The URL can be used to link to this page

Browse Search

Home My WebLink About20160110.tiff Weld County, Colorado 1150"O" Street P.O. Box 758 2015 Insurance Proposal Greeley, CO 80632 Policy Term: Dec. 31, 2015 to Dec. 31, 2016 Line of Coverage: Excess Workers'Compensation Presented: December 9, 2015 Final as Bound: December 30, 2015 Arthur J. Gallagher & Co. Karen Graham, CIC. CRM, ARM-P Area Executive Vice President/National Director Priscilla McCoy. CIC, CRM Area Sr. Vice President/Sr. Client Service Executive Analisa Murphy, CIC Client Service Manager Arthur J. Gallagher Risk Management Services, Inc. 6399 S. Fiddler's Green Cir., #200 Greenwood Village. CO 80111-4949 www.ajg.com ©2015/ Arthur J.Gallagher&Co. C acr 2016-0110 / - V-Ol to ?EGb37-i Weld County, Colorado Table of Contents Mission Statement 1 Client Service Team 2 Executive Summary and Marketing Results 3 Exposure Summaries, Premium Summary Comparison 4 Scope of Responsibility Statement, Major Changes to Expiring Program, Conditions to Bind Coverage, Named Insured Schedule 5 Coverage Summaries Specific Excess Workers' Compensation 6 Workers'Compensation Self Insurors Bond 8 Coverage Considerations, Changes and Developments 9 Gallagher Disclosures 10 Marketing Summary/Insurance Carrier Ratings and Admitted Status 12 Bindable Quotations and Compensation Disclosure Schedule 14 Client Authorization to Bind Coverage 15 Appendix Weld County, Colorado Mission Statement ARTHUR J. GALLAGHER- DENVER OUR MISSION We are an insurance brokerage, consulting& risk management services company committed to being the best at reducing the cost of risk and protecting the financial integrity of our clients. OUR VISION To be recognized and respected... By our clients as unparalleled customer service professionals providing responsive and innovative solutions that address their needs. By our markets as tenacious competitors providing opportunities for growth and operating with the highest degree of integrity and ethical character By our employees as "a winning team" providing a fair, challenging and friendly environment that rewards performance,encourages creativity and supports personal development. y our community as an organization promoting both individual and collective involvement that"makes Ba difference". .taaatii., x . .. i w -.4in 1 Weld County, Colorado Service Team Karen Graham has primary service responsibility for your company. We operate using a team approach. Your Service Team consists of: NAME/TITLE PHONE/ALT. PHONE EMAIL Karen Graham 303-889-2538 Karen Gh a' co Area Executive Vice President/National Director raam°� 19m Priscilla McCoy 303-889-2540 PriscillaMcCoy@ajg.com com Area Senior Vice President/Sr. Client Service Executive —Anay°�a Jg' n a Murphy 303-889-2590 AnalisaMurphy@ajg.com Client Client Service Manager — Anita Bruner 303-889-2574 AnitaBruner@ajg.com com Sr. Client Service Associate — runer°�a 19 Kendall Trump 303-889-2570 Kendall T co Claims Consultant — rum p°�a 1gm Ed Davis 303-889-2552 EdDavis@ajg.com com Sr. Loss Control Specialist — °ea Jg Arthur J.Gallagher Risk Management Services, Inc. Main Office Phone Number: (303)773-9999 .Arthur J.Gallagher Risk Management Set-vices, Inc. 2 Weld County, Colorado Executive Summary Renewal Strategy On September 14, 2015, Arthur J. Gallagher Risk Management Services, Inc. (Gallagher) contacted Weld County, Colorado (the County) to obtain 2015 renewal information for the upcoming December 31, 2015 Excess Workers' Compensation Renewal. Due to the extensive marketing that was done in 2012 and selected marketing to Travelers and the incumbent (Safety National) in 2014, Gallagher obtained renewal terms from the incumbent with an optional two-year rate guarantee. Historical Exposure Summary Specific Excess Workers' Compensation %Change 2010 2011 2012 201 2614 2015 Exposure Basis over Audited Audited Audited Audited Estimated Projected expiring Annual Payroll S 62,980,655 $ 64,812,149 $ 67,561,493 $ 77,284,560 $ 75,740,233 $ 80,592,411 6% Marketing Results Safety National provided an annual renewal premium of$132,977, a 6% increase over the expiring premium of$124,971. The rate per $100 of payroll remained the same as expiring at $0.165. The primary reason for the increase in renewal premium is due to the increase in payrolls from $75,740,233 to $80,592,411, a 6% increase. In addition, Safety National provided a two-year rate guarantee and maintained the same SIR of $750,000. For the optional two-year term, the premium is $132,977 payable in annual installments. Arthur J.Gallagher Risk\Ianagcmcut Surviccs, Inc. 3 Weld County, Colorado Premium Summary Comparison 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 %Change Coverage Audited Audited Audited Audited c, iris Renewal over expiring Excess Workers' Compensation Premium $ 95,731 $ 95,570 $ 120,124 $ 144,290 $ 124,971 $ 132,977 6% Excess Workers' Compensation Rate per $100 of payroll 0.152 0.152 0.1778 0.1867 0.165 0.165 0% Workers'Compensation SIR Bond $ 22,705 $ 22,705 $ 22,705 $ 22,705 $ 22,705 $ 22,705 0% i s illAiriii is.tom t= ;:i s, 4 1 Weld County, Colorado Premium Finance Options Premiums for the above policies are due and payable as billed in full or as insurance company installments. Premiums may be financed subject to acceptance by an approved finance company. Following acceptance, completion (and signature) of a premium finance agreement with the specified down payment is required. Major Changes to Expiring Program • Excess Workers' Compensation a Policyholder Disclosure Notice of Terrorism Insurance Coverage—new edition date On the Coverage sections any items in bold type are enhancements and any items in red bold type are coverage restrictions from expiring program. Scope of Responsibility Gallagher is responsible for the placement of the lines of coverage outlined on the Premium Summary/Comparison page: Excess Workers' Compensation and Self-Insurors Workers' Compensation Bond It is understood that any other type of exposure/coverage is either self-insured or placed by another brokerage firm other than Gallagher. If you need help placing other lines of coverage or covering other types of exposures, please contact your Gallagher representative. Conditions to Bind • None Named Insured Schedule Weld County, Colorado NOTE: Any entity not named as an insured may not be covered under this policy. This may include Partnerships and Joint Ventures. .Arthur J.Gallagher Risk Management Services,Inc. 5 Weld County, Colorado Specific Excess Workers' Compensation Carrier: Safety National Casualty Corporation Policy Period: December 31, 2015 to December 31, 2017 Limits: Workers' Compensation CO Statutory Per Indicated States Employers Liability $ 1,000,000 Maximum Limit of Indemnity Per Occurrence Self-Insured Retention: • $750,000 Terms: • Bodily Injury by accident must occur during the policy period. • Bodily Injury by Disease must be caused by or aggravated by the conditions of your employment. The employee's last day of exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. Coverage Extensions • Foreign Coverage • Colorado Notice Endorsement 000300 12/01/2006 • Incidental Longshoremen's And Harbor Workers'Comp 024100 12/01/1991 • Broad Form All States For Employee Travel 027602 04/01/2008 • Voluntary Compensation Endorsement-Premium Delineation 029100 07/01/2008 • Foreign Voluntary Workers'Compensation And Employers' Liability 029300 09/01/2006 • 90-Days Notice Of Cancellation 032200 12/01/1991 • Same Communicable Disease-Specific Excess 033901 09/01/2008 • Policyholder Disclosure Notice Of Terrorism Insurance Coverage 106111 01/01/2007 • Declarations-Specific Excess DSP 01/01/1995 • Declarations Item 6 1005 00 11/01/2001 • Endorsement Schedule 1004 00 11/01/2001 • Privacy Statement WC999928 • Specific Excess Workers Compensation And Employers SPWC 09/01/2008 • Broad Form All States Except Monopolistic(ND, OH, WA, WY) • Stop Gap Coverage Significant Exclusions • Voluntary Compensation (including but not limited • Longshore& Harbor Workers'Act to): • Owners or Officers • Bodily Injury to an Employee While Employed in Violation of Law • Bodily Injury Intentionally Caused by Insured • Federal Employers' Liability Act • Assumptions under Contract Minimum Premium: • 90% ($119,679) Audit Basis: • Annual Audit at Policy Expiration :Arthur J.Gallagher Risk Management Services, Inc. 6 Weld County, Colorado Specific Excess Workers' Compensation (Continued) Claims Reporting Claims are self-administered within the retention. Claims must be reported to Instructions: Safety National in accordance with policy provisions, • You must give carrier notice as soon as you learn of any of the following events involving loss which exceeds (or might in the future exceed) 50% of your retention: claim, award, verdict, action, suit, proceeding,judgment. • You must give carrier immediate (within 30 days)written notice of any accident involving: fatality, spinal cord injury, a permanent total disability as defined in the workers' compensation law, serious burn injury, brain injury, amputation of a major extremity, and any occurrence which results in a serious injury to two or more employees. Claims should be reported to: Safety National Casualty Corporation Attn: Claims Dept. 1832 Schuetz Road St. Louis, MO 63146 Claims should also be reported to: Arthur J Gallagher Risk Management Services, Inc. 6399 South Fiddlers Green Circle, Suite#200 Greenwood Village, CO 80111 Main Claims Email: wr-claims(a�ajq.com Contact: Kendall Trump, Claims Consultant Phone: 303.889.2570 Fax: 303.773.9776 Toll Free : 800.333.3231 Auditable Exposures: STATE CLASS CODE DESCRIPTION ESTIMATED ANNUAL PAYROLL CO 5506 Street&Road Paving - $8,222,887 CO 7720 Police Officers $20,982,739 CO I 8742 Outside Sales $6,619,240 CO 8810 Clerical Office/Elected Officials $30,906,254 CO 8820 Attorneys $4,512,162 CO 8832 Health Dept. Professional $3,993,062 CO 9014 Insect Extermination $368,461 CO 9015 Buildi g Operations $1,052,195 CO 9410 Municipal Employees—NOC $3,935,411 Total: $80,592,411 Weld County, Colorado Workers' Compensation Self lnsurors Bond Carrier: Travelers Casualty and Surety Company of America Policy Period: December 31, 2015 to December 31, 2016 Limits: Amounts Coverages $ 2,365,085 Penal Sum Required by State Principal: Weld County, Colorado Obligee: Executive Director, Department of Labor and Development Division of Labor, Workers' Compensation, State of Colorado Terms/Conditions: • Continuous Until Cancelled • State of Colorado Self Insurors Workers' Compensation Bond Form Minimum Premium: None Audit Terms: Not Subject to Audit Claim Reporting As soon as practicable Instructions: Report Claims to: Arthur J. Gallagher Risk Management Services, Inc. Attn: Kendall Trump, Claim Consultant 6399 S. Fiddler's Green Circle, Suite 200 Greenwood Village, CO 80111-4949 Direct—303.889.2570 Toll Free -800.333.3231 Fax-303.773.9776 Arthur 1.Gallagher Risk Management Services, Inc. 8 Weld County, Colorado Coverage Considerations Overview Coverages are highlighted here to review available coverages which you should consider. These coverages are included in the coverage section of this proposal only if quoted and highlighted as covered. - A proposal for any of the coverages can be provided. - The recommendations and considerations summarized in this section are not intended to identify all exposures. - Since Gallagher does not handle your complete insurance program, these recommendations only reflect items within our scope of responsibility. Specific Excess Workers' Compensation - Higher Employer's Liability Limits The above coverage may not necessarily represent the entirety of available insurance products. If you are interested in pursuing additional coverages other than those addressed in the coverage considerations included in this proposal, please list below. Changes and Developments It is important that we be advised of any changes in your operations that may have a bearing on the validity and/or adequacy of your insurance. The types of changes that concern us include, but are not limited to, those listed below: 1. Changes in any operation such as expansion to other states or new products. 2. Mergers and/or acquisition of new companies. 3. Any newly assumed contractual liability, granting of indemnities, or hold harmless agreements. 4. Circumstances which may require increased liability insurance limits. 5. Any changes in fire or theft protection, such as the installation of or disconnection of sprinkler systems, burglar alarms, etc.This includes any alterations to same. 6. Immediate advice of any changes to scheduled equipment such as contractors'equipment, electronic data processing, etc. 7. Property of yours that is in transit, unless we have previously arranged for the insurance. 8. Any changes in existing premises including vacancy, whether temporary or permanent, alterations, demolition, etc.Also, any new premises either purchased, constructed, or occupied_ Arthur J.Gallagher Risk Management Services,Inc. 9 Weld County, Colorado Proposal Disclosures The following disclosures are hereby made a part of this proposal. Please review these disclosures prior to signing the Client Authorization to Bind or e-mail confirmation. Proposal IMPORTANT: The proposal is an outline of certain terms and conditions of the insurance proposed by Disclaimer the insurers, based on the information provided by your company. It does not include all the terms, coverages, exclusions, limitations and/or conditions of the actual policy contract language. The insurance policies themselves must be read for those details. Policy forms for your reference will be made available upon request. We will not be operating in a fiduciary capacity, but only as your broker, obtaining a variety of coverage terms and conditions to protect the risks of your enterprise. We will seek to bind those coverages based upon your authorization; however, we can make no warranties in respect to policy limits or coverage considerations of the carrier. Actual coverage is determined by policy language, so read all policies carefully. Contact us with questions on these or any other issues of concern. Compensation One of the core values highlighted in The Gallagher Way states, "We are an Open Society,"and our Disclosure open society extends to the compensation Gallagher receives. In general, Gallagher may be compensated as follows: 1. Gallagher Companies are primarily compensated from the usual and customary commissions or fees received from the brokerage and servicing of insurance policies, annuity contracts, guarantee contracts and surety bonds(collectively"insurance coverages") handled for a client's account, which may vary from company to company and insurance coverage to insurance coverage. As permitted by law, Gallagher companies occasionally receive both commissions and fees. 2. In placing, renewing, consulting on or servicing your insurance coverages, Gallagher Companies may participate in contingent and supplemental commission arrangements with intermediaries and insurance companies. Contingent commissions provide for additional contingent compensation if underwriting, profitability, volume or retention goals are achieved. Such goals are typically based on the total amount of certain insurance coverages placed by Gallagher with the insurance company and/or through the intermediary, not on an individual policy basis. Some insurance markets, including Gallagher-owned intermediaries, have modified their commission schedule with Gallagher, resulting in an increase in some commission rates. These additional commissions, commonly referred to as"supplemental commissions"are known as of the effective date, but some insurance companies are paying this commission later and apart from when commission is normally paid at policy issuance. As a result, Gallagher may be considered to have an incentive to place your insurance coverages with a particular insurance company. Note: Upon request, your Gallagher representative can provide more specific market information regarding contingent and supplemental commission related to your insurance coverage. 3. Gallagher Companies may also receive investment income on fiduciary funds temporarily held by them, such as premiums or return premiums. 4. Gallagher Companies may access other facilities, including wholesalers, reinsurance intermediaries, captive managers, underwriting managers and others that act as intermediaries for both Gallagher and other brokers in the insurance marketplace. Gallagher Companies may own some of these facilities, in whole or in part. If such a facility was utilized in the placement of a client's account,the facility may have earned and retained customary brokerage commission or fees for its work. 5. Gallagher assists its customers in procuring premium finance quotes and unless prohibited by law may earn compensation for this value added service. 6. From time to time, Gallagher may participate in insurance company promotional events or training and development that insurers provide for Gallagher employees. Arthur J.Gallagher Risk Management Services, Inc. 1O Weld County, Colorado Proposal Disclosures (Continued) 7. Gallagher strives to find appropriate coverage at a competitive price for our customers. In order to achieve these goals, we gather and analyze data about our customers and their insurance coverage. This data and the resulting analytical tools help us better understand the current marketplace, more accurately predict future trends and offer tailored solutions to our customers. The data may also be provided to insurers pursuant to consulting service agreements from which we earn fees. If you have specific questions about the compensation received by Gallagher and its affiliates in relation to your insurance placements, please contact your Gallagher representative for more details. In the event you wish to register a formal complaint regarding compensation Gallagher receives from insurers or third parties, please send an e-mail to Compensation_Complaints@ajg.com or send a letter to: Compliance Officer Arthur J. Gallagher&Co. Two Pierce Place, 20th Floor Itasca, IL 60143 TRIA/TRIPRA If this proposal contains options to purchase TRIA/TRIPRA coverage, the proposed TRIA/TRIPRA Disclaimer program may not cover all terrorism losses. While the amendments to TRIA eliminated the distinction between foreign and domestic acts of terrorism, a number of lines of coverage excluded under the amendments passed in 2005 remain excluded including commercial automobile, burglary and theft insurance; surety insurance, farm owners multiple perils and professional liability(although directors and officers liability is specifically included). If such excluded coverages are required, we recommend that you consider purchasing a separate terrorism policy. Please note that a separate terrorism policy for these excluded coverages may be necessary to satisfy loan covenants or other contractual obligations. TRIPRA includes a $100 billion cap on insurers'aggregate liability. The TRIPRA program increases the amount needed in total losses by$20 million each calendar year before the TRIPRA program responds from the 2015 trigger of$100 million to$200 million by the year 2020. TRIPRA is set to expire on December 31, 2020. There is no certainty of extension, thus the coverage provided by your insurers may or may not extend beyond December 31, 2020. In the event you have loan covenants or other contractual obligations requiring that TRIA/TRIPRA be maintained throughout the duration of your policy period, we recommend that a separate"Stand Alone"terrorism policy be purchased to satisfy those obligations. Actuarial The information contained in this proposal is based on the historical loss experience and exposures Disclaimer provided to Arthur J. Gallagher Risk Management Services{Greenwood}. 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. \rthur J.Gallagher Risk Management Services,Inc. 11 Weld County, Colorado Insurance Company Ratings and Admitted Status PROPOSED INSURANCE COMPANIES A.M. BEST'S ADMITTED/NON- RATING ADMITTED Safety National Casualty Corporation A+XIII Admitted Travelers Casualty and Surety Company A++xV Admitted If the above indicated coverage is placed with a Non-Admitted Carrier, the carrier is doing business in the state as a surplus lines or non-admitted carrier.As such,this carrier is not subject to the same regulations which apply to an admitted carrier nor do they participate in any insurance guarantee fund applicable in that state. *The above A.M. Best Rating was verified on the date the proposal document was created. Guide to Best Ratings Rating Levels and Categories LEVEL CATEGORY Finar-c: i Size CetEg:sries A++,A+ Superior (ln 5000 of Reported Policyholders'Surpass Phis Conrietionel Reserve Funds? A,A- Exeeiertt FSC I Up to 1,000 FSC IX 250,0X))to 500.000 8++,B+ Good FSC II 1,000 to 2,010 FSC X 500,000 to 750,000 B,B- Fair FSC III 2,000 to 5,010 FSC XI 750,000 to 1.00,000 C++.C+ Marginal FSC IV 5.0XO to 10,000 FSC XII 1,000,000 to 1,250,000 Weak FSC V 10,000 to 25,009 FSC XIII 1,250,000 to 1,500,0X1 D Poor FSC VI 25,000 to 50,009 FSC XIV 1,500.000 to 2000,040 E Under Regulatory Supervta for FSC VII 50,000 to 100,000 FSC XV 2,000,000 or more F InLigtidation FSC VIII 100,000 to 250,00:1 Suspended 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. A Best's Financial Strength Rating opinion addresses the relative ability of an insurer to meet its ongoing insurance obligations.It is not a warranty of a company's financial strength and ability to meet its obligations to policyholders.View the A.M.Best Important Notice: Best's Credit Ratings for a disclaimer notice and complete details at http://www.ambest.com/ratinqs/notice. Best's Credit Ratings are under continuous review and subject to change and/or affirmation.For the latest Best's Credit Ratings and Best Credit Reports (which include Best Ratings),visit the A.M.Best website at http://www.ambest.com.See Guide to Best's Credit Ratings for explanation of use and charges. Copies of the Best's Insurance Reports for carriers listed above are also available upon request of your Gallagher representative. Best's Credit Ratings reproduced herein appear under license from A.M.Best and do not constitute,either expressly or impliedly.an endorsement of (Licensee's publication or service)or its recommendations,formulas,criteria or comparisons to any other ratings,rating scales or rating organizations which are published or referenced herein.A.M.Best is not responsible for transcription errors made in presenting Best's Credit Ratings Best's Credit Ratings are proprietary and may not be reproduced or distributed without the express written permission of A.M.Best Company. Gallagher companies use A.M.Best Company's rating services to evaluate the financial condition of insurers whose policies we propose to deliver.Gallagher companies make 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. I :Arthur J.Gallagher Risk Management Services, Inc. 12 Weld County, Colorado Insurance Company Ratings and Admitted Status (Continued) GUIDE TO BEST'S FINANCIAL STRENGTH RATINGS A Best's Financial Strength Rating is an independent opinion of an insurer's financial strength and ability to meet its ongoing insurance policy and contract obligations The rating is based on a comprehensive quantitative and qualitative evaluation of a company's balance sheet strength.operating performance and business profile. Best's Financial Strength Ratings Rating Descriptor Definition A++,A+ Superior Assigned to companies that have.in our opinion.a superior ability to meet their ongoing insurance obli- gallon. A,A- Excellent Assigned to companies that have in our opinion.an excellent ability to meet their ongoing insurance obligations. B++,B+ Good Assigned to companies that have.in our opinion.a good ability to meet their ongoing insurance oblige lions. B.B- Fair Assigned to companies that have.in our opinion,a fair ability to meet their ongoing insurance obliga- tions.Financial strength is vulnerable to adverse changes in underwriting and economic conditions. G++,C+ Marginal Assigned to companies that have.in our opinion,a marginal ability to meet their ongoing insurance obli- gations.Financial strength is vulnerable to adverse changes in underwriting and economic conditions. Assigned to companies that have.in our opinion.a weak ability to meet their ongoing insurance oblige- C.C- Weak lions.Financial strength is very vulnerable to adverse changes in underwriting and economic conditions. e Assigned to companies that have in our opinion.a poor ability to meet their ongoing insurance obliga- > D Poor Lions,Financial strength is extremely vulnerable to adverse changes in underwriting and economic con- ditions. Under Assigned to companies(and possibly their subsidiaries/affiliates)placed under a significant form of F Regulatory regulatory supervision,control or restraint including cease and desist orders conservatorship or reha- Supervision bititation.but not liquidation-that prevents conduct of normal.ongoing insurance operations F In I iquidatior Assigned to companies placed in liquidation by a court of law or by a forced liquidation. Assigned to rated companies when sudden arid significant events impact operations and rating implica- S Sustx'nded tions cannot be evaluated due to a lack of timely or adequate information:or in cases where continued maintenance of the previously published rating opinion is in violation of evolving regulatory require- ments. Rating Modifiers Modifier Descriptor Definition Under Review Indicates the rating may change in the near term.typically within six months.Generally is event driven.with positive.negative or developing implications. {xd Public Data Indicates rating assigned to insurer that chose not to participate in A.M.Best's interactive rating process. (Discontinued In 2010) s Syndicate Indicates rating assigned to a Lloyd's syndicate. Rating Outlooks Indicates potential direction of a Best's Financial Strength Rating over an intermediate term generally defined as 12 to 36 months. Positive Indicates possible rating upgrade due to favorable financial/market trends relative to the current rating level Negative Indicates possible rating downgrade due to unfavorable financial/market trends relative to the current rating level Stable Indicates low likelihood of a rating change due to stable financial/market trends. Under Review Implications Indicates the potential direction of a Best's Financial Strength Rating that is in Under Review status based on information currently available. Positive Indicates there is a reasonable likelihood the company's rating will he raised as a result 01 A.M Best's analysis of a recent event Negative Indicates there is a reasonable likelihood the company's rating will be lowered as a result of A.M.Best's analysis of a recent event. Developing Indicates there is uncertainty as to the final rating outcome.but there is a reasonable likelihood the company's rating will change as a result of A.M.Best's analysis of a recent event. Not Rated Designation NR-Assigned to companies that are not rated by A.M-Best. Rating Disclosure A Best's Financial Strength Rating opinion addresses the relative ability of air insurer to meet its ongoing insurance obligations.The ratings are not assigned to specific insurance policies or contracts and do not address any other risk.including.but not limited to.an insurer's claims-payment policies or procedures;the ability of the insurer to dispute or deny claims payment on grounds of misrepresentation or fraud.or any specific liability contractually borne by the policy or contract holder.A Best's Financial Strength Rating is not a recommendation to purchase.hold or terminate any insurance policy.contract or any other financial obligation issued by an insurer,nor does it address the suitability of any particular policy or contract for a specific purpose or purchaser In arriving at a rating decision,A.M.Best relies on third-party audited financial data and/or other information provided to it While this information is believed to be reliable.A.M.Best does not independently verify the accuracy or reliability of the information. For additional details.see AM Best's Terms of Use at wwwambest,com. Best's Financial Strength Ratings are distributed via press release and/or the AM.Best website at www.ambest.com and are published in the Credit Rating Actions section of Rest's Journalr" Rest's Financial Strength Ratings are proprietary and may not be reproduced without permission. Copyright irS 2014 by A.M.Best Company.Inc. Version 080114 ,OMy .Arthur J.Gallagher Risk Management Services, Inc. 13 4 Weld County, Colorado Bindable Quotations & Compensation Disclosure Schedule WHOLESALER,MGA OR INTERMEDIARY EST.ANNUAL COMM.% COMM.% COVERAGE(S) CARRIER NAME S PREMIUM' OR FEE` NAME' OR FEE' AJG OWNED?YES/NO Workers'Compensation Safety National Casualty Corporation $132,977 15% N/A N/A N/A SIR: $750,000(1 Yr.Term) Workers'Compensation Safety National Casualty Corporation $132,977 15% N/A N/A N/A SIR: $750,000(2 Yr.Term) Workers'Compensation Self-Insurors Bond . Travelers Casualty and Surety Company $22,705 15% N/A N/A N/A Some carriers pay Gallagher supplemental or contingent commissions in addition to the policy commission.Contingent commissions are typically contingent upon performance factors such as growth,profit,volume or retention,while supplemental commissions are not. These supplemental or contingent commissions may range from less than 1%up to 10%of the policy premium.Please refer to the Compensation Disclosure or contact your Gallagher representative for additional information. 1 A verbal quotation was received from this carrier.We are awaiting a quotation in writing. The premium indicated is an estimate provided by the market.The actual premium and acceptance of the coverage requested will be determined by the market after a thorough review of the completed application. A written quotation was received from this carrier. The premium indicated is an estimate provided by the market.The actual premium and acceptance of the coverage requested will be determined by the market after a thorough review of the completed application. 2 The commission rate is a percentage of annual premium excluding taxes&fees_ Gallagheris receiving commission on this policy. 3 We were able to obtain more advantageous terms and conditions for you through an intermediary/wholesaler. 4 The non-Gallagher intermediary/wholesaler did not provide their compensation information for this proposal.The usual and customary compensation to a wholesaler/intermediary ranges from 5%to 12%,but we cannot verify that range is applicable in connection with this proposal. Arthur).Gallagher Risk Managr'mcnt Service,Inc. I4 Weld County, Colorado Client Authorization to Bind Coverage After careful consideration of Gallagher's proposal dated December 9, 2015, we accept the following coverage(s). Please check the desired coverage(s)and note any coverage amendments below: LINE OF COVERAGE CARRIER ❑Accept ® Reject Specific Excess Workers'Compensation and Employers Liability Safety National Casualty Corporation $132,977—Annual Term Specific Excess Workers'Compensation ®Accept ❑Reject and Employers Liability $132,977—Two Year Rate Payable in Safety National Casualty Corporation Annual Installments ®Accept ❑ Reject Self Insurors Workers'Compensation Travelers Casualty and Surety Company of Bond- $22,705 America Producer/Insured Coverage Amendments and Notes: rnF Client Initials Provide Quotations or Additional Information on the Following Coverage Considerations: Other Coverage Considerations ❑Yes ❑No Higher Employers Liability Limits Note:Selecting the"Reject All or Accept All"option will override any selections that you have made above IT Reject All ❑Accept All-Coverages for Consideration 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. We agree that your liability to us arising from your negligent acts or omissions, whether related to the insurance or surety placed pursuant to these binding instructions or not, shall not exceed $20 million, in the aggregate. Further, without limiting the foregoing, we agree that in the event you breach your obligations, you shall only be liable for actual damages we incur and that you shall not be liable for any indirect, consequential or punitive damages. By: , Chair, Board of Weld Specify:owner,partner or corporate officer County Commissioners Mike Freeman Print Name JAN 0 6 2016 Date: :Arthur J.Gallagher Risk Management Services, Inc. oZLi' "° Appendix Hello