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Home My WebLink About000173.tiff ARTHUR J. GALLAGHER & CO- CURRENT SUMMARY OF INSURANCE PREPARED FOR WELD COUNTY, COLORADO MAY 1, 1997 SUBMITTED BY JOHN P. McLAUGHLIN VICE PRESIDENT- RISK MANAGEMENT SERVICES ARTHUR J. GALLAGHER & CO. - DENVER 7900 EAST UNION AVENUE, SUITE 200 DENVER CO 80237-2737 (303)773-9999 I IT SHOULD BE EMPHASIZED THAT THE DESCRIPTION OF COVERAGE ENCLOSED IS A SUMMARY ONLY. THE COVERAGE IS SUBJECT TO TERMS AND CONDITIONS OUTLINED AND CERTAIN RESTRICTIONS, LIMITATIONS AND EXCLUSIONS '.. CONTAINED IN THE POLICIES OF INSURANCE. THE DESCRIPTION IS NOTA POLICY OF INSURANCE. IN THE EVENT OF ANY CONFLICT BETWEEN THE ENCLOSED DESCRIPTION OF COVERAGE AND THE POL/CY OF INSURANCE, THE PROVISIONS CONTAINED IN THE POLICY OF INSURANCE WILL GOVERN. 173 M:ACLIENT.DOC\WELD{T19WC{51.9] AR-I-I-JUR J. GALLAGHER & CO. WELD COUNTY, COLORADO SUMMARY OF CURRENT POLICIES • 1 COMPANY ` POLICY# PERIOD EXCESS WORKERS COMPENSATION National Union 415-77-70 12/31/96-99 Fire • SELF INSURER'S BOND Aetna Casualty & 19S100729968 12/31/91 Surety Company ' Continuous M:\CL IE NT.DOC\W E L D{T11WC{51.97 . .......Page ARTHUR J. GALLAGHER & CO. WELD COUNTY, COLORADO EXCESS WORKERS COMPENSATION COVERAGE 4. SPECIFIC EXCESS ONLY 4 Limits Workers Compensation Statutory Each Accident Statutory Each Employee for Disease Employers Liability $ 1,000,000 Each Accident $ 1,000,000 Each Employee by Disease Specific Retentions Workers Compensation $ 300,000 Each Accident $ 300,000 Each Employee for Disease $ 500,000 USL&H Employers Liability $ 300,000 Each Accident $ 300,000 Each Employee for Disease $ 500,000 USL&H Terms/Conditions Allocated Claims expenses included in SIR and Limits • USL&H included (incidental only) • All States endorsement No Commutation Clause • Board Members included No Aircraft Exclusion 3 Year Rate Guarantee Communicable Disease Endorsement Adjustable Rate .0949 Per $100 Payroll 12/31/96-97 .0850 Per $100 Payroll 12/31/97-98 .0765 Per $100 Payroll 12/31/98-99 Adjustable Basis Payroll Estimated at $24,682,735 M Page,�aie�ur ooc�weiotmwctsi.y� Page 2 ARTHUR J. GALLAGHER & CO. WELD COUNTY, COLORADO WORKERS COMPENSATION BOND Carrier Aetna Casualty and Surety Company, A XIV Bond Penal Sum $ 605,000 (1) Terms / Conditions Continuous until cancelled 1) Subject to review by Division of Labor. MaCLIENT.DOQW{LD-Cmwc-CSI 9] _.. -_. _... Page 3 et V Pi '. ." : i._ J, k..ry . ,Y... ..'. .BEN \l ER July 21 , 1997 Mr. Don Warden Director of Finance & Administration WELD COUNTY, COLORADO P.O. Box 758 Greeley, CO 80632 Re: Current Summary of Insurance Dear Don: Enclosed is your Current Summary of Insurance document (one for the policy notebook and one loose copy). Please place this in the front of your policy notebook. Should you have any questions, please feel free to give me a call. Sincerely, ARTHUR J. GALLAGHER & CO.-DENVER /4\ Karen Graham, CIC Sr. Account Manager :kg enclosure KG\C:\WP\WELD.CNT\GEN.COP\90CSI.LTA July 21,1997 7900 E. Union Ave.. C , YOU, Denver, CO 8023;:-2737 , P.O. Box 24809, Denver, CO 80224 3-9999 , Fax 03 73 977 Gtifr glom;, July 18, 1997 Don Warden Weld County P.O. Box 758 Greeley, CO 80632 Dear Don, Over the past two years many of you have participated in a quality review process undertaken by our office. Overall we received very positive feedback from our clients about our product knowledge, commitment to service and responsiveness. This was gratifying and reinforced we are on the right track toward exceeding client expectations. However, there were areas where you indicated we could heighten our value to you. Specifically, these areas are: • Develop a more thorough understanding of your risk management goals and objectives (In some cases you asked for assistance in developing goals and objectives). To this end it was suggested we structure and measure our service plans based on your goals and objectives. • Increase our participation in your claims management practices and strategies. • Improve on the timeliness of policy deliverance. • Make available loss control services. • Increase client awareness of available Insurance Company services and make greater utilization of these services. To address these issues, we are taking the following steps: • Between now and September 1st, your account management team at Gallagher will be arranging a meeting with you to review your risk management goals and objectives and to revisit our broker service plan in light of your goals. If you do not have specific goals maybe this is an area where we can assist! , . ; i �f� „ GALLAGHERNC� Don Warden Page 2 July 18, 1997 • Effective July 1, Gary Longfellow has taken over as claims manager for all Risk Management Service accounts. Gary joined Arthur J. Gallagher & Company last year to support our goal of providing clients with superior claims service. He brings to this position twenty plus years of claim experience, both as a company and TPA adjuster. His responsibilities include coordinating the reporting, monitoring and settlement of claims reported to excess carriers, participation in periodic claims management meetings, internal claim audits, and assistance in developing litigation management strategies. In addition to these services, Gary can also provide support in auditing TPA's, developing internal claims management practices and procedures, rebuilding policy records and filing/settling claims with prior carriers. You will be receiving more information shortly about Gary's role on your account management team. • For the remainder of 1997, our goal is to deliver 100% of new and renewal policies to our clients within ninety days of the order to bind coverage. In 1998 we are looking to improve the delivery time to sixty days and in 1999 reduce this further to 45 days. With proper coordination, there is no reason policies cannot be delivered prior to your effective date. This is our ultimate goal. • Beginning January 1st, we contracted with Mike Cazel to provide a source of loss control support to our clients. Frankly, the demand for Mike's services out stripped his allotted time. We are evaluating ways to increase the availability of loss control services in 1998 and will keep you posted. • Effective immediately all of our proposals will include a summary of carrier claims and loss control services available with your policy and other services available at additional cost. The message is loud and clear, risk management resources are scarce and we need to maximize services from all sources. This is the beginning of our effort to provide world class brokerage and consulting services. We will continue to seek your advice in improving and refining our services. Over the next few months you will receive correspondence from your account executive related to the above issues. In the meantime, please do not hesitate to contact me concerning this or any issue. Sincerel , John P. g Vice President, RM n:hms-av/j m/unit/service.let EXCESS WORKERS COMPENSATION COLORADO AMENDATORY ENDORSEMENT ENDORSEMENT - REVISED This endorsement, effective 12:01 A.M. 12131/96 forms a part of Policy No. XWC 415-77-70 issued to WELD COUNTY, COLORADO By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. CANCELLATION In consideration of the premium charged, it is understood and agreed that Condition B Cancellation of this policy is hereby deleted and replaced by the following: B) Cancellation: 1) You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2) We may cancel this policy. If we cancel because of non-payment of premium, we must send by certified mail not less than ten (10) days advance written notice stating when cancellation is to take effect to you, your agent or representative and to: John Berger, ARM, CHCM Department of Labor and Employment Division of Workers' Compensation Self-Insurance 1515 Arapahoe Street Denver, Colorado 80202-2117 If we cancel for any other reason, we must send by certified mail not less than ninety (90) days advance written notice stating when the cancellation is to take effect to you, your agent or representative and to: John Berger, ARM, CHCM Department of Labor and Employment Division of Workers Compensation Self-Insurance 1515 Arapahoe Street Denver, Colorado 80202-2117 Mailing that notice to you by certified mail at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3) The policy period will end on the day and hour stated in the cancellation notice. All other terms, conditions and exclusions shall remain the same. (08/21/97)scm ILA C I c�i� 54199(9/92) AUTHORIZED REPRESENTATIVE ENDORSEMENT (REVISED) This endorsement, effective 12:01 A.M. 12/31096 forms a part of Policy No. XWC 415-77-70 issued to WELD COUNTY, COLORADO By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA EXCESS WORKERS COMPENSATION BOARD MEMBERS ENDORSEMENT It is hereby agreed that coverage is extended to include Board Members. For the purpose of premium computation, $2,500 per year shall be attributed as the payroll for each Board Member. All other terms, conditions and exclusions shall remain the same. (Z.oti - AUTHORIZED REPRESENTATIVE 61305(11/94) FORMS SCHEDULE REVISED EFFECTIVE DATE: 12/31/96 NAMED INSURED: WELD COUNTY, COLORADO POLICY NO.: XWC 415-77-70 S54199 (0992) S56291 (0393) S56317 (0393) U61305 (1194) U61073 (0994)/ENDT. #1 ENDT. #2 "lei IorNC rnov sor�s4 e ' September 5, 1997 Mr. Don Warden Weld County, Colorado P.O. Box 758 Greeley, CO 80631 RE: Excess Worker's Compensation & Employers Liability Policy #415-77-70 Dear Don, Endorsements, which Karen requested way back in April, that correct the following items for the above captioned policy effective 12/31/96 are enclosed: 1. Form Schedule - Revised, which adds endorsements 54199(9/92), 61073(9/94), and Endorsement #2 to the list 2. Colorado Amendatory Endorsement - Revised showing 90-day NOC for reason other than non-payment 3. Board Member Endorsement, which adds coverage for Board Members and deletes Volunteers None of the endorsements results in a change in the policy premium. Please place them with your copy of the policy. Should you have any questions about them, please contact either Karen Graham or me. Sincerely, ARTHUR J. GALLAGHER & CO. - DENVER h/ Pew Pat Person, MS Account Assistant Enclosure n\rme-evbN\weimgencen warden m 9/5/97 WELD COUNTY COLORADO 1996 to 1999 EXCESS WORKERS ' COMPENSATION POLICY \'gyp April 17, 1997 Mr. Donald Warden Weld County, Colorado P.O. Box 758 Greeley, CO 80631 Re: Specific Excess Workers' Compensation Policy Nat'l Union Fire Insurance Company#415 77-70 12/31/96-99 Term Dear Don: I am happy to enclose the captioned policy. I have reviewed this policy for accuracy and did identify a few errors. I have requested that these items be corrected by endorsement. Your copy of my request is enclosed. The requested changes will follow shortly. Additionally, I have forwarded a copy of this policy to your Third Party Administrator, OHMS. Should you have any questions after your review of this policy, feel free to give me a call. Thank you again for the opportunity to handle your insurance/brokerage services. Sincerely, ARTHUR J. GALLAGHER& CO.-DENVER Karen L. Graham, CIC Sr. Account Manager Enclosure c: Karen Lesko, OHMS (with enclosures) n, ARTHUR J. GALLAGHER & CO ----DENVER Memorandum To: Robert Chapton AIG - Los Angeles From: Karen L. Graham, CIC �� Sr. Account Manager Date: April 18, 1997 Re: Weld County, CO Excess WC#4157770 12/31/96-99 I have just completed my review of the captioned policy and will need the following changes effective 12/31/96: • The Forms Schedule does not list endorsements 54199(992) CO Amendatory, 61073(994) Communicable Disease Endorsement#1 or Endorsement. #2 (12997) Multi- Year Endorsement please have them added. • The Colorado Amendatory endorsement shows 60 days notice of cancellation and it should read 90 days notice of cancellation. • Endorsement #2 Volunteer& Board Members should be for Board Members only, please delete Volunteers. In addition, please correct the effective date on this endorsement to read 1/1/97 in lieu of 12/1/96. Please feel free to give me a call with any questions. I look forward to receiving these changes soon. Kind Regards. C: Donald Warden, Dir. Finance& Administration, Weld County, CO 1 IOW E, Union Ave.,Suite Deliver, CO 80237 7'a;' « F o:t , I) C;C.i $0224 ;trv. 77o-cq,i4 NATIONAL UNION POLICY NUMBER: FIRE INSURANCE COMPANY 415-77-70 OF PITTSBURGH, PA RENEWAL OF: NEW p .?-CtloN A CAPITAL STOCK COMPANY ADMINISTRATIVE OFFICES 70 PINE STREET, NEW YORK, N.Y. 10270-0150 EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY INFORMATION PAGE ITEM 1: Named Insured and Mailing Address WELD COUNTY, COLORADO P 0 BOX 758 GREELEY CO 80632-0000 ITEM 2: States (In which coverage is to apply) COLORADO ITEM 3: Policy Period FROM: 12/31/96 TO 12/31/99 12:01 A.M.Standard Time at the Mailing Address shown herein ITEM 4: Our Limit of Indemnity PART ONE: WORKERS COMPENSATION STATUTORY - Each Accident STATUTORY - Each Employee For Disease PART TWO: EMPLOYERS LIABILITY $1 ,000,000 - Each Accident $1 ,000,000 - Each Employee For Disease ITEM 5: Your Retention PART ONE: WORKERS COMPENSATION $300,000 - Each Accident $300,000 - Each Employee For Disease PART TWO: EMPLOYERS LIABILITY $300,000 - Each Accident $300,000 - Each Employee For Disease ITEM 6: Premium and Premium Computation Estimated Total Annual Remuneration $24,682,735 Rates Per$100 of Remuneration SEE ENDORSEMENT #2 Deposit Premium SEE ENDORSEMENT #2 Minimum Premium SEE ENDORSEMENT #2 THIS POLICY INCLUDES THESE ENDORSEMENTS: SEE ATTACHED SCHEDULE PRODUCER NAME AND ADDRESS: COUNTERSIGNED BY: ARTHUR J GALLAGHER S CO - DENV 7900 E. UNION AVE. #200 PO BOX 24809 DENVER CO 80224-2737 Z�7 ( � iC1-c - \ rt' `--- (AUTHORIZED REPR ENTATIVE) Date Issued 01/03/97 54360(10/92) EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY In return for the payment of the premium and subject to all terms of this policy, we agree with you as follows: GENERAL SECTION A. The Policy This policy includes at its effective date the Information Page and all endorsements listed there. It is a contract of insurance between you (the employer named in Item 1 of the Information Page) and us (the insurer named on the Information Page). 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 part of this policy. B. Who is Insured You are insured if you are an employer named in Item 1 of the Information Page. If that employer is a partnership or joint venture and if you are a partner in the partnership or a member of the joint venture, you are insured, but only in your capacity as an employer of employees of the partnership or joint venture. C. Workers Compensation Law Workers Compensation Law means the workers or workmen's compensation law and occupational disease law of each state or territory named in Item 2 of the Information Page. It includes any amendments to that law which are in effect during the policy period. It does not include any federal workers or workmen's compensation law, any federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. 0. State State means any state of the United States of America, and the District of Columbia. E. Location This policy covers all of your workplaces in the states listed in Item 2 of the Information Page. F. Qualified Self-Insurer You represent that you are a duly qualified self-insurer under the Workers Compensation Law of each state named in Item 2 of the Information Page and will continue to maintain such qualifications during the term this policy is in effect. If you should terminate such qualifications or if your qualification as a self-insurer is cancelled or revoked while this policy is in force, the amounts payable under this policy will not be increased and you will be responsible for payments within Your Retention. PART ONE WORKERS COMPENSATION INSURANCE A. How This Insurance Applies This insurance applies to losses paid by you as a qualified self-insurer under the Workers Compensation Law for Bodily Injury by Accident or Bodily Injury by Disease. Bodily Injury includes resulting death. 1. Bodily Injury by Accident must occur during the policy period. 2. 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. (1) 54361(10/92) 'Mc'IPFf S C(lPV If you begin work after the effective date of this policy in any state for which you are not insured or are not self-insured for such work, this insurance will apply as though that state were listed in Item 2 of the Information Page but only if you notify us in writing within ninety (90) days from the date you begin such work. B. We Will Indemnify We will indemnify you for your loss as a qualified self-insurer under the Workers Compensation Law in excess of Your Retention as stated in Item 5 of the Information Page but not for more than Our Limit of Indemnity as stated in Item 4 of the Information Page. Loss means amounts actually paid by you as a qualified self-insurer under the Workers Compensation Law and also includes your claim expenses. Your claim expenses are included within Your Retention. Our payments to indemnify you for your claim expenses are included within Our Limit of Indemnity. Your claim expenses mean your litigation costs, interest as required by law on awards or judgments and your claim investigation or legal expenses which can be directly allocated to a specific claim. Claim expenses do not include salaries and travel expenses of your employees, annual retainers, overhead and any fees you paid for claim administration. Your bankruptcy, insolvency or inability to pay will not relieve us from the indemnification of any claim covered by this policy. But under no circumstances will we be required to drop down and replace Your Retention or assume any of your obligations within the retention area. After Your Retention has been reached, indemnification due under this policy will be made by us as if you had not become bankrupt or insolvent but not in excess of Our Limit of Indemnity as stated in Item 4 of the Information Page. Such indemnification will be made to the Trustee in Bankruptcy or as a Court of competent jursidiction may ultimately direct. C. Defense We have no duty to investigate, handle, settle, or defend any claim, suit or proceeding against you. However, we have the right and shall be given the opportunity by you to associate with you in the defense, investigation or settlement of any claim, suit or proceeding which might involve a loss to us. In such an association, you shall promptly cooperate with us in all aspects of defense, investigation or settlement. D. Other Insurance If any other insurance exists protecting you against loss covered by this insurance, this insurance shall apply in excess of the other insurance. However, this provision shall not apply to other insurance which you have procured to apply in excess of the sum of Your Retention and Our Limit of Indemnity under this policy. E. Payments You Must Make You are responsible 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 of law; 3. you fail to comply with a health or safety law or regulation; 4. you discharge, coerce or otherwise discriminate against any employee in violation of the Workers Compensation Law; or 5. you violate or fail to comply with any Workers Compensation Law. If we make any payments in excess of the benefits regularly provided by the Workers Compensation Law on your behalf, you will reimburse us promptly. (2) 54361(10/92) F. Exclusion We will not indemnify you for any loss arising out of operations for which you have rejected any Workers Compensation Law. G. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. Any recovered loss will be allocated as follows: If there is insurance coverage in excess of Our Limit of Indemnity, that insurer's loss will be reimbursed first. The remaining recovered loss, after deducting our recovery expenses, will first be used to reduce our loss. Then we will pay the balance, if any, to you. H. Action Against Us There will be no right of action against us under this insurance unless you have complied with all the terms of this policy. Statutory Provision Terms of this insurance that conflict with the Workers Compensation Law are changed by this statement to conform to that law. PART TWO EMPLOYERS LIABILITY INSURANCE A. How This Insurance Applies This insurance applies to losses paid by you as a qualified self-insurer of Employers Liability for Bodily Injury by Accident or Bodily Injury by Disease. Bodily Injury includes resulting death. 1. The Bodily Injury must arise out of and in the course of the injured employee's employment by you. 2. The employment must be necessary or incidental to your work in a state or territory listed in Item 2 of the Information Page. 3. Bodily Injury by Accident must occur during the policy period. 4. 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. 5. If you are sued, the original suit and any related legal actions for damages for Bodily Injury by Accident or by Disease must be brought in the United States of America. If you begin work after the effective date of this policy in any state for which you are not insured or are not self-insured for such work this insurance will apply as though that state were listed in Item 2 of the Information Page but only if you notify us in writing within ninety (90) days from the date you begin such work. _ B. We Will Indemnify We will indemnify you for loss as a qualified self-insurer of Employers Liability in excess of Your Retention as stated in Item 5 of the Information Page but not for more than Our Limit of Indemnity as stated in Item 4 of the Information Page. (3) 54361(10/92) INSI IRFf'R CfPV Loss means amounts which you legally paid as damages as a qualified self-insurer because of Bodily Injury by Accident or Bodily Injury by Disease and also includes your claim expenses. Bodily Injury includes resulting death. Your claim expenses are included within Your Retention. Our payments to indemnify you for your claim expenses are included within Our Limit of Indemnity. Your claim expenses mean your litigation costs, interest as required by law on awards or judgments and your claim investigation or legal expenses which can be directly allocated to a specific claim. Claim expenses do not include salaries and travel expenses of your employees, annual retainers, overhead and any fees you paid for claim administration. Damages include: 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. Your bankrupty, insolvency, or inability to pay will not relieve us from the indemnification of any claim covered by this policy. But under no circumstances will we be required to drop down and replace Your Retention or assume any of your obligations within the retention area. After Your Retention has been reached, indemnification due under this policy will be made by us as if you had not become bankrupt or insolvent but not in excess of Our Limit of Indemnity as stated in Item 4 of the Information Page. Such indemnification will be made to the Trustee in Bankruptcy or as a Court of competent jurisdiction may ultimately direct. C. Exclusions This insurance does not cover: 1. liability assumed under a contract; 2. punitive or exemplary damages; 3. 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; 4. any obligation imposed by a workers compensation, occupational disease, unemployment compensation, or disability benefits law, or any similiar law; 5. bodily injury intentionally caused or aggravated by you; 6. bodily injury occuring outside the United States of America. This exclusion does not apply to bodily injury to a citizen or resident of the United States of America who is temporarily outside the United States of America; 7. damages arising out of coercion, criticism, demotion, evaluation, reassignment, discipline, defamation, harassment, humiliation, discrimination against or termination of any employee, or any personnel practices, policies, acts or omissions; 8. bodily injury to any person in work subject to the Longshore and Harbor Workers' Compensation Act (33 USC Sections 901-950), the Nonappropriated Fund Instrumentalities Act (5 USC Sections 8171-8173), (4) 54361(10/92) the Outer Continental Shelf Lands Act (43 USC Sections 1331-1356), the Defense Base Act (42 USC Sections 1651-1654), the Federal Coal Mine Health and Safety Act of 1969 (30 USC Sections 901-942), any other federal workers or workmen's compensation law or other federal occupational disease law, or any amendments to these laws; 9. bodily injury to any person in work subject to the Federal Employers' Liability Act (45 USC Sections 51-60), any other federal laws obligating an employer to pay damages to an employee due to bodily injury arising out of or in the course of employment, or any amendments to those laws; 10. bodily injury to a master or member of the crew of any vessel; 11. fines or penalties imposed for violation of federal or state law; 12. damages payable under the Migrant and Seasonal Agricultural Worker Protection Act (29 USC Sections 1801-1872) and under any other federal law awarding damages for violation of those laws or regulations issued thereunder, and any amendments to those laws; 13. damages arising out of operations for which you have violated or failed to comply with any Workers Compensation Law; 14. damages arising out of operations for which you have rejected any Workers Compensation Law. D. Defense We have no duty to investigate, handle, settle or defend any claim, suit or proceeding against you. However, we have the right and shall be given the opportunity by you to associate with you in the defense, investigation or settlement of any claim, suit, or proceeding which might involve a loss to us. In such an association, you shall promptly cooperate with us in all aspects of defense, investigation or settlement. __ E. Other Insurance If any other insurance exists protecting you against loss covered by this insurance, this insurance shall apply in excess of the other insurance. However, this provision shall not apply to other insurance which you have procured to apply in excess of the sum of Your Retention and Our Limit of Indemnity under this policy. F. Recovery From Others We have your rights, and the rights of persons entitled to the benefits of this insurance, to recover our payments from anyone liable for the injury. You will do everything necessary to protect those rights for us and to help us enforce them. Any recovered loss will be allocated as follows: If there is insurance coverage in excess of Our Limit of Indemnity, that insurer's loss will be reimbursed first. The remaining recovered loss, after deducting our recovery expenses, will first be used to reduce our loss. Then we will pay the balance, if any, to you. G. Actions Against Us • There will be no right of action against us under this insurance unless: 1. you have complied with all the terms of this policy; and 2. the amount you owe has been determined with our consent or by actual trial and final judgment. This insurance does not give anyone the right to add us as a defendant in an action against you to determine your liability. (5) 54361(10/92) INSURED'S COPY PART THREE YOUR RETENTION AND OUR LIMIT OF INDEMNITY A. Your Retention You shall pay for your own account any loss up to the amount stated in Item 5 of the Information Page as Your Retention. B. Our Limit of Indemnity We will indemnify you for loss over the amount stated as Your Retention in Item 5 of the Information Page. Our Limit of Indemnity for Workers Compensation Insurance will not exceed the limits stated in Item 4 of the Information Page. Our Limit of Indemnity for Employers Liability Insurance will not exceed the limits stated in Item 4 of the Information Page. C. How Your Retention and Our Limit of Indemnity Apply Your Retention and Our Limit of Indemnity stated on the Information Page apply to each loss paid by you as a qualified self-insurer of Workers Compensation and Employers Liability as follows: 1. To one or more employees because of bodily injury or death in any one accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. To any one employee for bodily injury or death by disease. Bodily injury by disease does not include disease that results directly from a bodily injury by accident. The inclusion of more than one legal entity as insured in Item 1 of the Information Page will not increase Your Retention or Our Limit of Indemnity. PART FOUR CLAIMS A. Your Claims Reporting Duties You must immediately notify us in writing of any claim, either paid or reserved, for 50% or more of Your Retention stated in Item 5 of the Information Page. You must also give us immediate written notice of any injury involving the following types of accident: 1. a fatality; 2. an amputation of a major extremity; 3. any serious head injury (including skull fracture or loss of sight of either or both eyes); 4. any injury to the spinal cord; 5. any second or third degree burn of 25% or more of the body; 6. any accident which causes serious injury to two or more employees; or 7. any disability of more than one year or where it appears reasonably likely that there will be a disability of more than one year. B. Your Claims Handling Duties It is your responsibility to investigate, settle, defend and appeal any claim, suit or other proceeding made against you. However, you must not make any voluntary settlement involving loss to us without our written consent. (6) 54361(10/92) fl.,.,., If you do not appeal an award or judgment which exceeds Your Retention, we have the right to take an appeal at our own cost and expense and shall be liable for costs, disbursements and interest related to the appeal. If • we elect to appeal, our liability on such an award or judgment shall not exceed Our Limit of Indemnity as stated in Item 4 of the Information Page plus the cost and expense of such appeal. C. Claim Audits We have the right to examine and audit your claims handling and reserving procedures, practices and records while this policy is in force and for three years after the final settlement of all claims. Also you will provide us any claim information which we may request. PART FIVE PREMIUM A. Premium Payments You will pay all premium when due. You will pay the premium even if part or all of a workers compensation law is not valid. B. Deposit Premium At the beginning of the policy period you must pay us the deposit premium shown on the Information Page. 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; but in any event, we shall retain the policy Minimum Premium shown on the Information Page. C. Final Premium The deposit premium shown on the Information Page is an estimate. The final premium will be determined after this policy ends by using the actual, not the estimated, premium basis which includes payroll and all other remuneration paid or payable during the policy period for the services of: 1. all your officers and employees engaged in work covered by this policy; and 2. all other persons engaged in work that could make us liable under Part One (Workers Compensation Insurance) of this policy. If you do not have payroll records for these persons, the contract price for their services and materials may be used as the premium basis. This paragraph 2 will not apply if you give us proof that the employers of these persons lawfully secured their workers compensation obligations. If this policy is cancelled, final premium will be determined in the following way: 1. If we cancel, 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 of the Minimum Premium. 2. If you cancel, final premium will be more than pro rata; it will be based on the time this policy was in force, and increased by our short rate cancellation table and procedure. Final premium will not be less than the short rate share of the Minimum Premium. D. 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. E. Audit (7) 54361(10/92) INSI IRFf'S CnPV You will let us examine and audit all your records that relate to this policy. These records include ledgers, journals, registers, vouchers, contracts, tax reports, payroll and disbursement records, and programs for storing and retrieving data. We may conduct the audits during regular business hours during the policy period and within three years after the policy period ends. Information developed by audit will be used to determine final premium. PART SIX CONDITIONS A. Acceptance By acceptance of this policy, you agree that the statements on the Information Page are your agreements and representations, that this policy is issued in reliance upon the truth of such representations, and that this policy embodies all agreements existing between you and us or any of our agents relating to this insurance. B. Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy. If we cancel because of non-payment of premium, we must mail or deliver to you not less than ten days advance written notice stating when the cancellation is to take effect. If we cancel for any other reason, we must mail or deliver to you not less than sixty days advance written notice stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3. The policy period will end on the day and hour stated in the cancellation notice. 4. Any of these provisions that conflict with a law that controls the cancellation of the insurance in this policy is changed by this statement to comply with that law. C. Inspection We have the right, but are not obliged to inspect your workplaces at any time. Our inspections are not safety inspections. They relate only to the insurability of the workplaces and the premiums to be charged. We may give you reports on the conditions we find. We may also recommend changes. While they may help reduce losses, we do not undertake to perform the duty of any person to provide for the health or safety of your employees or the public. We do not warrant that your workplaces are safe or healthful or that they comply with law, regulations, codes or standards. D. Sole Representative The insured first named in Item 1 of the Information Page will act on behalf of all insureds to give or receive notice of cancellation, accept indemnity, receive return premium or request change in this policy. E. Transfer of Your Rights and Duties Your rights and duties under this policy may not be transferred without our written consent. If you die and we receive notice within thirty days after your death, we will cover your legal representative as insured. (8) 54361(10/92) IN WITNESS WHEREOF, we have caused this policy to be executed and attested, but this policy shall not be valid _ unless countersigned by one of our duly authorized representatives, where required by law. SECRETARY PRESIDENT (9) 54361(10/92) INSI IPFfPS C(lPV FORMS SCHEDULE EFFECTIVE DATE: 12/31/96 JAMED INSURED: WELD COUNTY, COLORADO POLICY NO: 415-77-70 S55291(0393) S56317(0393) U51305( 1194) 'Kiel inch c rrnv EXCESS WORKERS COMPENSATION ENDORSEMENT This endorsement, effective 12:01 A.M. 12/31/96 forms a part of policy No. XWC 415-77-70 issued to WELD COUNTY, COLORADO by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. BROAD FORM ALL STATES ENDORSEMENT It is hereby agreed that this policy is amended to include coverage for loss under the Workers Compensation Law of a state not designated in Item 2 of the Information Page, provided said designated state is the state of the injured employees' normal employment. All other terms, conditions and exclusions shall remain the same. IL AUTHORIZED RE ES TATIVE 56291 (3/93) iticuPcn'c rnpv EXCESS WORKERS COMPENSATION ENDORSEMENT This endorsement, effective 12:01 A.M. 12/31/96 forms a part of policy No. XWC 415-77-70 issued t0 WELD COUNTY, COLORADO by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. UNITED STATES LONGSHORE AND HARBOR WORKERS' COMPENSATION ACT ENDORSEMENT (Incidental Operations Endorsement) It is agreed that with respect to operations in the State(s) designated in Item 2 of the Information Page, the term "Workers Compensation Law" includes the United States Longshore and Harbor Workers' Act (33 USC Sections 901-950) and paragraph C of the General Section is amended accordingly. This endorsement does not apply to work subject to the Defense Base Act, the Outer Continental Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. This endorsement is provided hereunder due to our reliance upon your warranty of no known USL&H exposure. III other terms, conditions and exclusions shall remain the same. /2& (1y ° - AUTHORIZED REPRES TATIVE 56317 (3/93) ENDORSEMENT This endorsement, effective 12:01 A.M. 12/31/96 forms a part of policy No. XWC 415-77-70 issued to WELD COUNTY, COLORADO by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. EXCESS WORKERS COMPENSATION VOLUNTEER AND BOARD MEMBERS ENDORSEMENT It is hereby agreed that coverage is extended to include Volunteers and Board Members. For the purpose of premium computation, $2,500 per year shall be attributed as the payroll for each Volunteer and/or Board Member. All other terms, conditions and exclusions shall remain the same. • /2iNtP4� C1 1 AUTHORIZED REPRES TATIVE 61305 (11/94 INSI IRFITS COPY THIS ENDORSEMENT, EFFECTIVE 12:01 A.M. 12/31/96 FORMS A PART OF POLICY NO. 415-7770 ISSUED TO: WELD COUNTY, COLORADO BY: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA EXCESS WORKERS COMPENSATION COLORADO AMENDATORY ENDORSEMENT CANCELLATION In consideration of the premium charged, it is understood and agreed that Condition B Cancellation of this policy is hereby deleted and replaced by the following: B) Cancellation: 1) You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2) We may cancel this policy. If we cancel because of non-payment of premium, we must send by certified mail not less than ten (10) days advance written notice stating when cancellation is to take effect to you, your agent or representative and to: Department of Labor and Employment Division of Workers' Compensation Self-Insurance 1515 Arapahoe Street Denver, CO 80204 Attention: John Berger If we cancel for any other reason, we must send by certified mail not less than sixty (60)days advance written notice stating when the cancellation is to take effect to you, your agent or representative and to: Department of Labor and Employment Division of Workers' Compensation Self-Insurance 1515 Arapahoe Street Denver, CO 80204 Attention: John Berger Mailing that notice to you by certified mail at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. 3) The policy period will end on the day and hour stated in the cancellation notice. All other terms, conditions and exclusions shall remain the same. zj (01/29/97)aa Authorized Representative 54199(9/92) EXCESS WORKERS COMPENSATION ENDORSEMENT#1 THIS ENDORSEMENT, EFFECTIVE: 12:01 A.M. 12/31/96 FORMS A PART OF POLICY NO.: 415-7770 ISSUED TO: WELD COUNTY, COLORADO BY: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. COMMUNICABLE DISEASE ENDORSEMENT (Revised Application of Your Retention) Solely as respects Bodily Injury by Disease caused by the same"communicable disease". It is agreed that in Part Three, Your Retention and Our Limit of Indemnity, paragraph C. is hereby deleted in its entirety and replaced by the following: C. How Your Retention and Our Limit of Indemnity Apply. Your Retention and Our Limit of Indemnity stated on the Information Page apply to each loss paid by you as a qualified self-insurer of Workers Compensation and Employers Liability as follows: 1. To one more employees because of bodily injury by accident unless it results directly from bodily injury by accident. A disease is not bodily injury by accident unless it results directly from bodily injury by accident. 2. To one or more employees for bodily injury or death by disease caused by the same "communicable disease". Bodily injury by disease does not include disease that results directly from a bodily injury by accident. The inclusion of more than one legal entity as Insured in Item 1 of the Information Page will not increase Your Retention or Our Limit of Indemnity. For the purposes of this endorsement, the term"communicable disease" shall be defined as an infectious disease transmissible from person to person by direct contact with an infected person or that person's bodily fluids. All other terms, conditions and exclusions shall remain the same. 61073(9/94) Authorized Representative ENDORSEMENT #2 THIS ENDORSEMENT, EFFECTIVE: 12:01 A.M. DECEMBER 31, 1996 FORMS A PART OF POLICY NO.: 415-7770 ISSUED TO: WELD COUNTY, COLORADO BY: NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. MULTI-YEAR ENDORSEMENT It is agreed that Item 6,Premium and Premium Computation,of the Information Page is amended to read as follows: TERM: From: 12/31/96 To: 12/31/97 Estimated Total Remuneration: S24,682,735 Rates Per S100 of Remuneration. $0.09490 Deposit Premium $23,435 Minimum Premium: SO TERM: From: 12/31/97 To: 12/31/98 Estimated Total Remuneration: $24,692,735 Rates Per$100 of Remuneration: $0.0850 Deposit Premium: $20,980 Minimum Premium: SO TERM: From: 12/31/98 To: 12/31/99 Estimated Total Remunaatian: $24,682,735 Rates Per S100 of Remuneration: $0.0765 Deposit Premium: S18,882 Minimum Premium: SO It is further agreed that you will,at the end of each annual term,provide us with the actual remuneration for the purpose of determining the final premium for each period of coverage. All other terms,conditions and exclusions shall remain the same. Endt. #2 /2()-2 /1-1 1 (1/29/97)aa AUTHORIZED REPRESE ATIVE 14 111). DATE(MM/DD/YY) 02/11/97 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Arthur J. Gallagher - Denver R R. THIS COVERAGE DOES NOT THAE AMEND, BELOW. R 7900 E. Union State 200 COMPANIES AFFORDING COVERAGE Denver CO 80237 COMPANY A National Union Are Ins INSURED COMPANY Weld County, Colorado B Aetna Casually & Steely P.O. Box 758 COMPANY Greeley CO 80632 C COMPANY elsimv s, F '4SYY ;VON,?3oir ' -,"AR_ ^a r. q t5,*1d, ' xs ))",r)" t T )11 Tar i E ottgb 0'G0 I§UEofr Tfi . �) e,"R° . rc rotleY PER10D INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY°MANOR UR TYPE OF a19111RANCE POLICY NUMBER DATE (MMDDNY) DATE (1AM/DD/TY) UWTS GENERAL LIABILITY GENERAL AGGREGATE S COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ I CLAIMS MADE n OCCUR PERSONAL&ADV INJURY $ OWNERS&CONTRACTORS PROT EACH OCCURRENCE $ FIRE DAMAGE(My one fire) $ MED EXP(My are person) E AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS NON OWNED AUTOS ORIGINAL MAIL!?TO BODILY INJURY)RY $ CERTIFICATE HOLDER PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: E EXCESS LIABILITY EACH OCCURRENCE E UMBRELLA FORM AGGREGATE E OTHER THAN UMBRELLA FORM E WORKERS COMPENSATION AND X WI:SIAIU- log EMPLOYERS'LIABILITY TORY ER aAa;Wra 1,00 A _ 415-7770 12/31/96 12/31/99 EL EACH ACCIDENT E 1,000,000 THE PROPRETOR/ INCL EL DISEASE POLICY UDR $ 1,000,000 PARTNERS/EXECUTIVE OFFICERS ARE' EXCL EL DISEASE-EA EMPLOYEE $ 1 000,000 OTHER B Self Insurers Workers 19S100729968 12/31/96 12/31/97 Penal Sum 605,000 Compensation Bond DESCRIPTION OF P RATgNSAOCAT N EHILES/SPECIAL ITEMS Self Insure elenl ion: 3 0,000 CERTIFICATE HOWER CANCEfl!potti t .,.,e s., ..s.; .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE State of Colo., Dept. of Labor & Employment EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL Et {TQ MAIL Workers' Compensation DIY. 90 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1515 Arapahoe SL BLXRMIPMX9$IKIL+A404EXR40 IPXX7R}iXX4C9t00KCTDIXX Deriver CO 80202-2117 AUTHORIZED REPRESENTATIVE ACORDf25S'(j195) m t AC-ORD OORP.ORXT ONr1988 C14 ARTHUR J. GALLAGHER & CO. DENVER January 12, 1998 Mr. Don Warden Director of Finance and Administration Weld County, Colorado P.O. Box 758 Greeley, CO 80631 RE: Self Insurer's Bond Travelers #19S 100729968 BCA Dear Don, An endorsement/rider for the above captioned bond is enclosed for your records. It changes the name of the insurance carrier from Aetna to Travelers Casualty and Surety Company effective 7/1/97 due to the two companies merging. It does not affect the premium for the bond (previously billed to you). Please place this rider with the bond file. Should you have any questions, feel free to contact either Karen Graham or me. Sincerely, ARTHUR J. GALLAGHER & CO. - DENVER di. / Cr5r7- . Pat Person, AIS Account Assistant Enclosure 7900 E. Union Ave., Suite 200, Denver, CO 80237-2737 • P.O. Box 24809, Denver, CO 80224 � • � �� •• 303/773-9999 • Fax 303/773-9776 THIS ENDORSEMENT/RIDER CHANGES THE POLICY OR BOND. PLEASE READ IT CAREFULLY. INSURER/SURETY AMENDMENT ENDORSEMENT/RIDER The name of your Insurer or Surety is changed from the former name to the new name listed below: Former Name New Name The Aetna Casualty and Surety Company Travelers Casualty and Surety Company' Aetna Casualty&Surety Company of America Travelers Casualty and Surety Company of America* Aetna Casualty&Surety Company of Illinois Travelers Casualty and Surety Company of Ilinois" COMPANY ADDRESS: `One Tower Square '"2500 Cabot Drive Hartford, Connecticut 06183 Lisle, Illinois 60532 This name change endorsement/rider does not alter the coverage provided by this policy or bond and has no affect on the premium for this policy or bond. IL T3 48 07 97 Effective July 1, 1997 Hello