Item C17
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. BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: September 17, 2008 Division: Employee Services
Bulk Item: Yes ~ No - Department: Employee Benefits
Staff Contact Person: Maria Z. Fernandez-Gonzalez Ext. 4448
AGENDA ITEM WORDING: Approval to purchase Specific Excess Workers' Compensation
Insurance from Star Insurance of Brown & Brown Insurance for a proiected annual premium of
$166,683.00
ITEM BACKGROUND: Monroe County is currently insured with Star Insurance of Brown &
Brown Insurance.
PREVIOUS RELEV ANT BOCC ACTION: Services bid in 2003 - Midwest was the selected
company: Services re-bid in 2006 at the direction of the BOCC and Safety National of Brown &
Brown Insurance was selected.
CONTRACT/AGREEMENT CHANGES: 3.4% increase in the annual premium. Premium is
up due to the increase in payroll.
STAFF RECOMMENDATIONS: Approval.
TOTAL COST: $166,683.00 BUDGETED: Yes L- No -
COST TO COUNTY: $166,683.00 SOURCE OF FUNDS:Primarilv Ad Valorem
REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year
APPROVED BY: County Arty ~ ~ur~ing _ Risk Managemen~ -
DOCUMENTATION: Included X To Follow Not Required
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DISPOSITION: AGENDA ITEM #
Revised 08/06
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MONROE COUNTY BOARD OF COUNTY COMMISSIONERS
CONTRACTSU~ARY
Contract #
Contract with: Star Insurance Effective Date:October 1, 2008
Expiration Date:September 30,2009
Contract Purpose/Description:Approval to purchase Specific Excess Workers' Compensation
Insurance.
Contract Manager: 4448 Employee Services
Maria Z. Fernandez-Gonzalez
(N ame) (Ext. ) (Department)
for BOCC meeting on September 17, 2008 Agenda Deadline: September 2, 2008
CONTRACT COSTS
Total Dollar Value of Contract: $166,683.00 Current Year Portion: $ -
Budgeted? Y es~ NoD Account Codes: 501-07502-530450- -
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Grant: $_ - - - -
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County Match: $_ - - - -
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ADDITIONAL COSTS
Estimated Ongoing Costs: $~yr For: -
(Not included in dollar value above) (eg. maintenance, utilities, janitorial, salaries, etc.)
CONTRACT REVIEW
Changes Date Out
~ Needed[!{ ~er ~bf.
Division Director . YesO No \ _ ___ qL-ci
Risk Marul~ent <tiJ21 YesO No!"f
eX;..:tJ' . q lUot
O.M.B./Purc ~mg <1-2.-{f6 YesD No[S1j' ~ ~
County Attorney 1/?u/oS YesO Noel ~ t .1hA1 t/~
Comments: -
OMB Form Revised 9/11/95 MCP #2
,r......""-~ BOARD OF COUNTY COMMISSIONERS
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O,~~T.y ~o~~~E Mayor Mario Di Gennaro, District 4
Mayor Pro Tern Dixie M. Spehar, District 1
George Neugent, District 2
Charles "Sonny" McCoy, District 3
(305) 294-4641 Sylvia J. Murphy, District 5
Office of the Employee Services Division Director
The Historic Gato Cigar Factory
lloo Simonton Street, Suite 268
Key West, FL 33040 ~<~'.
(305) 292-4458 - Phone
(305) 292-4564 - Fax
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TO: Board of County Commissioners DATE: August 26, 2008
FROM: Teresa E. Aguiar, ~
Employee Services Direc
SUBJ: Excess Workers' Compensation Insurance
This item requests approval to renew the current policy for Excess Workers' Compensation Insurance
from Star Insurance of Brown & Brown Insurance for the period of October 1, 2008 to September 30,
2009. The policy was last bid in 2006 and this is the last renewal of the policy. This policy is scheduled
to be bid again next year (2009) in accordance with purchasing policies and procedures.
The County is an authorized self-insurer for Workers' Compensation within the State of Florida. The
structure of our current program requires the County to assume the first $1 million of each claim. This
policy provides protection for any claim that exceeds this amount. The County's program provides
coverage for the full statutory benefits as outlined in Florida Statute 440.
The premium is based on actual payroll and claims history. The premium has increased 3% due to the
increase in payroll (which includes overtime pay).
It is the recommendation that the County renew its Excess Insurance Policy with Star National as the
insurer as presented by Brown and Brown Insurance at the annual premium of $166,683 for the period of
October 1,2008 to September 30,2009. If you have any questions on this item, please do not hesitate to
contact me at X4458.
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SUMMARY OF PROPOSED PREMIUMS AND RELATED INFORMATION
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Premiums as Proposed: $166,683
Payment Plan: Annual to agent
This proposal is based upon the exposures to loss made known to the Agency. Any changes
in these exposures (i.e., new operations, new products, additional states of hire, etc.) need to
be promptly reported to us in order that proper coverage(s) may be put into place.
Subject to signed application.
We appreciate the opportunity to assist your insurance needs. Information concerning
additional compensation paid to other entities for this placement and related services appears
below. Please do not hesitate to contact us if any additional information is required.
Our office is owned by Brown & Brown, Inc. Brown & Brown entities operate independently
and are not required to utilize other companies owned by Brown & Brown, Inc., but routinely
.so.
For the 2008 policy year your insurance was quoted with Star Insurance, through Public Risk
Underwriters, a company owned by Brown & Brown, Inc. PRU may also receive commissions
from insurance companies with whom it places your coverage, which commissions are
derived from the premium you pay to PGIT. Multiple underwriters may be involved in the
placement of your coverage. If so, they also may be compensated for their services from the
premium you pay.
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EXCESS COMMERCIAL GENERAL LIABILITY COVERAGE ,I
I'L - _w.. .-- J
Named Insured: Monroe County Board of County Commissioners
Policy Term: 10/1/08 to 10/1/09
Coverage Written On: (X) Occurrence Form
Limits Coverage Description
$ 1,000,000 Each Occurrence - Bodily Injury and Property Damage
$ 1,000,000 General Aggregate
$ 1,000,000 Employee Benefits
Self Insured Retention $1,000,000
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III EXCESS WORKERS' COMPENSATION POLICY I
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Named Insured: Monroe County Board of County Commissioners
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Policy Term: 10/1/2008 to 10/1/2009
Limits Coverage Description
$ 1,000,000 Employer's Liability - Each Accident
$ 1,000,000 Employer's Liability - Disease- Policy Limit
$ 1,000,000 Employer's Liability- Disease- Each Employee
Self insured retention $1,000,000
NON AUDIT ABLE
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PREMIUM SUMMARY
Named Insured: Monroe County BOCC
Dates: 10/1/2008 to 10/1/2009
DESCRIPTION OF COVERAGE PREMIUM
Property $ n/a
CommerciallnJand Marine $ n/a
Commercial General Liability- Excess $ included
Public Official Liability $ n/a
Crime $ n/a
Commercial Automobile $ n/a
Boiler and Machinery $ n/a
Worker's Compensation $ 165,000
$ n/a
Umbrella
$ 1.683
Florida Fees & Taxes
Total Estimated Premium I $ 166,683
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Star Insurane Company is rated A- by AM Best
<" ~ COMMERCIAL INSURANCE APPLICATION DATE (MMIDD/YYYY)
ACOkDS
\............./ APPLICANT INFORMATION SECTION 8/14/2008
AGENCY CARRIER NAIC CODE: 18023 UNDERWRITER UNDERWRITER OFF,
Brown & Brown of Florida, Inc. Star Insurance Co.
900 N 14th Street POLICIES OR PROGRAM REQUESTED POLICY NUMBER
PO Box 491636 CP02677 07
Leesburg FL 34749-1636 INDICATE SECTIONS ATTACHED EQU,PMENT FLOATER GARAGE AND DEALERS
( . o. Ext): (352)787-2431 PROPERTY INSTALLATIONiBUILDERS RISK VEHICLE SCHEDULE
( (352)787-9922 GLASS AND SIGN ELECTRONIC DATA PROC BOILER & MACHINERY
Scott.Hindman@bbleesburg ACCOUNTS RECEIVABLE! X COMMERCIAL X WORKERS COMPENSATION
A ORE VALUABLE PAPERS GENERAL LIABILITY
CODE: SUB CODE: CRIMEIMISCELLANEOUS CRIME BUSINESS AUTO UMBRELLA
AGENCY CUSTOMER 10: 00009579 TRANSPORTATION! TRUCKERSIMOTOR CARRIER
MOTOR TRUCK CARGO
STATUS OF TRANSACTION PACKAGE POLICY INFORMATION
QUOTE ISSUE POLICY X RENEW ENTER THIS INFORMATION IM-fEN COMMON DATES AND TERMS APPLY TO SEVERAL LINES, OR FOR MONOllNE POLICIES
BOUND (GIVe Date and/or Attach Copy) PROPOSED EFF DATE PROPOSED EXP DATE BILLING PLAN PAYMENT PLAN AUDIT
CHANGE DATE TIME X AM DIRECT BILL
CANCEL 10/1/2008 12:01 PM 10/1/2008 10/1/2009 X AGENCY BILL
APPLICANT IN FORMA TION
NAME (First Named Insured & Other Named Insureds) MAILING ADDRESS INCL ZlP+4 (of First Named Insured)
Monroe County BOCC Director of Purchasing Ofc.
1100 Simonton St.,Rm 2-268
Key West FL 33040
592206928 (305)292-4466
WEBSITE
ADDRESS(ES):
10 NUMBER DATE BUS
STARTED
E.MAIL
ADDRESS:
LOCI BLDIll STREET, CITY. COUNTY. STATE, ZlP+4 CITY LIMITS INTEREST AX~T # ANNUAL % OCCUPIED
EMPLOYEES REVENUES
Sr. Administration Benefits lJ INSIDE X OWNER part
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Key West FL 33040 OUTSIDE - TENANT
1 1 Monroe
Sr. Administration Benefits ~ INSIDE OWNER
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Key West FL 33040 OUTSIDE TENANT
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2 1 Monroe
NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREMISE(S)
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GENERAL INFORMATION
EXPLAIN ALL "YES" RESPONSES YES NO EXPLAIN ALL "YES" RESPONSES YES NO
1a IS THE APPLICANT A SUBSIDIARY OF ANOTHER ENTITY? X 8 DURING THE LAST FIVE YEARS (TEN IN RI). HAS ANY APPLICANT BEEN
INDICTED FOR OR CONVICTED OF ANY DEGREE OF THE CRIME OF FRAUD,
1b DOES THE APPLICANT HAVE ANY SUBSIDIARIES? BRIBERY, ARSON OR ANY OTHER ARSON.RELATED CRIME IN CONNECTION
'MTH THIS OR ANY OTHER PROPERTY?
2 IS A FORMAL SAFETY PROGRAM IN OPERATION? X (In RI, thIS queslion must be answered by any applICant fO( property Irlsurance
F arlure to diSClose the eXistence of an arson ConViCtion IS a misdemeanor
3 ANY EXPOSURE TO FLAMMABLES, EXPLOSIVES. CHEMICALS? X punIShable by a sentence o! up to one year of Iffipnsonment) X
4 ANY CATASTROPHE EXPOSURE? X 9 ANY UNCORRECTED FIRE CODE VIOLATIONS? X
5 ANY OTHER INSURANCE 'MTH THIS COMPANY OR BEING SUBMITTED? X 10 ;~N'H~~ffif~~~s~ AX OR CREDIT LIENS AGAINST THE APPLICANT X
5 ANY POLICY OR COVERAGE DECLINED, CANCELLED OR NON-RENEWED 11 HAS BUSINESS BEEN PLACED IN A TRUST?
DURING THE PRIOR 3 YEARS? (Not appllC<lble '" MO) X 12 IF YES, NAME OF TRUST
ANY FOREIGN OPERATIONS, FOREIGN PRODUCTS DISTRIBUTED IN USA. OR US
7 ANY PAST LOSSES OR CLAIMS RELATiNG TO SEXUAL ABUSE OR PRODUCTS SOLDIDISTR,BUTED IN FOREIGN COUNTRIES? (W 'YES", attach
MOLESTATION ALLEGATIONS, DISCRIM,NATION OR NEGLIGENT HIRING? X ACORD 815 fO( Loollrty Exposure andlor ACORD 816 for Property Exposur,,)
REMARKS/PROCESSlNG INSTRUCTIONS (Attach additional sh"els If more spac" is requl,ed)
ANY PERSON IM-fO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPliCATION FOR INSURANCE OR STATEMENT OF CLAIM
CONTAINING ANY MATERIALLY FALSE INFORMATION, OR CONCEALS FOR fHE PURPOSE OF MISLEADING, INFORMATION CONCERNING ANY FACT MATERiAl THERETO, COMMITS A
~r~Z~~ll';;,~~=C~f~ ~~~~~S~ 2~~~ AND SUBJECTS THE PERSON TO CRIMINAL AND [NY SUBSTANTIAL) CIVIL PENAL TIES (Not applicable In CO, HI, NE, OH, OK. OR. 0( VT Irl DC, LA,
THE UNDERSIGNED IS AN AUTHORIZED REPRESENTAT'Y:;~Of,,:~E APPlICAN~~~9-xt~TI~~~ST~H~JFREASONABLE ENQUIRY HAS BEEN MADE TO OBTAIN THE ANSWERS TO QUESTIONS ON THIS
APPLlCANrs SIGNATURE I DATE I PRODUCER'S SIGNA,TURE_~ A I NATIONAL PRODUCER NUMBER
8/14/2008 ~B-c/ :7 p>~-<I~___
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ACORD 125 (2005/06) PLEASE COMPLETE PAGE 2 @ ACORD CORPORATION 1993-2005
INS125 (200506) 02a Page 1 of 2