HomeMy WebLinkAboutCC Resolution 10830 (Workers Comp. Insurance)RESOLUTION NO. 10830
RESOLUTION AUTHORIZING THE RENEWAL OF
EXCESS WORKERS' COMPENSATION INSURANCE WITH
UNITED STATES FIDELITY AND GUARANTY COMPANY
FROM JULY 1, 2001 THROUGH JUNE 30, 2004.
THE CITY COUNCIL OF THE CITY OF SAN RAFAEL RESOLVES as follows:
The RISK MANAGER is authorized to renew, on behalf of the City of San Rafael, the
Excess Workers' Compensation Insurance with United States Fidelity and Guaranty Company
(USF&G) from July 1, 2001 through June 30, 2004.
I, JEANNE M. LEONCINI, Clerk of the City of San Rafael, hereby certify that the
foregoing resolution was duly and regularly introduced and adopted at a regular meeting of the
City Council of said City on Monday, the 21St day of May, 2001, by the following vote, to wit:
AYES: COUNCILMEMBERS: Heller, Miller, Phillips and Mayor Boro
NOES: COUNCILMEMBERS: None
ABSENT: COUNCILMEMBERS: Cohen
+1PP JEANNE M. LEONCINI, City Clerk
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CNRISTOPIIER M. IRVINE
ASSISTANT VICE PRESIOENT
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June 1, 2001
RECEIVED
Patricia Clark JUN j ZQQj
Marsh Risk and Insurance Services
Three Embarcadero Center d & H MARSH & MCLENNAN
San Francisco, CA 94111 SAN FRANCISCO, CA
Re: City of San Rafael — Excess Workers' Compensation
Policy Number: D003X00001
Dear Jim and Pat:
Discovery Managers, Ltd, is pleased to bind Workers' Compensation coverage for
City of San Rafael in accordance with the following terms and conditions;
Carrier: Discover Property & Casualty
(A Member of the St Paul Group of Co's. Bests At XV)
Term:. July 1, 2001 — July 1, 2004
Tvpe of Insurq>t1(,ce;
Excess Workers' Compensation Subject to a Self -Insured
Retention
ONE MgRIIET PLUA
STWT TOWER rZOSO
SAH MEMO, CA 94105.1000
(415) 5438111
HIS; (415) 543.8119
ElAA1L clrvin�s�e�remm
RECEIVED TIME MAY,31, 5:29PM
PRINT TIME MAY. 31. 5:32PM
Type of ProVaam:
Self -Insured
Retention States.-
Coverage
tates:
Coverage & Limits:
Self -Insured Retention
California
Workers' Compensation: $10,000,000 for all states shown above
Employers Liability: $1,000,000 Each Accident - (BI by accident)
$1,000,000 Each Employee - (BI by Disease)
$1,000,000 Aggregate - (BI by Disease)
• Other States Coverage: All states except Monopolistic States
• USL&H Coverage: "if any" basis (no known exposure)
• Notice of Cancellation /Non Renewal: 60 days except 10 days for non-
payment
Self -Insured Retention Program Premiums:
The first $250,000 Each Accident for Bodily Injury by Accident
The first $250,000 Each Employee for Bodily Injury by Disease
Year 1:
The Estimated Annual Premium is $54,500 adjustable % $.2105 per $100 of Self -
Insured Workers' Compensation payroll estimated at $25,893,163 for the first
annual term.
The Minimum 1' Year Premium:
$54,500
RECEIVED TIME MAY.31. 5:29PM PRINT TIME MAY.31. 5:32PM
Year 2:
The Estimated Annual Premium iS $64,500 adjustable at $.2491 per $100 of Self-
Insured
elfInsured Workers' Compensation payroll estimated at $25,893,163 for the fust
annual term,
The Minimum 2"d Year Premium: $64,500
Year 3:
The Estimated Annual Premium. is $74,000 adjustable at $.2858 per $100 of Self -
Insured Workers' Compensation payroll estimated at $25,893,163 for the first
annual term.
The Minimum 3" �d Year Premium: $74,000
Poliev / Program features:
Allocated Loss Adjustment Expenses are ' ide the SIR, and outside of the policy
limits.
USF&G filed policies, forms and endorsements will be used unless otherwise
indicated.
USF&G does not have the duty to investigate, defend, or settle any claim or suit
USF&G has the right to associate with the prospective Insured in the
investigation, defense or settlement of any claim or suit which feels may involve
its liability under the policy.
Premium Pavment Terms:
Premium is payable in annual installments per the following schedule:
$54,500 due in full on 8/1/2001,
$64,500 due in full on 7/1/2002,
$74,000 due in full on 7/1/2003.
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RECEIVED TIME MAY.31. 5:29PM PRINT TIME MAY.31. 5:32PM
Claim Handling Renuirements:
Please see Exhibit A. It is our understanding that Acclamation Insurance
Management Services are acting as the Insured's TPA upon renewal,
It is agreed that subsequently issued polcies & invoices shall conform
Jim and
to &4you for the binder! Please call if you have any questions.
Sincerely,
O-,,- LLk.
Christopher M. Irving
Trent C. Tr h
4
RECEIVED TIME MAY. 31. 5:29PM PRINT TIME MAY. 31. 5:32PM