HomeMy WebLinkAboutR-2008-107 Renewal Property Casualty Workers Comp RESOLUTION NO. 2008-107
A RESOLUTION OF THE CITY OF DANIA BEACH, FLORIDA, RENEWING
PACKAGE INSURANCE THROUGH PUBLIC RISK INSURANCE AGENCY
(TO INCLUDE COVERAGES FOR PROPERTY AND CASUALTY, CRIME
AND EMPLOYEE DISHONESTY, GENERAL LIABILITY, AUTOMOTIVE
LIABILITY AND PHYSICAL DAMAGE, PUBLIC OFFICIALS LIABILITY,
EMPLOYMENT PRACTICES LIABILITY INSURANCE), IN A COMBINED
TOTAL NOT TO EXCEED $609,000.00 FOR THE PERIOD BEGINNING
JULY 1, 2008 THROUGH SEPTEMBER 30, 2009, PROVIDING FOR
CONFLICTS; FURTHER, PROVIDING FOR AN EFFECTIVE DATE.
BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF DANIA
BEACH, FLORIDA:
Section 1. That the Dania Beach City Commission approves renewal of
Comprehensive Package Insurance for the City of Dania Beach, through Public Risk Insurance
Agency, such package to include coverage for property and casualty, crime and employee
dishonesty, general liability, automotive liability and physical damage, public officials liability,
and employment practices liability insurance, for the period from July 1, 2008 to September 30,
2009.
Section 2. That all resolutions or parts of resolutions in conflict with this Resolution
are repealed to the extent of such conflict.
Section 3. That this Resolution shall be in force and take effect immediately upon its
passage and adoption.
PASSED and ADOPTED on June 24, 2008.
QO.S FIRST pTY
ATT ST: .
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awt
LOUISE STILSON, CMC ALBERT C. JONES
CITY CLERK Arm MAYOR-COMMI ONER
4i4� 0.PtfO
APPROVED AS TjFORM CORRECTNESS:
BY: �l
THO AS JOCITY ATTO
L M PR
IA
PUBLIC RISK INSURANCE AGENCY
CITY OF DANIA BEACH
PREMIUM RECAPITULATION
15-month Premium Check Ontion
Yes No
Property / Inland Marine /Equipment Breakdown $ 402,929 �� C
Crime/Employee Dishonesty $ 1,834 1A
General Liability $ 199,440 eP, L
Automobile Liability & Physical Damage $ 105,084 /'} C
Public Officials/Employment Practices Liability $ 83,709
Total 15 month premium* $ 792,996
Estimated return premium from current policy** - $ 195,217
Installment due 10/01/2008 $ 597,779
THE BUILDING AND CONTENTS VALUE DOES NOT INCLUDE THE
ADDITION AT FROST PARK AND THE TWO UNDERGROUND STORAGE
TANKS. THESE ITEMS WILL BE INCLUDED IN THE SCHEDULE CHANGES
EFFECTIVE 10/1/2008.
I authorize PRIA to request the underwriters to cancel my current policy, bind coverage
effective 7/l/2008 on the items indicated above and acknowledge receipt of the
Compensation Disclosure(s) provided in this proposal.
i
(signiettrie) q )
(Name&Title)
Ask
(Date)
Page 15 of 20
Public Risk Underwriters public Entity Application 06103108 12:03 PM
r PO Box 958455 Lake mary, FL 32795-8455 Renewal Application Muni[PKMFLI 0062001 08-071
Phone: 321-832-1450 Coverage Term 07/0112008-10/01/2009
Fax: 321-832-1489 Portal Reference# 201355 Page 1
General Member Information
Name: Dania Beach, City of
Mailing: 100 West Dania Beach Blvd
City/State/Zip: Dania Beach, FL 33004
Physical: 100 West Dania Beach Blvd
City/State/Zip: Dania Beach,FL 33004
Phone#: 954-924-MW &9.00 3L Fax#: 954-92=3W C12 - e
Member Contact Information Additional Member Information
Contact: Mary McDonald FEIN: NCCI Risk ID:094006937
Title: Dir of Adrmietretwe-Sewiws'.Il vr`C.n o—(AAn y) Population 3 ��p
Phone 954-924�BSQI&gm Fax 954-924-tW County: Bro and
Email: mmcdonald,gci.dania-beach.fl.us i614 Member Type:Municipality
Agency Information Agency Contact Information
Agency: PRIA-Daytona Contact: Robin Faircloth
Address: P.O. Box 2416 Phone#: 386-2394043
Fax#:
City/State/Zip:Daytona Beach, FL 32115 Email: rfaircloth@bbpNa.com
Phone#: 386-239-4044 Fax#: 386-239-4049
CERTIFICATION
The undersigned being authorized by,and acting on behalf of the applicant and all persons/concerns seeking insurance,has
read and understands this application,including any appendices and/or supplements,and declares that all statements set forth
herein are true,complete and accurate. The undersigned acknowledges and agrees that the submission and the Trusrs receipt
of such written report,prior to the Inception of the coverage agreement applied for,is a condition precedent to coverage.
The signing of this Application does not bind the undersigned to purchase the coverage,nor does the review of same bind The
Trust to issue a coverage agreement. This application shall be the basis of the contract,should one be issued.
This Application must be signed by the"Ranking Elected I Appointed Official"of the Entity making the application(e.g.
Mayor/Manager I equivalent Officer)or the Risk Manager(or ranking official)assigned this function.
SIGNATURE: c
TITLE: -1)) I2 P I`J u P
DATE: LA 2-y� d r}
NOTICE TO APPLICANT
For your protection,the following Fraud Warning is required to appear on this application:
FLORIDA FRAUD STATEMENT
Any person who knowingly and with intent to injure,defraud or deceive any Insurer,files a statement of claim or an application
containing any false,incomplete or misleading information is guilty of a felony of the third degree.
"I hereby authorize the release of claims information from any Prior Insurer/Carrierrrrust to PRU Wor PGIT."
Renewal Application Muni [PKMFLI 0062001 08-071 Page 5
Coverage Term: 07101/2008-10/0112009 Portal Reference# 201355
Member Name: Dania Beach, City of
r Agency: PRIA- Daytona
COVERAGE INFORMATION-PROFESSIONAL LIABILITY-PUBLIC OFFICALS&EMPLOYMENT PRACTICES
THIS IS AN APPLICATION FOR"CLAIMS MADE AND REPORTED"COVERAGE
POL/ELL/EPLI Old Response New Response
1.Are you requesting POL Defense Coverage? No
2.What is the requested EPLI Deductible? $10,000 $10,000
3.What is the requested EPLI Limit? $1,000,000 $1,000,000
4.What is the requested EPLI Retro Date?
5.What is the requested POL Deductible? $15,000 $15.000
6.What is the requested POL Limit? $1,000,000 $1,0D0,000
7. Have you attached the most recent audited
financial&Obudget?
100. Enter the actual audited year-end Total Revenue(All $39,373.140 $39,373,140
Fund Types)for 20134-2005
110. Indicate total employment turnover during the last 3 47
years for 0 Full-time employees hired
111. Indicate total employment turnover during the last 3 13
years for#Part-time employees hired
.� 112. Indicate total employment turnover during the last 3 51
years for#Full-time employees terminated(vol/invol)
113. Indicate total employment turnover during the last 3 40
years for#Part-time employees terminated(vol/invol)
121. Indicate current number of employees employed less 43
than 2 years:
122. Indicate current number of employees employed 63
between 2-10 years
123. Indicate current number of employees employed more 61
than 10 years
130.Over the last 6 years has any person made a claim See Below
alleging unfair or improper treatment regarding employee
hiring,remuneration,advancement,treatment or termination
of employment?(indicate total#&primary allegations):
131. Racial Discrimination 1
132.Age Discrimination We
133.Gender Discrimination n/a
134. Religious Discrimination n/a
135.Other Ethnic Discrimination n/a
,'► 136.All Others n/a
137. Fair Labor Standards Act Violation n/a
138.Violation of Amer.w/Disab.Act C456 n/a
Initial Date 2.! d J
Renewal Application Muni[PKMFLI 0062001 OM7] Page 6
Coverage Term: 07/01/2008-10/01/2009 Portal Reference# 201355
Member Name: Dania Beach, City of
Agency: PRIA-Daytona
COVERAGE INFORMATION-PROFESSIONAL LIABILITY-PUBLIC OFFICALS&EMPLOYMENT PRACTICES
THIS IS AN APPLICATION FOR"CLAIMS MADE AND REPORTED"COVERAGE
POL/ELL/EPLI OldRespoase New Response
140.With respect to"Litigated Cases"(including wrongful None
termination suits under state law other than
anti-discrimination law)and EEOC/state agency charges
over the last six years for which any settlement was or may
be paid,provide following:
151.With respect to all other claims(including wrongful None
termination suits under stale law other than
anti-discrimination law)and EEOC/state agency charges
over the last six years for which any settlement was or may
be paid,provide the following:
152, Date of occurrence,allegation,claimant,damages n/a
paid,damages reserved, legal expense paid,&legal
expense reserved:
160. Provide names&positions of persons with whom any n/a
insured has written employment agreement(s)
170. In the past 3 years, has any claim been made or is now
pending against the Entity or any person in his/her capacity
as an official or employee of the entity?
Dow 172.Within the past 3 years,has/does any official or
employee have any knowledge of any fad,circumstance or
situation which might reasonably be expected to give rise to
a claim against them or against the entity?
200.Enter the actual audited year-end Total Revenue(All $47.015,623 $47,015,623
Fund Types)for 2005-2006
300.Enter the actual audited year-end Total Revenue(All
Fund Types)for 2006.2007
400. Enter the number of employees(excluding 167
independent contractors)-Full Time
500. Enter the number of employees(excluding 25
independent contractors)-Part Time
600. Enter the number of employees(excluding 0
independent contractors)-Volunteers
700. For how many individuals(no FEIN)does applicant 3
report earnings on IRS Form 1099?
800. Is Entity currently in compliance with the"Americans Yes
With Disability Act of 1992"?
810.Are certifications for building inspectors,EMITS,etc. Yes
verified?
820,Are elected and appointed officials required to sign a Yes
conflict of interest statement?
821.Has the Entity instituted written guidelines for handling Yes
Sexual Molestation?
Initial Date 2+ b`9
Renewal Application Muni [PKMFLI 0062001 08-07) Page 7
Coverage Term: 07/0112008-10101/2009 Portal Reference# 201355
FAMPl Member Name: Dania Beach, City of
�. Agency: PRIA- Daytona
COVERAGE INFORMATION-PROFESSIONAL LIABILITY-PUBLIC OFFICALS&EMPLOYMENT PRACTICES
THIS IS AN APPLICATION FOR"CLAIMS MADE AND REPORTED"COVERAGE
POL/ELLIEPLI Old Response New Response
830.Has any employee of the Entity been suspended, No
demoted,dismissed,transferred or had their Contract of
employment non-renewed within the last twelve months?
840.Has the Entity instituted written guidelines for handling Yes
Sexual Harassment?
ll Has the Entity instituted written guidelines for handling Yes
Employee Termination?
842. Has the Entity instituted written guidelines for handling Yes
Pre-employment Screening?
843.Do you have an annual training program for the above
4 items? J
850. Do you have an updated employee handbook? Yes
900.Have job descriptions been drafted for regular full-time Yes
positions?
1000.Has there been an employee strike or disruption No
within the past 3 years?
.ow PROFESSIONAL LIABILITY
IT IS AGREED THAT IF ANY SUCH FACT, CIRCUMSTANCE OR SITUATION NOT
LISTEDIDISCLOSED HEREIN,THEN ANY CLAIM BASED UPON,ARISING OUT OF,OR
ATTRIBUTABLE THERETO, IS EXCLUDED FROM THE COVERAGE BEING APPLIED FOR.
The undersigned being authorized by, and acting on behalf of the applicant and all persons or concerns
seeking coverage, has read and understands this Application, and declares all statements set forth
herein are true,complete and accurate. The undersigned further declares and represents that any
occurrence or event taking place prior to the inception of the coverage agreement applied for, which may
render inaccurate, untrue or incomplete any statement made herein will immediately be reported in
writing to the Trust. The undersigned acknowledges and agrees that the submission and the Trusts
receipt of such written report, prior to the Inception of the coverage agreement applied for, is a condition
precedent to coverage.
The signing of this Application does not bind the undersigned to purchase coverage,nor does
the review of this Application bind PGIT to Issue a coverage agreement. This Application shall,
however, be the basis of the contract,should a coverage agreement be Issued.
Signed Title-OrcOr 06 PO Datebl2gl J6
This Application must be sign y the"Rankkrg Elected/Appointed Official'of the Entity making the application(e.g.Mayor/
Manager/equivalent O?il or"Risk Manager(or ranking official)assigned this function.
SIGNATORY ABOVE IS ALSO TO INITIAL EACH AND EVERY PAGE OF THIS POL I EPLI APPLICATION.
/`
IMPORTANT NOTICE: SHOULD THE SIGNED APPLICATION DIFFER IN ANY WAY FROM THE
APPLICATION SUBMITTED FOR UNDERWRITINGIRATING PURPOSES,THE TERMS,CONDITIONS AND
PREMIUM AS REFLECTED ON QUOTEfBINDERICOVERAGE AGREEMENT MAY BE SUBJECT TO CHANGE.
Initial Date
COVERED PARTY: City of Dania Beach
AGREEMENT NO.: PKMFLI 0062001 08-07
AGREEMENT PERIOD: 07/01/2008 To 1010112009
YOU ARE ELECTING NOT TO PURCHASE CERTAIN VALUABLE COVERAGE WHICH PROTECTS YOU AND YOUR
FAMILY OR YOU ARE PURCHASING UNINSURED MOTORISTS LIMITS LESS THAN YOUR BODILY INJURY LIABILITY
LIMITS WHEN YOU SIGN THIS FORM, PLEASE READ CAREFULLY.
Uninsured Motorist coverage provides for payment of certain benefits for damages caused by owners or operators of
uninsured motor vehicles because of bodily injury or death resulting there from. Such benefits may include payments for
certain medical expenses, lost wages,and pain and suffering,subject to limitations and conditions contained in the Coverage
Agreement. For the purpose of this coverage,an uninsured motor vehicle may include a motor vehicle as to which the bodily
injury limits are Was than your damages.
Florida law requires that automobile liability coverage agreements include Uninsured Motorist coverage at limits equal to the
Bodily Injury limits in your coverage agreement unless you select a lower limit offered by the Trust,or reject Uninsured
Motorist entirely. Please indicate whether you desire to entirely reject Uninsured Motorist coverage,or,whether you desire
this coverage at limits lower than the Bodily Injury Liability limits of your Coverage Agreement:
❑✓ a. I hereby reject Uninsured Motorist coverage.
❑ b. I hereby select the following Uninsured Motorist limits which are lower than my Bodily Injury Liability Limits:
each person(enter limit if applicable):
each accident.
❑ c. I hereby select Uninsured Motorist coverage limits equal to my Bodily Injury Liability limits. (if you select
this option disregard the bold face statement above.)
ELECTION OF NON-STACKED COVERAGE
(Do not complete if you have rejected Uninsured Motorist)
You have the option to purchase,at a reduced rate, non-stacked(limited)type of Uninsured Motorists coverage. Under this
form if injury occurs in a vehicle owned or leased by you or any family member who resides with you,this Coverage
Agreement will apply only to the extent of coverage(if any)which applies to that vehicle in this Coverage Agreement. Ilan
injury occurs while occupying someone else's vehicle,or you are struck as a pedestrian,you are entitled to select the highest
limits of Uninsured Motorist coverage available on any one vehicle for which you are a Named Covered Party,covered family
member,or covered resident of the Named Covered Party's household. This Coverage Agreement will not apply if you select
the coverage available under any other Coverage Agreement issued to you or the Coverage Agreement of any other family
member who resides with you.
If you do not elect to purchase the non-stacked form,your Coverage Agreement limit(s)for each motor vehicle are added
together(stacked)for all covered injuries. Thus,your Coverage Agreement limits would automatically change during the
Coverage Agreement term if you increase or decrease the number of autos covered under the Coverage Agreement.
❑ 1 hereby elect the non-stacked form of Uninsured Motorist coverage.
I understand and agree that selection of any of the above options applies to my liability Coverage Agreement and future
renewals or replacements of such Coverage Agreement which are issued at the same Bodily Injury Liability limits. If I decide
to select another option at some future time, I must let the Trust or my agent know in writing.
Signed
(Covered Party)
Signed
0 (Covered Party)
JIT 398(07 05) Date: I )2 t1I ✓ 13
Ilia brief description of coverage contained in this document is being provided as an accommodation only and is not intended to cover or describe all
Coverage Agreement terms. For more complete and detailed information relating to the scope and limits of coverage,please refer directly to the Coverage
Agreement documents. Specimen forms are available upon request.
Page 13
PUBLIC ENTITY
D
SIGNATURE PAGE
Covered Party: City of Dania Beach
Agreement Number: PKMFLI 0062001 08-07
Coverage Period: From:07/01/2008 To: 1010112009
1 heaeby confirm that limits/eoverages as shown hereunder, corresponding with the Coverage Agreement, are
correct:
Property TIV $28,840,946 Buildings iL Contents Combined
Inland Marine $400,000Communication Equipment
$835,000 Contractor's I Mobile Equipment
$270,000 Electronic Data Processing Equipment
$250,000�mergency Services Portable Equipment
$10,000 ine Arts
$10,000Other Inland Marine
$50,000 Rented, Borrowed, Leased Equipment
$100,000 Valuable Papers
$22,026 Watercraft
I reject TRIA(Terrorism Risk Insurance Act)coverage
Automobile 88 #of Units-Auto Liability
88 #of Units-Comprehensive
88 #of Units-Collision
I hereby confirm that I have received a copy of PGITs Current Interlocal Agreement(effective
October 1, 2004)
NIA I confirm having read and agreed to the terms as laid out in the attached PGIT Participation
Agreement(which also requires a signature)
Please remember that a signed copy of the following are also required:
• First Page of PGIT application
• Uninsured Motorist Rejection/Election form, if applicable
• Professional Liability (POL I EPLI or ELL/E}PLI)application, if applicable.
7 j 3
Signafure Title � �— Date
Name
/•� Please note:Failure to return this signature page could result in cancellation of coverage.
The brief description of coverage contained in this document is being provided as an accommodation only and is not intended to cover or describe all
Coverage Agreement terms. For more complete and detailed information relating to the scope and limits of coverage,please refer directly to the Coverage
Agreement documents. Specimen forms an:available upon request, Page 14
MPRIA
PUI M RU IN5t7RANC�AG-ENC:Y
THE CITY OF DANIA BEACH
7/1/2008 TO 10/1/2009 PACKAGE INSURANCE RENEWAL
PREMIUM COMPARISON
ANNUALIZED 10/1/07-8 EXPIRING PREMIUM $ 800,324.40
ANNUALIZED 10/1/08-9 RENEWAL PREMIUM $ 633,487.00
ANNUAL SAVINGS $ (166,837.40) —21%
7/1/2008 — 10/1/2008 SAVINGS $ (35,708.00)
OVERALL SAVINGS $ 202,545.40 -25%
OTHER ADVANTAGES:
► PROPERTY COVERAGE AT A GUARANTEED RATE FOR 2 HURRICANE SEASONS
► REDUCTION OF NAMED STORM OCCURRENCE DEDUCTIBLE
► OTHER COVERAGE TERMS PER EXPIRING
► ACCURATE BUDGET NUMBERS (PACKAGE POLICY)
No, EXPOSURES PER EXPIRING — EXPOSURE UPDATES WILL BE ADJUSTED
6/9/2008