advaDce, n:pRIeots a men: agJ"ifiNlut portion aftbc overall COlIS when compared to other alternatives. This produces a higher overall CXlSt5 OIl a MPmal Value" basis. It is thm:fore recommended tbat the Florida League of Cities' proposals be e1imj........t from further oonsideration.. 08/29/2082 12:05 8132871041 INTERISf< PAGE 05 Ms. Nanq Cohen Auguat 29. 2002 Page3of3 Employe" ~"aace COr)MJratioa Employers ReinsuraMe (Employers Re) proposed the foUowing tbn:e options: RdeIItioIa Level PrnaIIuD $500.000 $193533 $600 000 $106.422 $750,000 $80,422 It should be DOled that all three oCEmployers h's proposals 0DIy included per~ limits of S25 million. While this exposes the County to additional cJabn expenditures if a e:ataIUapbic eveDt. ~ to occur, it i5 believed that the probIbility of Sdcl1 an event is exttel1Idy remote 8IId 1\'81 only sligbtly fadored in the overall evaluation process. Wben iDcludiag the projectt.d claim obligations of the County, the Employers Re', $500.000 opIicm produces the overall ~ cost ($1,257,406 of the tbrce plopoaIs. This is sligbdy more ($9.759) tIum tile estimated alIl of !be Florida' Leque's $350,000 proposal. Sinc:c. sipri~ ponioD of the CoUDIy's claim oblipticms will be dderrcd for sevaaI years. the praent ~UIC of the premium. smna:s bc::twcaa the twO programs makes the EmplOyerS Re's opIioa more att:nIctive. It is tbcrd'otc ra::ommended thai. Monroe County sded the EmpIoyu's RciDsmaDcc Corpontioa pmposa1 that indudcs a $500,000 self-insured retcnUcm for its 200212003 policy year. If you have any questions, please do nor hesitate to call. Cordially, IN1HUSK CORPORATION J~/l Sidney G. Webber CPCU, ARM 88/2g/2882 12:05 8132871841 ImEPISk PAGE 06 - .-. It J ~- i ~ l~ 8'~ ~ ~ ~ go ;;- 3 ~ 6 C ; !l i . I g :z; ~ >- >- t'\ .~ e2 es ~ <8 on ,.,. ~t ~~. - '" ,.., .. "" .... "" ~ ~ 1 .... i J .a i~ '" .... IS. ~ ~ ~ .. e~ 11 ~~. I ~I ~ '1= t~ g 8 ~ CIO o ..t; C"1 8 .rl ~~ f 'a ~ ~ ~ ~ rJ ~ "'i n ~ ;z I~ >- :! ~ t ~-i ~~ = ;; "" ~ .... '" ~ - ~ ~. ~~-< -< .-.- ~::;) ...., N Q~~ I l;e;h l;Jo> . I~ ~ "'uw r. " U s ,.., 'i If.l ; r:: ~. I ~ jj~ ~ ~ ~ ~ ~ :! ~ .laha .,; ~ I~ '" - Q= :z; ;s: ~ ,.., f"'l ~ !j.... ~S .. .,.. .. .... ~~ UJ i H ji ~ ~ ~. 1: <~ ~~ - 0 Z l"-. on - < '" '" 2 ~ ,.,. .... 'il.~ u <I:l- ~ - ztJ.. ! ~ '",; .. J! t;; ~ l~ ~ I~ " ~ 11 1 i U ! )! e :i :2. ~ .. (,j IC r! ~ - I~ ~ il1i ! ! fn II IlIl Hht . 88/:9/:80: 1::85 8132871041 WTERISf< PAGE 07 Monroe County Projedion of Retained Losses @ Various SIRs SIR 350.000 400.000 500,000 600.000 150.000 1,000.000 Under 50,000 2,798.188 2,798 188 2.798,188 2,798.188 2.798,188 2,798.188 $50,001 to $100,000 2,111014 2.111.01. 2.111.014 2111.014 2.111.014 2111.014 $100.001 to $250.000 2 155.221 2.155,221 2 155221 2.155.221 2,155.221 2,155221 $250,001 to $350 000 1539,231 839.231 1539,231 1539 231 839.231 838,231 $350,001 to $500,000 379,111 379,111 378 111 379,111 379.111 367,359 367 359 381,359 3457.359 367 359 400,000 419,189 -479,189 478.189 419,168 400 000 -445567 -445.587 445.567 4045 567 OVer $500 000 eoo 000 750 000 800,868 515,385 515,385 515,_ Total Of " Tears 1,903,654 9.450,124 9,574,880 10.080,225 1D,RAIl.??" 10,991 ,Din Average 171.114 1,010,014 1,OA..n 1.1'7.1O~ 1,2M,- 1 .- .,... ..~ ., '" ARTHUR J. GALLAGHER & CO. - BOCA RATON PROPOSAL MONROE COUNTY BOARD OF COUNTY COMMISSIONERS WORKERS' COMPENSATION INSURANCE AND ACCIDENTAL DEATH & DISMEMBERMENT OCTOBER 1, 2002 - OCTOBER 1, 2003 Submitted Bv: SUSAN AINSZTEIN, ARM HEIDI L. GREENE, CIC Account Executive Account Manager susan _ ainsztein@ajg.com heidiJreene@ajg.com Arthur J. Gallagher & Co. 2255 Glades Road, Suite 400E Boca Raton, FL 33431 Telephone: (561) 995-6706 Fax: (561) 995-6708 ajg.com August 29, 2002 THIS PROPOSAL IS ISSUED AS A MATTER OF INFORMATION ONLY AND DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE PROVIDED BY THE ACTUAL INSURANCE POLICIES. One Boca Place, 2255 Glades Road, Suite 400E, Boca Raton. Florida 33431-7379 561/995-6706 . Fax 561/995-6708 - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS IMPORT ANT DISCLOSURES The proposal is an outline of the coverages proposed by the insurers, based on the information provided by your company. It does not include all the terms, coverages, exclusions, limitations, or conditions of the actual contract language. The policies themselves must be read for those details. Policy forms for your reference will be made available upon request. In addition to the fees and/or commissions retained by Arthur J. Gallagher & Co., it is understood and agreed that other parties, such as excess and surplus lines brokers, wholesalers, reinsurance intermediaries, underwriting managers, and similar parties, some of which may be owned in whole or in part by Arthur J. Gallagher & CO.'s corporate parent, may earn and retain usual and customary commissions and/or fees in the course of providing insurance products. Any such fees and/or commissions will be the responsibility of client and not Arthur J. Gallagher &Co. The information contained in this proposal is based on the historical loss experience and exposures provided to Arthur J. Gallagher & Co. This proposal is not an actuarial study. Should you wish to have this proposal reviewed by an independent actuary, we will be pleased to provide you with a listing of actuaries for your use. Gallagher from time to time enters into arrangements with certain insurance carriers or those carriers' reinsurers providing for compensation, in addition to commissions, to be paid by such carriers or reinsurers to Gallagher or its affiliates based on, among other things, the volume of premium and/or underwriting profitability ofthe insurance coverages written through Gallagher by such carriers or reinsurers. In addition, Gallagher and its affiliates provide management and other services to, and receive compensation for those services from; certain reinsurers that reinsure insurance coverages written through Gallagher by other insurance carriers. The insurance coverages your purchase through Gallagher might be issued by an insurance carrier or reinsured by a reinsurer that has such a relationship with Gallagher or its affiliates. N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS TABLE OF CONTENTS Executive Summary/Market Review.................. ...... ..... ...... .................... ................... ...........1 . Marketing Results Excess Workers' Compensation Renewal Proposal..............................................................2 . National Union Fire Insurance Company - Renewal Offer . Employers Reinsurance Corporation - Recommended - Specimen Policy Form AD&D Renewal Proposal.. ....... ..... ....... ........... ........ ...... ...... ..... ...... ............. .......... .... ..... .......3 . Hartford Insurance Company Insurance Company Selection / Best's Rating............. ..................... ................. ....................4 Appendix.......... ...... ........... ..... ... .... .................. ........... ...... ........ ..... ...... ........ ......... .......... ........5 . Client Authorization to Bind Coverage . Estimated Payroll for 2002-2003 . Additional Underwriting Information N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS EXECUTIVE SUMMARY INTRODUCTION: Arthur J. Gallagher & Co. is the County's agent for its current Accidental Death and Disability and Excess Workers' Compensation/Employers Liability programs. Arthur J. Gallagher & Co. aggressively marketed the County's coverages to reaffirm that the County is receiving the most competitive and broadest terms in the market. MARKETING RESULTS: EXCESS WORKERS' COMPENSATION: The Excess Workers' Compensation continues to be a tough market. There are less markets available with stricter guidelines and less coverage, requiring much more underwriting information than before. Some markets continue to offer full statutory limits while others have reduced Coverage A to $10,000,000 or $25,000,000 each accident. Please note in the Marketing Results the Coverage A limits being offered. For Monroe County BOCC, we approached the following Excess Workers' Compensation markets and noted the results of each: Excess Workers' Com ensation: ACE-Risk Management AIX Quoted A: Statutory B: $1,000,000 SIR options of: 1. SIR $350,000/Premium $410,000 2. SIR $500,000/Premium $218,000 3. SIR $l,OOO,OOO/Premium $167,000 ALEA A- Declined. Still endin a roval b state. Clarendon Insurance Co. AIX Unable to offer Industrial and Jones Act Endorsement. CNAlWexford (Continental Casualty) AXV Pending response - waiting for Industrial Aircraft a roval from mana ement. Crum & Forster A-X Declined due to class of business. No longer willing to look at municipality business. Discover Reinsurance A-VII Declined Public Entit business. N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS EXECUTIVE SUMMARY (Continued) 200Z:B,st'sltatfDg ..sof Camer A..ltUsf~1,%OO2 Results Employers Reinsurance Corporation A++XV Proposed and recommended: (ERC) Quoted A: $25,000,000 Quoted B: $1,000,000 SIR options of: 1. SIR $500,000/Premium $193,533 2. SIR $600,000/Premium $106,422 3. SIR $750,000/Premium $80,381 Genesis Re A++XV Declined. Package only basis. Coverage A limited to $1 OM/Municipal Business Unacceptable. Hartford Insurance Co. A+XV Declined JLT/ISAC- not an approved TPA. Midwest Employers Casualty AX Pending response. Corporation PGIT Trust Preferred Government Insurance Trust. Not an XSWC market at this time. Safety National Insurance Co. - UK A VIII Quoted A: $Statutory Quoted B: $1,000,000 SIR Options of: 1. SIR $500,000 (Excess Corridor deductible $100,000 Annual Aggregate) Premium $395,546 2. SIR $500,000 No Corridor deductible Premium $623,723 St. Paul Insurance Co. AXV Declined. No Monoline Bus plus Florida Environment not desirable. N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS EXECUTIVE SUMMARY (Continued) United National/ AIG A+IX Proposed. Quoted A: Statutory Quoted B: $1,000,000 SIR Options of: 1. $350,000/Premium $564,043 2. $500,000/Premium $414,068 3. $l,OOO,OOO/Premium $232,193 Zurich A+XV Declined. No longer willing to write on a stand-alone basis. We believe that the following is the best option for the County at this time. Weare still pending responses from several insurers. · ERC - $500,000 SIRlRate .3616 - $193,533 - Coverage A: $25,000,000 Coverage B: $ 1,000,000 N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS EXECUTIVE SUMMARY (Continued) AD&D: We approached the following AD&D markets and below are the results: Z~Qest's ltatiJlg ~~,. carrie.. . .' 'I? 2002 Re$ulfs AD&D Hartford Life Insurance Co. A+XV Proposed term - three year policy $8,466/ Annual installments $2,822 . AD&D -$ 50,000 In Line of Duty . AD- $ 50,000 Fresh Pursuit . AD- $150,000 Unlawful & Intentional Death VFIS (Volunteer Fire Insurance/Glatfelter TBD Offered annual premium of $2,643 Ins. Group . $ 50,000 In Line of Duty . $100,000 Emergency Response . $150,000 Unlawful & Intentional Death We believe Hartford Life Insurance continues to offer the best coverage at the best price with the three-year premium locked in with new Florida Statute Requirements. THANK YOU Arthur J. Gallagher has attempted to demonstrate our public entity expertise in the proposal included herein. We welcome any questions you may have. Thank you for the opportunity to be of service. N :WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SPECIFIC WORKERS' COMPENSATION Policy Term: October I, 2002 - October I, 2003 CarrierlRating: National Union Fire Insurance Company ofPA (A++ XV as of Au~st 26, 2002) Coveral!e: Specific Excess Workers' Compensation Coverage/ Elite Form 78052 Specific Limit: Cov. A Workers' Compensation Statutory Cov. B Employers Liability $1,000,000 per employee/ aggregate per accident for Employers Liability Estimated Annual Payroll: $53,524,298 Self-Insured Retention: $500,000 per occurrence (or for each employee for occupational disease under Coverage B) Rate: .7298 per $100 Payroll (subject to audit based on actual payroll) Minimum and Deposit $390,620 plus Aircraft Charge Premium: Aircraft Charl!e: $ 23,448 Combined Minimum & Deposit Premium: $414,068 Major Exclusions: . Punitive or Exemplary Damages (including but not limited to) . Employment Related Practices Claims . Serious or willful misconduct of the employee, including intentional acts Terms and Conditions: . Includes Incidental USL&H and Jones Act . Voluntary Compensation Endorsement . Broad Form Other States Endorsement . Defense Costs are included in Retention . Industrial Aid Aircraft Endorsement-for an additional premium . Premium and Loss Fund are subject to annual audit based on PAYROLL, NOT PREMIUM . Signed Application to be provided subsequent to binding . Receipt and favorable review semi-annually oflarge losses of $100,000 or greater . Receipt and favorable review of recently valued large losses, and aggregate claims information . On-site claims audit during policy term . Receipt of current Financials TPA: JLT/ISAC - Approved Option 1: SIR of $350,000 Rate of 1.01 per $100 payroll Minimum and Deposit: $540,595 plus aircraft charge Aircraft Charj?;e: (SIR $500,000) $23,448 Option 2: SIR of $1,000,000 Rate of .39 per $100 payroll Minimum and Deposit: $208,745 plus aircraft charge Aircraft Charj?;e: $23,448 N :WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS SPECIFIC WORKERS' COMPENSATION Policy Term: October 1, 2002 - October 1, 2003 CarrierlRating: Employers Reinsurance Corporation (ERe) (A++ XV as of August 22, 2002) Coverage: Specific Excess Workers' Compensation Coverage - Policy Form ERC21201 and Endorsements S45PL, S78, SAC 66, SC77, SAC FL, SAC 43). Specimen policy form to follow. Specific Limit: Cov. A Workers' Compensation $25,000,000 each accident Cov. B Employers Liability $1,000,000 per employee/ aggregate per accident for Employers Liability Estimated Annual Payroll: $53,524,298 Self-Insured Retention: $500,000 per occurrence (or for each employee for occupational disease under Coverage B) Rate: .3616 per $100 Payroll (subject to audit based on actual payroll) Minimum and Deposit Premium: $193,533 Major Exclusions: . Punitive or Exemplary Damages (including but not limited to) . Employment Related Practices Claims . Serious or willful misconduct of the employee, including intentional acts Terms and Conditions: Broad Form Coverage Endorsement includes: . Defense Base Act . Non-appropriated Funds Instrumentalities in relations to USL&H . Outer Continental Shelf Lands Act . Limited US Longshoreman & Harbor Workers Act (exposures to USL&H are incidental due to the location of Monroe County / 6 Waverunners) . Limited Jones Act . FELA - Federal Employers Liability Act . Voluntary Compensation Coverage . Communicable Disease Exception - regarding only one retention applying . Claim Reporting: reporting "as soon as practicable upon the acknowledgement of risk manager or other departments designated by you". TPA: JLT/ISAC - Approved. Subject to completed application. Option 1: SIR of $600,000 Rate of .1988 per $100 payroll Minimum and Deposit Premium: $106,422 Opion 2: SIR of $750,000 Rate of .1502 per $100 payroll Minimum and Deposit Premium: $80,381 N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INDEMNITY POLICY EMPLOYERS REINSURANCE CORPORATION No, SCHEDULE 1. Insured: 2. Mailing address: 3. Named states: DRAFT 4. Excluded states: 5. Policy Period: (a) From: (b) To: Both days at 12:01 A.M. standard time at the Insured's address shown in Item 2 of this Schedule 6. Retention: (a) Each accident: (b) Each employee for disease: 7. Limit each accident: (a) Policy Part One, Workers Compensation: $25,000,000 (b) Policy Part Two, Employers Liability: $1,000,000 8. Limit each employee for disease: (a) Policy Part One, Workers Compensation: $25,000,000 (b) Policy Part Two, Employers Liability: $1,000,000 9. Premium: (a) Payroll divided by $100 multiplied by: (b) Minimum: (c) Deposit: ERC-2120 I SPECIFIC EXCESS WORKERS COlVlPENSATION AND EMPLOYERS LIABILITY INDEMNITY POLICY In return for the payment of the premium and subject to all tenns of this policy, we agree "S<~ou as follows: ~ GENERAL SECTION ~~ A. Self-Insurance. Your acceptance of this policy indicates that you are now and will remain until the end of the policy period a duly qualified self-insurer in each state named in Schedule Item 3. If you are not a duly qualified self-insurer with respect to any loss covered by this policy, this policy will apply as if you were. B. The Policy. This policy includes the Schedule and the endorsements listed in Schedule Item 10. It is a contract of insurance between you (the Insured named in Schedule Item 1) and us (the Insurer named on the Schedule). The only agreements relating to this insurance are stated in this policy. The terms of this policy may not be changed or waived except by. endorsement issued by us to be a part of this policy. Endorsements amending Schedule Items 1, 3, 4, 6, 7 or 8 apply with respect to accidents and disease exposures occurring at or after 12:01 A.M. on the endorsement's effective date. C. Policy Period means the period of time covered by this policy as shown in Schedule Item 5. If this policy is cancelled, the policy period will end at 12:01 A.M. on the cancellation date. D. Workers Compensation Law includes occupational disease law. It does not include the provisions of any law that provide non-occupational disability benefits. E. State means any state of the United States of America and the District of Columbia. PART ONE - WORKERS COMPENSATION , A. How This Part Applies. Part One applies to loss paid by you because of liability imposed upon you by the workers compensation law of any state named in Schedule Item 3. Part One also applies to loss paid by you because of liability imposed upon you by the workers compensation law of any other state which is not shown in Schedule Item 4. LIABILITY MUST RESULT FROM BODILY INJURY BY ACCIDENT OR BODILY INJURY BY DISEASE SUSTAINED BY AN EMPLOYEE YOU NORMALLY EMPLOY IN A STATE NAMED IN SCHEDULE ITEM 3. Bodily injury includes resulting death. Bodily injury by accident must Occur during the policy period. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. Bodily injury by disease does not include disease that results directly from bodily injury by accident. ERe 2120 I Page 1 B. Your Retention. You must retain loss as shown in Schedule Item~. Yo r ~~ion applies to Part One loss and to Part Two loss together. IT IS IMPOR )-~OR YOU TO UNDERSTAND THAT YOUR RETENTION FOR DISEASE AP EPARATELY TO EACH EMPLOYEE. Naming more than one Insured in Schedule I does not increase your retention. C. Our Indemnity. We will indemnify you for loss paid by you in excess of your retention. This indemnity may be reduced by a late reporting penalty. D. Our Limit. The most loss we will reimburse you for with respect to each accident is shown in Schedule Item 7(a). The most loss we will reimburse you for with respect to each employee for disease is shown in Schedule Item 8(a). Naming more than one Insured in Schedule Item 1 does not increase our limit. E. Late Reportinl! Penalty. As respects each accident or each employee for disease: ... .....,;.;-:.. 1. If you ;~t~,Ii~f:gi~e us written notice withiuJ>,ue year of when requiredJ?)!';-lhrt Three, our iI};~i~fwill be reduced by 15%. _::f~Z;~3'~.;~\~1-";:- " .........._ow ........,...."'. ,-., ,_....0/.,""... - -~~- .. .;il__",,"" ,......_.,._""''"1.'......... ... _"oil ...".. .............,;;_ .............;........... -'~,...._...~. p ,~-_... ... ...._~l'"'~ 2r:S'::"; ~If you do not give us written noetee$within three years of wh~nVe'ciuired by Part Three, our - - indemnity will be reduced by 40%. F. Loss means the amount actually paid by you for regular benefits provided under the workers compensation law in effect upon the date the accident or disease exposure Occurs. Loss includes: 1. the amount paid by you in settlement of claims for regular benefits under the workers compensation law; 2. the amount paid by you in satisfaction of awards or judgments for regular benefits under the workers compensation law; 3. court costs, interest upon awards and judgments, and allocated investigation, adjustment and legal expenses pertaining to workers compensation claims. This subparagraph 3 does not include: (i) salaries paid to your employees; (ii) service company fees; (iii) claims administrator fees. G. Exclusions. Part One does not cover: , 1. loss insured by full coverage workers compensation or employers liability insurance; 2. loss payable under the workers compensation law of any state which is not named in Schedule Item 3, if you are protected from the loss by any other insurance; 3. punitive or exemplary damages because of bodily injury sustained by any employee; ERe 2120 I Page 2 4. punitive, exemplary or compensatory damages because of your conduct, or the conduct of anyone acting for you: (a) in the investigation, trial or settlement of any workers compen~Iaim; (b) in failing to payor delay in payment of any workers compensa claim; 5. any assessment made upon self-insurers, whether impo~'f(;,tute, regulation or otherwise. H. Payments You Must Make. You are responsible (without reimbursement from us) for any payments in excess of the benefits regularly provided by the workers compensation law including those required because: 1. of your serious and willful misconduct; 2. you knowingly employ an employee in violation oflaw; 3. you fail to comply with a health or safety law or regulation; or 4. you discharge, coerce or otherwise discriminate against any employee in violation of the workers compensation law. I. Other Insurance. If, as respects any state named in Schedule Item 3, any other insurance exists protecting you against loss covered by this insurance, this insurance shall apply in excess of the other insurance. J. Recoverv From Others. We have your rights, and the rights of persons entitled to compensation benefits from you, to recover our loss from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. The recovered loss remaining after deducting our recovery expenses will first be used to reduce our loss. Then we will pay the balance, if any, to you. PART TWO - EMPLOYERS LIABILITY . A. How This Part Applies. Part Two applies to loss paid by you for damages imposed upon you by the law of any state shown in Schedule Item 3. Part Two also applies to loss paid by you for damages imposed upon you by the law of any other state which is not shown in Schedule Item 4. DAMAGES MUST RESULT FROM BODILY INJURY BY ACCIDENT OR BODILY INJURY BY DISEASE SUSTAINED BY AN EMPLOYEE YOU NORMALLY EMPLOY IN A STATE NAMED IN SCHEDULE ITEM 3. Bodily injury includes resulting death. Bodily injury must arise out of and in the course of the injured employee's employment by you. Bodily injury by accident must occur during the policy period. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. Bodily injury by disease must be caused or aggravated by the conditions of your employment. The employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. Bodily injury by disease does not include disease that results directly from bodily injury by accident. ERe 2120 I Page 3 B. Your Retention. You must retain loss as shown in Schedule Item 6. Your retention applies to Part One loss and to Part Two loss together. IT IS IMPORTANT FOR YOU TO UNDERSTAND THAT YOUR RETENTION FOR DISEASE APPLIES SEPARATELY TO EACH EMPLOYEE. Naming more than one Insured in Schedule Item 1 does not increase your retention. C. Our Indemnity. We will indemnify you for loss paid by you in excess ~our retention. This indemnity may be reduced by a late reporting penalty. ~ D. Our Limit. The most loss we will reimburse you for with re~ accident is shown in Schedule Item 7(b). The most loss we will reimburse you for' ect to each employee for disease is shown in Schedule Item 8(b). Naming more than one red in Schedule Item 1 does not increase our limit. E. Late Reportinl! Penalty. As respects each accident or each employee for disease: ~ 'J;>, .>1"-... 1. If you ;clq",r;(\\1l~~f~e us written notice withinJ;>.ne year of when required.b.;r:J&.rt Three, our iI19~@l1lr~ill be reduced by 15%. .~:i~~r"" .;.~\;~~:;:~. ... ........-... .........~... ~ -- "'.:,...... ....... ................ ,....ilt....-_"" _~....., "".,it ."'" .. -'" 'Ot".... '......!lo""._ ""'_~""'..... _...><;;;..,"'- --~'''''''''''..., '"" ~,...,.~ i:~~~: ~If you do not give us written ndi~c~:within three years of wh~7i€quired by Part Three, our indemnity will be reduced by 40%. F. Loss means the amount actually paid by you for damages imposed upon you by law. Loss includes: 1. the amount paid by you in settlement of claims for legal damages; 2. the amount paid by you in satisfaction of awards or judgments for damages; 3. court costs, interest upon awards and judgments, and allocated investigation, adjustment and legal expenses pertaining to employers liability claims. This subparagraph 3 does not include: (i) salaries paid to your employees; (ii) service company fees; (iii) claims administrator fees. G. Damal!es includes: 1. damages for which you are liable to a third party by reason of a claim or suit against you by that third party to recover the damages claimed against such third party as a result of injury to your employee; 2. damages for care and loss of services; and 3. damages for consequential bodily injury to a spouse, child, parent, brother or sister of the injured employee; provided that these damages are the direct consequence of bodily injury that arises out of and in the course of the injured employee's employment by you; and 4. damages because of bodily injury to your employee that arises out of and in the course of employment, claimed against you in a capacity other than as employer. ERe 2120 I Page 4 H. Exclusions. Part Two does not cover: 1. liability assumed under a contract. This exclusion does not apply to a warranty that your work will be done in a workmanlike manner; 2. loss payable under the law of any state which is not named in Schedule Item 3, if you are protected from the loss by any other insurance; 3. punitive or exemplary damages because of bodily injury sustained by any employee; 4. punitive, exemplary or compensatory damage~'lSe of your conduct, or the conduct of anyone acting for you: (a) in the investigation, rria! or sett~~y employers liability claim; (b) in failing to payor delay in pay any employers liability claim. 5. bodily Injury to an employee while employed in violation of law with your actual knowledge or the actual knowledge of any of your executive officers; 6. any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similar law; 7. bodily injury intentionally caused or aggravated by you. This exclusion does not apply to claim expenses (listed in subparagraph 3 of the definition ofloss) related to the injury; 8. damages arising out of the discharge of, coercion of, or discrimination against any employee in violation of law. I. Other Insurance. If, as respects any state named in Schedule Item 3, any other insurance exists protecting you against loss covered by this insurance, this insurance shall apply in excess of the other insurance. J. Recoverv From Others. We have your rights to recover our loss from anyone liable for an injury covered by this insurance. You will do everything necessary to protect those rights for us and to help us enforce them. The recovered loss remaining after deducting our recovery expenses will first be used to reduce our loss. Then we will pay the balance, if any, to you. P ART THREE - CLAIMS A. Your Claims Handling Duties. It is your responsibility to investigate, settle, defend and appeal any claim made against you. It is also your responsibility to investigate, settle, defend and appeal any suit brought or other proceeding instituted against you. ERe 2120 I Page 5 B. Your Claims Reportinf! Duties. You must give us written notice as soon as you learn of: 1. any of the following events involving loss which exceeds (or might in the future exceed) 50% of your retention: (a) claim; (b) a ward; (c) verdict; (d) action; , (e) suit; (f) proceeding; (g) judgment; 2. any accident involving: (a) disability for a period of nine months or more; , (b) spinal cord injury; ~ (c) a permanent total disability as defined in th~r ers compensation law; (d) serious bum injury; ~ (e) brain injury. ~ C. Claims Information. You agree to send to us glaim information which we may request. D. Claims Participation Bv Us. At our own election and expense, we have the right to participate with you in the settlement, defense or appeal of any claim, suit or proceeding which might involve a loss to us. E. Settlements. You agree not to make any voluntary settlement involving loss to us without our written consent. PART FOUR - PREMIUM A. Deposit and Adjustment Premiums. At the beginning of the policy period you must pay us the deposit premium shown in the Schedule. At the end of the policy period: 1. you will owe us the amount by which the final premium is greater than the deposit premIUm; or 2. we will owe you the amount by which the deposit premium is greater than the final premIUm. B. Pavroll Report. Within 45 days after the end of the policy period, send us a report showing the amount of payroll earned by your employees during the policy period. C. Final Premium. The final premium due us for the policy period will be computed as shown in Schedule Item 9(a). Unless this policy is cancelled, final premium will be at least the minimum premium shown in the Schedule. ERe 2120 I Page 6 If we cancel this policy, final premium will be calculated pro rata based on the time this policy was in force. Final premium will not be less than the pro rata share ~e minimum premium. If you cancel this policy, fmal premium will be more t~ it will be based on the time this policy was in force, and increased by the customary s table and procedure. Final premium will not be less than the short rate portion of the m premium. D. Payroll means the gross pay to your employees for the policy period plus other amounts and items received by your employees as part of their pay for the policy period. We will send you a payroll reporting form describing what is included in payroll. E. Records. You will keep records of information needed to compute premium. You will provide us with copies of those records when we ask for them. F. Audit. You will let us or our representatives examine and audit all your payroll records. The audits may be conducted during your regular business hours. PART FIVE - CONDITIONS A. Al!reement Upon Terms. Your acceptance of this policy means that you agree with us upon the terms of this policy. B. Sole Representative. The Insured first named in Schedule Item 1 will act on behalf of all Insureds to change this policy, accept loss payments, receive return premium and give or receive notice of cancellation. C. Bankruptcy or Insolvency. Your bankruptcy or insolvency will not relieve us from the payment of any claim covered by this policy. D. Transfer of Your Ril!hts and Duties. Your rights or duties under this policy may not be transferred without our written consent. This provision does not apply to duties transferred to a service company or a claims administrator. ~ E. Cancellation. You may cancel this policy by giving us at least 30 days advance notice by registered mail stating the cancellation date. We may cancel this policy by giving you at least 30 days advance notice by registered mail stating the cancellation date. Our mailing of registered notice to your address shown in Schedule Item 2 will be sufficient proof that we cancelled this policy. We have executed this policy by printing below the facsimile signatures of our President and Secretary and by the actual signature of our authorized representative on the Schedule. EMPLOYERS REINSURANCE CORPORATION CG(2L ~ .h-dt.. Pres1l:Jent a. CEO Secreta.-y ERe 2120 I Page 7 10. Endorsement serial numbers: ~~ 9:-~ <:J EMPLOYERS REINSURANCE CORPORATION HOME OFFICE - 5200 Metcalf, P.O. Box 2991 Countersigned Overland Park, Kansas 66201 (913) 676-5200 or 1-800-255-6931 ~ fClJL..t- Licensed Resident Agent Date Authorized Representative ERe-2l20 I FLORIDA BROAD FORM COVERAGE ENDORSEMENT This endorsement applies only in the State of Florida. I. In consideration of the premium charged, it is hereby understood and agreed that: A. Federal Acts Coverae:e 1. Part One of the policy shall also apply to loss paid by you because of liability imposed upon you by: (i) The Longshore and Harbor Workers Compensation Act (33 USC Sections 901-950). (ii) The Defense Base Act (42 USC Sections 1651-1654). (iii) The Outer Continental Shelf Lands Act (43 USC Section l~~). (iv) The N onappropriated Fund Instrumentalities Act (5 US~ions 8171.8173). 2. Part Two of the policy shall also apply to loss paid by yo~e of liability imposed upon you by: (i) The Jones Act (46 USC Section 688 ). (ii) The Federal Employers Liability Act (45 USC Sections 51-60). (iii) The Migrant and Seasonal Agricultural Worker Protection Act (29 USC Sections 1801-1872). B. V oluntarv Comoensation Coveral!e Part One of the policy shall also apply to payments you gratuitously make because of bodily injury by accident or disease sustained by any employee included within either group described below (or to the employee's dependent) for benefits indicated in the workers compensation law of the state where the employee is normally employed, but only if that state is named in Schedule Item 3. Employees: a) those employees not covered under the worker's compensation law of a state listed in Schedule Item 3; or b) those employees who sustain a bodily injury while traveling or temporarily (less than 2 years) working outside of the United States of America. This voluntary compensation coverage does not apply: (a) unless the gratuitous benefits are paid as a result of an accident or disease exposure occurring during the policy period and in the course of employment; or (b) if the employee (or dependent) is entitled to benefits under any workers compensation law; or (c) to bodily injury intentionally caused or aggravated by you; or (d) in the event an employee who receives gratuitous payments from you for a bodily injury brings a common law action against you based on that bodily injury, in which event, policy Part Two will apply. Page 1 of2 Endorsement Serial No. S-45(12/97) FL ~'\ <::>~~ This voluntary compensation coverage does apply: (a) to bodily injury resulting from diseases endemic to a region outside the United States of America; and (b) to limited repatriation expenses such that Part One loss will inel u~ount of transportation expenses you incur returning an employee who sustains a bodily i . hile traveling or temporarily working ontside the United States of America (or, in the e~ ,returning the employee's body) to the location where the employee is normally employed whi ds the cost of returning the employee in an uninjured condition. This voluntary compensation coverage will be reduced, in the event the employee is eligible for benefits under a foreign workers compensation law and you are paying premiums for that coverage, by any workers compensation benefits payable under the foreign law. II. It is also understood and agreed that: A. Unintentional Failure to Report Your unintentional failure to disclose or accurately identify all hazards existing as of the inception date of this policy shall not constitute grounds for a declination of coverage by us. B. Waiver of Subroe:ation If you enter into a written contract with another party that requires you to waive your right of subrogation against the party, the last paragraph ("Recovery From Others") contained in Part One and Part Two of the policy will not apply with respect to the party with whom you contracted. Page 2 of2 All other terms and conditions of this policy shall remain unchanged. This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Endorsement Effective Error! Reference Policy No. Error! Endorsement No. source not found. Reference source not found. Named Insured I Error! Reference source not found. Countersigned EMPLOYERS REINSURANCE CORPORATION ..................................... . Authorized Re resentative Endorsement Serial N CLARIFICATION OF EMPLOYERS LIABILITY EXCLUSION ~ Exclusion 8 contained in Paragraph H of Part Two of the policy ~nded to read as follows: 8. damages arising out of coercion, criticism, demot~uation, reassignment, discipline, defamation, harassment, humiliation, discriminati . ainst or termination of any employee, or any personnel practices, policies, acts or omissions. All other terms and conditions of this policy shall remain unchanged. This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Endorsement Effective Error! Reference Policy No. Error! Endorsement No. source not found. Reference source not found. Named Insured I Error! Reference source not found. Countersigned EMPLOYERS REINSURANCE CORPORATION ..................................... . Authorized Re resentative Endorsemen~l No. S-78 <:>~ DEFINITION OF PAYROLL PERTAINING TO VOLUNTEER WORKERS Payroll pertaining to volunteer workers (except volunteer firefighters and volunteer police officers) means the federal minimum hourly wage multiplied by the hours worked by the volunteers. L per year shall he included in payroll for each volunteer ~ter or volunteer police officer. Dulies performed by volunteer workers will be migne~tt;.laSSification which the duties would be assigned to if performed by regular employees. Q No amount is included in payroll pertaining to any volunteer worker who is not covered under the workers compensation law because Part One of the policy does not apply with respect to that worker. All other terms and conditions of this policy shall remain unchanged. This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Endorsement Effective Error! Reference Policy No. Error! Endorsement No. source not found. Reference source not found. Named Insured I Error! Reference source not found. Countersigned EMPLOYERS REINSURANCE CORPORATION ..................................... . Authorized Re resentative MODIFIED CLAIMS REPORTING DUTIES Paragraph B of Part Three of the policy is amended to read as follows: B. Your Claims Reporting Duties. You must give us ~~otice as soon as you learn of any of the following events involving loss which exceeds (or. '. .. in the future exceed) 50% of your retention: . (al claim; <::)~ (b) award; (c) verdict; (d) action; (e) suit; (f) proceeding; (g) judgment. All other terms and conditions of this policy shall remain unchanged. This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Endorsement Effective Error! Reference Policy No. Error! Endorsement No. source not found. Reference source not found. Named Insured I Error! Reference source not found. Countersigned EMPLOYERS REINSURANCE CORPORATION ..................................... . Authorized Re resentative FLORIDA ENDORSEMENT I. Paragraph E of Part Five of the policy is amended to read as follows: E. Cancellation. You may cancel this policy by giving us and the authority shown below at least 60 days advance notice by registered mail stating the cancellation date. We may cancel this policy by giving you and the authority shown below at least 60 days advance notice by registered mail stating the cancellation date. Our mailing of registered notice to your address shown in Schedule Item 2 will be sufficient proof that we cancelled this policy. Florida Department of Labor and Employment Security Division ofWnrkers' co~ation Bureau of Operations Sup' Self-Insurance Section PO Box 5497 ~ Tallahassee, Florid. 4-5497 If by mutual consent we $I with you to cancel the policy, we will mail to the authority shown above a copy of the cancellation endorsement that you and we have signed, but it will become void if rejected by the authority shown above. II. The following Paragraph F is added to Part Five of the policy: F. Non-Renewal. If you do not renew the policy, you must give us and the authority shown above at least 60 days advance notice of non-renewal by registered mail. Ifwe do not renew the policy, we must give you and the authority shown above at least 60 days advance notice of non-renewal by registered mail. If by mutual consent we agree with you to non-renew the policy, we will mail to the authority shown above a copy of the non-renewal endorsement that you and we have signed, but it will become void if rejected by the authority shown above. Page I of2 This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Endorsement Effective Error! Reference Policy No. Error! Endorsement No. source not found. Reference source not found. Named Insured I Error! Reference source not found. REINSURANCE CORPORATION Countersigned EMPLOYERS ................... . ~ Authorized Re ;e's~~;;ti;e""""" Endn"'m''$.t::-~n. SAC-FL- 7 Q III. Where necessary to assure prompt payment to your employees or their dependents the regular benefits provided under the workers compensation law of Florida, we will pay loss to which Part One applies as directed by the authority shown above. This provision is subject to the policy retention(s) and limit(s). IV. As respects the relationship between you and us (but not with respect to the relationship between you and your employees or their dependents), we agree to be subject to the claim handling standards established by the Florida Division of Workers' Compensation. V. In the event nfynuc bonkruptcy oc U"OlVenCY:~A.... A. The eight of claim, participa~ntained in Pacagmph D of Part Tlrree of the policy may be exercised with respect to t a Self-Insurers Guaranty Association, Inc. B. Upon payment by the Florida Sf-Insurers Guaranty Association, Inc. ofloss covered by the policy, we will reimburse the Association for the loss. This provision is subject to the policy retention(s) and limit(s). Page 2 of2 All other terms and conditions of this policy shall remain unchanged. This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to the preparation of the policy.) Endorsement Effective Error! Reference Policy No. Error! Endorsement No. source not found. Reference source not found. Named Insured I Error! Reference source not found. Countersigned EMPLOYERS REINSURANCE CORPORATION ..................................... . Authorized Reoresentative Endorsement Serial No. SAC-FL-7 EPIDEMIC DISEASE ENDORSEMENT Schedule Item 6 is amended to read as follows: 6. Retention: (a) Each accident: $_ (b) Each employee for disease: $_ O~PidemiC I. The third sentence is deleted from paragraph B co~ed in Policy Part One and Policy Part Two. II. The word "epidemic" means the outbreak o~~eMe which infects three or more of your employees during anyone period of 14 consec tive days selected by you. All other terms and conditions of this policy shall remain unchanged. This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to the preparation ofthe policy.) Endorsement Effective Error! Reference Policy No. Error! Endorsement No. source not found. Reference source not found. Named Insured Error! Reference source not found. Countersigned EMPLOYERS REINSURANCE CORPORATION I ....~ I ..................................... . Authorized Representative Endorsement ~NO. SAC-4J 9.~ Q - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ACCIDENTAL DEATH AND DISMEMBERMENT OCTOBER 1, 2002 - OCTOBER 1, 2003 Carrier: Hartford Life Insurance Company Best Rating: A+ XV as of August 23,2001 Policy Term: Three (3) Years - Annual installments billed annually October 1,2002 - October 1,2005 Policy Form: 7679 - B2 (HL) same as expiring Limit: $ 50,000 AD&D in the Line of Duty $ 50,000 Fresh pursuit $150,000 Unlawful & Intentional Death Eligible Persons: All Full-Time, Part-Time, Volunteer and Auxiliary Firefighters of the Policyholder Exclusions · Intentionally Self-Inflicted Injury (including but not · Suicide or Attempted Suicide limited to): · War Premium: $2,822 Annual Premium/Three Year Premium $8,466 Note: New limit reflects amended Florida Statutes 112.19 and 112.191 increasing benefits. N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CLIENT AUTHORIZATION TO BIND COVERAGE After careful consideration of your Workers' Compensation and Accidental Death & Dismemberment proposal dated August 29,2002, we accept your insurance program subject to the following exceptions/changes: Exceptions It is understood this proposal provides only a summary of the details; the policies will contain the actual coverages. We confirm the values, schedules, and other data contained in the proposal are from our records and acknowledge it is our responsibility to see that they are maintained accurately. Please provide us with a binder(s) and invoice(s) for the coverages agreed upon at your earliest convemence. Broker's Signature Client Signature Dated Dated N :WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS PAYROLL PROJECTIONS OCTOBER 1, 2002 - OCTOBER 1, 2003 t~jH._tj;j :!llfijlltllllltlllllll!llllll~m~~i~!!!!!!imm~~!:!~1~!1I!II~~Illlltllllll~lll!ltljll!lllllj lfllllllllt~:.~:i~I~~jliijil~:!i!I~!~lllllllfl 1t:'I1ml,~~_1~~~im!~~~~iii; ....-... ~~n~r:~~.~ .-I,HH 5506 Street, Road Construction & Drivers $ 749,844 $ 16.22 $ 121,625 7370 Taxicab Co. & Drivers $ 2,119,614 $ 12.33 $ 261,348 7380 Driver/Chauf7Help NOC Connn $ 316,336 $ 13.84 $ 43,781 7422 Aircraft! Heli Operation- Patrol $ 203,546 $ 6.72 $ 13,678 7423 Aircraft! Heli Operations $ 432,258 $ 7.75 $ 33,500 7590 Garbage Workers $ 333,984 $ 13.74 $ 45,889 7704 Firefighters & Drivers $ 170,334 $ 10.68 $ 18,192 7720 Police Officers & Drivers $ 18,620,736 $ 7.22 $ 1,344,417 8380 Automobile Service or Repair Center $ 561,878 $ 6.95 $ 39,051 8720 Inspection of Risks For Ins. Or Values $ 874,716 $ 4.15 $ 36,301 8742 Sales/Collect/Mess Out $ 671,538 $ 1.20 $ 8,058 8810 Qerical Office NOC $ 19,575,156 $ 0.65 $ 127,239 8820 Attomey- All Employees & Qerical $ 666,536 $ 0.54 $ 3,599 8829 Convalescent or Nursing Home $ 195,942 $ 8.19 $ 16,048 8835 Nursing $ 452,066 $ 7.48 $ 33,815 9015 Bldg Op Own/I..essee $ 1,875,046 $ 9.64 $ 180,754 9019 Bridgt>- Vehicle Tunnel Operations $ 257,880 $ 9.24 $ 23,828 9101 Public Library $ 225,778 $ 8.78 $ 19,823 9102 Park NOC all & Drivers $ 485,032 $ 10.01 $ 48,552 9410 MunidTownlCounty State NOC $ 4,522,500 $ 15.01 $ 678,827 9519 Household Api Elee. Ins. $ 213,578 $ 5.47 $ 11,683 TOfAL $ 53,524,298 $ 3,110,008 Rates effective August 1, 2002 N :WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS ADDITIONAL UNDERWRITING INFORMATION OCTOBER 2002-2003 OVERVIEW: - . . -. - -- . -- W-_l__~ Librarv Volunteers 364 5845 Poll Sitters 330 4386 Volunteer Police Office 81 N/A Volunteer Firefil!hters 125 N/A Countv Emolovees 1619 N/A Paid Firefil!hters 54 N/A AIRCRAFT: . 1976 Beech C-12C 9 N465MC Rotorcraft 1966 Bell UH-1H 8 N911GE Rotorcraft 1968 Bell OH-58 4 N463MC Rotorcraft WATERCRAFT: I N~ I Descrtption I Len&th I Waverunners N/A N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS INSURANCE COMPANY SELECTION The Best's Guide is the guidebook the insurance industry uses to determine the financial stability of an Insurance company. A copy of the Best's Guide report on the insurance companies quoted is available for your review. While we strive to be certain that your insurance is placed with reputable, highly rated insurance companies, we have no way of guaranteeing the financial accuracy of the Best's Guide or the financial stability of any insurance company. For these reasons, we recommend that you take into account the financial stability of all the insurance companies prior to making your selection as to who will write your insurance. Excess Workers' Com ensation Em 10 ers Reinsurance Co oration (ERC) A++ XV Yes No United National/AIG A+IX Yes No AD&D Hartford Life Insurance Co. A+XV Yes No Alphabetical Listin2 Numerical Listin2 A+, A++ = Superior Ranges from 1 to 15 A, A- = Excellent 1 = Smallest Category B+,B++ = Very Good 15 = Largest Category B, B- = Good C+,C++ = Fair C = Marginal Admitted Carrier - Authorized licensed insurer doing business in Florida and protected by the Florida Insurance Guarantee Association, Inc. under F.S. 631. Surplus Lines Carrier - An unauthorized insurer which has been made eligible by the Florida Department of Insurance to issue insurance coverage. Surplus Lines carriers are not protected by the Florida Insurance Guarantee Association, Inc. under F .S. 631. N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC- WC.0802.doc - MONROE COUNTY BOARD OF COUNTY COMMISSIONERS GUIDE TO A.M. BEST'S RATINGS Best's Insurance Reports, published annually by A.M. Best Company, Inc., presents comprehensive reports on the financial position, history, and transactions of insurance companies operating in the United States and Canada. Companies licensed to do business in the United States are assigned a Best's Rating which attempts to measure the comparative position of the company or association against industry averages. Best's ratings are based on analysis, which give consideration to a number of factors of varying importance. While the analysis is believed to be reliable, we cannot guarantee the accuracy of the rating or the financial stability of the insurance company. A copy of the Best's Insurance Report on the insurance companies is available for your review. Best's Rating Classifications are: A++ to A+ Superior A to A- Excellent B++ to B+ Very Good B to B- Fair C++ to C+ Marginal C to C- Weak Best's Financial Classifications are: I $0 to $1,000,000 II $1,000,000 to $2,000,000 III $2,000,000 to $5,000,000 IV $5,000,000 to $10,000,000 V $10,000,000 to $25,000,000 VI $25,000,000 to $50,000,000 VII $50,000,000 to $100,000,000 VIII $100,000,000 to $250,000,000 IX $250,000,000 to $500,000,000 X $500,000,000 to $750,000,000 XI $750,000,000 to $1,000,000,000 XII $1,000,000,000 to $1,250,000,000 XIII $1,250,000,000 to $1,500,000,000 XIV $1,500,000,000 to $2,000,000,000 XV $2,000,000,000 to or more Note: At your option, you may wish to consult with other available rating services. Arthur J. Gallagher & Co. uses A.M. Best & Co.'s rating services to evaluate the financial condition of insurers whose policies we propose to deliver. The rating of the carrier and the year of publication ofthat rating are indicated. Arthur 1. Gallagher & Co. makes no representations and warranties concerning the solvency of any carrier, nor does it make any representation or warranty concerning the rating of the carrier which may change. N:WG\PUBLPROP\MONROE.BCC\2002.2003 WC.ADD\MONR-BCC-WC.0802.doc