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Home My WebLink About20150018.tiff Weld County, Colorado 2014 Insurance Proposal G 758 eeeyxCO 80623 Presented: December 22, 2014 Revised: December 23, 2014 Policy Term: December 31, 2014 to December 31, 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 Services Executive Arthur J. Gallagher Risk Management Services, Inc. 6399 S. Fiddler's Green Cir., #200 Greenwood Village, CO 80111-4949 www.ajg.com ©2014 Arthur J.Gallagher&Co aka- 2015-0018 1-5-arxy Weld County, Colorado Table of Contents Section Page 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, 5 Conditions to Bind Coverage, Named Insured Schedule Coverage Summaries Specific Excess Workers' Compensation 6 Workers' Compensation Self Insurors Bond 8 Coverage Considerations, Changes and Developments 9 Gallagher Disclosures 10 Marketing Summary/Guide to A.M. Best Ratings 12 Bindable Quotations and Compensation Disclosure Schedule 14 Client Authorization to Bind Coverage 15 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. y our markets as tenacious competitors providing opportunities for growth and By with the highest degree of integrity and ethical character Byour 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 a difference": 1 Weld County, Colorado Client Service Team Main Phone Number: (303) 773-9999 6399 South Fiddlers Green Circle, Suite 200 Greenwood Village, Co 80111 A service team approach will be implemented for Weld County to provide a senior level availability for all of your services and risk management needs as well as daily services requirements. Karen Graham Priscilla McCoy TBD Area Executive Vice Area Senior Vice President Client Services Manager President/National Director Sr. Client Services Executive Telephone#303-889-2590 Telephone#303-889-2538 Telephone#303-889-2540 TBDe@ajg.com karen_graham@ajg.com Priscilla_mccoy@ajg.com Anita Bruner Kendall Trump Client Associate Claims Advocate Telephone#303-889-2574 Telephone#303-889-2570 anita_bruner@ajg.com kendall_trump@ajg.com 2 Weld County, Colorado Executive Summary Renewal Strategy On July 29, 2014, Arthur J. Gallagher Risk Management Services, Inc. (Gallagher) contacted Weld County, Colorado (the County) to obtain 2014 renewal information for the upcoming December 31, 2014 Excess Workers' Compensation Renewal. Due to the extensive marketing that was done in 2012 and receiving declinations from all carriers except the incumbent (Safety National), we determined we would pursue renewal terms from the incumbent. Exposure Summary Specific Excess Workers'Compensation Exposure Basis 2010 Audited 2011 2012 2013 2014 %Change over expiring Annual Payroll S 62,980,655 $ 62,875,209 $ 65,898,526 S 66,506,820 $ 75,704,233 14% Marketing Results Excess Workers' Compensation Insurance Safety National Casualty Corporation (SNCC) SNCC is proposing limits and retentions as expiring at a $750,000 SIR. After negotiations with SNCC, SNCC agreed to maintain reduce the rate instead of requiring a 5% rate increase because of the increase in payroll. The 2014 rate is $.1650 per $100 of payroll, a 12% decrease over the expiring rate of$.1867. The 2014 deposit premium is $124,912, a 1% increase over the expiring premium of$124,168. SNCC also provided a $850,000 SIR option for consideration. The 2014 deposit premium is $116,812, a 6% decrease over the expiring premium of$124,168. The rate is $.1543, a 17% decrease over the expiring rate of$.1867. Workers' Compensation Self-Insurance Bond Travelers provided a flat renewal rate of$9.60. The penal sum remains at $2,365,085, therefore, the pricing remains flat at $22,705. This could change based on review by the State of Colorado Division of Workers' Compensation. 3 a C co i.. a > E o a on O CD C co p1'- \ ° o °N. a) D7 C Ili C .Q r N CO 0 C R a o r x co -a X V O N V d :- N o a 5 V o a) 6 O > N O ER o I- N o N V 0 Q C) in vs O (6 O N as C co co r N N C Q) N 4 >,— > p N CO Q N- O N0 C N (fl N (fl 69 (C N- O O r h d fA e} CD CO CO OD 0 U a) U w O L V V p a' p N @ U N 0O N N N 0 a) CO O M a 6 r U (1) M O 1N-- N L r11 CO IS) C N (V C N M O CD CO O ea ea e3 Cl] 3 N co in a) .-' t/) o 0 0 C 2 ,— N- C a) `O in h C1 N c Q. p , a) CD E co O OCT a lii0 N U N = , 01 O > a) E) CO r N N U ill N co � N E M O C F» e» E .-c Y 0 0 i eft vas s `fl o o in E .- r. m E N CA C) a) � N C in O N CL a C O a 0 r y O7 N Q Or• L W r N n ay O O 3 is .C O U U r N N N < L N '= N CNO IN... 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WUWUWUOWUse > el3 Q aZ Weld County, Colorado Major Changes to Expiring Program On the Coverage sections any items in bold type are enhancements and any items in red bold type are coverage restrictions from expiring program. • None 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 4 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. 5 Weld County, Colorado Specific Excess Workers' Compensation Carrier: Safety National Casualty Corporation Policy Period: December 31, 2014 to December 31, 2015 Limits: Workers' Compensation CO Statutory Per Indicated States Employers Liability $ 1,000,000 Maximum Limit of Indemnity Per Occurrence Self Insured $750,000 Retention: 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 • Broad Form All States for Employee Travel Extensions • Voluntary Compensation Endorsement • Limited Longshoremen's and Harbor Workers' Compensation Act Coverage Endorsement • Foreign Endorsement • Same Communicable Disease Endorsement • 90 Days Notice of Cancellation, except 10 Days Nonpayment of Premium • Colorado Mandatory Endorsement—special cancellation provision to Division of Labor Significant • Loss insured by full coverage workers' compensation or employers liability Exclusions insurance (including but • Any Loss arising out of operations for which you have rejected any workers' not limited to): compensation law • Punitive or exemplary damages • Any assessment made upon self-insurers, whether imposed by statute, regulation or otherwise Minimum • 90% ($105,131) Premium: Audit Basis: • Annual Audit at Policy Expiration • 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 Att: 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@ajg.com Contact: Kendall Trump, Claims Consultant Phone: 303.889.2570 Fax: 303.773.9776 Toll Free : 800.333.3231 7 Weld County, Colorado Workers' Compensation Self Insurors Bond Carrier: Travelers Casualty and Surety Company of America Policy Period: December 31, 2014 to December 31, 2015 Limits: Amounts Coverages $ 2,365,085 Penal Sum Required by State Principal: Weld County Obligee: Executive Director, Department of Labor and Development Division of Labor,Workers' Compensation, State of Colorado Terms I 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 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 (if available) - Aggregate Deductible Stop Loss (if available) 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: • Changes in any operation such as expansion to another state, new products. • Mergers and/or acquisition of new companies. • Any newly assumed contractual liability, granting of indemnities, or hold harmless agreements. • Circumstances which may require an increased liability insurance limits. • 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. • Immediate advice of any changes to scheduled equipment such as contractors'equipment, electronic data processing, etc. • Property, of yours that is in transit, unless we have previously arranged for the insurance. • Any changes in existing premises including vacancy, whether temporary or permanent, alterations, demolition, etc. Also, any new premises either purchased, constructed, or occupied. 9 Weld County, Colorado Gallagher Disclosures The following disclosures are hereby made a part of this proposal. Please review these disclosures prior to signing the proposal acceptance agreement 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. 10 Weld County, Colorado Gallagher 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 most recent legislation eliminated the distinction between foreign and domestic acts of terrorism, a number of lines of coverage excluded under the TRIEA legislation 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. The Terrorism Risk Insurance Program Reauthorization Act(TRIPRA) includes a$100 billion cap on insurers'aggregate liability. TRIPRA is set to expire on December 31, 2014.There is no certainty of extension,thus the coverage provided by your insurers may or may not extend beyond December 31,2014. 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, Inc.. 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. 11 Weld County, Colorado Carrier Ratings and Admitted Status Proposed Carriers A.M. Best's Rating Admitted/Non-Admitted Safety National Casualty A+ XII Admitted Corporation Travelers Casualty and Surety A+ XV Admitted Company If the above indicates 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 Rang Levels and Categories LEVEL CATEGORY Financial Size Categories A++,A+ Superior 1705000 afReineed FLra yfaatiiers'Sins Firs Conditional'Rese►veFUnds) A.A- Excelei FSC I Up to 1.030 FSC IX 250.000 to 500,000 ti++,S+ Good FSC II 1.030 to 2,040 FSC X 500.000 to 750,000 5.5- Fain FSC III 2000 05.000 FSC XI 750,000 to 1.00.000 C++.C+ Marginal FSC IV 5.030 to 10.000 FSC XII 1.000,000 to 1.250.000 C.C- 1i4teak FSC V 10.000 to 25.000 FSC XIII 1.250.040 to 1.500.000 D Poor FSC VI 25,000 to 53.040 FSC XIV 1,500.000 to 2,004.040 E Urdu Reguktdcgy Su ry u for FSC VII 50.000 to 100,0) FSC XV 2.000,000 or more F lar Leta cation FSC VIII 100.000 to 250,430 S 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/ratings/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. 12 Weld County, Colorado Carrier Ratings and Admitted Status (Continued) GUIDE TO BESTS FINANCIAL STRENGTH RATINGS-INSURER A Best's Financial Strength Rating is an independent opinion of an insurer's financial strength and ability to meet its ongoing insurance policy an 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. Financial Strength Ratings-Insurer Rating Descriptor Definition A++,A+ Superior Assigned to companies that have,in our opinion,a superior ability to meet their 023ongoing insurance obligations A,A- Excellent Assigned to companies that have,in our opinion,an excellent ability to meet their ongoing insurance obligations co B++,B+ Good Assigned to companies that have,in our opinion,a good ability to meet their ongoing insurance obligations B,B- Fair Assigned to companies that have,in our opinion,a fair ability to meet their ongoing insurance obligations. Financial strength is vulnerable to adverse changes in underwriting and economic conditions. C++,C+ Marginal Assigned to companies that have,in our opinion,a marginal ability to meet their ongoing insurance obligations. Financial strength is vulnerable to adverse changes in underwriting and economic conditions C,C- Weak Assigned to companies that have,in our opinion,a weak ability to meet their ongoing insurance obligations. Financial strength is very vulnerable to adverse changes in underwriting and economic conditions D Poor Assigned to companies that have,in our opinion,a poor ability to meet their ongoing > insurance obligations. Financial strength is very vulnerable to adverse changes in underwriting and economic conditions E Under Regulatory Assigned to companies(and possibly their subsidiaries/affiliates)placed under a Supervision significant form of regulatory supervision,control or restraint-including cease and desist orders,conservatorship or rehabilitation,but not liquidation-that prevents conduct or normal,ongoing insurance operations. F In Liquidation Assigned to companies placed in liquidation by a court of law or by a forced liquidation S Suspended Assigned to rated companies when sudden and significant events affect their balance sheet strength or operating performance and rating implications cannot be evaluated due to a lack of timely or adequate information Rating Outlooks Assigned to an interactive Financial Strength Rating to indicate its potential direction 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 Rating Modifiers Modifier Descriptor Definition U 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. Pd Public Data Indicates rating assigned to insurer that chose not to participate in A.M.Best's interactive rating process. s Syndicate Indicates rating assigned to a Lloyd's syndicate Affiliation Codes Indicates rating is based on a type of affiliation with other insurers I g I Group I p I Pooled I r I Reinsured Not Rated Categories Assigned to companies reported to by A.M.Best,but not assigned a Best's Rating NR-1: Insufficient Data NR_2: Insufficient Size and/or Operating Experience NR-3: Rating Procedure Inapplicable NR-4: Company Request NR-5: Not Formally Followed Rating Disclosure A Bests Financial Strength Rating opinion addressed the relative ability of an 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 does not independently verify the accuracy or reliability o the information. For additional details,see A.M.Best's Terms of Use at www.ambest.com. Best's Financial Strength Ratings are distributed via press release and/or the A.M.Best Website at www.ambest.com and are published in the Rating Actions section of BestWeek®. Best's Financial Strength Ratings are proprietary and may not be reproduced without permission. Copyright©2010 by A.M.Best Company,Inc. Version 041410 13 o Q7 L (C N O Z U v o m 3 o Q Q Q c al o0 E y z z Z aE .c2 a)O 0 � a) a) c ' } L ac Q mQa) rn 3 E cU) o Q N fn O L.. rn a) 3 - ;o y .Ei- El) m E LL Q < < E } c vi m O Z Z z U C Fa W y O C ' N N L Oc w C C p C O cn U N.cC.) L C E w N O E O E Cl,' QEc N W 2 Z E@ C N L' ,_-. R Q Q Q o (D N 7,1 o z z z TE , U a) m O n na L O 07, V _ mac+ a) j co N OL E N Ci C OO c La. C o5 .J O A N cn c '5 +. ,U C a) O C 2 d @ O Q,C N Tr •O H LL o 0 tic'' .C •-a) a) D +J as Q E O ,— C ` .r N O _ U) p o O a) O O C U O 15 a) E o o ._ > � Ego . E E N N C co CD U O d O E cu m E N N O E c E v co • o" N N r N a�o O / ♦ V) Q s- N C V W a ElltR p p a`) TO c U o)-c .C C C to U) O) 0 :=, CO N (a 0 m cts .4 6U - Vr a) )C ar cc) Cg CD E y o c s.a O ° al OO Op OC °) pcT U L 0 0 �o C) ai O Q U a U 1) .T o 0 u) C U) C ` C cn m U) 4- _ C a 0 69 L Vc c) YE YE '� E � LL) coo .U1 p o r: O o O o cn p) N E p a) n O O 5CU) 5LV) 5o C (o E c a) N V (0 0 0 3 C o �r i-i G) >, a) r_n O 'in N U (n d (Ti O_ C E ui E @ u N o E E V 'O E z c To c o c u) a) 7cpio 0 co L '- >. • G G U O O L Z c Z .>'o' Z .>. io `) m C U co os crr- ) � C C ( > 3 O >' 7 0 N V) O- a) C C E H � n � � Q > � E ECCE COa} a3 O co a3 O a O 0 0 0 0 W V U) oo cnoo F coo co 0 0o ,--1 Weld County, Colorado Client Authorization to Bind Coverage After careful consideration of Gallagher's proposal dated December 22, 2014, we accept the following coverage(s). Please check the desired coverage(s)and note any coverage amendments below: LINE OF COVERAGE CARRIER Specific Excess Workers'Compensation and Accept ❑R ect Employers Liability-$750K SIR Safety National Casualty Corporation RIA Cannot be rejected Premium$124,912 (Safety National Group) ❑ Accept ER a j;ct Specific Excess Workers'Compensation and Safety National Casualty Corporation TRIA Cannot be rejected Employers Liability—$850K SIR (Safety National Group) Premium$116,812 Workers'Compensation-Self Insurers Bond Accept ❑R e j:ct Travelers Casualty and Surety Co TRIA Cannot be rejected TRIA Coverage America(Travelers Group) Premium, $22,705 Provide Quotations or Additional Information on the Following Coverage Considerations: Other Coverage Considerations ❑ Yes ❑No Workers'CompensationAggregate LossFund)Deductble-ifavailable Note:Selecting the"Reject All or Accept All"option will override any selections that you have made above ❑ R e j ctA II ❑A cceptA II-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: (ivy,c fit✓ Specify:owrier,partner or rporate officer Douglas Rademacher, Chair Print Name Date: 12/24/2014 15 Hello