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Home My WebLink About000357.tiff TRAVELERS J� wrap-r® for Governmental Plans Sara C Rogers 6060 S Willow Dr GREENWOOD VILLAGE,CO 80111 Phone: (720)200-8478 Email: SCROGERS@travelers.com September 7,2017 Mickele Kunselman GALLAGHERIA JIRMS 6300 S SYRACUSE WAY STE 700 CENTENNIAL,CO 80111 RE: Benefit Plan: WELD COUNTY RETIREMENT PLAN Insurance Representative: John Lefebvre Binder Type: Conditional Product: Wrap+® for Governmental Plans- DBP-15001 (11-12) Policy Number: 106796588 Policy Period: September 1,2017 to September 1,2018 Transaction Effective Date: September 01,2017 Binder Expiration Date: October 7,2017 Dear Mickele Kunselman On behalf of Travelers Casualty and Surety Company of America we are pleased to conditionally bind coverage for Wrap+® for Governmental Plans Insurance. Travelers Casualty and Surety Company of America LIABILITY COVERAGES: Coverage Limit Additional I Retention Continuity Prior&Pending Defense Date Proceeding Limit Date Designated Benefit Plan $1,000,000 for all Claims N/A $5,000(A)for each 06/16/2014 06/16/2014 Fiduciary Liability Claim under Insuring Agreement A TOTAL ANNUAL PREMIUM-$7,600.00 (Other term options listed below, if available) COVERAGE DETAILS: Settlement Program Limit of Liability: $250,000 for each Settlement Program Notice, which amount is included within,and not in addition to,any applicable Designated Benefit Plan Fiduciary limit of liability LTR-4001 Rev.07-16 Page 1 of 3 ©2016 The Travelers Indemnity Company. All rights reserved oc:)a35-7 HIPAA Limit of Liability: $500,000 which amount is included within, and not in addition to, any applicable Designated Benefit Plan Fiduciary limit of liability 502(c)Penalties Limit of Liability: $250,000 which amount is included within, and not in addition to, any applicable Designated Benefit Plan Fiduciary limit of liability EXTENDED REPORTING PERIOD AND RUN-OFF: Extended Reporting Period for Liability Coverages: Additional Premium Percentage: 75% Additional Months: 12 Run-Off Extended Reporting Period for Liability Coverages: Additional Premium Percentage: N/A Additional Months: N/A CLAIM DEFENSE FOR ASSOCIATION MANAGEMENT LIABILITY COVERAGE. LIABILITY COVERAGES AND/OR CYBER COVERAGE: Duty to Defend ANNUAL REINSTATEMENT: Liability Coverage Limit of Liability: N/A PREMIUM DETAIL: Term Payment Premium* Taxes Surcharges Total Total Term Type Premium* Premium Transaction Prepaid $0.00 $0.00 $0.00 $0.00 $7,600.00 *The total premium for the year the change is made is based off the transaction effective date. POLICY FORMS: DBP-15001-1112 Designated Benefit Plan Fiduciary Liability Coverage Declarations DBP-16001-1112 Designated Benefit Plan Fiduciary Liability Coverage ENDORSEMENTS: AFE-19004-0115 Cap on Losses From Certified Acts of Terrorism Endorsement AFE-19008-0115 Federal Terrorism Risk Insurance Act Disclosure DBP-17005-1112 Colorado Changes Endorsement DBP-19001-1112 Designation of Insurance Representative Endorsement DBP-19003-1112 Governmental Plan Endorsement DBP-19031-1112 Settlement Condition Endorsement Defense % 20 DBP-19042-1112 Policy Changes Endorsement DBP-19078-0313 Amend Cancellation Condition-90-Day Notice of Nonrenewal DBP-19083-0315 Global Coverage Compliance Endorsement DBP-19089-0516 Add Civil Unions to Spousal and Domestic Partner Liability Coverage Endorsement DBP-19090-0617 PPACA, Section 203, Section 4975, and Other Civil Money Penalties Endorsement CONTINGENCIES: This binder is contingent on the acceptable underwriting review of the following information prior to the Binder Expiration Date. 1 Completed Travelers DBPFL application LTR-4001 Rev. 07-16 Page 2 of 3 ©2016 The Travelers Indemnity Company. All rights reserved. 2 Loss runs This binder is a conditional binder, valid until October 7, 2017. This binder will expire on the noted date, at the noted time, unless the required underwriting information stated in the Contingencies section is provided to Travelers and then reviewed and accepted by Travelers prior to the noted expiration date and time. This policy will not take effect unless Underwriting Information is received and satisfactorily reviewed by October 7, 2017 (Binder Expiration Date). If you do not submit the Underwriting Information on or before the Binder Expiration Date, no policy will be issued. Commission: 16.50% NOTES: NOTICES: It is the agent's or broker's responsibility to comply with any applicable laws regarding disclosure to the policyholder of commission or other compensation we pay, if any, in connection with this policy or program. Important Notice Regarding Compensation Disclosure For information about how Travelers compensates independent agents, brokers, or other insurance producers, please visit this website: http://www.travelers.com/w3c/legal/Producer_Compensation_Disclosure.html If you prefer, you can call the following toll-free number: 1-866-904-8348. Or you can write to us at Travelers, Agency Compensation, One Tower Square, Hartford, CT 06183. Sincerely, Sara C Rogers Travelers Bond&Specialty Insurance LTR-4001 Rev. 07-16 Page 3 of 3 ©2016 The Travelers Indemnity Company. All rights reserved. Hello