HomeMy WebLinkAbout2002 09 23 Consent K General Insurance and Worker's Compensation Insurance for FY 03
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COMMISSION AGENDA
ITEM K
ICONSENT
INFORMATIONAL
PUBLIC HEARING
REGULAR
x
Septemher 21, )OO?
Meeting
/DEPT. ~
REQUEST: The Finance Department is requesting the City Commission select an
Insurance Carrier for the City's General Insurance and Worker's Compensation
Insurance Needs for FY 03.
PURPOSE: To select an insurance carrier for the City's general insurance and worker's
compensation insurance for FY 03.
CONSIDERATIONS:
. The City currently has general insurance policies with Coregis and a worker's
compensation policy with Preferred Governmental Insurance Trust (PGIT).
. The City's general insurance and worker's compensation insurance policies expire
September 30,2002. Coregis has informed Staff that they will not be offering a quote for
the upcoming year.
. The City provided to both PGIT and FMIT bid requirements based on the prior year policy
updated for substantial changes in fixed asset additions and revisions as prepared by Staff.
. Both PGIT and FMIT have quoted the City. Please see attached spreadsheet for
comparison of quotes prepared by Staff. Policy sections with quotes for each have also been
included where applicable.
. RMA (PGIT's) quote was $722,586 which was approximately 44% or $219,000 higher than
the prior year; whereas, FMIT's quote was $616,979 which was 22% or $113,500 higher
than the prior year.
. RMA (PGIT) submitted a revised quote of $665,443 which is still higher than FMIT.
FMIT PGIT - Revised PGIT - Original
Property $49,573 $63,949 $63,949
Crime/Employee Dishonesty $591 $570 $570
General Liability, Law & $64,566 $70,193 $82,076
EMT
Auto Liability & Physical $64,389 $70,125 $90,125
Damage
Public Officials Liability $22,820 $51,649 $51,649
Worker's Compensation $410,141 $404,740 $430,000
Accidental Death & $3,899 $3,249 $3,249
Dismemberment
Third Party Storage Tank $1,000 assume $968 $968
Liability
Total $616,979 $665,443 $722,586
. In addition, RMA (PGIT) submitted a comparison of their policy versus FMIT's. Staff
requested a rebuttal from FMIT. Both are attached.
. Staff feels the FMIT policy, in overall substance, provides better coverage to the City with
less monetary exposure.
FUNDING:
General Insurance expense will be funded by the General Fund and recouped in part from the
Stormwater and Utility Fund through their fair share contribution.
Workman's Compensation will be funded by each fund affected based on their class of employee
and total payroll.
Sufficient funds exist in the budget between the two categories to fund the FMIT policy.
However, adjustments will be made at a later date between the two categories to reflect their
quoted expense.
RECOMMENDATION:
Staff recommends selecting FMIT as our carrier for both general insurance and worker's
compensation insurance for the period October 1,2002 - September 30,2003.
ATTACHMENTS:
Spreadsheet - FY 03 Premium Quote Analysis
RMA (PGIT) quote and select policy sections
FMIT quote and select policy sections
RMA (PGIT) revised quote and comparison of policies
FMIT's rebuttal and comparison of policies
COMMISSION ACTION:
CITY OF WINTER SPRINGS
GENERAL INSURANCE AND WORKERS' COMPENSATION INSURANCE
FY OJ PREMIUM QUOTE ANALYSIS
PRIOR YEAR CURRENT YEAR - OPTION #1-PGIT CURRENT YEAR - OPTION #2-FMIT
Quoted Quoted
FY02 FY02 FY03 FY03 $ % FY03 FY03 $ %
Insurance Annual Insurance Annual Diffto Diff to Insurance Annual Diff to Diff to
Company Premium Company Premium Prior Year Prior Year Company Premium Pripr Year Prior Year
Property (bldg. contents. inland marine, ind equip breakdown) Coregis $13,224 PGIT $63,949 $50,725 $49,573 i
384% FMIT $36,349 275%
PGIT $5,000 ded \
FMIT $1,000 ded
Crime/Employee Dishonesty Coregis $253 PGIT $570 $317 125% Travelers $591 $338 134%
PGIT $50,000 bond, $1k ded
FMIT $10,000 crime bond, $50,000 honesty bond
General Liability. Law Enforcement and EMT/Paramedics Coregis . $50,781 PGIT $82.076 $31,295 62% FMIT $64,566 $13.785 27%
PG IT $2mill per OCC, $25k ded per occ
FMIT $2milllimit. $25k stop loss
Automobile Liability and Physical Damage Coregis $56,935 PGIT . $90,125 $33,190 58% FMIT $64,389 $7,454 13%
PGIT $2mill, $25k ded, $10k pip, $1k damage
FMIT $2mill. $25k ded, $10k pip. $1k damage
Public Officials Liability Nat'l Un Fire $51,500 PGIT $51,649 $149 0% FMIT $22,820 ($23,680) -56%
PGIT $1 mill agg, $25k per wrongful act I
FMIT $1 mill limit, $25k stop loss
Workers' Compensation PGIT $328,208 PGIT $430,000 $101,792 31% FMIT $410.141 $81,933 25%
PGIT .98 mod. slat, on $8.7mill payroll
FMIT .98 mod, stat, on $8.7mill payroll. pay 1st dollar
Accidental Death & Dismemberment AIG Life $2,515 Hartford $3,249 $734 29% AIG $3,899 $1,384 55%
PGIT $50,000 limit
FMIT $50,000 limit
Third Party Storage Tank Liability $0 Great Am $968 $968 100% $0 #DIV/O!
Total $503,416 $722,586 $219,170 44% $615,979 $112,563 22%
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PREFERRED GOVERNMENTAL
INSURANCE PROGRAM
PROPOSAL
FOR
City of Winter Springs
Effective: October 1, 2002
Presented by:
Paul Dawson
Risk Management Associates
598 S. Northlake Blvd., Suite 1040
AItamonte Springs, FI. 32701
407-331-4400
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R'MIA
Risk-Mk~a~~~tlt Associates
CITY OF WINTER SPRINGS
PREMIUM RECAPITULATION
Annual Premium
\
Property/Inland Marine/Equipment Breakdown
Optional Flood
$ 63,9490
t..' '9;-8'14'
$ 570 CD
$ 82,076 c.9
$ 90,125 CD
$ 51,649 CO
;1
Crime/Employee Dishonesty
..3
General Liability
y
Automobile Liability & Physical Damage
,
,
)
Public Officials/Employment Practices Liability/
Law Enforcement Liability
<y
Workers Compensation
$440,672
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l----rhird Party Storage Tank Liability-Commerce & Industry
Option 1 1 mil/1 mil $10,000 Deductible $
. Option 2 Dedicated limits per location . $
, Third Party Storage Tank Liability - Great American Insurance Co.
L-- 1 mil/1 mil aggregate limit per location $
..-"" : ~ .
1,277
1 ,405
-)-
968
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-'-' AD&D - AIG Life
Annual - Option 1
Annual with Optional WAI- Option 2
Three Year Installments - Option 3
Three Year Installments with WAI - Option 4
Three year Prepaid - Option 5
Three Year Prepaid with WAI - Option 6
AD&D - Hartford Life
Annual - Option 1
Three Year Installments - Option
Three Year Prepaid
$ 4,398
$ 5,253
$ 12,537
$ 14,976
$ 12,315
$ 14,709
$ 3,249 G)
$ 9,261
$ 8,772
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The brief description of insurance coverage contained in this propoml is being provided (IS WI accomll/odation only and is
not intended 10 cover or describe all policy terms. For more complete and dewiled in(o/'11/(1tion relating 10 the scope and
limits of coverage, please refer direclly to the policy docl/ments. Specimen forms (Ire available l/pon reql/est.
WINTER SPRfNGS
10- I -2002 INSURANCE RENEW AL
Summary of Exposures Changes
Property
Bui ldings, contents and equipment increased by $ 11,511,000 in val ues
Automobile Liability and Physical Damage
Number of vehicles increased by 14 for liability and 87 for physical damage
General Liability, Law Enforcement Liability
Net operating expenditures increased by 3.5%
Workers' Compensation
State rates and the Heart and Lung Presumption amendment have increased this
exposure significantly.
Ris~an~j~ssOciates
CITY OF WINTER SPRINGS
PROPERTY-INLAND MARINE
Term: October 1,2002 to 2003
Company: Preferred Governmental Insurance Trust (PGIT)
Limits of Liability:
(Per schedules provided) $20,444,000 Blanket for Buildings and Contents
Contractor's Equipment: $995,543
Electronic Date Processinq: $790,707
Flood Sublimit: $1,000,000
Deductibles: ,.j....,...po;~ --=;,. $5,000 Per Occurrence-Buildings and Contents.
.-:J__.....
~,;:.....;; _ ~2% TIV Per Occurrence/Per Location for "Named"
,"'.: tyr'~'..>' ).- -- Windstorm Subject to minimum of $10,000 per
'r .~ occurrence
$5,000 Per Occurrence-Inland Marine
Flood Deductible:
$5,000 Other than Zones A or V
Zones A or V - Excess of maximum limits (buildings
& contents) available from NFIP, whether
purchased or not.
Coveraqe:
1. Special form (formerly "All Risk"), subject to policy exclusions.
2. Replacement Cost applicable to Buildings, Contents and EDP. All others paid per policy
form.
3. No Coinsurance Clause
4. ACV applies to Wharves, Piers and Docks.
5. Certain coverages subject to sublimits stated in policy.
R"'M'-jA
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Risk Managem nt AssocIates
PROPERTY
Covered Property:
Buildings or structures newly acquired, occupied or constructed:
Personal property newly acquired:
Personal property temporarily away from premises:
Personal property of others:
(limited to $1,000 per volunteer, $2,500 per employee)
$1,000,000 **
$ 250,000 **
$ 100,000
$ 50,000
** subject to 90 Day reporting period
Notes of Importance:
) 1. A signed schedule(s) of property for all property to be insured is required within 30 days of
binding. .The following information should be included:
. Street address or plat description
. 100% replacement cost value of all property to be insured
. Brief description of the construction of all buildings or structures at each location
Functional replacement cost applies to buildings over 65 years old or other property with
historical/landmark status
RM'A
Risk Management Associates
SPECIAL PROPERTY COVERAGES
Standard ISO property coverages are provided In the Preferred Governmental
Insurance Program, as well as the following:
COVERAGE LIMIT
1. Business Interruption
2. Extra Expense
3. Valuable papers
4. Accounts receivable
$250,000
$250,000
$100,000
$100,000
$100,000
$ 25,000
$ 25,000
$ 50,000
$ 10,000
$ 25,000
$100,000
$100,000
$250,000
$ 50,000
Per Form
5. Fine arts (maximum per item $5,000)
6. Miscellaneous property (if included in property schedule)
7. Trees, shrubs, and landscape planting (maximum per tree $1,000)
8. Golf course greens and tees (maximum anyone green or tee $5,000)
9. Food spoilage
10. Animals (maximum per animal $1,000)
11. Paved surfaces
12. Commandeered property or impounded property
13. Emergency service portable equipment
14. Communications equipment
15. Vacant buildings
Please refer to policy on how above coverage applies. Subject to deductibles and
certain restrictions. Above coverage is provided to you as part of the blanket limit
of insurance. If higher limits are required, they will be stated in the property or
inland marine sections of this proposal, but will remain a part of the blanket limit
of insurance.
RMJA
Risk Managem nt Associates
EXTENSIONS OF COVERAGE
The limits below are in addition to the blanket limit of insurance but subject to the blanket limit
deductible shown in the property section of this proposal:
COVERAGE
1. Preservation of property
2. Fire Department service charge
3. Repair of theft damage to non-owned buildings
4. Debris removal: the greater of 25% of loss or
5. Increased cost of construction: greater of 15% of value of damaged bldg. or
6. Fire Protection Device
7. Pollutant clean up and removal
8. Arson and crime reward
9. Utility interruption (excluding Transmission & Distribution)
10. Sewer back up during flooding
LIMIT
$100,000
$ 25,000
$ 50,000
$500,000
$500,000
$ 10,000
$ 50,000
$ 10,000
$100,000
$ 25,000
Please refer to policy form on how above coverage applies. Subject to deductibles and restrictions as
stipulated in policy. PGIT's liability for loss or damage will be limited only to the loss or damage due a
covered cause of loss.
RMJA
Risk Managem nt ASSOcIates
MAJOR EXCLUSIONS
Property Not Covered:
1. Accounts, bills, currency, or other moneys, deeds, food stamps, or other evidences of
debt, scrip, notes or securities except under conditions described in "Special Property
Coverages" section of the policy.
2. Automobiles
3. Dams, levees, reservoirs, tunnels, bridges, roadways, walks, patios, or other paved
surfaces except under conditions described in "Special Property Coverages" section of
the policy.
4. Contraband, or property in the course of illegal transportation or trade.
5. Cost of excavations, grading, backfilling, or filling.
6. Land, water, and growing crops.
7. Bulkheads, pilings, piers, wharves, or docks unless scheduled.
8. Property covered under another coverage form of this or any other policy in which it is
more specifically described.
9. Retaining walls that are not part of buildings you own.
10. Underground tanks, pipes, flues, sewers, or drains you own that are not located on
"premises" insured under this policy.
11. Electrical or communication lines, towers, and poles you own that are not located on a
"premises" insured under this policy.
12. Buildings that are "vacant" except under conditions described in "Special Property
Coverages" section of the policy.
13. Watercraft not included in the schedule of property or aircraft.
14. Aircraft.
15. Personal property while airborne or waterborne.
Excluded Risks of Direct Physical Loss:
1. Building ordinance enforcement
2. Collapse
3. Water, except as provided under "Extensions of Coverage"
4. Utility failure, except as provided under "Special Property Coverages"
5. Government action
6. War, military action and terrorism
7. Mold
8. Nuclear reaction
9. Pollution, except as provided under "Extensions of Coverage"
10. Asbestos
11. Earthquake
Covered Equipment:
Coverages:
Equipment Breakdown Limit
Property Damage
Business Income
Extra Expense
Service Interruption
Perishable Goods
Demolition and ICC
Expediting Expenses
CFC Refrigerants
Deductibles:
)
R'M"-jA
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Risk Managem nt Associates
EQUIPMENT BREAKDOWN
Covered Property built to operate under vacuum or
pressure, other than weight of contents, or used for
the generation, transmission or utilization of energy.
$20,000,000
$20,000,000
$250,000
$250,000
Combined with Business Income and Extra Expense
$100,000
$100,000
$100,000
$100,000
Same as Property-Building and Contents
-'J
RMJA
Risk Managem nt Associates
CITY OF WINTER SPRINGS
CRIIVI E
Term:
October 1, 2002 to 2003
Company:
Preferred Governmental Insurance Trust
Limits of Liability and Coveraqe:
Employee Dishonesty
Honesty Blanket Bond
Deductible
$ 50,000 per Loss
$ 1,000
)
Theft, Disappearance, and Destruction $10,000 inside premises
$10,000 outside premises
Deductibles $ 1,000 inside premises
$ 1,000 outside premis'es
Forgery or Alteration
not quoted
Computer Fraud
not quoted
Notes of Importance:
1. Employee dishonesty coverage is extended to cover those employees required by Florida
Statute to be separately bonded. Coverage applies in excess of the statutory bond
amount.
2. Electronic Transfers are automatically covered under Computer Fraud.
3. Excludes Faithful Performance.
)
J
RMjA.
Risk Managem nt Associates
CITY OF WiNTER SPRINGS
GENERAL LIABILITY
Term:
October 1, 2002 to 2003
Company:
Preferred Governmental Insurance Trust
Form:
Occurrence
Limits of Liability:
Primary Bodily Injury and Property
Damage Liability-Combined
$2,000,000 Per Occurrence
General Aggregate
$4,000,000 Annual
Deductible:
$25,000 Per Occurrence
J
Coveraqe:
1. EMT/Paramedic professional services
2. Premises operations
3. Products and completed operations
4.' Fire legal liability $50,000
5. "Insured" contracts
6. Host liquor Law liability
7. Broad form property damage
8. Watercraft liability (under 52 feet)
9. Limited worldwide coverage
10.Additional persons insured
11. Employee benefits liability
(Claims-made basis )-Retro Date
(~ 10/1182. Separate Limits Apply
/t.-j -99 12. Failure to supply water
13. Principle of Eminent Domain
including Inverse Cond.emnation
n.:/" , $100,000 Per occurrence/annual
(fP/1 ,,'- aggregate
(.....o--.c./'
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I
Notes of Importance:
1. Premium is not audited,
2. Defense Costs are paid in addition to policy limits.
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Risk Management Associates
MAJOR EXCLUSIONS
. Expected or intended injury
. Workers' Compensation and simil~r laws
. Employment-Related Practices Liability
. Employer's Liability
. Pollution
. Automobiles
. Aircraft and airports
. Damage to owned property
. Asbestos
. Nuclear
. Health care facilities
. Hospital/Clinic Medical Malpractice
. War
. Law Enforcement Professional Liability
For additional exclusions and more details on how they apply, please refer to coverage
form.
RMA
)
Risk Management Associates
CITY OF WINTER SPRINGS
LAW ENFORCEMENT LIABILITY
Term:
October 1, 2002 to 2003
Company:
Preferred Governmental Insurance Trust
Form:
Occurrence
Coveraqe:
Pays damages the insured becomes
legally obligated to pay because of a
"wrongful act" resulting in "personal
injury" in the performance of law
enforcement activities.
)
Limits of Liability:
Each Person Limits:
$2,000,000
$2,000,000
Occurrence Limits:
Deductible-per occurrence:
$2,000,000
$ 25,000
Aggregate Limits:
Notes of Importance:
1. Defense Costs are paid in-addition-to policy limits. 't'
2. Premium is not auditable.
3. Deductible applied to money damages and claims expenses( including investigation,
adjustment and defense costs).
)
RMIA
Risk Managembnt AssocIates
CITY OF WINTER SPRINGS
LA W ENFORCEMENT LIABILITY
Major Exclusions:
1. Contractual Liability (except mutual aid or reciprocal law enforcement contracts.)
2. Workers Compensation, Employer's Liability and similar laws.
3. Pollution
4. Asbestos, Silica and Dust
5. Lead
6. War
)
7. Personal Property in insured's care, custody or control (except for property on persons
at time of arrest)
8. Criminal Acts
9. Aircraft, Auto or Watercraft
10. Employment Injury
11. Non-monetary Damages
)
The brief description of insurance coverage cOlltailled inlhis proposal is being provided as an accommodatioll only and is
nol intended to cover or describe all policy terms. For more complete and delailed illformation relating to the scope and
limits of coverage. please refer directly 10 Ihe policy dOCl/mellts. Specimen forms are available upon reql/est.
.)
RMlA
Risk Mclnagem nt AssocIates
CITY OF WINTER SPRINGS
AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE
Term:
October 1, 2002 to 2003
Company:
Preferred Governmental Insurance Trust
Limits of Liability (Based on 154 Vehicles:
Primary bodily Injury and Property
Damage Liability-Combined
$2,000,000 (symbol 1 - Any Auto)
Personal Injury Protection
$10,000 (Statutory)
Uninsured Motorist
$30,000 (Non-stacked)
)
Liability Deductible:
$25,000 Each Accident
Physical Damaqe:
Comprehensive - (154 vehicles symbol 2)
Collision - (154 vehicles symbol 2)
Physical Damaqe Deductible:
Comprehensive
Collision
$1,000
$1 ,000
Coveraqe and Notes of Importance:
1. Hired and non-owned liability is included:
2. Premium is not audited.
3. Need schedule of vehicles with "ACV" amounts.
4. Need signed UM form
)
The brief description of insurance coverage contained in this proposal is being provided as an accommodation only and is
not intended to cover or describe all policy terms. For more complete and detailed information relating to the scope and
limits of coverage, please refer directly to the policy documents. Specimen /orms are (II'ailable upon request.
R1MlA
RiskMt~a~em nt Associates
CITY OF WINTER SPRINGS
PUBLIC OFFICIALS LIABILITY
Term:
October 1 , 2002 to 2003
Company:
Preferred Governmental Insurance Trust
Form:
Claims Made-Duty to Defend
Coveraqe:
Pays damages the insured becomes
legally obligated to pay because of a
"wrongful act" arising out of the discharge of duties
Limits of Liability:
$1,000,000 Each Wrongful Act
$1,000,000 Annual Aggregate
Deductible:
$ 25,000 Per Wrongful Act
Coveraqe Extensions:
1. Defense costs are included in the policy limit. The company appoints counsel.
2. Deductible applies towards damages, "claims expense" and supplemental payments.
3. Full Prior Acts coverage provided.
4. Broadened definition of "Who is an Insured".
Notes of Importance:
1. This quotation is subject to receipt and approval of completed and signed application prior
to binding.
2. Excluded coverage for Employment Practices Liability. (see EPL coverage section)
)
The brief description of illsurance coverage contained ill this proposal is beillg provided liS 1111 IIcco//l//lodatioll only anri /5
not intended to cover or describe all policy terms. For //lore complete and detailed in/or//lation relating to the scope and
limits of coverage. please refer directly to the policy docl///Ients. Specimen forms are available l/pon reql/est.
RlMlA
Risk M nagem nt Associates
CITY OF WINTER SPIUNGS
PUBLIC OFFICIALS LIABILITY
Major Exclusions:
. Fiduciary Liability
. Workers Compensation, Employers Liability and similar laws
. Pollution
. Asbestos, Silica, Dust, Lead, Fungi and Bacteria
. Bodily Injury, Personal Injury, Property Damage or Advertising Injury
. War, Strikes or Terrorism
. Law Enforcement Activities
. Criminal Acts
. Failure to effect and maintain insurance
. Non-monetary damages, fines or penalties
. Insured vs. Insured
. Employment Practices
. Bonds, Taxes or Construction contracts
. Collective Bargaining Agreements
. Strike and Lockouts
. Prior and Pending claims
. Damages arising out of Eminent Domain, Condemnation, Inverse Condemnation or Adverse
Possession (except costs for those items, which are covered up to $10,000 annually)
. Workers' Adjustment and Retraining Notification Act....
. Health Care Professional or Health Care Facilities
. Contractual Liability
. Capital Improvement to make property more accessible or accommodating to disabled persons
. R.1.C.().
The brief description of insurance coverage contained in this proposal is being provided as an accommodation only and is
not intended to cover or describe all policy terms. For more complete and detailed information relating to the scope and
limits of coverage. please refer directly to the policy dOClIments. Specimenforllls are available upon request.
RIMIA
Risk Mlnagem~nt ASSOcIates
CITY OF WINTER SPRINGS
EMPLOYMENT PRACTICES LIABILITY
Term:
October 1 , 2002 to 2003
Company:
Preferred Governmental Insurance Trust
Form:
Claims Made-Duty to Defend
Coveraqe:
Pays damages the insured becomes
legally obligated to pay due to a "wrongful
employment practices" arising out of the discharge of
duties
Limits of Liability:
$1,000,000 Each Wrongful Employment Practice
)
$1,000,000 Annual Aggregate
Deductible:
$ 10,000 Per Wrongful Employment Practice
Coveraqe Extensions:
1. Defense costs are included in the policy limit. The company appoints counsel.
2. Deductible applies towards damages, "claims expense" and supplemental payments.
3. Full Prior Acts included.
4. Broadened definition of "Who is an Insured".
5. Defense costs (attorney) provided for claims or suits seeking relief or redress in any
form other than monetary damages including EECO hearings.
Notes of Importance:
1. This quotation is subject to receipt and approval of completed and signed application prior to
binding.
2. Coverage included for sexual harassment (including physical contact)
3. Definition of "Wrongful Employment Practice" extended to include discriminatiori
misrepresentation, invasion of privacy, defamation and retaliation, infliction of emotional
distress, wrongful discipline, negligent evaluation, negligent hiring or supervision.
}
The brief description of insurance coverage contained ill this proposal is being provided as an accommodation Dilly alld is
not intended to cover or describe all policy terms. For //lore complete and detailed information relating to the scope alld
limits of coverage, please refer directly to the policy dOCl///lents. Specimell forms are available upon reql/est.
R1MlA
Risk"Mlna~~m nt Associates
CITY OF WINTER SPRINGS
EMPLOYMENT PRACTICES LIABILITY
Major Exclusions:
. Criminal Acts
. Fiduciary Liability
. Pollution
. Asbestos, Silica, Dust, Lead, Fungi and Bacteria
. Bodily Injury, Personal Injury, Property Damage or Advertising Injury
. Self-Dealing or Illegal Profit
. Damages arising out of Eminent Domain, Condemnation, Inverse Condemnation or Adverse
(Reimbursement for defense costs up to $10,000 annually is provided)
. Law Enforcement Activities
. War, Strikes or Terrorism
. Failure to Effect and Maintain Insurance
. Bonds, Taxes or Construction contracts
. Prior and Pending claims
. Non-monetary damages, fines or penalties
. Insured vs. Insured
. Workers' Compensation or similar laws
. Collective Bargaining Agreements
. Strike and Lockouts
. Workers' Adjustment and Retraining Notification Act
. Health Care Professional or Health Care Facilities
. Contractual Liability
. FZ.I.C:.().
The brief description 0/ insurance coverage cOlltailled ill this proposal is being provided as an accommodation only and is
/lot intended to cover or describe all policy terms. For more complete and detailed information relating to the scope and
limits of coverage. please refer directly to the policy documents. Specimen forms are available upon request.
RIMIA
Risk Mknagembnt Associates
CITY OF WINTER SPRINGS
WORKERS' COlVIPENSATION
GUARANTEED COST
Term:
October] , 2002 to October 1, 2003
Insurer:
Preferred Governmental Lnsurance Trust
Class Description of Class Code Rates Estimated Payroll
Code
5509 Street or Road Maintenance by Co or 11.08 487,478
municipal
7520 Waterworks Ops & Sales 6.24 724,622
7580 Sanitary or Sanitation District 4.50 557,456
7704 Firefighters & drivers 10.68 1,654,062
7720 Police & drivers 10.68 2,563,920
8380 Auto Repair Shop 6.95 108,262
8810 Clerical NOC .65 1,922,004
9102 Parks NOC 10.01 439,748
9410 Municipal Township 15.01 320,808
Estimated Manual Premium
Experience Modification .98
Estimated Discounted Premium
$686,985
$440,672
Notes of Importance:
This quote is subject to reinsurance approval.
The "Estimated Discounted Premium" includes all applicable credits including safety program and drug-
free workplace credits as per F.S. 440 subject to program requirements. Return to work and fitness for duty
programs will be loss control directives this coming year.
Employer's Limit of Liability is $1,000,00011 ,000,00011 ,000,000.
Experience modi fication factor is subject to veri fication. The final amount of credit is dependent upon
compliance with program requirements. Final premium subject to payroll audit.
The expense constant charge has been included.
Paymcnt tcnns arc quarterly installmcnts.
The brief descriplioll of illsurallce coverage cOlllailled ill Ihis proposal is being provided as an accommodation only and is
1101 inlellded /0 cover or describe all policy lerms. For more complete alld detailed information relating to the scope and
limils of coverage, please refer directly 10 the policy documelllS. Specimell forms are available upon request.
R1MlA
J ' I i
:' ili,:'
Risk M ~.~~;~ nt Associates
CITY OF WINTER SPRINGS
STORAGE TANK THIRD PARTY LIABILITY AND
CORRECTIVE ACTION POLICY
Term:
October I, 2002 to 2003
Company:
Great American Insurance Company
(Rated AXIl by A.M. Best)
Limits of Liability:
General aggregate
$1,000,000 per occurrence
$1,000,000 annually
Deductible:
$10,000
Preliminary Quote:
$968
Coverage as defined by the policy includes the following~ . .
. Coverage A - Claims for Bodily Injury or Property Damage (Third Party Liability)
. Coverage 13 - Claims for Corrective Action (First Pal1y Clean-up Costs)
)
Defense Coveraqe:
. Coverage A & B - UST Defense Limit (Incident limits or exhausted aggregate limit - does
not erode primary coverage)
. Coverage C - Not applicable
Notes of importance:
. Location is in compliance with DEP rules
. Quote valid until 10/1/02
. Application is reviewed and approved by Underwriter
. There are no mid-term credit given for upgrades or replacements
. Aggregate limit applies to each location individually.
The brief descriplioll of illsllrollce covcroge cOlltailled in this proposal is beillg providcd as an accommodation only and is
nol inlel/ded 10 cover or descrihe all policy lerms. For more complete and delailed il/formalion relating to the scope and
limils of coverage. please refer direclly 10 Ihe policy docllments. Spccimcl/ forms are available IIpon request.
RtMlA
:.-: : ! '/
! i f.1 /".
Risk M nagem nt AssocIates
CITY OF WINTER SPRINGS
CITY OF WINTER SPRINGS
STORAGE TANK THIRD PARTY LIABILITY AND
CORRECTIVE ACTION POLICY
Tenn:
October I, 2002 to 2003
Company:
Commerce & Industry Insurance Company
(Rated A++, XV by A.M. Best)
Limits of Liability:
General aggregate
$ I ,000,000 per occurrence
$1,000,000 annually
Deductible:
$10,000
Premium $1,277 - Option 1
Premium $1,405 - Option 2 Dedicated Limits per Location
Coverage:
Third party bodily injury and property damage
Expenses for defense
Corrective action for underground storage tank releases
Clean up for aboveground storage tank releases .
Additional modifications to the fonn include:
Declarations page
Covered locations
Cancellati on/non -renewal
Independent counsel
Cross liability exclusion
Extended reporting endorsement
Storage tank enhancement endorsement
Policy terms & conditions
}
Enhancements:
An automatic extended reporting period of60 days with an optional ERP of up to 40 months.
Defense costs are now in addition to the limit of liability & will not erode the aggregate.
The brief description of insurance coverage contained in this proposal is being provided as an accommodation only and is
/lot intended to cover or describe a/l policy terms. For more complete and detailed illforlllation relating to the scope and
limits of coverage. please refer directly to the policy documellts. Specimen for/lls are available upon request.
')
RMIA
Risk Managembnt Associates
Definition ofUST & AST includes underground or aboveground piping
Notice of claims reporting is "as soon as possible"
Quole is subject to receipt of the following:
Receiving signed, original application with the premium by renewal date.
No mid tern1 credits for tank upgrade or removal
Tank changes, additions or deletions require an updated quote.
Notes of Importance:
All submitted information is subject to underwriter approval
This indication is valid until the renewal date.
Premium must be received prior to binding
The brief descnjJlion of insurance coverage contained in this proposal is being provided as an accommodalion only and is
not intended 10 cover or describe all policy IeI.",s. For II/ore cOlI/plete and detailed informalion relaling to the scope and
/iII/its of coverage. please refer directly to the policy docl/II/ents. 5{)(ximen foml.\' are available upon request.
)
R1MlA
Risk Mhnagem nt Associates
CITY OF WINTER SPRINGS
ACCIDENTAL DEATH AND DISMEMBERJY1ENT
Term:
October I) 2002 to 2003
Company:
Hartford Life Insurance Company
(rated A+XV by A. M. Best)
Coverage (] 20 persons):
50,000 Occupational
50,000 Fresh Pursuit
] 50,000 Intentional Death
)
Optional $] 00 Weekly Accident Indemnity Coverage available
Premium:
Annual - Option I
Three Year Prepaid-Option 2
Three Year Installments ~ Option 3
$ 3,249
$ 8,772
$ 9,261
)
The brief description of insurance coverage contained in this proposal is being provided as an accommodation only and is
not intended to cover or describe all policy terms. For more complete and detailed information relating to the scope and
limits of coverage, please refer directly to the policy documents. Specimen forms are (Ivai/able upon request.
FLORIDA MUNICIPAL INSURANCE TRUST
ANNUAL PREMIUM SUMMARY
City of Winter Springs
FMIT# 0648
Option I
Liability Coverages
- Comprehensive General Liability
Police Professional Liability
- Public Officials E & 0
- Public Officials E & 0 Prior Acts Coverage'
'Retroactive Date 10/1/00.
DEDUCTIBLE
$25,000 Sloploss /
$25,000 Stoploss
$25,000 Stoploss;,
$25,000 Stoploss
Automobile Coverage.
- Comprehensive Automobile Liability
- Personal Injury Protection (PIP)
- Automobile Medical Payment
- Automobile Physical Damage
,
$25,000 ,/
n/a
n/a
As per Schedule
Workers' Compensation
- Total Payroll:
- Experience Modification
Effective Date
$8,769,360
0.980
10/1/2002
First Dollar $0
Property Coverage
- Coinsurance:
- Valuation Basis:
- Coverage Form:
- Basis of Value:
- Total Real & Personal Property
- Real & Personal Property
Miscellaneous Coverages
- Business Income
- Extra Expense
- Valuable Papers
- Accounts Receivable
Electronic Data Processing
- Equipment & Software:
- Inland Marine
- Inland Marine - Blanket Coverage
- Crime/Bonds Coverages
- Money and Securities -
- Bond Type *
Honesty Blanket Bond
100%
Agreed Amount
Special
Blanket
$1,000
100% Coinsurance
40%-80%-100%
n/a
n/a
n/a
n/a
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LIMIT NET PREMIUM
.'
..(.r"'" ,",
~~ "~'_'.." ~_...." '7
-$.1 ;000,000 .
-$'1~000;OOO '
$1,000,000,/
$1,000,000
;I., .e' ,-..... '." . .
$+,eOO;DOO.
$10,000 ,/
$1,000 v'
n/a
STATUTORY
S21,234,240
$250,000
$250,000
$100,000
$100,000
Yes
-. Included in Contents
As per Schedule
$500
Loss Inside/Outside
As per Schedule
$10,000
$50,000
$36,219 ;",)'<3
$22,902 ):;-. _ -<
$13,692
$9,128
$4.1882 r"'~ b \ C;
Included
Included
$13.770
$410,141
$49,573 .
Included
Included
Included
Included
Included
Included
Included
Included
Included
Included
*Certain Officers and Subordinates are excluded automatically from coverage by the terms of the designated Blanket Bonds:
1. All Coverages - Finance Directors. Treasurers and Tax Collectors by whatever title known.
2. Faithful Performance Coverages - Personnel required by law to furnish an individual bond to qualify for office (Policemen excluded).
3. Honesty Coverages - Personnel required by law to 'give bond for faithful performance duties.
TOTAL ANNUAL FMIT PREMIUM
I r,JI ~Q~RiT:j,XN~~~,.
\ !w\~. .;l~_.....>~..~ ""{-.c,~i1\.t<~lf~
cT8EfFMh,.l'RREMlliJ '
~:j:.it.~~ ~~r,,'~fij;'15,i~8~ill1~~t;;
Ql!J.0JEDV{liT.s.0~.lit5 .
$597,307
Accidental Death and Dismemberment:
Bond (Publid Officila/Schedule Position:
GRAND TOTAL PREMIUM
$3,899 .'
$591
$601,797
FLORIDA MUNICIPAL INSURANCE TRUST
ANNUAL PREMIUM SUMMARY
City of Winter Springs
FMIT# 0648
Option"
Liability Coverages
Comprehensive General Liability
Police Professional Liability
- Public Officials E & 0
Public Officials E & 0 Prior Acts Coverage'
'Retroactive Date 10/1/00
DEDUCTIBLE
LIMIT NET PREMIUM
$25,000 Stoploss
$25,000 Stoploss
$25,000 Stoploss
$25,000 Stoploss
$2,000,000
$2,000,000
$2,000,000
$1,000,000
$39,543
$25,023
$14,960
$9,128
Automobile Coverage
- Comprehensive Automobile Liability $25,000 $2,000,000 $50,619
- Personal Injury Protection (PIP) n/a $10,000 Included
- Automobile Medical Payment n/a $1 ,000 Included
- Automobile Physical Damage As per Schedule n/a $13,770
Workers' Compensation
- Total Payroll: $8,769,360 $10,000 STATUTORY $334,595
- Experience Modification 0.980
Effective Date 10/1/2002
Property Coverage
- Coinsurance: 100% $49,573
- Valuation Basis: Agreed Amount
- Coverage Form: Special
- Basis of Value: Blanket
- Total Real & Personal Property
- Real & Personal Property $1 ,000 $21,234,240 Included
Miscellaneous Coverages
- Business Income 100% Coinsurance n/a $250,000 Included
- Extra Expense 40%-80%-100% n/a $250,000 Included
- Valuable Papers n/a $100,000 Included
- . Accounts Receivable n/a $100,000 Included
- Electronic Data Processing
- Equipment & Software: Included in Contents Included
- Inland Marine As per Schedule Included
- Inland Marine - Blanket Coverage Yes $500 Included
- Crime/Bonds Coverages
- Money and Securities - Loss Inside/Outside As per Schedule $10,000 Included
- Bond Type'
Honesty Blanket Bond $50,000 Included
*Certain Officers and Subordinates are excluded automatically from coverage by the terms of the designated Blanket Bonds:
1. All Coverages - Finance Directors, Treasurers and Tax Collectors by whatever title known.
2. Faithful Performance Coverages - Personnel required by law to furnish an individual bond to qualify for office (Policemen excluded).
3. Honesty Coverages - Personnel required by law to give bond for faithful performance duties.
TOTAL ANNUAL FMIT PREMIUM
.tl'flg9~R{p~t:I}]ilr!!9" . ,
.' .... .',"'r'1~i'~t'\"':>;,l":1;~~.,*,:'.rt
'I\~.E; fM};T~e~~~l8.~<"
Qi'JOYED:\i.IF.~QNdY1$ .
$537,211
Accidental Death and Dismemberment:
Bond (Publid Officila/Schedule Position:
GRAND TOTAL PREMIUM
$3,899
$591
$541,701
WORKERS' COMPENSATION MANUAL PREMIUM WORKSHEET
5509 Street or Road Maintenance or Beautification & Drivers $487,4 78 ../
7520 Waterworks Operation & Drivers $724,622 /'
7580 Sewage Disposal Plant Operation & Drivers --r ., .:.> '.\ ,~ ,:' ,_ "- '_'.) \.., ~-- $557,456 .../
7720 Firefighters & Drivers ~ $1,645,062 ../
8380 P,utomobile Service or Repair Center & Drivers ," ), D : J I,' ~\ " < ~ .s '--' j, " J.-';' $108,262./
8810 Clerical Office Employees NOC .~ I..r.>~ $1,922,004 ./
9102 Park NOC - All Employees & Drivers $439,748 ../'
9410 Municipal, Township, County or State Employee NOC S320,808 J
~ "~,~"",,' '~,~,'~ WORKERS' COMPENSATION ANO EMPLOYERS' LIABILITY TOla'~4
$1,000,000 Each Accident !
$1,000,000 By Disease
' - , $1,000,000 Agglega'e by O>se"e
'~.;~, ;,~,~' Compensation premium is subject to adjustment when the October 1, 2001 experience modlficalion is rec~7 d.
......... .--":,-;;L",~;,-,,, ;,-,,-:;;,-~,=.c_- 5% Drug Free Credit, 2% Safety Credit /
/
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GENERAL LIABILITY
COVERAGES INCLUDE:
Premises Operations
Products/Completed Operations
Contractual Liability (Designated Contracts Only)
Owners' & Contractors' Protective Liability
Personal Injury Liability
Host Liquor Liability
Incidental Medical Malpractice Liability
Watercraft Liability
Fire Legal Liability - $250,000 limit
Advertising Injury Liability
Supplemental Errors & Omissions - Subject to a $2,500 Deductible
Employee Benefits Program Administration Liability
Extra Contractual Legal Expense - $25,000 Limit
~~~.(~i~?~1~~~~*~~i~~:~.:M~~~~:W~~~:~~,g#~~~~'~H~;~~~~*f~'
~;t:., i' K:::r';'~:,UM::;"P;K:::~SA::;EB;'.0NiAliv:c0F:;~:r<PiE!A8QV8~CGVEMGES~~f~ .
. '.~ ,.: ,'.~.". .',I..~,-d::".';,,~.t""'_''',L_lI_\:;r..;.~~~..<:t_r:' ~-/,,,' ~"1~;t\1'l(;'~! ,~~* '..j ,fl.:':--:! . ,.",_ .tr:~~~:::t'ior,t,~;.:I.; , r.+ -~;i~;':7-,q.:,i"',(;" ).t;~,",/:''E.'~l:''. '::.'
- ::'TH E;;EXPERiEN€e:MP:0IFle~TI.ONS' Ffl.:CTOW0RIGINAtrl'X,a!JSESf;A;lil!:t
Prior Acts
Coverage for prior acts is retroactively extended for claims that occurred but were not reported to the designated member
or to the Florida Municipal Insurance Trust until the effective date of coverage, whether or not reported to the prior
insurer
AUTOMOBILE COVERAGE
COVERAGES INCLUDE:
Rental Reimbursement - scheduled
Lease Differential - scheduled vehicles
limited Replacement Cost - owned
PHYSICAL DAMAGE DEDUCTIBLES: Comprehensive
Specified Perils
Collision
$1,000
$25
$1 ,000
PROPERTY COVERAGE
WINDSTORM. HAILSTORM AND WATER DAMAGE ARE EXCLUDED FOR ALL PROPERTY LOCATED WITHIN
1/2 MILE OF COASTAL WATERS
Blanket Inland Marine coverage is defined as: Coverage for all unscheduled Inland Marine equipment valued at $15,000 or
less subject to $500 deductible.
The following additional coverages are included at no additional premium:
1. Newly acquired or constructed property - $1,000,000.00 per locations
2. Valuable Papers and Records - Cost of Research - $100,000.-- maximum per member per occurrence.
3. Outdoor Property/Signs - $10,000.00
4. Accounts Receivable - $100,000 maximum per member per occurrence.
5. Extra Expense - $500,000.00 maximum per member per occurrence.
6. Excess Flood - $500,000.00 maximum per member per occurrence.
7. Police Dogs - $5,000.00 for death in line of duty.
8. Business Interruption -$50,000.00. Applicable to water and wastewater treatment plants.
9. Terrorism - $5,000,000.00 maximum per occurrence for loss or damage
10. Electronic Date Processing Equipment (Software) - $10,000.00 per occurrence for mechanical breakdown.
The above is orlly a summary of certain terms and conditions of the extension described. Please refer to the actual
endorsement for complete details of coverages and limitations.
Inland Marine - Coverage for items valued between $15,001 and $25,000 have not been included
in thi~ proposal. The premium for these items will be determined when the city provides a schedule.
STATUTORY nFATH
INSl JRER:
Ale; [ ire InsIJr<'lncp. Comp<'lny
liMIT OF I IARIIITY:
$50,000 Principal Sum - In Line or Duty
$50,000 Principal Sum - Fresh Pursuit
$150,000 Principal Sum - Unlawful or Intentional Death
THE FOllOWING COVERAe;FS ARF INr:IIJDED:
1. Accidental Death & Dismemberment on each purchased component.
2. Heart and Circulatory, Hepatitis, Meningitis, Tuberculosis.
3. Weekly Accident Indemnity - $100.00/week, maximum 52 weeks. Coordinates with workers
compensation. Intentional act only.
4. Day Care Benefit - $2,500/year, maximum 2 years. Currently enrolled in day care. Intentional death
only.
5. . Education Benefit - $2,500/year, maximum 2 years. Currently enrolled in an institution of higher
learning. Intentional death only.
6. Medical Insurance Continuation/Catastrophic Injury 440.02 (34) F.S. - Maximum $5,000,00 per year.
Maximum years - 5. Intentional Death Only.
PFRSONS COVFRFD:
I.
Police
~ Full Time
Part Time/Aux.
---2.2- Clerical/Dispatchers
II.
Firefighters
---3.L Full Time
Part Time/Aux.
Clerical/Dispatchers
Volunteer Firefighters
III. Other Employees
($50,000 In Line of Duty Only)
TOTAL PREMIUM:
$~ R99 Annual
OPTIONAl COVERAGF/AnnITIONAI COST (replaces #3 above)
Up to $300 per week, maximum 100% of salary (when combined with workers' compensation) with a 7
day elimination period. After 20 consecutive days, retroactive to 1 st day-maximum 260 weeks.
Coverage is only for filII-time Police and Firefighters who are intentionally or maliciously injured
on the job.
AnDITIONAI ANNUAL COST: $.Jl.ID.
RONns
INSIJRFR:
Tr<lvp.lers C<lstJ<llty <lnci Sllrety Comp<lny
PURIIC OFFICIAl S BONO / POSITION SCHFOl JI F RONO
Limit of Liability:
Deductible:
Position/Person Covered:
$100000
.w5
Finance Director
Prp.millm:
$59.1
PLEASE READ THIS PAGE CAREFULLY
NO COVERAGES, TERMS OR CONDITIONS ARE TO BE ASSUMED.
All Trust Programs are Non-Assessable
Terms of this Agreement:
Premiums shown are subject to year-end audit adjustments.
All coverages provided by the Florida Municipal Insurance Trust are on an occurrence format. The Florida Municipal
Insurance Trust does not automatically included prior acts (tail) coverage.
2002/2003 PREMIUM INSTALLMENT PLAN
First Installment
25% minimum due
October 1, 2002
Second Installment
25% minimum due
January 2, 2003
Third Installment
25% minimum due
April 1, 2003
Fourth Installment
25% minimum due
July 1, 2003
Payment will be forward to the League Office in Tallahassee
For any other coverages, the premium is billed by the Florida League of Cities
and due in full at inception, regardless of the size of premium
Forty-five (45) Days Notice of Cancellation and Non-Renewal
Fifteen (15) Days Notice of Cancellation for Non-Payment of Premium
RMA
Risk Management Associates
PG IT
September 19, 2002
Ron McLemore, City Manager
City of Winter Springs
1126 East SR 434
Winter Springs, FL 32708
Dear Ron,
Please find attached a revised property, casualty and workers' compensation insurance
premium summary page. As I indicated on the phone PGIT has received commitments
from enough current and new clients to reach our loss fund goal. Consequently, we are
able to reduce premiums for some accounts with favorable loss experience. Our original
quotations were very conservative pending the success of the program. We are very
pleased with the statewide acceptance ofPGIT and will add about $10,000,000 in new
premium along with about 30 new members bringing our totals to over $50,000,000 in
premium and 200 members.
In addition to the superior financial structure, PGIT also provides broader property,
public officials' liability, and employment practices liability coverage. I have attached a
coverage comparison for PGIT versus FMIT for your review,
We value the City's business and hope to be able to maintain a long and mutually
beneficial relationship for years to come.
Regards,
,~(~
Paul Dawson
Senior Account Executive
Commercial Insurance. Bonds. Risk Management Services. Program Design and Administration
P.O, Box 161507. Altamonte Springs, Florida 32716-1507. Phone: (407) 331-4400. Facsimile: (407) 331-4800
~ ..
RlMlA
Risk M nagem nt Associates
fC; S-\
CITY OF WINTER SPRINGS
PREMIUM RECAPITULATION
CZ e oJ ' I -<. J .l--<-
~......o
Annual Premium
Property/Inland Marine/Equipment Breakdown
Optional Flood
$ 63,949
$ 9,814
Crime/Employee Dishonesty
$
570
Public Officials/Employment Practices Liability
$ 70,193
$ 70,125
$ 51,649
General Liability/ Law Enforcement Liability
Automobile Liability & Physical Damage
Workers Compensation
$404,740
$661 ,226
Total
Third Party Storage Tank Liability-Commerce & Industry
Option 1 1 mil/1 mil $10,000 Deductible $
Option 2 Dedicated limits.per.location_ .. .. $
Third Party Storage Tank Liability - Great American Insurance Co.
1 mil/1 mil aggregate limit per location $
1,277
1 ,405
968
AD&D - AIG Life
Annual - Option 1
Annual with Optional W AI- Option 2
Three Year Installments - Option 3
Three Year Installments with WAI - Option 4
Three year Prepaid - Option 5
Three Year Prepaid with WAI - Option 6
AD&D - Hartford Life
Annual - Option 1
Three Year Installments - Option
Three Year Prepaid
$ 4,398
$ 5,253
$ 12,537
$ 14,976
$ 12,315
$ 14,709
$ 3,249
$ 9,261
$ 8,772
The brief description of insurance coverage contained in this proposal is being provided as an accommodation only and is
not intended to cover or describe all policy terms. For more complete and detailed information relating to the scope and
limits of coverage, please refer directly to the policy documents. Specimen forms are available upon request.
fG
-
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City of Winter Springs
Coverage Comparison
Line of Coveraee PGIT FMIT
Property Coverage for Trees, shrubs, None
landscaping $25,000 limit.
Paved surfaces $100,000 limit None
No coinsurance penalty 100% or 90% coinsurance clause
Business Intenuption $250,000 Business Intenuption $50,000
Sewer back up during flooding None
$25,000
Debris Removal and Increased None?
cost of construction.
$1,000,000
Crime Coverage is provided for all Coverage excludes finance
employees director, tax collector and
treasurer excluded
Automobile:Liability.. : .,. . :Notauditable =.noccharge:foE ~:.:.: c Premium .due..during ,the year -for.
and Physical Damage autos added during the year. additional autos.
General Liability Contractual Liability Covered Contractual Liability provided
only for contracts between public
entities.
Public Officials Breach of Contract covered Excluded
Liability
Leased employees included Excluded
Punitive Damages covered Excluded
Contractual Liability covered Contractual Liability provided
only for contracts between public
entities.
Arbitration Proceedings Excluded
covered
Page 1 of2
,. -:
PG \\
~
c.-~''''-'
Employment Practices Breach of Employment Contract Covered Excluded
Liability
Non-Monetary Damages covered Limited defense
reimbursement only
Punitive Damages covered Excluded
Defamation, Slander, Invasion of Privacy, Excluded
all covered
EEOC Claims covered Limited defense
reimbursement only
pc.". .L-(
;:; I""- \..--
Page 2 of2
Line of Coverage
Property
PGIT
Trees, Shrubs, Landscaping
Limited to $1,000 per
tree
Paved surfaces
Business Interruption $250,000
- -
(--- h-L- \
FMIT
C-~.,........-
r ,......~.... \
$250 per item!
$1,000 maximum limit
Covered if scheduled
Business Interruption $50,000 - higher
limits available if scheduled
Sewer backup $500,000 xs of NFIP or
Sewer backup during flooding - $25,000 $250,000 whichever is greater
Subject to $5,000 deducitble, excluded
in zones A or V
Debris Removal and Increased Cost of
Construction
Included in Ordinance & Law form Prop-
12. Limit equal to scheduled location
limit + 25% - not limited by aggregate
sublimit
Mold - $15,000 Sublimit
Debris Removal and Increased Cost of
Construction - 1,000,000
Mold - Excluded
Crime
Coverage excludes finance directors, tax
Coverage is provided for all employees collector and treasurer.
Finance directors, tax collectors' and
treasurers are normally required by law
to have a separate fiduciary liability bond Coverage available at additional charge
Automobile Liability and
Physical Damage
Notauditable - no charge for autos
added during the year.
Does not return premium for vehicles
destroyed during the policy term or sold
at auction.
Premium due during the year for
additional autos, premium returned for
deleted vehicles
Line of Coverage
PGIT
C::M"\,
-------
c- ~ '... ~
-\-
FMIT
r G ~~l,-\- """ \
General Liability
Contractual Liability Covered
PGIT's wording for contractual liability is
the same in scope as the FMIT wording.
FMIT covers incidental contracts, such
as lease of premises, easements etc.
Refer to Endt B, Page 3 Paragraph L
Defense expense included in limit - If
defense costs exceed liabiltiy limit,
then duty to defend is over. Defense expense outside of limit
Public Officials Liability Breach of contract covered.
Excluded Public Officials Liability,
Section 2, page 5, paragraph 22.
Leased employees included
Punitive Damages covered
Could not find any language in PGIT's
policy forms pertaining to punitive
damages,
Arbitration Proceeding covered
Reporting period for claims limited by
Claims Made form
Coverage limited by Aggregate
Defense expense include in limit - If
defense costs exceed Iiabiltiy limit,
then duty to defend is over.
Excluded
FMIT will cover the City for acts
commited by leased employees, the
employee himself would be covered by
the leasing company.
State statute prohibits reimbursement of
punitive damages.
Covered
Per Occurrence - No limitation on claims
reporting
No Aggregate
Defense expense outside of limit
Line of Coverage
Employment Practices
Liability
PGIT
Breach of Employment Contract
Covered Excluded
Exluded - see PGIT's Public Officials
Liability form Section 2, page 4,
exclusion #15
Non-Monetary Damages Covered
-'- d'~
FMIT
c-=>~>~
....e(..,~\.-I.-r.>oo. ,
Limited defense reimbursement only
$2,000,000 Aggregate
No Aggregate
Exluded - see PGIT's Public Officials
form, Section 2, page 4, paragraph 13
Punitive Damages covered Excluded
Could not find any language in PGIT's
policy forms pertaining to punitive State statute prohibits reimbursement of
damages. punitive damages.
Defamation, Slander, Invasion of Privacy
all covered Covered
EEOC Claims covered Covered
Sexual Harassment excluded - Public
Officials forms, Seciton 2, page 4,
paragraph 15b Covered
Defense expense included in limit - If
defense costs exceed Iiabiltiy limit,
then duty to defend is over. Defense expense outside of limit
I Law Enforcement
..._----....,
C)
N.
l- '" ~ ,
L (' ,~ j /c ._')
f(
G.
"-
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"Designated Member", means the entity, organization or constitutional officer named in Item I...
or V. of the Declarations of this Agreement; designated member does not include employees or
agents of that entity or organization.
H.
"Designated Member's Products", means goods or products manufactured, sold, handled, or
distributed by the designated member or by others trading under his name, including any
container thereof (other than a vehicle), but "designated member's products" shall not include a
vending machine or any other property, rented to or located for use of others but not sold.
I.
"Elevator", means any hoisting or lowering device to connect floors or landings, whether or not
in service, and all appliances thereof; but does not include an automobile servicing hoist, a
material hoist used in alteration, construction or demolition operations, or an inclined conveyor
used exclusively for carrying property or a dumbwaiter.
J.
"Employee Benefits Program", means any pension and profit sharing plan; individual
retirement account (IRA) plan; salary reduction plan under Internal Revenue Code 401 (k) or
Amendments; employee stock subscription plan, savings plan; group plan for life, health, dental,
disability, automobile, home owners, or legal services insurance; social security system benefits;
workers' compensation and unemployment insurance; travel and vacation plans; or educational
tuition reimbursement Pla~reated,.administered or endorsed by a member.
"Errors and omissi6n~" ~rts any actual or alleged error or misstatement or act of omission
or neglect or breac1\, of dl,ilty in~ing misfeasance or non-feasance by the members in their
official capacity, indi~lIy A col!,ectively, or any matter of claims against them solely by
reason of their having se~or acred ~official capacity.
"Incidental Contract", means ~~Ye/ (a) lease of premises, (b) easement agreement,
except in connection with construc' n or de olitl operations on or adjacent to a railroad, (c)
undertaking to indemnify a municipa y re uired bfn;Junicipal ordinance, except in connection
with work for the municipality, (d) sidetrac% agreement \ (e) elevator maintenance agreement;
but does not include any hold harmless agfeament 0 agrleent to indemnify any non-public or
private person, corporation, or entity under any ~ a7a reement..
"Incidental Medical Malpractice Injury", means b~ily in~~9 out of the rendering of or
failure to render medical services or treatment by a nem:pr~sio.n~ring the period of this
Agreement, including the following services: ~ ~ / / '\ I
1. medical, surgical, dental, x-ray or nursing service or tre~t or )Kei furQishing of food
or beverages in connection therewith; or .~ I /'
2. the furnishing or dispensing of drugs or medical, dental or s~ical supplies Dr
appliances.
"
11
il
I'
Il
Ij
I'
!
i
"
Il
l~
\1
!:
K.
&L
M.
"Inverse Condemnation", means a cause of action by a property owner to recover the
monetary value of property that has been taken by the designated member having the power of
eminent domain where no formal exercise of that power has been undertaken.
O. "Member", as used herein means:
(10/2001)
a.
the designated member;
J
I
,
b.
while acting within the scope of his employment, any officer (except constitutional
officers), volunteer, servant, or employee of the designated member, including elected
and appointed officials, and members of Boards or Commissions. However, ,the
coverage so provided any officer, servant, or employee does not apply to bodily injury to
another officer, servant or employee of the designated member injured in the course of
and arising out of his employment.
B-3
P G J:- \" e ~c...\ .......-5 \' - -.J l - d-.s
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18. Strike and Lock Out
Any damages arising out of a strike. lockout, picket line, replacement, or other similar action resulting from labor disputes or
labor negotiations or any protections contained within the National Labor Relations Act.
19.W.A.R.N.
Any damages arising out of the Workers' Adjustment and Retraining Notification Act, Public Law 100-379 (1988) or any
amendment thereto, or any similar federal, state or local law.
20.Governmental Fines or Penalties
Any damages, costs, civil fines, penalties or expenses against any insured arising out of any complaint or enforcement action
from any federal, state or local government regulatory agency.
21.Health Care Professionals or Health Care Facilities
Any damages arising out of:
b. The operation of or professional health care services provided by any hO~Pita~~ , nur . om. ny oth health
~\care facility. .
~)Zontractual Liability - ~ x: .:::... \ ___5 ' _...-...-J , ~
Any damages the insured is obligated to pay by reason of assumption of ljability n a on ac r agreement 'his exclusion
does not apply to liability for damages that the insured would have in the 'abs'Elnce ~~ c~tract or /r'8ement.
23.Capilallmpwveman" \ ~~ V L
Any costs, expenses or damages incurred by an insured to modyYor~apt anY~~b~Uill~d~'n ,or property In order to make such
building or property more accessible or accommodating to any di~~~ \\ ~ 'v'
24. R.I.C.O. ~':::-..' ~~ \
Any damages arising out of any actual or alleged violation of ~--Backete~h~en'ce. and Corrupt Organizations Act, 18 USC
section et seq any amendments thereto, or any rUI~atiO~.r~omUUlgate'd ther'e'Gnder.
25. Fung; and BacW;a ( (... ~ ~-~
a. Any damage which would not have occyzred i~~ole or in part,<b'111.J:>t~ctual, alleged or threatened inhalation of,
ingestion of, contact with, exposure t9<:,e~tenc of"or presence bf,'any "fungi" or bacteria on or within a building or
structure, including its contents, re}lardjess of wh her~y other c;kupe, event, material or product contributed
concurrently or in any sequenc~o syCh injury or da~~ J.
b. Any loss, cost or expense ariSingtt~of the ab~g, testtng..foJ:,-monitoring, c1eanining up, removing, containing, treating,
detoxifying, neutralizin'g, remediati"J~PO;~'Of, or in any way responding to, or assessing the effects of, "fungi" or
bacteria, by any insuredJr15Y3:nY-.lZtn6(,perf6n or enti
This exclusion does not aP'p~\,f0ngi~'b~teria~ a re, are on, or are contained in, a good or product intended for
co~sumPtio.n. -( ~ \ \ ' "'../
ThiS exclUSion also apPhes~:",,/ ) '
a. Any supervi~or1.TriSttuctions~c~mmendations, warnings or advice given or which should have been given in connection
with the above;'Cl'ld---,j ~~
b. Any Obligat\o~\to sh~damag~s with o(,fepay someone else who must pay damages because of any of the above.
"Fungi" means\~pe orAc5I'iTiO(ftJn~',.1;'CIUding mold or mildew and any mycotoxins, spores, scents or byproducts
produced or released'iJrfungi." ) \
SECTION III - WHO IS AN INSUR~
Each of the following is an ~~.
A. You;
B. Any full or part-time "employee," but only while acting within the scope of duties as an "employee;"
C. Your elected or appointed officials while acting within the scope of their duties as elected or appointed officials;
D. Any volunteer while acting on your behalf, at your request, and under your direction and control; or
PGIT 500 (10 02)
Page 5
~~_._.
..
fG-r-r
---
Cy:.. .::-' ___5' p~
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f~':::>\,"" oC.C,'e..,',..,(,J
(a) Physical injury that involves a substantial risk of death;
(b) Protracted and obvious physical disfigurement; or
(c) Protracted loss of or impairment of the function of a bodily member or organ; or
(3) The "terrorism" involves the use, release or escape of nuclear materials, or directly or indirectly results in nuclear
reaction or radiation or radioactive contamination; or
(4) The "terrorism" is carried out by means of the dispersal or application of pathogenic or poisonous biological or chemical
materials; or
(5) Pathogen or poisonous biological or chemical materials are released, and it appears that one purpose of the "terrorism"
was to release such materials. For the purposes of determination the total of all damage to all types of property or the total
number of deaths or "serious physical injuries," multiple incidents of "terrorism" which occur ynttJin a seventy-two hour
period and appear to be carried out in concert or to have a related purpose or common lead~er,sI1lP shall be considered to
be one incident of "terrorism." ~
10. Failure to Effect and Maintain Insurance ~ ~ '
Any damages arising out of the failure to effect or maintain insurance or the amou , Ip~{S<;,op~~~~~~
coverage, or the failure to advise or counsel with respect to the procuring, obtain' g maint~'n R of a~~
coverage.
11. Bonds, Taxes or Construction Contracts
Any damages arising out of:
a. The is'suance of bonds;
b. The improper collection of taxes;
c. Construction, architectural or engineering contracts; or ~
d. The faHu,e 10 pay any bond, In'e,e,', 0' any debl, f1nan~~'1tt~;;;"'~eb reo
12.Priorlnsurance ~ ~ ~ ~
Any damages for which an insured is entitled to receive-indemnity ~p~e .l...by re sem of having given notice of any
I circumstance which might give rise to a "claim" UrideF-an~liCY(ie,~s) W'chh~'t~minated or expired prior to the inception
date of this insurance. (_.V
Bon-monetary Dama es, Fines or Penalties f.. c.- ' .r-.
a. Any damages arising out of a "claim'/6\)uit" se~kt~ relief or re e s in any form other than money damages; or
b. Any costs, fees or expenses Wh~'Ch~e 'nsured m become oblig te to pay as a result of an adverse judgment for
injunctive or declaratory relief. /)
14.1nsured versus Insured /./
Any damages arising out o~~raim" o<;,su~' brou9ht~f)e insured against another insured.
&mPloyment Practices/ '\ \ ~~/ /.../5 ~ "'-.,
Any damages arising out~~ T-) ~,,/-
--@mPloyment giscriminatioR in'-<;on~ction with hiring, promotion, advancement or opportunity, demotion, discipline, pay,
layoff o~ t~rrp(n~~0R-in)~~i~eah.h of any oral.or wr~tten or i~plied employment contra~ on the basis of ra~e, color, sex,
age, rehglo~, ?atlonal ongln, d~s'~~llty" sexual onentatl~n" m~ntal status, or pregnancy, or any conduct that violates any
federal, stat\, ~ocallaw-prohlbltln'g~ml(IOyment dlSCnmlnatlon;
0s~xual harass(!:!en~JUdlriQ'u~~lc6m~ sexual advances, requests for sexual favors, or other verbal or physical
conduct 01 a sexbal-nature that 01) IS made an explicit or implied term or condition of employment; or (2) is used as a
basis for employment d~ 01(3) creates a work environment that is intimidating, hostile or offensive; or
C. Any of the following e~~ment-1elated acts: misrepresentation whether negligent or intentional, invasion of privacy,
defamation, retaliation, intentior:;al or negligent infliction of emotional distress, wrongful discipline, negligent evaluation,
negligent hiring, or negligent supervision.
16.Workers Compensation
Any obligation under any workers' compensation, disability benefits or unemployment compensation law, or any similar law.
17 .Collective Bargaining Agreement
Any damages due to any collective bargaining agreements.
PGIT 500 (10 02)
Page 4
APPLICATION TO
FLORIDA MUNICIPAL INSURANCE TRUST
GOVERNMENT APPLICANT: City of Winter SprinQs
ACCOUNT NUMBER:
TYPE OF GOVERNMENTAL ENTITY:
Municipality
ADDRESS:
1126 East State Road 434 Winter SprinQs FI 32708
FEDERAL EMPLOYER IDENTIFICATION NUMBER: .5 '\ - \ =~ (., :3 G::> '-\
o NOTIFICATION TO DEPARTMENT OF COMMERCE
OFFICIALS AUTHORIZED TO EXECUTE CONTRACTS:
I.
Name:
~_~\ 6 l...J ...---. C \...~Or ~
II.
Name:
~:
Title:
c : J,.. 7' fY'""\ = r-r=:- c:;, ~
Title:
PRIOR INSURANCE COVERAGE CARRIED BY: p...",.,......... p... C <.. ~ c .s'.J e:. ~ <S .::L-'\ )
Applicant hereby makes application with the Trust for continuing membership for liability, property, allied lines, automobile physical damage,
workers' compensation, employers' liability, medical, dental, short-tenn disability, and/or life coverage, to be effective 12:01 a.m. October 1, 2002 and, if
accepted by the Trust's duly authorized representative, does hereby constitute and appoint the Florida League of Cities, Inc., to act as Admmlstratorof said
Trust and to act as Applicant's agent-in-fact in all matters relating to its participation in said Trust and agent-in-fact to the extent any such coverage is placed
with the Trust.
Applicant, by execution of this Agreement, further agrees:
(a) That, by this reference, the tenns and provisions of the Agreement and Declaration of Trust creating the Florida Municipal Insurance Trust, as may
be amended periodically by its Board of Trustees, a copy of which Applicant hereby acknowledges receipt, is hereby adopted, approved, ratified, and
confinned by Applicant; and further, Applicant will accept, assume, abide by and be bound by the provisions and obligations set forth therein;
(b) That Applicant will pay all premiums on or before the date the same shall become due and, in the event Applicant fails to do so, will pay any
reasonable late penalties and charges arising therefrom and all costs of collection thereof, including reasonable attomey's fees;
(c) That Applicant, as long as it remains a member of the Trust; will abide by the rules and regulations adopted by the Trust's Board and will conform
its conduct to the terms of any agreements entered into by the Board to administer the Trust;
(d) That Applicant, in the event of any changes in the Applicant's corporate or business structure, or if any locations are to be added or deleted from
any coverage provided by the Trust, will notify the Trust immediately; and that Applicant further understands that, if workers' compensation coverage or
employers' liability coverage is provided by the Trust, the failure to provide said notice within thirty (30) days of any such change may result in the
assessment of a civil penalty not to exceed $100 for each failure;
(e) That should either the Applicant or the Trust desire to cancel coverage, it will give written notice to the other at least forty-five (45) days prior to
cancellation;
(f) That, should Applicant default hereunder, Applicant agrees to save and hold harmless the Trust and the Trust's Board from any and all damages,
causes of action, claims, delinquency or expenses; including reasonable attomey's fees, which would have otherwise been incurred by the Trust or the Board
hereunder absent such default on the part of the Applicant;
(g) That, if workers' compensation or employers' liability coverage is placed with the Trust, Applicant will accept and be bound by the provisions of the
Florida Workers' Compensation Act, that coverage arising from this Application shall be for Florida operations only, and that the Wage Declaration Schedule
(Form No.----.J and/or Renewal Certificates, when completed and returned to Applicant by the Trust, shall become a part of this agreement; and
(h) That, if medical, dental, short-term disability, and/or life coverage is placed with the Trust, the probationary period for new employees shall be:
( ) 30 days ( ) 60 days ( ) 90 days ( ) other
WITNESSES TO SIGNATURE
, :'
"
. I
City of Winter'Sj);i.,gsM' " L' , \
Ronaia w. ~ ~m~re
Andrea Lorenzo-Luaces
d~~Of;;;~
Allthoriiecf,bfficer
Name
1126 East State Road 434, Winter Springs, Florida
Address 32708
, ,',,/
Andrea Lorenzo-Luaces
Name
Date
1126 East State Road 434, Winter Springs, Florida
32708
Address
October
IS HEREBY APPROVED FOR MEMBERSHIP IN THIS TRUST, AND COVERAGE IS EFFECTIVE THE 1 st DAY OF October, 2002
SIGNED THIS
DAY OF
,20_
BY:
(10/96)
Administrator/Trustee
0 Administration/
Marketing
0 Risk Control
rif Underwriting
Property & Casualty
Health
Post Office Box 530065
125 EastColonial Drive
Orlando, FL 32853-0065
800-445-6248
407-425-9142
Suncom 344-0725
Fax 407.425-9378
0 Health Claims
Post Office Box 538140
Orlando, FL 32853-8140
800-756-3042 .
407-245"0725
Suncom 344-0725
Fax 407-425-9378
.0 Workers'
Compensation Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407 -245-0725
Suncom 344-0725
Fax 407-425-9378
.0 Property & Liability.
Claims
Post Office Box 538135
Orlando, FL 3~853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
FLORIDA LEAGUE OF CITIES, INC.
. PUBLIC RISK SERVICES
October 18, 2002
..-----.......
......./.- ."
,/,,,,
/
~
\
. \
I
I
I
Mr. Ronald W. McLemore
City of Winter Springs
1126 East State Road 434
Winter Springs, FI. 32708
Re: Signed Application
Dear Mr. McLeMore:
Enclosed is your signed application to the Florida Municipal Insurance Trust. Please
keep this with your Insurance Package. We will also be keeping one in our file.
Thank You,
~~e,~
Margaret E. Gross, CPCU
Public Risk Service
Enclosure
Florida Municipal Insurance Trust
, .
,. .
. .
APPLICATION TO
FLORIDA MUNICIPAL INSURANCE TRUST
I' ~ . . i'.
GOVERNMENT APPLICANT: City of Winter SprinQs
ACCOUNT NUMBER:
TYPE OF GOVERNMENTAL ENTITY:
Municipality
ADDRESS:
1126 East State Road 434 Winter SprinQs FI 32708
FEDERAL EMPLOYER IDENTIFICATION NUMBER: -5 '\. - \ =:;)... c.o 3 G:. L...\
o NOTIFICATION TO DEPARTMENT OF COMMERCE
OFFICIALS AUTHORIZED TO EXECUTE CONTRACTS:
N'me, "'~.--. \ "', J. '"'"'. L~ ----"- II. N,me ~
Title: C.- .' ..... 7' ........... -- ~ ""~ Title: _
PRIOR INSURANCE COVERAGE CARRIED BY: p... M. A ( c:= r (i' 5 \ ~ L ~ <.::. ::s:...- T )
Applicant hereby makes application with the Trust for continuing membership for liability, property, allied lines, automobile physical damage,
workers' compensation, employers' liability, medical, dental, short-tenn disability, and/or life coverage, to be effective 12:01 a.m. October 1, 2002 and, if
accepted by the Trust's duly authorized representative, does hereby constitute and appoint the Florida League of Cities, Inc., to act as Administrator of said
Trust and to act as Applicant's agent-In-fact in all matters relating to its participation in said Trust and agent-in-fact to the extent any such coverage is placed
with the Trust.
Applicant, by execution of this Agreement, further agrees:
(a) That, by this reference, the tenns and provisions of the Agreement and Declaration of Trust creating the Florida Municipal Insurance Trust, as may
be amended periodically by its Board of Trustees, a copy of which Applicant hereby acknowledges receipt, is hereby adopted, approved, ratified, and
confinned by Applicant; and further, Applicant will accept, assume, abide by and be bound by the provisions and obligations set forth therein;
(b) That Applicant will pay all premiums on or before the date the same shall become due and, in the event Applicant fails to do so, will pay any
reasonable late penalties and charges arising therefrom and all costs of collection thereof, including reasonable attomey's fees;
(c) That Applicant, as long as it remains a member of the Trust; will abide by the rules and regulations adopted by the Trust's Board and will confonn
its conduct to the tenns of any agreements entered into by the Board to administer the Trust;
(d) That Applicant, in the event of any changes in the Applicant's corporate or business structure, or if any locations are to be added or deleted from
any coverage provided by the Trust, will notify the Trust immediately; and that Applicant further understands that, if workers' compensation coverage or
employers' liability coverage is provided by the Trust, the failure to provide said notice within thirty (30) days of any such change may result in the
assessment of a civil penalty not to exceed $100 for each failure;
(e) That should either the Applicant or the Trust desire to cancel coverage, it will give written notice to the other at least forty-five (45) days prior to
cancellation;
(f) That, should Applicant default hereunder, Applicant agrees to save and hold hannless the Trust and the Trust's Board from any and all damages,
causes of action, claims, delinquency or expenses; including reasonable attorney's fees, which would have otherwise been incurred by the Trust or the Board
hereunder absent such default on the part of the Applicant;
(g) That, if workers' compensation or employers' liability coverage is placed with the Trust, Applicant will accept and be bound by the provisions of the
Florida Workers' Compensation Act, that coverage arising from this Application shall be for Florida operations only, and that the Wage Declaration Schedule
(Fonn No.----.J and/or Renewal Certificates, when completed and returned to Applicant by the Trust, shall become a part of this agreement; and
(h) That, if medical, dental, short-tenn disability, and/or life coverage is placed with the Trust, the probationary period for new employees shall be:
( ) 30 days ( ) 60 days ( ) 90 days ( ) other
WITNESSES TO SIGNATURE
I.
CihL of Wiotw Sorin'~s 1-'
Rona~a W. ~c eIDore
-
Name of Applicant
I~.i./! <JVJ$-
, . Authorii:ed Officer
~ . '
Ii CORP[T I
\ SEA
(-.J~" . -
,,_ JA-
Andrea Lorenzo-Luaces
Name
~
1126 East State Road 434, Winter Springs, Florida
Address
32708
or Secretary
Andrea Lorenzo-Luaces
Name
October 1, 2002
Date
1126 East State Road,434, Winter Springs, Florida
Address 32708
BY:
(10/96)
Administratorrrrustee
BIN'OER OF COVERAGE
NAME AND ADDRESS OF DESIGNATED MEMBER
Ms. Louise Frangoul
City of Winter Springs
1126 East State Road 434
Winter Springs FI 32708
EFFECTIVE DATE
EXPI RES
AGREEMENT NUMBER:
12:01 am 1011/02
12:00 midnight 1 2/31 /02
FMIT 0648
NAME AND ADDRESS OF ADMINISTRATOR
Florida League of Cities, Inc.
Public Risk Services
P.O. Box 530065
Orlando, Florida 32853-0065
COVERAGE PROVIDED BY:
THIS BINDER IS A TEMPORARY CONTRACT OF COVERAGE, SUBJECT TO THE CONDITIONS SHOWN BELOW.
FLORIDA MUNICIPAL INSURANCE TRUST
TYPE OF COVERAGE - LIABILITY
General Liability
t8J Comprehensive General Liability, Bodily Injury, Property Damage and
Personal Injury
t8J Errors and Omissions Liability
t8J Supplemental Employment Practices
t8J Employee Benefits Program Administration Liability
t8J Medical Attendants'/Medical Directors' Malpractice Liability
t8J Broad Form Property Damage
t8J Law Enforcement Liability
t8J Underground, Explosion & Collapse Hazard
Limits of Liability
* Combined Single Limit
Deductible Stoploss $25,000
Automobile Liability
t8J Automobile Liability t8J Medical Payments $N/A
t8J Leased Automobile Liability t8J Personal Injury Protection
0 Uninsured Motorists Protection $N/A
Limits of Liability
* Combined Single Limit
Deductible Stoploss $25,000
Automobile/Equipment - Deductible
t8J Physical Damage $1,000 - Comprehensive - Auto
TYPE OF COVERAGE - PROPERTY
t8J Buildings t8J Miscellaneous
0 Basic Form t8J Inland Marine
t8J Special Form t8J Electronic Data Processing
t8J Personal Property t8J Bond
0 Basic Form 0
t8J Special Form
t8J Agreed Amount
t8J Deductible $1,000
t8J Coinsurance 100%
t8J Blanket
o Specific
t8J Replacement Cost
o Actual Cash Value
Limits of Liability on File with Administrator
TYPE OF COVERAGE - WORKERS' COMPENSATION
t8J Statutory Workers' Compensation
t8J Employers Liability $1,000,000 Each Accident
$1,000,000 By Disease
$1,000,000 Aggregate By Disease
o Deductible N/A
o
SPECIAL CONDITIONS/OTHER COVERAGES
$1,000 - Collision - Auto
Per Schedule - Miscellaneous Equipment
* $2,000,000 Combined Single Limit
CONDITIONS
The Trust binds the kind(s) of coverage stipulated above. This coverage is subject to the terms, conditions and limitations of the Agreement in current
use by the Trust. This binder may be cancelled by the member by surrender of this binder or by written notice to the Trust stating when cancellation will
be effective. This binder may be cancelled by the Trust by notice to the member in accordance with the conditions of the Agreement. This binder is
cancelled when replaced by an Agreement. If this binder is not replaced by an Agreement, the Trust is entitled to charge a premium for the binder
according to the rules and rates in use by the Trust.
~C&~
~,~. . -, ,-- ()I= ,,-
FMIT-BINDER 110/96)
. .-
September 25, 2002
nll.Tl:
AGREEMENT NO. FMIT #0648
FLORIDA MUNICIPAL INSURANCE TRUST
NAMED INSURED City of Winter Springs
OPTION FORM
1, PERSONAL INJURY PROTECTION
IX] The member acknowledges and understands that the agreement identified above will provide the
full no-fault Personal Injury Protection coverage required by the Florida Reparations Reform Act, .
as amended.
2. Deductible Amount Applicable to Personal Injury Protection - Optional (select only one)
o
o
o
$250
$500
$1,000
o
$2,000
3.
o
Coverage reduced by "Medicare" Program (42 USC 1395) and by Military benefits - Optional
4.
o
Work loss does not apply - Optional
5. No Deductible Applicable to Personal Injury Protection - Optional
IX] No Deductible
THE MEMBER HAS READ THE ABOVE APPLICATION & DECLARES THAT MEMBER HEREBY ELECTS
THE OPTIONS MARKED ABOVE AND REQUESTS THEY BE MADE A PART OF THE AGREEMENT ABOVE.
10/01/2002
Date
FMIT PIP 1002
FLORIDA MUNICIPAL INSURANCE TRUST
UNINSURED MOTORISTS I UNDERINSURED MOTORISTS SELECTION FORM
THIS FORM REQUIRES YOU TO MAKE A CHOICE REGARDING UNINSURED MOTORISTSI
UNDERINSURED MOTORISTS COVERAGE, WHICH PROTECTS YOU AND YOUR EMPLOYEES. YOU
MAY REJECT, INCREASE, DECREASE OR MAINTAIN LIMITS EQUAL TO YOUR BODILY INJURY
LIABILITY LIMITS. PLEASE READ CAREFULLY.
AGREEMENT NO. FMIT #0648
DESIGNATED MEMBER' City of' Winter Springs
SELECTION FORM
C.HECK, SIGN & DATE FOR ONLY ONE OPTION
!XI UNINSURED MOTORISTS I UNDERINSURED MOTORISTS COVERAGE - REJECTION: I/We REJECT
Uninsured I Underinsured Motorists coverage and request that such coverage be eliminated from the
Agreement, all renewals, and any other provisions which extends, changes, supersedes or replaces this
agreement.
o UNINSURED MOTORISTS I UNDERINSURED MOTORISTS COVERAGE - INCREASED LIMITS: I/We
accept the offer of INCREASED limits for Uninsured I Underinsured Motorists in the Combined Single
Limit amount of bodily injury each accident.
o Limit(s) LOWER than the limit(s) of the agreement for bodily injury liability, but not less than the Financial
Responsibility minimum Iimit(s) required by law. Limit
o Limit(s) EQUAL to the limit(s) of the agreement limit(s) for bodily injury liability. Limit:
&----f~.~ ~
'\ .. Authorized Signatuv .
10/01/2002
Date
FMIT UM 1002
0 Administration/
Marketing
0 Risk Control
if Underwriting
Property & Casualty
Health
Post Office Box 530065
125 East Colonial Drive
Orlando, FL 32853-0065
800-445-6248
407-425-9142
Suncom 344"0725
Fax 407-425-9378
0 Health Claims
Post Office Box 538140
Orlando, FL 32853-8140
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Workers'
Compensation Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Property & Liability
Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
FLORIDA LEAGUE OF CITIES, INC.
PUBLIC RISK SERVICES
TO:
Member
FROM:
Administrator
RE:
Florida Municipal Insurance Trust (FMIT)
Property Statement of Values for the 2002/2003
DATE:
October 1, 2002
Attached is a current Statement of Values for the locations that we have on
file for your property coverage. The amounts listed represent the property
values at the coinsurance listed. In order to maintain Blanket Coverage, the
Statement of Values must be renewed annually.
Information on the attached Statement of Values should be reviewed for
accuracy. Please make any changes on the original and initial the change.
When the form is correct, please sign and date Page 2 where indicated and
return the completed form to the Orlando office within 30 days of receipt. If
the construction is left blank, please fill in the type of construction, as we do
not have that information.
Failure to provide accurate property values will result in your being paid less
than the full amount in the event of a property loss. This is caI1ed a
. coinsurance penalty and is described on page 10 of 13 of the Building and
Personal Property Coverage fonn (CPOO 10 10 00).
If you have any questions, please feel free to call your Rating Manager,
Margaret Gross, ext. 306.
Fln..tdn M".ft~~~ft!!:lO 11_Q!'IIl._~_"''''' T_.....,...
FLORIDA MUNICIPAL INSURANCE TRUST
MEMBER'S STATEMENT OF VALUES
MUNICIPAL
PROPERTY
Member City of Winter Sprinqs
FMIT # 0648
Headquarters Address 1126 East State Rd. 434 Winter Springs, FL 32708
Form of Coverage
/Xl
o
Agreed Amount applies to Items
Replacement Cost applies to Items
Coinsurance
o
90% !Xl
100% Blanket Rate Effective
Causes of loss for which rates are requested:
)
'0
/Xl
Basic
o
o
Other (Specify)
Other (Specify)
Special
Basic Coverage may apply to specified locations. Refer to the Schedule of Property Locations.
This statement of values form must be filed annually.
MEMBER:
All values submitted are accurate to the best of my knowledge and belief.
I I, s / ~ ~
I
Authorized Signature
Date
PROP-STMTVAL (1/93)
09/25/2002 '
Member's 'property Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Locatlon# Address Occupancy Construction Cause of ~ldK Cause of Pers
Loss 2!!!!... Loss rroK
Loc Bid 2!!!!...
)01 001 1126 E. State Rd 434, WS Winter City Hall Complex- City Hall Fire Resistive Special Form $2,662,717 Special Form $1,105,907
Springs,FL
101 002 1126 E. State Rd 434, WS Winter Gas Tank & Pump Non-Combustible Special Form $16,306 $0
Springs,FL
101 003 1126 E. State Rd 434, WS Winter Appex Utility Building Joisted Masonry Special Form $53,550 Special Form $52,500
Springs,FL
102 001 102 Moss Road, WS Winter Springs,FL Fire Station #24 - Fire House Fire Resistive Special Form $540,855 Special Form $138,100
102 002 102 Moss Road, WS Winter Springs,FL Antenna & Radio Tower Non-Combustible Special Form $2,285 $0
103 001 850 Northern Way, WS Winter Springs,FL Fire Station #26 - Fire House Jolsted Masonry Special Form $400,336 Special Form $36,800
104 001 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Concessions/P&R Joisted Masonry Special Form $309,472 Special Form $12,900
Office
104 002 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Maintenance Garage Non-Combustible Special Form $139,901 Special Form $84,000
04 003 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 22 Concrete Ught Non-Combustible Special Form $64,738 $0
Poles
04 004 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 152 Ballfield Non-Combustible Special Form $103,542 $0
Ughts
04 005 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 38 Single FIxt, Non-Combustible Special Form $47,242 $0
Site Ughting
04 006 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 11 Double Fixt, Non-Combustible Special Form $14,998 $0
Site Ughting
04 007 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Irrigation Sys & Non-Combustible Special Form $119,023 $0
Pumps
04 008 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - New Soccer Conc Joisted Masonry Special Form $220,000 $0
StlRestrm
05 001 Torcaso Winter Springs,FL Torcaso Park - New Restrooms Joisted Masonry Special Form $127,000 $0
06 001 Moss Winter Springs,FL Moss Park - New Restrooms Joisted Masonry Special Form $120,000 $0
)7 001 Trotwood Winter Springs,FL Trotwood Park - existing restrooms Joisted Masonry Special Form $84,000 $0
)8 001 400 N. Edgemon Ave., WS Winter Senior Center J~isted Masonry Special Form $265,173 Special Form $59,000
Springs,F[
)8 002 400 N. Edgemon Ave., WS Winter Civic Center Joisted Masonry Special Form $192,441 Special Form $42,000
Springs,F[
)9 001 300 Moss Road, WS Winter Springs,FL Police Complex - Police Station Fire Resistive Special Form $1,186,069 Special Form $493,000
Page 1 of 4
09/25/2002
Member's p'roperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Locatlon# Address Occupancy Construction Cause of ~ldH Cause of Pars
Loss ..J!!!!... Loss rro~
Loc Bid ..J!!!!...
110 001 110 N. Aamingo Ave. Winter Springs,FL Public Works - Garage Joisted Masonry Speclal Form $154,530 Speclal Form $38,053
110 002 100 N. Flamingo Ave. Winter Springs,FL Public Works - Utility Office Joisted Masonry Special Form $71,556 Speclal Form $80,000
111 001 N. 1st Street Winter Springs,FL Public Works - Storage Joisted Masonry Special Form $16,438 $0
112 001 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Digesters Fire Resistive Special Form $2,480,844 $0
Springs,FL
'12 002 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Chlroine Fire Resistive Special Form $219,300 Speclal Form $94,700
Springs,FL Contact
12 003 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Filters Fire Resistive Speclal Form $37,026 Special Form $9,300
Springs,FL
12 005 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Aerator Fire Resistive Special Form $128,214 Special Form $25,000
Springs,FL
12 006 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Plant Ops Flre Resistive Speclal Form $61,812 Special Form $200,000
Springs,FL . .
12 007 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Uft Station Non-Combustible Special Form $112,455 $0
Springs,FL
12 008 1560 Winter Springs Blvd, WS Winter . East Wastewater Plant #1 - Reclaim Fire Resistive Speclal Form $481,134 $0
Springs,FL Water Tank
13 001 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 :. Pump House Non-Combustible Special Form $138,433 $0
13 002 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - LP Gas Tank Non-Combustible Speclal Form $914 $0
13 003 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Ground Level Tank Non-Combustible Special Form $238,663 $0
13 004 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Hydropneumatic Tank Non-Combustible SpeclalForm $46,868 $0
13 005 ,Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Water Well Non-Combustible Special Form $20,397 $0
3 006 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Well #6 Water Plant 2 Non-Combustible SpeclalForm $174,962 $0
3 007 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible SpeclalForm $129,753 $0
3 008 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible SpeclalForm $97,654 $0
4 001 1000 W SR 434, WS Winter Springs,FL West Wastewater Plant #2 - Water Plant Fire ResistiVe Speclal Form $1,985,480 $0
5 001 Bahama Rd, WS Winter Springs,FL Water Plant #3 - LP Gas Tank Non-GolT'bustibfe Special Form $914 $0
5 002 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Ground Level Tank Non-Combustible Special Form $238,663 $0
5 003 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Well Non-Combustible Speclal Form $19,789 $0
Page 2 of 4
09/2512002
Member's P'toperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Locatlon# Address Occupancy Construction Cause of ~ldR Cause of Pers
Loss -!!!!!... Loss rro~
.oc Bid ..J!!!L
15 004 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Plant Fire Resistive Special Form $336,362 $0
15 005 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Chlorinator Building Fire Resistive Special Form $66,309 $0
16 001 851 Northern Way Winter Springs,FL Water Plant #1 - E. Water Plant Op, Bldg Fire Resistive Special Form $128,n5 Special Form $75,000
16 002 851 Northern Way Winter Springs,FL Water Plant #1 - Chlorine Handling Fire Resistive Special Form $63,257 $0
Facility
16 003 851 Northem Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0
16 004 851 Northern Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0
17 001 Indian Ridge Seminole Winter Springs,FL Uft Station Non-Combustible Special Form $85,898 $0
18 001 David Street Winter Springs,FL Lift Station Non-Combustible Special Form $76,104 $0
19 001 Hacienda Village Winter Springs,FL Uft Station Non-Combustible Special Form $58,473 $0
~O 001 Tanglewood Drive Winter Springs,FL Uft Station Non-Combustible Special Form $91,777 $0
~1 001 S. Edgemon Ave Winter Springs,FL Uft Station & Fence Non-Combustible Special Form $343,598 $0
~ 001 Panama Circle Winter Springs,FL Uft Station Non-Combustible Special Form $63,446 $0
:3 001 Alton & Mockingbird Winter Springs,FL Uft Station Non-Combustible Special Form $89,667 $0
4 001 E. of Wetland 1000's Winter Springs,FL Lift Stallon Non-Combustible Special Form $53,045 $0
5 001 Club Drive Winter Springs,FL Lift Station Non-Combustible Special Form $56,228 $0
6 001 Dolphin Road Winter Springs,FL Lift Station Non-Combustible Special Form $56,228 $0
7 001 Papaya Lane Winter Springs,FL Lift Station Non-Combustible Special Form $33,462 $0
8 001 Sybilwood Circle Winter Springs,FL Lift Station Non-Combustible Special Form $26,989 $0
9 001 Tuscany Place Winter Springs,FL Uft Station Non-Combustible Special Form $34,095 $0
) 001 Winter Springs Blvd. Winter Springs,FL Lift Station Non-Combustible Special Form $50,605 $0
I 001 Northem Way Winter Springs,FL Lift Stallon Non-Combustible Special Form $28,500 $0
001 Wood Duck Drive Winter Springs,FL Uft Station Non-Combustible Special Form $41,046 $0
001 Seneca Blvd Winter Springs,FL Uft Station Non-Combustible Special Form $65,224 $0
001 Seneca Blvd Winter Springs,FL Uft Station Non-Combustible Special Form $46,107 $0
001 Trotwood Blvd Winter Springs,FL Uft Station Non-Combustible Special Form $44,982 $0
Page 3 of 4
0912512002
Member's I-'roperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Locatlon#
Loe BId
Address
Occupancy
Construction
Cause of
Loss
~ldR
....!.!!!!..
Cause of
Loss
Pers
rro~
....!.!!!L
036
037
038
039
040
041
042
001 Seneca Blvd & Chelse Winter Springs,FL
001 Shepard Rd. Winter Springs,FL
001 Cherry Creek Circle Winter Sprlngs,FL
001 Vistawilla Drive Winter Sprlngs,FL
001 Nandina Terrace Winter Springs,FL
001 Winter Springs Blvd Winter Springs,FL
001 Various Winter Springs,FL
Uft Station Non-Combustible Special Form $45,955
Uft Station Non-Combustible Special Form $46,589
Lift Station Non-Combustible Speclal Form $57,674
Lift Station Non-Gombustible Special Form $45,010
Lift Station Non-Combustible Special Form $49,802
Oak Forest Wall Joisted Masonry Special Form $500,000
Tuscawilla Lighting and Beautification Non-Gombustible Special Form $2,000,000
ImprovementS
T ota/: $18,687,980
$0
$0
$0
$0
$0
$0
$0
$2,546,260
Page 4 of 4
09/25/2002
~'
...
. -:,:i
. -' .
FLOlUDA MUNiCI;PAL INStJRANcE ,TRUST FtC' Og-l'
" . .' . '. .' . (ReviSed 2/97):
. APPLXCiTI~N FOR '1)Rt1G";~'W:ORDLAcii:'~uYciUI:D~T :PROG~
Name o:fMeInber:, City'. of;.Wi'rit~'r,springs.{FMIT.64~J. "
. .. ""
Date. pro~r~ ImPlemented:: ',July. 8~ 1'996..
'X.
'l'ESTXNG,:
2()02! 2;()03>', .
D~ug test.i~g l1a:s' b~~ri' qonducted,in thefoliowiI)g 'ar~as:
Routine :E1.:ti)ess for dti~y
181
(8j
Job applicat$ons
181'
'.181. .
.' Reasonable susp:icion:
181
It. NOTIcE OF ~'S:'DRUGTEST.mG ~~ICY:'
~
~,I . '. ','
Posted on. eIllPloyer' is p'rernises
Copy to jC)b': appJ,.ic~ntspriorto
. testing
GeReral noti€e ,given 60.' days
,pri':or to tes'tin9
tn. EDUCATION:
181
181
181
Copy.to 'all employees prior
to t~sting.' ". '..
181'
MIA
181 Resource file on Prov~ders
181 .'. Employee: AsEjlstance Prog,'!:'am
~.
. .'
Foll~w-up to~loyee'~~~s~ance progtam
,Show not~ce. of drug test:j,.ng' ori vac:a:ncy
Elnnoun~em~nts . . .
Copi~s av~ilC!lhle inp~:r:soilrteloffic~' or
~th~r' S~i.t'a~~el,'o6'ations'. .
. 'N~ no:tiCie' 'r~qU~red because the eriiployer
had ,a d1;'uq te~~ing!>rqg'ram in placepr10r
,to July 1, .1990
. L :."
\ "~"
Ed~.cat.i;o?
. .
. '
IV. . 'NAME OF ,MEDX.cAi. ~EW C;>n'ICJm: '0..0<.:1:. $top: "Medi'qal Review.. O'fficelr,.'. .JockSneedoh, '.'
MP,.,.94a4~h ..0$1:~: _Ot;L'ao(:i.o:,. '.F~.32,8':f7i..(;4.'O.7l':'~5.7-'5573." ....
. .~. .'..., .... .
A. Nanie. qf approved, Age.ncyfor' H~~.:ii1:.hC.aiie. A,Qitti.,nJ;itra,t.ton. 'L~b.o.:r Unit.ed 'States.. .
,Departmen.t' of Health. and Human .Servj;j;:e's 'Ce~tifie~taboratoJ<:Y': .
',Americ;an' Meclic~lI.aboX'a.t.oFi:e,$.": " . " ."." ...."
; . . .' .." .' .... ':". .' . . ....J", .,..
B. Phone #: (407 )857- 81":8
c. : Address: . 8549 ~aJ<kl~ne~JH,..:vd~.l) O~lii,l'.,O:~t: .f'~32a;09.
SPECIAL N<?TE: ALJ.. ZT:E$WST SE: C~L~BD riirH IN O~I$Tom: ~~~stBUFI'6~ .~.cluilIlI~;'
~ . .
Any person who knowingly ~and w~t;h' i%)ten~t9. inJ~re~ :d.'ef'rauq, .o'r:d;e,~e,i~~)'.:anY :liis~:~e:r f1r~s
a statementQf clcdJll.oi an, i:lppl~ca't:-iori c:6ntai~i-n:9 . "lSe, i'.'''. '~3;'~te, ,or ."In:li',$:leadihg
. infortnation, is guilty of a 'f~lon.y.'of the thirdde<,1J! . . .. '., '.
CitypfWinterSprings
Member Name
, November .12 ;' 2002 ,:,.
',"Date:
:......:-..
,::';.
. ;;"
Tit1'&. .'..
, ,; ~.
. ~'. ~.
THE ABOVE SIGNED CERTIF'ltS THAT THl'S. !N,FO~TION IS' A TRl),E AND FACTUAL':' PEi,ICTIC>N.OF T.HJi:IR
Ct.JRRENT PROGRAM. , " .
t
. .
be signed by. anele~ted6tfj.c~a:l. dr
Signature
N.ovember 12,.2002
'Date.
-
-
, '
FLORIDA MUNICIPAL 'INSURANCE TRUST
APPLICATION FOR EMPLOYER WORKPLACE
SAFETY PROGRAM PREMIUM CREDIT'
Policy #:
Cit~ of Winter Springs
Ms. Louise Franghoul
FMIT 648
Telephone:
Effective Date of Policy:
407 -327 ~ 1800
October 1, 2002
Member Name:
Contact Person:
I am submitting a copy of my workplace safety program that meets the requirements of the Florida
Occupational Safety and Health Act, Chapter 93-415, ~ '52-74, Laws o(Florida, and Rule 381-17 of the
Florida Administrative Code. I certify that this safety progtam has been implemented in my workplace and Is
being maintained as submitted to my canier.
This Is to certify that my workplace safety program meets or exceeds the following prOVisions as provided
for In RWe 381..17:
1)
2)
3)
4)
Management Commitment to Safety
Safety Committee
Safety and Health ,and Training ,/
Safety Rules, Policy and Procedures Requirements
5)
6)
7)
Accident Prevention
First-Aid Procedures
Record Keeping
The workplace safety program and application I ar:nsubmittlngfor the purpose of obtaining a premium credit
do not contain any misleading or untrue Infonnation. I am aware that I may :be subject to an on-site
inspection by the Florida Department of Labor and Employment Security, Divlslol') of Safety, or my carrier,
for the purpose of validating the acCuracy of this llifonnatioll. .
I am aware that If I knowingly and willfully falsify or conceal a material fact, make a false, fictitious or
fraudulent statement,()f representation; or make or use any false document. knowing the document to
contain any false, fictitious or fraudulent entry or statement to my canier or workers compensation insurance
under Chapter 442, Florida Statutes, I ,will be guilty of ~ .mlsdemeanor of the second degree, punishable as
provided In sections 775.082 or 775.083, Florida Statutes, and will be subject further to a penalty in the
amount of $500 a day,not to exceed $50,000 for each oCcurrence; and
I am also aware that if I, In any matter within the jurisdiction of the division, knowingly and willfully falsify or
conceal a material fact, make any false, fictitious, or fraudulent statement or representation, or make or use
any false document, knowing the sama to contain any'false, fictitious, or fraudulent entry, that I commit a
misdemeanor of the' second degree, punishable as provided in sections 775.082 or 775,083, Florida
Statutes. Moreover, I understand that an employer Who commits such an act will be subject further to a
penalty in the amount of $500 a day,not to exceed $50,000 for each occurrence. .
Any person who knowingly and with Intent to Injure, defraud, .or deceive any Insurer files a statement of
claim or an application containing any false, incomplete, or misleading Infonnationls guilty of a felony of the
third degree.
Effective date of premium credit October 1 t 2002
City of Winter Springs
Member Name'
/1- (). S'"'~ " ~
Date
~CMVW;J1J1~ .
. · 'Elected Official or other Official
.~~
(
'-..-
be signed by an elected official or other offiCial.
{II )<&"d-
I Dae
ANDREAt0RENZO-LUACES
CC 831931
I lk May 9, 2003
HlOl)'3-NoTAQY RI'! tm1fllYServIce & Bondirv Co,
(safety reVised 3/99)
, .
'. " '. '. FLORIDA MUNICIPAL INSURANCE TRUST . "
. .' :OA TE: I ~/ z.. Sl fJ 2.- .'
;,MEMBER NAME: Ci iy af . b},'rr+V fi~:5
CONTACT: Ms.- locl;Se FrIO~DIAJ PHONE: f()7.12...7./B'f)()
. i
In ~ef to assure that your sateiy wid health program ;"eets the requirements of the Slate. of Rorida, Department of Labor and Employment Security, Division of Safety, ~ety pItlgram guidelines, the ..,
fIlIJow;ng provlsions sIlould be in place: . . '. .' ....... .
1. MAJIAOEMEHT COMMITMEIilT AHD IHVOLVEMEHT: (Pages 11 & 12 of 381-17.006 Compllane:.. Publication Part II).
H_ yOu issUed and communicated to a1i employees a :t!!il!!!!l policy statement? '. XYES ..'0 NO
Comments:
Does )OW' policy statement contains thlllollclwing;
a. A dear vi- of management's commitment to safet(7 .
Comments:
b. Managemllllts position on safely funding?
~YES aNO
~Yss aNO
)4 YES aNO
)pES aNO
Comments:
Co Employee's rights when wotk is considenld ull$llfe?
Comments:
d.' Olsc:lplinary procedures for violation of safety rules?' .
Comments:
... Does your safety policy assign and communicate in writing the responsibility for the. impiemen1ation of your safety program? . )(YES 0 Na
Comments:
t. Does your safety program ind~te how management is actively participating in:
. .' . .
Safety. committees, safety education and training, and establishment of sarely rules, policies and procedures? . ){ YES
Comments:
ONO -
2. . 8AI'E'T"i COhmI,,,ris: (Pages 12 through 14 of 38~11.00e Compliance Publication Part IQ.
Rule 381-11 specffically addtesses the requirements of the safety committee mad&-llp for )OW' program. Have you addressed the following:
a. The fo",,~on of a, safety committee? ' . )(YES . " a NO
Comments:
b.
Assured thaI your committee is made' up of both management and employees?
.){ves ,'aNa
Comments:
c. '
Assured that the r.Itio of this committee is such that employees have an eq\l81 number 01, or more representatives than the employet7
'.' Ale. . A/'I<... -f~'y"v:y rl-TJ "'c:(:,~~/~ -:M'J ,..1-'0
Scheduled meetlngs, ~ qUanerty1. ~ YES a NO
aYES
~
Comments;
. d. .
Comments:
e.
Assured that recQrds of meeiings are recorded and maintained for alleast three years?
)(YeS
ONa
. Comments:
f.
,Comments:
Established procedures tor ins~ns to .......Iuale th.e suCcess of ,your P"'If""'7 . a YES. Jt(NO
'7h~ otVJly JilCHJJ ~~A.su;,e"""'~~.Is I~ ~,''''''/MAl
. Established procedures tor, il1\'eSligating all accidents" safety related Incidents, illness and fatalities? . )(YES .
;'ecp/'d' 41 .1?~;tleYJir~
ONa
9-
Comments:
Established procedures to< evaluating and recommending improvements to em~'s accident and illness ~ in the wot1<piaCe? )(YEtriIIIb
h.
Comments:
I.
Comments:
j.
Established and communicated procedures for training committee m1:nbers and ensuring that this training is accomplished? "
CI-lrr-tvz,1IyCAAYJ~ Cn.J&.//V A//-Ir~,~ "j ~C.Cb~J/Jk.
establishing proc:e<lures to assure minutes of !Ill committee meetings are communicabod to !Ill employees? . a YES
Ne.. U/J/ WP/i. . d"lytl~~ . f)A- ~J.I~ /~/)ce~v~~
aYES
;1!NO
J(NO
Comments:
AND HEALTH TlUUHIHO: (Pages 14 & 15 <11381-17.006 Compliance Publication Part IQ.
Have' Y9U Implemented safely and health trainillli that i"eludes ,at a mi'nimum the following: .
a. Safety orientltion on /\lIes, policies and procedures. )( YES a NO
,/.,
Comments:
b. Job specific prDcedures fa; all new employees? 1st YES
ONO
Comments:
c.
Job soeeific trainin~ for employees before they are assigned their job tas~
.JlrYEs
000
Comments:
d.
Periodic retaining' of employees on worItplaee safety /\lIes, policies, and proced,"",,7
~YES
ONO
Comments:
. '4. I'IftST A1D'pftOCEDlJItES: (Pages 15 & 18 of 381-17.~ Compliance Publication PartlQ.
Have you established First Aid proc<<lures for first aid and medical services that Includes at a minimum the followi;,g:
a.
Availability of approved, First Aid KIts, or First Aid fac;i1ities to all employees?
)Qves' 000
Comments:
b.
First, Aid training for employees in line with the potential hazard of their WOf1<pIace and their work environment?
AfYES
ONO
Comments:
c..
POsting of emergency telephone numbers aild the teachlng of easily understDod procedures?
ll(YES
aNa
Comments:
5. ACCIDENT IHVESTlGATIOH:.(pages 18 through 18 of 381-17.008 Compliance Publication Part IQ.
Have :IOu I!$labllshed a procedure requiring the investigation of the following:.
a.
Accidents:
XYES
aNO
Comments:
b. .
Injuries:
)( YES
000
Comments:
c.
Occupational diseases:
~YES
.aNO
Comments:
Aves
000
d. Are all of the above forms and records nl'IIiewed by the safety committee7
Comments: . DlPAr1~ t- fe/~sen+""-;J1ie.J
e. Does the safety committee initialB recommendations based on the above7
Comments:
~YES
000
.. 'ItECOftDKEEPINO PftOCEDUftES: (page 18 of 381-17.008 Compliance Publication Part lQ.
. Have you:
a.
Comments:
Established recordkeeping procedures to control and maintain all accident and injury records7
~YES
000
b..
Made provisions to assure all records are retained for three yea".7
..;rYES . . a NO
Comments: .
NOTE: TIle NelOrdS IIstiod below aN 1II_ rwcords lIIat MISt be _hltalllecl.
1. . Dlrisioa of Safaty, Lot ami Summary of Clccl!patIollallnlarles, D....... alHlln-
. %. Ha1Icoo of Injury (LES FORM DWC-l)'.
7. SAFETY RULES, POUCIES AND PftOCEDURES: (Page 18 of 381-17 Compliance Publication Part II.
1.' HaW:IOu developed a safety manual containing all workplace safety /\lIes, policies, and procedunl37
Comments:
~YEs
aNO
2. Is the above manual updated when changes in the work orwoik environment occurs? )q YES a NO
,Comments: -1'.!!G;.f: '" Jo 1J1d;ot7 n1<=.rr1 .
3., Do the above safety rules include both general and job specifIC /\I1es7l!{ YES a NO ' A
Comments: SON'lc. d~Ar-l~~ y;e<'lt"'c:. rv&.J ~/"t:. c~~-I~;"'efl 1"'1-
~rv1~,J ~~/'A-I,j CVJ~d/':' e../-
1J~~~t:;o. -I.
, .
.J..
. .
. ..
'9nal1l", of Pefson Completing tllis Fonn: ______
Y:'~A/./tIk::;. r:r,-ck~-t
~ t- (/. /
e/'" .'
J~"1/ /~ . I r..
.: ...
3
. .
0 Administration/
Marketing
0 Risk Control
~ Underwriting
Property & Casualty
Health
Post Office Box 530065
125 East Colonial Drive
Orlando, FL 32853-0065
800-445-6248
407-425-9142
Suncom 344-0725
Fax 407-425-9378
0 Health Claims
Post Office Box 538140
Orlando, FL 32853-8140
800-756-3042
407 -245-0725
Suncom 344-0725
Fax 407-425-9378
0 Workers'
Compensation Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Property & Liability
Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407 -245-0725
Suncom 344-0725
Fax 407-425-9378
FLORIDA LEAGUE OF CITIES, INC.
PUBLIC RISK SERVICES
October 28,2002
Ms. Louise Franghoul
Director of Finance
City of Winter Springs
1126 East State Road 434
Winter Springs, FL 32708
Re: Position Schedule Bond 103940482
Dear Ms. Franghoul:
Attached please find your Position Schedule Bond as requested. The Bond is for
your files. As this policy is continuous in nature, only an annual billing will be issued
each year at renewal.
If you have any questions, please do not hesitate to contact me.
Valerie M. Morrison
Underwriting Assistant
VMM/vmm
Enclosure
Florida Municipal Insurance Trust
I""':'
Name
Position
Employed at
Amount of
Guarantee
Premium
"
1 Finance Director City of Winter Springs $100,000 $591.00 10/01/02
"
.
8-1560-8 (08-99)
.,.q.~.'
~, ,._'r
. PUBliC OFFICIAL
SCHEDULE BOND
(Continuous for Indefinite Term)
Bond No, 103940482
Travelers Casualty and Surety Company of America
One Tower Square 3PB, Hartford, CT 06183 .
~
KNOW ALL MEN BY THESE PRESENTS, that Travelers Casualty and Surety Company of America, of Hartford,
Connecticut, a corporation organized and existing under the laws of the State of Connecticut, hereinafter called the Surety,
is held and firmly bound unto CITY OF WINTER SPRINGS, hereinafter called the Obligee, in the sums as set forth in the
schedule forming part of this bond, or as hereafter added to said schedule as hereinafter provided, for the payment of
which said sums the Surety binds itself, its successors and assigns, firmly by these presents.
WHEREAS, the Obligee desires to have the various officers, employees or other incumbents, all hereinafter called the
Principals, as named in the schedule; or as hereafter added to said schedule as hereinafter provided, bonded for the
faithful performance of their duties in the capacities and in the amounts set opposite their respective names in said
schedule.
NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH that if each Principal named in the schedule or
hereafter added to the schedule, as hereinafter provided, shall faithfully perform the duties of his/her office or employment,
as required by law; and at the expiration of his/her term or employment shall pay over and deliver all money, records, and
property that may come into his/her possession, then this obligation to be void; otherwise to remain in full force and effect.
PROVIDED, HOWEVER, that this bond is executed and accepted subject to the following agreements and limitations:
FIRST: As to Principals named in the attached schedule, the Surety shall not be liable for losses occurring prior to the
date of this bond, and as to Principals hereafter added to the schedule, as hereinafter provided, the Surety shall not be
liable for losses occurring prior to the effective dates of such additions to the schedule.
SECOND: The Obligee may, during the continuance of this bond, add other Principals to the schedule, by giving written
notice to the Surety, and may likewise increase or decrease the amounts of suretyship as to any Principal or Principals, by
giving like written notice to the Surety. Such additions of Principals, and increases or decreases of the suretyship on
Principals, shall be effective on the date when the Surety shall receive written notice thereof from the Obligee.
THIRD: The aggregate liability of the Surety on account of anyone Principal shall in no event exceed the largest single
amount for which said Principal is at any time bonded hereunder, regardless of the number of years this bond, or the
renewals thereof, shall continue in force; nor shall the Surety be liable for an amount in excess of the amount for which
said Principal is bonded during the period when the loss occurred.
FOURTH: Upon the payment of any loss on any Principal under this bond, the Obligee shall, to the extent of the payment
so made, assign to the Surety the claim of the Obligee against said Principal. .
FIFTH: This bond shall remain in full force and effect until canceled and terminated by either the Obligee or the Surety as
follows:
(1) The Obligee may cancel and terminate this bond ,either in ,its entirety'or as to any individual Principal or Principals by
giving the Surety written notice, in which event the cancellation and termination shall be effective on the date when the
. Surety shall receive such notice. .
(2) The Surety may cancel and, terminate this bond either in its entirety or as to any individual Principal or Principals by
giving written notice to the Obligee, in which event the cancellation and termination shall be effective thirty (30) days
after the Obligee shall have received such notice,
IN WITNESS WHEREOF, Travelers Casualty and Surety Company of America has caused this bond to be signed by
its Attorney-in-Fact, and its corporate seal to be hereunto affixed this 23rd day of October, 2002,
By:
urety Company of America
8-1560-8 (08-99)
.
APPLICATION TO
FLORIDA MUNICIPAL INSURANCE TRUST
.
GOVERNMENT APPLICANT: Citv of Winter Serinas
ACCOUNT NUMBER: FMIT 0648
TYPE OF GOVERNMENTAL ENTITY:
Municipality
ADDRESS: 1126 East State Road 434 Winter Serinas FI 32708
FEDERAL EMPLOYER IDENTIFICATION NUMBER: .5 ~ - \ e>~ <0 3 C:.Y
o NOTIFICATION TO DEPARTMENT OF COMMERCE
OFFICIALS AUTHORIZED TO EXECUTE CONTRACTS:
N,me' (>..~.....\",. ). "".\..~ ~ II. N.me: ~
TOe: c.. -' y c-.-.. .....-.=.. 'i".r- TOe' _ -
PRIOR INSURANCE COVERAGE CARRIED BY: ~ M A ( C' ~ r ~ 5" j L p <:. I- "'\ )
Applicant hereby makes application with the Trust for continuing membership for liability, property, allied lines, automobile physical damage,
workers' compensation, employers' liability, medical, dental, short-term disability, and/or life coverage, to be effective 12:01 a.m. October 1, 2002 and, if
accepted by the Trust's duly authorized representative, does hereby constitute and appoint the Florida League of Cities, Inc., to act as Administrator of said
Trust and to act as Applicant's agent-in-fact in all matters relating to its participation in said Trust and agent-in-fact to the extent any such coverage is placed
with the Trust.
Applicant, by execution of this Agreement, further agrees:
(a) That, by this reference, the terms and provisions of the Agreement and Declaration of Trust creating the Florida Municipal Insurance Trust, as may
be amended periodically by its Board of Trustees, a copy of which Applicant hereby acknowledges receipt, is hereby adopted, approved, ratified, and
confirmed by Applicant; and further, Applicant will accept, assume, abide by and be bound by the provisions and obligations set forth therein;
(b) That Applicant will pay all premiums on or before the date the same shall become due and, in the event Applicant fails to do so, will pay any
reasonable late penalties and charges arising therefrom and all costs of collection thereof, including reasonable attomey's fees;
(c) That Applicant, as long as it remains a member of the Trust; will abide by the rules and regulations adopted by the Trust's Board and will conform
its conduct to the terms of any agreements entered into by the Board to administer the Trust;
(d) That Applicant, in the event of any changes in the Applicant's corporate or business structure, or if any locations are to be added or deleted from
any coverage provided by the Trust, will notify the Trust immediately; and that Applicant further understands that, if workers' compensation coverage or
employers' liability coverage is provided by the Trust, the failure to provide said notice within thirty (30) days of any such change may result in the
assessment of a civil penalty not to exceed $100 for each failure;
(e) That should either the Applicant or the Trust desire to cancel coverage, it will give written notice to the other at least forty-five (45) days prior to
cancellation;
(f) That, should Applicant default hereunder, Applicant agrees to save and hold harmless the Trust and the Trust's Board from any and all damages,
causes of action, claims, delinquency or expenses; including reasonable attorney's fees, which would have otherwise been incurred by the Trust or the Board
hereunder absent such default on the part of the Applicant;
(g) That, if workers' compensation or employers' liability coverage is placed with the Trust, Applicant will accept and be bound by the provisions of the
Florida Workers' Compensation Act, that coverage arising from this Application shall be for Florida operations only, and that the Wage Declaration Schedule
(Form No.-> and/or Renewal Certificates, when completed and retumed to Applicant by the Trust, shall become a part of this agreement; and
(h) That, if medical, dental, short-term disability, and/or life coverage is placed with the Trust, the probationary period for new employees shall be:
( ) 30 days ( ) 60 days ( ) 90 days ( ) other
WITNESSES TO SIGNATURE
I.
CihL of Wiote.r Sorino.s l'
Ronaia w. ~c emore
Name 01 Applicant
_ If rnuJAllj <JYJ$- I~
, Authoriied Offleer
Andrea Lorenzo-Luaces
Name
1126 East State Road 434, Winter Springs, Florida
Address
32708
c_
Andrea Lorenzo-Luaces
Name
Date
1126 East State Road,434, Winter Springs, Florida
Address 32708
BY:
(10/96)
AdministratorlTrustee
BINDER OF COVERAGE
NAME AND ADDRESS OF DESIGNATED MEMBER
Ms. Louise Frangoul
City of Winter Springs
11 26 East State Road 434
Winter Springs FI 32708
EFFECTIVE DATE
EXPIRES
AGREEMENT NUMBER:
12:01 am 10/1/02
12:00 midnight 12/31/02
FMIT 0648
NAME AND ADDRESS OF ADMINISTRATOR
Florida League of Cities, Inc.
Public Risk Services
P.O. Box 530065
Orlando, Florida 32853-0065
COVERAGE PROVIDED BY:
THIS BINDER IS A TEMPORARY CONTRACT OF COVERAGE, SUBJECT TO THE CONDITIONS SHOWN BELOW.
FLORIDA MUNICIPAL INSURANCE TRUST
TYPE OF COVERAGE - LIABILITY
General Liability
181 Comprehensive General Liability, Bodily Injury, Property Damage and
Personal Injury
181 Errors and Omissions Liability
181 Supplemental Employment Practices
181 Employee Benefits Program Administration Liability
181 Medical Attendants'/Medical Directors' Malpractice Liability
181 Broad Form Property Damage
181 Law Enforcement Liability
181 Underground, Explosion & Collapse Hazard
Limits of Liability
* Combined Single Limit
Deductible Stoploss $25,000
Automobile Liability
181 Automobile Liability
181 Leased Automobile Liability
o
181 Medical Payments $N/A
181 Personal Injury Protection
Uninsured Motorists Protection $N/A
LImits of Liabirlty
* Combined Single Limit
Deductible Stoploss $25,000
Automobile/Equipment - Deductible
181 Physical Damage $1 ,000 - Comprehensive - Auto
TYPE OF COVERAGE - PROPERTY
181 Miscellaneous
181 Inland Marine
181 Electronic Data Processing
181 Bond
o
181 Buildings
o Basic Form
181 Special Form
181 Personal Property
o Basic Form
181 Special Form
181 Agreed Amount
181 Deductible $1 ,000
181 Coinsurance 100%
181 Blanket
o Specific
181 Replacement Cost
o Actual Cash Value
LImits of LIability on File with Administrator
TYPE OF COVERAGE - WORKERS' COMPENSATION
181 Statutory Workers' Compensation
181 Employers Liability $1,000,000 Each Accident
$1,000,000 By Disease
$1,000,000 Aggregate By Disease
o Deductible N/A
o
SPECIAL CONDITIONS/OTHER COVERAGES
$1 ,000 - Collision - Auto
Per Schedule - Miscellaneous Equipment
* $2,000,000 Combined Single Limit
CONDITIONS
The Trust binds the kind!s) of coverage stipulated above. This coverage is subject to the terms, conditions and limitations of the Agreement in current
use by the Trust. This binder may be cancelled by the member by surrender of this binder or by written notice to the Trust stating when cancellation will
be effective. This binder may be cancelled by the Trust by notice to the member in accordance with the conditions of the Agreement. This binder is
cancelled when replaced by an Agreement. If this binder is not replaced by an Agreement, the Trust is entitled to charge a premium for the binder
according to the rules and rates in use by the Trust.
~~
~,~
,IRJ::: nJ::: .-.
FMIT-BINDER 11 0/961
Seotember 25, 2002
nll.TJ:::
AGREEMENT NO. FMIT #0648
FLORIDA MUNICIPAL INSURANCE TRUST
NAMED INSURED City of Winter Springs
OPTION FORM
1. PERSONAL INJURY PROTECTION
IX! The member acknowledges and understands that the agreement identified above will provide the
full no-fault Personal Injury Protection coverage required by the Florida Reparations Reform Act,
as amended.
2. Deductible Amount Applicable to Personal Injury Protection - Optional (select only one)
D
D
D
$250
$500
$1,000
D
$2,000
3.
D
Coverage reduced by "Medicare" Program (42 USC 1395) and by Military benefits - Optional
4.
D
Work loss does not apply - Optional
5. No Deductible Applicable to Personal Injury Protection - Optional
IX! No Deductible
THE MEMBER HAS READ THE ABOVE APPLICATION & DECLARES THAT MEMBER HEREBY ELECTS
THE OPTIONS MARKED ABOVE AND REQUESTS THEY BE MADE A PART OF THE AGREEMENT ABOVE.
10/01/2002
Date
FMIT PIP 1002
;i'-;::;!"tl..~ .,
FLORIDA MUNICIPAL INSURANCE TRUST
UNINSURED MOTORISTS I UNDERINSURED MOTORISTS SELECTION FORM
THIS FORM REQUIRES YOU TO MAKE A CHOICE REGARDING UNINSURED MOTORISTSI
UNDERINSURED MOTORISTS COVERAGE, WHICH PROTECTS YOU AND YOUR EMPLOYEES. YOU
MAY REJECT, INCREASE, DECREASE OR MAINTAIN LIMITS EQUAL TO YOUR BODILY INJURY
LIABILITY LIMITS. PLEASE READ CAREFULLY.
AGREEMENT NO. FMIT #0648
DESIGNATED MEMBER City of Winter Springs
SELECTION FORM
CHECK, SIGN & DATE FOR ONLY ONE OPTION
IX] UNINSURED MOTORISTS I UNDERINSURED MOTORISTS COVERAGE - REJECTION: I/We REJECT
Uninsured I Underinsured Motorists coverage and request that such coverage be eliminated from the
Agreement, all renewals, and any other provisions which extends, changes, supersedes or replaces this
agreement.
o UNINSURED MOTORISTS I UNDERINSURED MOTORISTS COVERAGE - INCREASED LIMITS: I/We
accept the offer of INCREASED limits for Uninsured I Underinsured Motorists in the Combined Single
Limit amount of bodily injury each accident.
o Limit(s) LOWER than the Iimit(s) of the agreement for bodily injury liability, but not less than the Financial
Responsibility minimum Iimit(s) required by law. Limit
o Limit(s) EQUAL to the limit(s) of the agreement limit(s) for bodily injury liability. Limit:
d,----r A~ S;9;'turf<
10/01/2002
Date
FMIT UM 1002
0 Administration/
Marketing
0 Risk Control
t! Underwriting
Property & Casualty
Health
Post Office Box 530065
125 East Colonial Drive
Orlando, FL 32853-0065
800-445-6248
407-425-9142
Suncom 344-0725
Fax 407-425-9378
0 Health Claims
Post Office Box 538140
Orlando, FL 32853-8140
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Workers'
Compensation Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Property & Uability
Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
FLORIDA LEAGUE OF CITIES, INC.
PUBUC RISK SERVICES
TO:
Member
FROM:
Administrator
0:
Florida Municipal Insurance Trust (FMIT)
Property Statement of Values for the 2002/2003
DATE:
October 1, 2002
Attached is a current Statement of Values for the locations that we have on
file for your property coverage. The amounts listed represent the property
values at the coinsurance listed. In order to maintain Blanket Coverage, the
Statement of Values must be renewed annually.
Information on the attached Statement of Values should be reviewed for
accuracy. Please make any changes on the original and initial the change.
When the form is correct, please sign and date Page 2 where indicated and
return the completed form to the Orlando office within 30 days of receipt. If
the construction is left blank, please fill in the type of construction, as we do
not have that information.
Failure to provide accurate property values will result in your being paid less
than the full amount in the event of a property loss. This is called a
coinsurance penalty and is described on page 10 of 13 of the Building and
Personal Property Coverage form (CPOO 10 10 00).
If you have any questions, please feel free to call your Rating Manager,
Margaret Gross, ext. 306.
Florida Municipal Insurance Trust
FLORIDA MUNICIPAL INSURANCE TRUST
MEMBER'S STATEMENT OF VALUES
MUNICIPAL
PROPERTY
Member City of Winter Sprinqs
FMIT # 0648
Headquarters Address 1126 East State Rd. 434 Winter Springs, FL 32708
Form of Coverage
[Xl
o
Agreed Amount applies to Items
Replacement Cost applies to Items
Coinsurance
o
90% [Xl
100% Blanket Rate Effective
Causes of loss for which rates are requested:
Basic
o
o
Other (Specify)
Other (Specify)
)
o
[Xl
Special
Basic Coverage may apply to specified locations. Refer to the Schedule of Property Locations.
This statement of values form must be flied annually.
MEMBER:
All values submitted are accurate to the best of my knowledge and belief.
Authorized Signature
I I, s ! -::.~
I
Date
PROP-STMTVAL (1/93)
09/25/2002
Member'sP'roperty Schedule
City of Winter Springs, FMIT #0648
10/0112002 - 10/0112003
Locatlon# Address OccuDancy Construction Cause of ~~I Cause of Pers
Loc Bid LOSS LOss Efrml
001 001 1126 E. State Rd 434, WS Winter City Hall CompIex- City Hall Fire Resistive Special Form $2,662,717 Special Form $1,105,907
Springs,FL
001 002 1126 E. State Rd 434, WS Winter Gas Tank & Pump Non-Combustible Special Form $16,306 $0
Springs,FL
001 003 1126 E. State Rd 434, WS Winter Appex Utility Building Joisted Masonry Special Form $53,550 Special Form $52,500
Springs,FL
002 001 102 Moss Road, WS Winter Springs,FL Fire Station #24 - Fire House Fire Resistive Special Form $540,855 Special Form $138,100
002 002 102 Moss Road, WS Winter Springs,FL Antenna & Radio Tower Non-Combustible Special Form $2,285 $0
003 001 850 Northem Way, WS Winter Springs,FL Fire Station #26 - Fire House Joisted Masonry Special Form $400,336 Special Form $36,800
004 001 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - ConcesslonslP&R Joisted Masonry Special Form $309,472 Special Form $12,900
Office
004 002 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Maintenance Garage Non-Combustible Special Form $139,901 Special Form $84,000
004 003 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 22 Concrete Ught Non-Combustible Special Form $64,738 $0
Poles
004 004 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 152 Ballfield Non-Combustible Special Form $103,542 $0
Ughls
004 005 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 38 Single FIxt, Non-Combustible Special Form $47,242 $0
Site Ughting
004 006 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 11 Double Filet, Non-Combustible Special Form $14,998 $0
Site Ughting
004 007 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Irrigation Sys & Non-Combustible Special Form $119,023 $0
Pumps
004 008 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - New Soccer Cone Joisted Masonry Special Form $220,000 $0
StlRestrm
005 001 Torcaso Winter Springs,FL Torcaso Park - New Restrooms Joisted Masonry Special Form $127,000 $0
006 001 Moss Winter Springs,FL Moss Park - New Restrooms Joisted Masonry Special Form $120,000 $0
007 001 Trolwood Winter Springs,FL Trolwood Park - existing restrooms Joisted Masonry Special Form $84,000 $0
008 001 400 N. Edgemon Ave., WS Winter Senior Center Joisted Masonry Special Form $265,173 Special Form $59,000
Springs,FI:
008 002 400 N. Edgemon Ave., WS Winter Civic Center Joisted Masonry Special Form $192,441 Special Form $42,000
Springs,FI:
009 001 300 Moss Road, WS Winter Springs,FL Police Complex - Police Station Fire Resistive Special Form $1,186,069 Special Form $493,000
Page 1 of 4
09125/2002
Member'sF'roperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 -10/01/2003
Locatlon# Address Occuoancy Construction Cause of ~ Cause of Pers
LOSS Loss ~
Lac Bid ~
010 001 110 N. flamingo Ave. Winter Sprlngs,FL Public Works - Garage Joisted Masonry Special Form $154,530 Special Form $38,053
010 002 100 N. Flamingo Ave. Winter Sprlngs,FL Public Works - Utility Office Joisted Masonry Special Form $71,556 Special Form $80,000
011 001 N. 1st Street Winter Springs,FL Public Works - Storage Joisted Masonry Special Form $16,438 $0
012 001 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Digesters Fire Resistive Special Form $2,480,844 $0
Sprlngs,FL
012 002 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Chlroine Fire Resistive Special Form $219,300 Special Form $94,700
Sprlngs,FL Contact
012 003 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Filters Fire Resistive Special Form $37,026 Special Form $9,300
Sprlngs,FL
012 005 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Aerator Fire Resistive Special Form $128,214 Special Form $25,000
Springs,FL
012 006 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Plant Ops Fire Resistive Special Form $61,812 Special Form $200,000
Springs,FL
012 007 1560 Winter Springs Blvd, WS Winter East Wastewaler Plant #1 - Lift Station Non-Combustible Special Form $112,455 $0
Springs,FL
012 008 1560 Wlnler Springs Blvd, WS Wlnler East Wastewater Plant #1 - Reclaim Fire Resistive Special Form $481,134 $0
Springs,FL Water Tank
013 001 Sheoah Blvd, WS Wlnler Springs,FL Waler Plant #2'" Pump House Non-Combustible Special Form $138,433 $0
013 002 Sheoah Blvd, WS Winter Sprlngs,FL Waler Plant #2 - LP Gas Tank Non-Combustible Special Form $914 $0
013 003 Sheoah Blvd, WS Wlnler Springs,FL Water Plant #2 - Ground Level Tank Non-Combustible Special Form $238,663 $0
013 004 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Hydropneumatic Tank Non-Combustible Special Form $46,868 $0
013 005 Sheoah Blvd, WS Wlnler Springs,FL Water Plant #2 - Water Well Non-Combustible Special Form $20,397 $0
013 006 Sheoah Blvd, WS Wlnler Springs,FL Water Plant #2 - Well #6 Water Plant 2 Non-Combustible Special Form $174,962 $0
013 007 Sheoah Blvd, WS Winter Springs,FL Waler Plant #2 - Uft Station Non-Combustible Special Form $129,753 $0
013 008 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible Special Form $97,654 $0
014 001 1000 W SR 434, WS Winter Springs,FL West Wastewater Plant #2 - Water Plant Fire Resistive Special Form $1,985,480 $0
015 001 Bahama Rd, WS Winter Springs,FL Water Plant #3 - LP Gas Tank Non-Combustible Special Form $914 $0
015 002 Bahama Rd, WS Wlnler Springs,FL Water Plant #3 - Ground Level Tank Non-Combustible Special Form $238,663 $0
015 003 Bahama Rd, WS Winter Springs,FL Waler Plant #3 - Water Well Non-Combustible Special Form $19,789 $0
Page 2 of 4
09/2512002
Member's ~toperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/0112003
Locatlon# Address OCCUDancv Construction Cause of ~ Cause of Pers
Loc Bid Loss Loss b'iml
015 004 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Plant Fire Resistive Special Form $336,362 $0
015 005 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Chlorinator Building Fire Resistive Special Form $66,309 $0
016 001 851 Northern Way Winter Springs,FL Water Plant #1 - E. Water Plant Op. Bldg Are Resistive Special Form $128,n5 Special Form $75,000
016 002 851 Northern Way Winter Springs,FL Water Plant #1 - Chlorine Handling Fire Resistive Special Form $63,257 $0
Facility
016 003 851 Northem Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0
016 004 851 Northem Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0
017 001 Indian Ridge Seminole Winter Springs,FL UftStatlon Non-Cornbustible Special Form $85,898 $0
018 001 David Street Winter Springs,FL Uft Station Non-Combustible Special Form $76,104 $0
019 001 Hacienda Village Winter Springs,FL Uft Station Non-Combustible Special Form $58,473 $0
020 001 Tanglewood Drive Winter Springs,FL Uft Station Non-Combustible Special Form $91,7n $0
021 001 S. Edgemon Ave Winter Springs,FL Uft Station & Fence Non-Combustible Special Form $343,598 $0
022 001 Panama Circle Winter Springs,FL Uft Station Non-Combustible Special Form $63,446 $0
)23 001 Alton & Mockingbird Winter Springs,FL Uft Station Non-Combustible Special Form $89,667 $0
)24 001 E. ofWetiand 1000's Winter Springs,FL Uft Station Non-Combustible Special Form $53,045 $0
)25 001 Club Drive Winter Springs,FL Uft Station Non-Combustible Special Form $56,228 $0
)26 001 Dolphin Road Winter Springs,FL Uft Station Non-Combustible Special Form $56,228 $0
)27 001 Papaya Lane Winter Springs,FL Uft Station Non-Combustlble Special Form $33,462 $0
l28 001 Sybllwood Circle Winter Springs,FL Uft Station Non-Cornbustlble Special Form $26,989 $0
129 001 Tuscany Place Winter Springs,FL Uft Station Non-Combustible Special Form $34,095 $0
130 001 Winter Springs Blvd. Winter Springs,FL Uft Station Non-Cornbustible Special Form $50,605 $0
131 001 Northem Way Winter Springs,FL Uft Station Non-Combustlble Special Form $28,500 $0
132 001 Wood Duck Drive Winter Springs,FL Uft Station Non-Combustible Special Form $41,046 $0
133 001 Seneca Blvd Winter Springs,FL Uft Station Non-Combustible Special Form $65,224 $0
134 001 Seheca Blvd Winter Springs,FL Uft Station Non-Combustible Special Form $46,107 $0
'35 001 Trotwood Blvd Winter Springs,FL Uft Station Non-Cornbustible Special Form $44,982 $0
Page 3 of 4
09125/2002
Member's t-'roperty Schedule
City of Winter Springs, FMIT #0648
10/0112002 - 10/0112003
Locatlon#
Loe Bid
Address
Occuoanev
Construction
Cause of
LOSS
~~ft
Cause of
Loss
Pers
rr~G
036
037
038
039
040
041
042
001 Seneca Blvd & Chaise Winter Springs,FL
001 Shepard Rd. Winter Springs,FL
001 Cheny Creek Circle Winter Springs,FL
001 VlStawllla Drive Winter Springs,FL
001 Nandlna Terrace Winter Springs,FL
001 Winter Springs Blvd Winter Springs,FL
001 Various Winter Springs,FL
Uft Station
Uft Station
Uft Station
Uft Station
Uft Station
Oak Forest Wall
Tuscawllla Ughting and Beautification
ImprovementS
Non-Combustlble
Non-Combustlble
Non-Combustlble
Non-Combustible
Non-Combustible
JoIsted Masonry
Non-Combustlble
Special Form
Special Form
Special Form
Special Form
Special Form
Special Form
Special Form
$45,955
$46,589
$57,674
$45,010
$49,802
$500,000
$2,000,000
$18,687,980
$0
$0
$0
$0
$0
$0
$0
$2,546,260
Total:
Page 4 of 4
0912512002
---
.y:'
I'LOlUDA YUlUotl'u. U.UlWJCII mUST FtC' 09-1
(ReviSed 2/97)
APPLICATION I'OR DaUG-.... wouPLAcZPltIMlUW cUD:tT'1'aOGMH
<::1 ty . ofWint.rS~r,inC}Js tl'MtT 64a ~
Name of Member:
Date ProgrciD\ Implemented: . July. ~, 1,'996
2002/2003
1. TESTING:
Drug testing has been conducted in the following areas:
181
181
Job applications
181
181
Routine fitness for duty
Follow-up to Eltnployeehlsistance Program
Reasonable suspicion
181
11. NOTICE 01' ~""SJjl\UG a$"PfG POlalCY:
II
Show not;J.ce of drug testing on vacancy
announcements
181
181
181
Copy ~o all employees prior
to te'sting
~.l
Posted onenaploy.r's premises
Copy to job applicants pdor to
testing
General notieegiven 60 days
prior to testing
Copies av.ilable in pe.tt'sonnel office or
other su,ttableloeations.
No notice r.qu!red because the employer
had a d1;'ug testing pro<}ram in place prior
to July 1,1990 .
1m
HIA
XII. BJ)UCATION:
181
181
lV.
A.
B.
Resource file on Providers
II
l!:ducatiOJ1 '
Employee ASAJistance Prog.1:aIn
1Wm 01' .M&DXCAL UVl&W Ol'l':tc&a: D..O.1'.stop'MeClieal Review. Officer, JockSneedon,
~L9484S. .'. O'81'f. ,OtlandQ,. .!$32,8$7.. (407). 857-5573
~ ..
He..1tbCare Adrni..nj.,st:rationLab or United' States
Services Ce2ttifiec:i taboratoJ:Y:
Rameof approved Agen.cY.for
. Department of Health . and H:I1ma."
~erican Medical ~orato~ies
) .
Phone #:
( 407 )857-81$8
C. Address: 8549 parkline~lvd., O):f~~' "l'J.; 32$09
ALJo. I~HUST . ~L:J:_ 1I1'tH IN 0.. 1'0_ a~G:t"1'O!l 'tBJl. CNlD1:T.
SPECIAL NoTB:
)
'/' .
Any person who kn~winqly and with intent to injure, defraud, or de~eix~vany ins~rer files
a statement of claim .or an application containing !ii>lete, or rrddeading
informatioi;l is guilty of a felony of the tbird<ie9re.
November lZ,2002
Date
a1
City of Winter Spdngs
Member Name .
.",J
Mayor
. Ti t.t~
ii.
:; i>.
TH~ ABOVE SIGNED CERTIFltS THAT THIS !NFO~TIOt.r ;(SA rPit1E ANn FAC'+UlUi D'E.PICTION OF THEIR
CURRENT PROGRAM. ' ,
*Appli ation must be signed by an ele<;:tedoff.:l.cial or
t
November 12, 2002
Date
-
-
'.
FLORIDA MUNICIPAL INSURANCE TRUST
APPLlCAnON FOR EMPLOYER WORKPLACE
SAFETY PROGRAM PREMIUM CREDIT
Member Name:
Contact Person:
Policy #:
C~ of Winter Springs
Ms. Louise Franghoul
FMIT 648
Telephone: 407-327~1800
Effective Date of Policy: October 1, 2002
I am submitting a copy of my wor1q)lace safety program that meets the requirements of the Florida
Occupational Safety and Health Ad, Chapter 93-415, 552-74, Laws of Florida, and Rule 381-17 of the
Florida Administrative Code. I certify that this safety program has been implemented in my wor1q)lace and is
being maintained as submitted to my carrier.
This is to certify that my workplace safety program meets or exceeds the following provisions as provided
for in R\Jle 381-17:
1) ", Management Commitment to safety
2) Safety Committee
3) Safety and Health and Training
4) Safety Rules, Policy and Procedures Requirements
The workplace safety program and application I am submitting for the purpose of obtaining a premium credit
do not contain any misleading or untrue information. I am aware that I may .be subjed to an on-site
inspection by the Florida Department of Labor and Employment Security, Dlvislof) of Safety, or my carrier,
for the purpose of validating the accuracy of this information.
5)
6)
7)
Accident Prevention
First-Aid Procedures
Record Keeping
I am aware that if I knowingly and willfully falsify or conceal a material fad, make a false, flditious or
fraudulent statement,or representation; or make or use any false document knowing the document to
contain any false, flditious or fraudulent entry or statement to my carrier or workers compensation Insurance
under Chapter 442, Florida statutes, I will be guilty of a misdemeanor of the second degree, punishable as
provided In sections 775.082 or 775.083, Florida Statutes, and will be subjed further to a penalty in the
amount of $500 a day, not to exceed $50,000 for each occurrence; and
I am also aware that if I, In any matter within. the jurisdiction of the division, knowingly and willfully falsify or
conceal a material fad, make any false, flditious, or fraudulent statement or representation, or make or use
any false document, knowing the same to contain any'false, fictitious, or fraudulent entry, that I commit a
misdemeanor of the second degree, punishable as provided In sections 775.082 or 775.083, Florida
Statutes. Moreover, I understand that an employer Who commits such an act will be subjed further to a
penalty in the amount of $500 a day,not to exceed $50,000 for each occurrence.
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.
Effedive date of premium credit October 1 , 2002
City of Winter Springs
Member Name
/ / - 8 s--~ 0 ~
Date
;e~iJ1tl~ .
. *Eleded Official or Other Official
~~
mu be signed by an eleded official or other official.
(If )d"d-
. s Signature D~
ANDREA LORENZO-LUACES
C 831831
: May 0, 2003
1-8QO:3.NOl'AlW fi", l'Il*1lly8elYlca& ~ Co.
~;iy of . j,J,~t.r fi~tjS .
lo u ;S~ Fr.IJ~ D I.f. J
PHONE:
'10732.. 7./fp{)
In anIet ID assure that your safely and heallh pagram meets the requirements d the Slalie. d Florida, Oepertment d Labor Md Employment Secwlty, 0Msi0n d s.tety, SlIfety pagl1lm guidelines, the
fallawjng plOIIisions should be in pllIce: ... .
1, MAIWIEMUT COIIIMITM8NT AND INVOLVEMIJlT: ~ 11 & 12 d 381-17.008 ComplJ,nce Publication PlIIt II).
...... you issued and communicatlld ID lIll employees a mll!!D policy stel8ment? . XYES a NO
Comments:
Does your policy atIllIrMnt cont:elne tile followlng:
... A clev viM d menegement's comm~ ID uIety?
Comments:
b. Managemenl'S position on safety fundlng7
Comments:
Co Employee's rights when wafk ill considelwd UftlIlIfe7 ..
Comments:
d. OIsciplinely procedU18S lot violation d SlIfety Nles7
Comments:
e. Does your safely pollc:y ....ign and communicatlt in writing the A1Sponsibility for the implementation d )'OUt'SlIfIlly pagram1 )(YES a NO
rYES a NO
~YES aNO
)llYES aNO
)(YES 000
Comments:
f. Does your SlIfllly pagram indicatlt how rnanegement ill adIveIy per1lcipetlng in:
s.fety committHs, SlIfety education and lIIIining, and establishment of safety NI.., policies and ~7 )( YES a NO
Comments:
2. 8AI'In"Y c:..-, ....a: (Pages.12lhrough 14 of 381-17.006 Compliance Publlc:alion Part II),
Rule 381-17 specifically IlddAISses the requi_ of tile SlIfllly commitllM med....p for your paogram. HINe you edcIIessed the following:
.. The fonmdlon of ~ sahity commibe7 Jl{YES a NO
Comm-=
b.
Assured that your commibe is made up d botII menagement and em~7
)(YES aNO
Comments:
Co
Assured that thel8lio d thill commilllle ill such that employees have an eql!al number d, or ~ rep~tIves tIIen tile emp\0yer7 a YES
Ale. . AI'<c.. . -f,..y~ ~1) "'c(:v~/~ -#J,J r..+,g
Scheduled meetings, ~ quaaterty? ~ YES a NO
~
Comments:
d.
Comments:
eo
Assuntd that I8Cl>RIs of meetings .,. recorded and maintained for at 1_ "'.... ~1
)(Yes a. NO
Comments:
f. EstabIlshed paocedUIWS for inspections ID ~uata tile ---- d your ~1 a YES. /J(NO. 0 I ..J.
.Comments: ~_ ."..., r JilcuJ.J ~A.su~e~f~ ""S 14.!. "",:,~~l reu,.d 41 "'~;~ea4lf..
g. Established paocedures lot ilMlSligating all accidents,. safety relallld incidents, iII.- and f1Italities7 )(YES a NO
Comm-=
h. Established pIOC8dures lor evaluating and recommending im~ ID employee's ac:cidenl and illness preYlIlIlion in tile ~7 )('rr.._ JiI' '
Comments:
established and communicated procedures for training committee m1J"beas and ..-ring that this lIIIining ill acc:ompllshed7 J
Com_: Cl/r,.-e""-+!VCAr1J1~ CJ1.J&.I/v A (/ -Ir~1 ~ I J ~c.cb",?,hjk~
j. establishing paocedures ll:l 8SlIU1e minutes of !!! committee meetings are communialllld 110 !!! employees7 a YES
Comments: Ne.. ~/I) W/)/L d:lyl~~ lIoN -I~ ~~ /~t'lJcei1i'v,;'tJ
aYES
J!NO
J(NO
AND HEALTH TftAlNING: ("-lIes 14 & 15 al38I-17.008 Compl__ Publication Part II).
. .
Haw ~ Implen\elacl Alety and hnllh IIUring Ill_Includes at. minimum Ill. folklwing:
a. Safety orientation on Nlas, policlas and ptaeadur-. )( YeS 0 NO
,I
I
I
l
Comments:
b. Job specillc pn)ceduras tot ... new employeas? AC YeS
Comments:
ONO
c.
Job sDe9ific trainina lor employaa before lIley are aalgnad lhair job !uk? )fi(YES
ONO
Comments:
d.
Comments:
Periodic retainin9a1 employeeS on ~ safety Nlas, pollcIas, and plOClldurw?
)(yes
ONe
4. I'lIlST AID 1'ft00000RU: (Pages 15 & 18 al38l-17.008 CompllallCll Publlcallon Part 11).
Haw you ..mbllshed First Aid PfOC8du/eS far first aid and medical saMces lIl81 includes 81. minimum tile lollowiilg:
..
AVIIllablllty aI .pproved First Aid Kits, ar Fim Aid facilities III all employees? )Q YES
ONe
Comments:
b.
Comments:
Fim. Aid training lor employees in Ilne witlllIle poIIential hazanl allIlait warkplace .nd ltIair ~ envinlnmant?
"'YeS
ONe
c..
POlIting of emelgeflCy t8tephane numbers .nd lIleleaehlng olllOlSily undenIlIood procedures?
ll(YeS
ONe
Comments:
50 ACCIDENT INVIISTlGATlON: (Pao-18 lhlough 18 at 381-17.008 Compliance Publication Part II).
Haw you established. pIOCadUI1l requiring lIla investigallon of tile fallowing:
.. AccIdents: )I YeS 0 Na
Comments:
II.
Injuries:
)( YeS
ONa
Comments:
c.
Occupllllonal disaaes:
~YeS
ONa
Comments:
d. AI1I all allIle .bove farms and reconIa l1IVlawad by lIle safety commillM?
Comments: . Dt'Arf~ t f'~N,s.e~IIO-}'lie.J
.. Con lIle safety commiIIM inillllta racommandatlons baed on lIla aboVII?
Comments:
~YES
ONO
~YES
ONO
t.IUICORDKEEP1NG 'ROC1!DUR&S: (Page 18 al38I-17.008 CompllallCll Publication Part II).
Have you:
..
established rec:ordIcHping pftlCadunls III contnIl and maintain all accident and injury .-ds?
~YeS
ONa
Comments:
b..
Mad. pnMsions 1D _re .n reconIa are retained far 1Il_ years?
,,-YES
ONO
Comments:
II~ n. ....m ....... beloW an __ ,..,u tIIat _ lie ......Ill....
1. DIvtslo. fit SaMy, Lot .... .....ry ", Oeea........ hIIartas, D.......... ----
Z. ........ of h1jary (LEa I'ORM DWC-11
7.
8AI'IETY RULliS, I'OUCIES AND I'ftOCEDURBS: (p.lIe 18 ol381-17 Complillnce Publication Part II.
1. HaVe you developed . safety m.nual containing .11 wotkplace safety Nles, policies. and pIOClIdures?
Comments:
"ves
ONO
2. Is tile above manual updated wilen changes in tile ~ ar woik envi.....ment occurs? )q YES 0 NO
Comments: -f'.t!Co;,f:e; -1-0 J}~",,-j,,,,~1Ir1
3. 00 lIle above safety Nles includ. bolh general and job specific NIes? ~ YES Q NO . J
Comments: SON1Co d~A,...j~41 J':e.t.):f,~ rV&J ~~c. ~n-lA;"'~/l 1-1-
JI......nd...,J 9'I!/I;t~:Y CV/~dl;' c.../-
;J~~~e~-I
,
J..
re of "- CompIring tills Fonn: """--
~_~. · /l. X~.. .... p.r...c;,."e-t
.~t-(/ /
er
J~/' 11 /~ . 1"'\
3
0 Administration/
Marketing
0 Risk Control
if Underwriting
Property & Casualty
Health
Post Office Box 530065
125 East Colonial Drive
Orlando, FL 32853-0065
800-445-6248
407-425-9142
Suncom 344-0725
Fax 407-425-9378
0 Health Claims
Post Office Box 538140
Orlando, FL 32853-8140
800-756-3042
407 -245-0725
Suncom 344-0725
Fax 407-425-9378
0 Workers'
Compensation Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Property & Liability
Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
FLORIDA LEAGUE OF CITIES, INC.
PUBLIC RISK SERVICES
October 28, 2002
Ms. Louise Franghoul
Director of Finance
City of Winter Springs
1126 East State Road 434
Winter Springs, FL 32708
Re: Position Schedule Bond 103940482
Dear Ms. Franghoul:
Attached please find your Position Schedule Bond as requested. The Bond is for
your files. As this policy is continuous in nature, only an annual billing will be issued
each year at renewal.
If you have any questions, please do not hesitate to contact me.
~
Valerie M. Morrison
UndelWriting Assistant
VMM/vmm
Enclosure
Florida Municipal Insurance Trust
',',lPf:
I" A
Name
Position
Employed at
Amount of
Guarantee
Premium
.
1 Finance Director City of Winter Springs $100,000 $591.00 10/01/02
S-1560-B (08-99)
"'11'~~
rf.. .
, '- ~
~
.
FORMS SCHEDULE
FLC UNDERWRITING
NOV 1 2 2002
RECEIVED
Named Insured: CITY OF WINTER SPRINGS
Policy No:FPL 8084255
Effective 12:01 A.M. November 9. 2002
END # Form Name
Form Numberl
Edition Date
DECLARATIONS PAGE 56100 7/93
1 COVERED LOCATIONS 60298 5/94
2 CANCELLATION/NON-RENEWAL 76105 5/00
3 INDEPENDENT COUNSEL 59048 11/93)
4 CROSS LIABILITY EXCLUSION 58052 7/93)
5 EXTENDED REPORTING ENDORSEMENT 74623 11/99
6 OTHER INSURANCE ENDORSEMENT 74622 11/99
7 STORAGE TANK ENHANCEMENT ENDORSEMENT 74553 11/99
8 DATE RECOGNITION ENDORSEMENT 70632 5/98)
9 PER LOCATION LIMITS OF LIABILITY 60300 5/94)
NOTICE OF LOSS/NOTICE OF CLAIM N/A
POLICY TERMS & CONDITIONS 56101 (7/93)
~- ~---~~--:--
0(' '"
, - .,.
COMMERCE AND INDUSTRY INSURANCE COMPANY
70 PINE STREET
NEW YORK, N.Y. 10270
STORAGE TANK THIRD-PARTY LIABILITY,
CORRECTIVE ACTION AND CLEANUP POLICY
NOTICE: THIS IS A CLAIMS-MADE AND REPORTED POLICY. AMOUNTS INCURRED FOR LEGAL
DEFENSE SHALL BE APPLIED AGAINST THE DEDUCTIBLE AMOUNT AND ALSO SHALL REDUCE
THE SEPARATE LIMIT OF LIABILITY AVAILABLE TO PAY LEGAL DEFENSE COSTS COVERED BY
THIS INSURANCE.
PLEASE READ CAREFULLY
POLICY NUMBER: FPL8084255
REN/NEW: R
DECLARATIONS
Item 1: NAMED INSURED
ADDRESS
CITY OF WINTER SPRINGS
1126 SR 434 EAST
WINTER SPRINGS, FL 32708
Item 2: POLICY PERIOD: FROM November 9, 2002 TO November 9, 2003
12:01 a.m. standard time at the address of the named insured shown above
Item 3: LIMIT OF LIABILITY, up to
$1,000,000
$1,000,000
Each Incident
Aggregate Limit
Item 4: DEDUCTIBLE
$10,000
Each Claim
Item 5: COVERED LOCATION(s):
See Covered Location(s) Endorsement.
Item 6: COVERED UNDERGROUND STORAGE TANK SYSTEM(s) AND OR ABOVEGROUND
STORAGE TANK(s): See Covered Location(s) Endorsement.
Item 7: RETROACTIVE DATE:
November 9, 1995
Item 8: POLICY PREMIUM
$1,405
Broker: Morefar Marketing, Inc.
501 Carr Road
Wilmington, DE 19809
p,.w ,,~,,-~
AUTHORIZED REPRESENTATIVE
or countersignature (where required by law)
56100(7/93)
>F:lTJ["Y:~'~
pl" --",- ,....
-.~----------~
.. ,.
.
r'
ENDORSEMENT NO.1
. This endorsement, effective 12:01 AM, November 9,2002
Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
COVERED LOCATIONS UNDERGROUND STORAGE TANKS
AND ABOVEGROUND STORAGE TANKS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT
CAREFULLY
It is hereby agreed that Item 5 of the Declarations, Covered Location(s), and Item 6 of the Declarations, Covered
Underground Storage System(s) and Aboveground Storage Tank(s), shall include only the following:
.SEE ATTACHED APPENDIX- A SCHEDULED LIST OF SITESITANKS.
All other terms, conditions and exclusion remain the same.
j2~ "~~a_~,
AUTHORIZED REPRESENTATIVE
or countersignature (where required by law)
60298(5/94)
( t
t APPENDIX A-LIST OF SCHEDULED SITESIT ANKS
APPENDIX TO ENDORSEMENT #1 FORM# 60298(5/94)
NAME INSURED: CITY OF WINTER SPRINGS
POLlCY#: FPLBOB4255 EFFECTIVE: 11-9-02
SCHEDULED LOCA TIONS
LOCA TION# 1 TANK CAPACITY AST/UST CONTENT INSTALL DA TE
WINTER SPRINGS, CITY PUBLIC TANK#1 1000 AST DIESEL 1995
WORKS
1 ST ST & N FLAMINGO AVE
WINTER SPRINGS, FL
DEP#8520773
RETRO DATE:11/9/95
LOCA TION# 2 TANK CAPACITY AST/UST CONTENT INSTALL DATE
WINTER SPRINGS, CITY POLICE TANK#1 10000 UST UNLEADED GAS 1985
DEPT
1126 SR 434 E TANK#2 1000 UST FUEL-GENERATOR 1985
WINTER SPRINGS, FL
DEP#8731664
RETRO DATE:11/9/95
LOCA nON# 3 TANK CAPACITY AST/UST CONTENT INSTALL DA TE
WINTER SPRINGS CITY LIFT TANK#1 2000 UST FUEL-GENERATOR 1989
STAT. #7
EDGEMON AVE
WINTER SPRINGS, FL
DEP#8944283
RETRO DATE:11/9/95
LOCA TION# 4 TANK CAPACITY AST/UST CONTENT INSTALL DA TE
WINTER SPRINGS CITY WATER TANK#1 2000 AST FUEL-GENERATOR 1996
& SEWER
851 NORTHERN WAY
WINTER SPRINGS, FL
DEP#9045575
RETRO DATE:11/9/95
:Jl'l'''''~
LOtATION# 5 TANK CAPACITY AS T/UST CONTENT INSTALL DA TE
WINTER SPRINGS CITY WATER TANK#1 1000 UST FUEL-GENERATOR 1987
& SEWER
1000 W SR434
WINTER SPRINGS, FL
DEP#9300098
RETRO DATE:11/9/95
LOCA T10N# 6 TANK CAPACITY AST/UST CONTENT INSTALL DA TE
WINTER SPRINGS CITY WRF TANK#1 2000 AST FUEL-GENERATOR 1996
1560 WINTER SPRINGS BLVD
WINTER SPRINGS, FL
DEP#9601163
RETRO DATE:11/9/95
LOCA TION# 7 TANK CAPACITY AST/UST CONTENT INSTALL DATE
WINTER SPRINGS CITY PUBLIC TANK#1 750 AST FUEL-GENERATOR 1997
SAFETY
300 N MOSS RD
WINTER SPRINGS, FL
DEP#9701186
RETRO DATE:11/9/95
>-,,-'~.
'-
f
AMENDATORY ENDORSEMENT NO: 2
This endorsement, effective 12:01 AM, November 9,2002
Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
FLORIDA CANCELLATION/NONRENEWAL ENDORSEMENT
Wherever used in this endorsement: 1) "we", "us", "our", and "Insurer" mean the insurance company
which issued this policy; and 2) "you", "your", "named Insured", "First Named Insured", and "Insured"
mean the Named Corporation, Named Organization, Named Sponsor, Named Insured, or Insured stated
in the declarations page; and 3) "Other Insured(s)" means all other persons or entities afforded coverage
under the policy.
It is hereby agreed and understood that the cancellation provision of this policy is to be deleted in its
entirety and to be replaced with the following:
A. The Insured shown in the Declarations may cancel this policy by mailing or delivering to
the Insurer advance written notice of cancellation.
B.1. Cancellation for Policies in Effect Ninety (90) Days or Less
If this policy has been in effect ninety (90) days or less the Insurer may cancel this policy by
mailing or delivering to the Insured written notice of cancellation, accompanied by the reasons for
cancellation, at least:
a) Ten (10) days before the effective date of cancellation if the Insurer
cancels for nonpayment of premium; or
b) Twenty (20) days before the effective date of cancellation if the Insurer
cancels for any other reason, except the Insurer may cancel immediately
if there has been:
1. A material misstatement or misrepresentation; or
2. A failure to comply with underwriting requirements
established by the Insurer.
B.2. Cancellation for Policies in Effect for More Than Ninety (90)
Days.
If this policy has been in effect for more than ninety (90) days the Insurer may cancel this
policy only for one or more of the following reasons:
a) Nonpayment of premium;
b) The policy was obtained by a material misstatement;
c) There has been a failure to comply with underwriting requirements
established by us within ninety (90) days of the effective date of
coverage;
d) There has been a substantial change in the risk covered by the policy; or
e) The cancellation is for all insureds under such policies for a given class
of insureds.
76105(5/00)
,~
i
If the Insurer cancels this policy for any of these reasons, the Insurer will mail or
deliver to the First Named Insured written notice of cancellation, accompanied by
the reasons for cancellation at least:
1. Ten (10) days before the effective date of cancellation if
cancellation is for the reason stated in 2(a) above; or
2. Forty-five (45) days before the effective date of
cancellation if cancellation is for the reasons stated in
2(b), (c), (d) or (e) above.
The following is added.
C.1. Non-Renewal
a). If the Insurer decides not to renew this policy the Insurer will mail or deliver to the
Insured written notice of nonrenewal, accompanied by the reason for
nonrenewal, at least forty-five (45) days prior to the expiration of this policy.
b). Any notice of nonrenewal will be mailed or delivered to the Insured's last mailing
address known to the Insurer. If notice is mailed, proof of mailing will be
sufficient proof of notice.
C.2. Renewal
a) The Insurer shall give the named insured at least forty-five(45) days' advance
written notice of the renewal premium.
All other terms, conditions and exclusions remain the same.
p,.,l", ,,~~~-~
AUTHORIZED REPRESENTATIVE
Or countersignature (where required by law)
76105(5/00)
7'';Sji2~(:'i.~~'/'':
ENDORSEMENT NO.3
This endorsement, effective 12:01 AM, November 9,2002
Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
INDEPENDENT COUNSEL
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
In the event the INSURED is entitled by law to select independent counsel to defend the INSURED at the Company's
expense, the attorney fees and all other litigation expenses the Company must pay to that counsel are limited to the
rates the Company actually pays to counsel the Company retains in the ordinary course of business in the defense of
similar claims or suits in the community where the claim arose or is being defended.
Additionally, the Company may exercise the right to require that such counsel have certain minimum qualifications
with respect to their competency including experience in defending claims or suits similar to the one pending against
the INSURED and to require such counsel to have errors and omissions insurance coverage. As respects any such
counsel, the INSURED agrees that counsel will timely respond to the Company's requests for information regarding
the claim or suit.
Furthermore, the INSURED may at anytime, by its signed consent, freely and fully waive its right to select
independent counsel.
All other terms, conditions and exclusions remain the same.
fZ,6.I "4.~rt~
AUTHORIZED REPRESENTATIVE
or countersignature (where required by law)
59048(11/93)
- ---_.__.----.~-
ENDORSEMENT NO.4
This endorsement, effective 12:01 AM, November 9,2002
Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
CROSS LIABILITY EXCLUSION
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
It is hereby agreed that this insurance does not apply to any Claims made by any Insured against any other person
or entity who is also an Insured under this policy.
f1,6.1 ".i:.~6_~,
AUTHORIZED REPRESENTATIVE
58052(07/93)
~~-
-t>Y.'::~<;f:~
ENDORSEMENT NO. #5
This endorsement, effective 12:01 AM, November 9,2002
Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
EXTENDED REPORTING PERIOD ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
1. It is agreed that Section VI. EXTENDED REPORTING PERIOD, is deleted in its entirety and replaced with the
following:
VI. EXTENDED REPORTING PERIOD
The Named Insured shall be entitled to an Automatic Extended Reporting Period, and be entitled
to purchase an Optional Extended Reporting Period upon termination of coverage as defined in
paragraph B of this Section. Neither the Automatic nor the Optional Extended Reporting Period
shall reinstate or increase the limit of liability shown in Item 3 of the Declarations as applicable to the
"Aggregate Limit" of this Policy.
A. Automatic Extended Reporting Period
Provided that the Named Insured has not purchased any other insurance to replace this insurance
which applies to a Claim otherwise covered hereunder, the Named Insured shall have the right to a
period of sixty (60) days following the effective date of such termination of coverage in which to
provide written notice to the Company of Claims first made and reported within the Automatic
Extended Reporting Period.
A Claim first made and reported within the Automatic Extended Reporting Period will be deemed
to have been made on the last day of the Policy Period, provided that the Claim arises from a
Pollution Condition that commenced before the end of the Policy Period and is otherwise covered
by this Policy. No part of the Automatic Extended Reporting Period shall apply if the Optional
Extended Reporting Period is purchased.
B. Optional Extended Reporting Period
The Named Insured shall be entitled to purchase an Optional Extended Reporting Period upon
termination of coverage as defined herein as follows:
1. A Claim under which is first made and reported during the Optional Extended Reporting
Period, if purchased in accordance with the provisions contained in Paragraph 2 below,
will be deemed to have been made and reported on the last day of the Policy Period if
the Claim arises from a Pollution Condition which commenced on or after the
Retroactive Date shown in the Declarations and before the end of the Policy Period.
2. The Company shall issue an endorsement providing an Optional Extended Reporting
Period of up to forty (40) months from the date of the termination of coverage hereunder
for all locations designated in Item 5 of the Declarations if the Policy is cancelled or
non renewed, or any specific location listed in the Declarations, if coverage for that
specific location is terminated during the Policy Period. The Named Insured must:
a. make a written request for such endorsement which the Company receives within
thirty (30) days after termination of coverage as defined below; and
74623(11/99)
~..1'i:1';;
b. pay the additional premium when due. If that additional premium is paid when
due, the Optional Extended Reporting Period may not be canceled, provided
that all other terms and conditions of the Policy are met.
3. Termination of coverage occurs:
a. At the time of cancellation or nonrenewal of this Policy by the Named Insured or
by the Company; or
b. At the time of the deletion of a listed location in the Declarations from this Policy
by the Company at the Insured's written request, but solely with respect to such
location;
4. The Optional Extended Reporting Period is available to the Named Insured for not
more than 100% of the Policy premium.
2. For purposes of coverage under this Endorsement, the following definition is added to Section III.
DEFINITIONS:
Extended Reporting Period means either the automatic additional period of time or the optional
additional period of time, whichever is applicable, in which to report Claims following termination of
coverage, as described in Section VI. of this Policy.
All other terms, conditions and exclusions shall remain the same.
fl,.t", "~~fr~^
AUTHORIZED REPRESENTATIVE
or countersignature (where required by law)
74623(11/99)
"T-ii11
,~----------:------; --jfi~
ENDORSEMENT NO. #6
. This endorsement, effective 12:01 AM, November 9,2002
Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
AMENDMENT TO OTHER INSURANCE CONDITION ENDORSEMENT (THIS INSURANCE IS
EXCESS OVER STATE TANK FUNDS)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
It is hereby agreed that Section VIII, CONDITIONS, Paragraph I is deleted in its entirety and replaced
with the following:
I. Other Insurance - Where other insurance, or funds from any Tank Fund, is available to the
Named Insured for Losses or for costs for Corrective Action or Cleanup covered under the
terms and conditions of the Policy, the Company's obligation to the Insured shall be as follows:
1. This insurance shall apply as excess insurance over any other valid insurance, whether
collectible or not, be it primary or excess. This excess insurance shall in no way be
increased or expanded as a result of the receivership, insolvency, or inability to pay of
any insurer with respect to both the duty to indemnify and the duty to defend.
2. Where this insurance is excess over any other valid insurance, the Company will pay only
its share of the amount of Loss and covered costs for Corrective Action or Cleanup, if
any, that exceeds the total amount of all such valid insurance, whether collectible or not.
3. This insurance shall also apply as excess insurance over any Tank Fund, provided that
in the event of the receivership, insolvency, or inability to pay of any state fund or
program, this insurance shall act as primary insurance.
The Insured shall promptly upon request of the Company provide the Company with copies of all
policies potentially applicable against the liability covered by this Policy.
For purposes of this endorsement, the following definition applies:
Tank Fund means any state storage tank trust fund, state administered insurance program,
restoration (corrective action) funding for storage tanks whose owners qualify for reimbursement,
or any self insurance fund established for the purpose of funding Corrective Action or Cleanup
for Pollution Conditions from Underground Storage Tank Systems or Aboveground Storage
Tanks.
All other terms, conditions and exclusions shall remain the same.
f1~Jt~,,~~
AUTHORIZED EPRESENTATIVE
or countersignature (where required by law)
7 4622( 11/99)
~
ENDORSEMENT NO. #7
This endorsement, effective 12:01 AM, November 9,2002
. Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
STORAGE TANK THIRD PARTY LIABILITY. CORRECTIVE ACTION AND CLEANUP
BROADENING ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
It is hereby agreed that the Policy is amended as follows.
1. Section I, INSURING AGREEMENT, Coverage D: DEFENSE is deleted in its entirety and
replaced with the following:
COVERAGE D: DEFENSE.
The Company shall have the right and the duty to defend the Insured against any Claim under
Coverages A, B or C provided such coverage has been purchased. The Company's duty to defend
or continue defending any such Claim shall cease when the "Aggregate Limif' as described in
Section V. LIMITS OF LIABILITY AND DEDUCTIBLE, has been exhausted by the payment of Loss
or costs for Corrective Action or Cleanup.
2. Section II, CLAIM PROVISIONS, paragraph A is deleted in its entirety and replaced with the
following:
A. It is a condition precedent to coverage under this Policy that:
1. NOTICE OF CLAIM:
Coverage A.: In the event of a Claim under Coverage A., the Insured shall
give the Company's representative as identified in this paragraph written notice
as soon as possible after receipt of the Claim by the Insured.
Coverage B.: In the event that a Pollution Condition has taken place which
the Insured has verified as a Confirmed Release, the Insured must submit a
Claim under Coverage B., in writing, as soon as possible after verifying the
Confirmed Release.
Coverage C.: In the event the Insured is issued a Governmental Order
requiring Cleanup, the Insured must submit a Claim under Coverage C., in
writing, as soon as possible after receipt of the Governmental Order.
All Claims under Coverage A., Coverage B. and Coverage C. shall be reported
to:
Division Attorney - Pollution legal Liability
Commerce and Industry Insurance Company
175 Water Street, 1ih Floor
New York, New York 10035
&
Home Office Senior Supervisor, Pollution legal Liability
AIG Technical Services, Inc.
Environmental Claims
80 Pine Street
New York, New York 10005
or other address(es) as substituted by the Company in writing.
74553(11/99)
j 3. Section III. DEFINITIONS, paragraph A. Aboveground Storage Tank; paragraph B. Bodily Injury;
paragraph H. Environmental Laws; and paragraph R. Underground Storage Tank are deleted
in their entirety and replaced with the following, respectively:
A. Aboveground Storage Tank means a stationary device on, within, or under a location
designated in Item 5 of the Declarations and that is designated in Item 6 of the
Declarations:
1. designed to contain an accumulation of hazardous waste, waste product,
petroleum product or any other product, which is constructed primarily of non-
earthen materials (e.g., wood, concrete, steel, plastic) which provide structural
support;
2. that is situated in such a way that the entire surface area of the tank is
completely above the plane of the adjacent surrounding surface and the entire
surface area of the tank (including or excluding the tank bottom) is able to be
visually inspected; and
3. includes any underground or aboveground piping directly connected to the tank,
dispensing system, underground or aboveground ancillary equipment and
containment system.
B. Bodily Injury means physical injury, or sickness, disease, mental anguish or emotional
distress, sustained by any person, including death resulting therefrom.
H. Environmental Laws means any applicable federal, state, provincial or local law pursuant
to which the Insured has or may have a legal obligation to pay for Corrective Action or
Cleanup.
R. Underground Storage Tank System means a tank or tanks operated by the Insured,
including any connected underground or aboveground piping, dispensing system,
underground ancillary equipment and containment system:
1. that are on, within, or under a location designated in Item 5 of the Declarations
and that are designated in Item 6 of the Declarations; and
2. that are used solely to contain Regulated Substances.
Each tank in an Underground Storage Tank System, including associated underground
piping connected to the tank, must have at least ten (10) percent of its volume beneath
the surface of the ground.
4. Section IV. EXCLUSIONS, paragraphs A, Band D are deleted in their entirety and replaced with
the following, respectively:
A. arising from Pollution Conditions existing prior to the inception of this Policy and not
disclosed in the application for this Policy, if the Insured knew or reasonably could have
expected that such Pollution Conditions could give rise to a Claim, Corrective Action,
or Cleanup.
B. due to or for any punitive, exemplary or the multiplied portion of multiple damages, or any
civil or administrative fines, penalties or assessments, except where such damages, fines,
penalties or assessments are insurable by applicable law; or any criminal fines, penalties or
assessments.
D. arising out of the ownership, maintenance, use, operation, loading or unloading of any
automobile, aircraft, watercraft or rolling stock, except that this exclusion does not apply
to Claims arising out of the loading or unloading from or to any automobile at locations
designated in Item 5 of the Declarations.
74553( 11/99)
-~~-- ---- "'"
5. Section IV. EXCLUSIONS, paragraphs F, N., and 0., are deleted in their entirety.
6. Section V. LIMITS OF LIABILITY AND DEDUCTIBLE, is deleted in its entirety and replaced with the
following:
A. The Company's total liability:
1. for all Losses from Claims first made against the Insured and reported; and
2. for all costs for Corrective Action from Claims first reported by or on behalf of
the Insured; and
3. for all costs for Cleanup from Governmental Orders first made against the
Insured and reported by or on behalf of the Insured as a Claim
in writing to the Company during the Policy Period and including the Extended Reporting
Period, if applicable, shall not exceed the limit of liability shown in Item 3 as applicable to
the "Aggregate Limit". The purchase by the Named Insured of an Extended Reporting
Period, pursuant to Section V. of this Policy, shall not serve to reinstate or increase the
"Aggregate Limit" limit of liability.
B. Subject to Paragraph A. above, this Policy is to pay any Loss, or any costs as a result of any
Corrective Action or Cleanup. in excess of the deductible amount shown in Item 4 of the
Declarations, up to but not exceeding the limit of liability shown in Item 3 of the Declarations as
applicable to the "Each Incident" limit of liability.
However, regardless of the number of Claims, claimants, or Insureds, the total liability of
the Company for all Claims, during one or more policy periods, resulting either in Loss,
or in costs for Corrective Action or Cleanup, or in any combination thereof, and arising
out of the same, interrelated, associated, repeated, or continuous Pollution Conditions,
shall be considered one incident, subject to the "Each Incident" limit of liability shown in
Item 3 of the Declarations of the Policy in effect when the first such Claim was made and
reported to the Company. Such Claims shall be deemed first reported to the Company
during the policy period in which the first such Claim was first reported to the Company
or an affiliate.
C. For each Claim under Coverage A., Coverage B. or Coverage C., or under any combination of
Coverage A., Coverage B. and or Coverage C., one deductible amount as shown in Item 4 of
the Declarations shall apply collectively to the "Each Incident" limit of liability shown in Item 3 of
the Declarations. However, the deductible amount does not reduce either the "Each Incident"
limit of liability or the "Aggregate Limit", unless the Insured fails to reimburse the deductible
amount. Such costs within the deductible amount are to be assumed by the Insured, and any
payment of such costs by the Company is subject to prompt reimbursement by the Insured.
7. Reference in Item 3 of the Declarations page to "Aggregate Defense Expense Limit" is deleted.
All other terms, conditions and exclusions shall remain the same.
f1,.(", II 4.~~-~
AUTHORIZED REPRESENTATIVE
or countersignature (where required by law)
74553(11/99)
For use with Storage Tank Third-Party Liability, Corrective Action and Cleanup Policy Form No. 56101(7/93) or 56099(7/93)
Endorsement NO.8
This endorsement, effective 12:01 AM, November 9,2002
Forms a part of policy No. FPl8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
DATE RECOGNITION ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUllY.
THIS ENDORSEMENT MODIFIES INSURANCE UNDER THE FOllOWING:
Cleanup Cost Cap Insurance
Contractors Operations and Professional Services Environmental Insurance
Contractors Pollution Liability
Professional Services Environmental Insurance
Agriculture Cooperative PLL
PLL for the Horticulture Industry
Owner's Protective Environmental Insurance
Automobile Dealer's PLL
Secured Creditor Impaired Property
PLL Select
Storage Tank Third Party Liability, Corrective Action and Cleanup Policy
Commercial General Liability and PLL
Commercial General Liability and Professional Liability
Supplemental Environmental Automobile Liability
Coverages under this Policy do not apply to any damages, claims, loss, costs, expenses, bodily injury, property
damage, personal injury, advertising injury arising from:
A. Any actual or alleged failure, malfunction or inadequacy of:
(1) Any of the following, whether belonging to any Insured or to others:
(a) Computer hardware, including microprocessors;
(b) Computer application software;
(c) Computer operating systems and related software;
(d) Computer networks;
(e) Microprocessors (computer chips) not part of any computer system; or
(f) Any other computerized or electronic equipment or components; or
(2) Any other products, and any services, data or functions that directly or indirectly use or rely upon, in any
manner, any of the items listed in Paragraph A(1 )(a)-(f) of this endorsement
due to the inability to correctly recognize, process, distinguish, interpret or accept the year 2000 and beyond.
B. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair, replacement or
supervision provided or done by you or for you to determine, rectify or test for, any potential or actual
problems described in Paragraph A. of this endorsement.
70632(5/98)
-~,~-~-
;..;."';;':
Such damages, claims, loss, costs, expenses, bodily injury, property damage, personal injury, advertising injury are
excluded regardless of any other cause or event that contributes concurrently or in any sequence to the damages,
claims, loss, costs, expenses, bodily injury, property damage, personal injury, advertising injury.
We will not pay for repair, replacement or modification of any items in Paragraph A(1 )(a)-(1) and Paragraph B. of this
endorsement to correct any deficiencies or change any features.
All other terms, conditions and exclusions remain the same.
f1,.,/,,1 ".!:.~a_~.
AUTHORIZED REPRESENTATIVE
or countersignature (where required by law)
70632(5/98)
'~$
ENDORSEMENT #9
I ,
This endorsement, effective 12:01 AM November 9, 2002
Forms a part of policy No. FPL8084255
Issued to: CITY OF WINTER SPRINGS
By: COMMERCE & INDUSTRY INSURANCE COMPANY
Per Location Limits of Liability.
Defense Expense Limits and Deductibles Endorsement
In consideration of the premium charged, it is hereby agreed that Section V. of the
policy jacket, "Limit of Liability and Deductible," is deleted in its entirety and replaced
with the following:
V. LIMIT OF LIABILITY AND DEDUCTIBLE
A. The Company's total liability arising from Pollution Conditions at anyone
location designated in the Declarations:
1. for all covered Losses from Claims first made against the Insured and
reported; and
2. for all covered costs for Corrective Action from Claims first reported by
or on behalf of the Insured; and
3. for all covered costs for Cleanup from Governmental Orders first made
against the Insured and reported by or on behalf of the Insured as a
Claim
in writing to the Company during the Policy Period and including the Extended
Reporting Period, if applicable, shall not exceed the limit of liability shown below
as applicable to the "Aggregate Limit" for each such location. The purchase by
the Named Insured of an Extended Reporting Period, pursuant to Section VI. of
this Policy, shall not serve to reinstate or increase the "Aggregate Limit" limit of
liability applicable to any and all locations designated in the Declarations.
B. Subject to Paragraph A. above, this Policy is to pay any Loss, or any costs as a
result of any Corrective Action or Cleanup, arising from Pollution Conditions
at anyone location, in excess of the applicable deductible amount shown below,
up to but not exceeding the limit of liability shown below as applicable to the
"Each Incident" limit of liability for each such location.
However, regardless of the number of Claims, claimants, or Insureds, the total
liability of the Company for all Claims, during one or more policy periods,
resulting either in Loss, or in costs for Corrective Action or Cleanup, or in any
combination thereof, and arising out of the same, interrelated, associated,
repeated, or continuous Pollution Conditions, shall be considered one incident,
subject to the "Each Incident" limit of liability and "Aggregate Defense Expense
Limit" of liability shown in Item 3 of the Declarations of the policy in effect when
the first such Claim was made and reported to the Company. Such Claims shall
be deemed first reported to the Company during the policy period in which the
first such Claim was first reported to the Company or an affiliate.
1of2
60300 (5/94)
l r' .. c.
'~1~
The most the Company will pay in defending anyone Claim and all Claims
under Section I., Coverage D: Defense, is shown below as applicable to the
"Aggregate Defense Expense Limit" for each such location. Each payment or
reimbursement the Company makes in defending a Claim under Section I.,
Coverage D: Defense, reduces the "Aggregate Defense Expense Limit"
applicable to such location but does not reduce the "Aggregate Limit" shown
below applicable to such location.
For each Claim under Coverage A., Coverage B. or Coverage C., or under any
combination of Coverage A., Coverage B. and or Coverage C., and arising from
Pollution Conditions at anyone location designated in the Declarations, one
deductible amount shown below as applicable to the location shall apply
collectively both to the "Each Incident" limit of liability and to the "Aggregate
Defense Expense Limit" shown below as applicable to that location. However,
the deductible amount does not reduce either the "Each Incident" limit of liability
or the "Aggregate Defense Expense Limit", unless the Insured fails to reimburse
the deductible amount. Such costs within the deductible amount are to be
assumed by the Insured, and any payment of such costs by the Company is
subject to prompt reimbursement by the Insured.
LOCATIONS: See endorsement #1, covered locations, scheduled sites/tanks.
D.
Each Incident Aggregate
Limit Limit
Aggregate
Defense Expense
Limit
Deductible
$1,000,000 $1,000,000
(N/A See endorsement #7)
$10,000
f1,./,,1 "-I:.~r-~'
AUTHORIZED REPRESENTATIVE
or countersignature (where required by law)
60300 (5/94)
'f::/. -'!ff""
. , , .,.
CERTIFICATE OF INSURANCE
NAME: CITY OF WINTER SPRINGS
ADDRESS: 1126 SR 434 EAST,WINTER SPRINGS, FL 32708,
POLICY NUMBER: FPL8084255
ENDORSEMENT: N/A
PERIOD OF COVERAGE: FROM November 9, 2002 TO November 9, 2003
NAME OF INSURER: COMMERCE & INDUSTRY INSURANCE COMPANY
ADDRESS OF INSURER: 70 PINE STREET, NEW YORK, NY, 10270
NAME OF INSURED: CITY OF WINTER SPRINGS
ADDRESS OF INSURED: See item 1, Certification, below
CERTIFICATION
1. COMMERCE & INDUSTRY INSURANCE COMPANY, as identified above, hereby certifies that it has issued liability
insurance covering the following underground storage tank(s):
Covered Location(s):
* SEE ENDORSEMENT #1, COVERED LOCATIONS, OF POLICY INDICATED ABOVE
Forcorrective action and compensating third parties for bodily injury and property damage caused by sudden
accidental releases and non-sudden accidental releases, in accordance with and subject to the limits of liability,
exclusions, conditions and other terms of the policy arising from operating the underground storage tank(s)
identified above.
The limits of liability are $1,000,000 each loss $1,000,000 total for all losses exclusive of legal defense costs which are
subject to a separate aggregate under the policy. This coverage is provided under Policy Number FPL8084255
The effective date of said policy is November 9, 2002.
The insurer further certifies the following with respect tot he insurance described in Paragraph 1:
a. Bankruptcy or insolvency of the insured shall not relieve the insurer of its obligations under the policy to which
this certificate applies.
b. The insurer is liable for the payment of amounts within any deductible applicable to the policy to the provider of
corrective action or damaged third party with a right of reimbursement by the insured for any such payment made
by the insurer.
c. Whenever requested by a Director of an implementing agency, the insurer agrees to fumish to the Director a
signed duplicate original of the policy and all endorsements.
d. Cancellation or any other termination of the insurance by the insurer, except for non-payment of premium and
misrepresentation by the insured, will be effective only upon written notice and only after the expiration of sixty
(60) days after a copy of such written notice is received by the insured.
Cancellation for non-payment of premium or misrepresentation by the insured will be effective only upon
written notice and only after expiration of a minimum of ten (10) days after a copy of such written notice is received by
the insured.
.. , I .
e. The insurance covers claims otherwise covered by the policy that are reported to the Insurer within six months of
the effective date of cancellation or non-renewal of the policy except where the new or renewed policy has the
same retroactive date or a retroactive date earlier than that of the prior policy, and which arise out of any covered
occurrence that commenced after the policy retroactive date, if applicable, and prior to such policy renewal or
termination date. Claims reported during such extended reporting period are subject to the terms, conditions,
limits, including limits of liability, and exclusions of the policy.
I hereby certify that the wording of this instrument is identical to the wording in 40 CFR 280.97 (b) (2) and that the
insurer is licensed to transact the business of insurance in one or more states.
f1,.,1", If ~~6_~
Authorized Representative of Insurer
Florida Petroleum Liability Insurance Program Administrators, Inc.
P.O. BOX 1947
COCOA, FL 32923-1947
.. , ' -4
NOTICE OF LOSSINOTICE OF CLAIM
STORAGE TANK
AIG Technical Services, Inc.
Environmental Claims
80 Pine Street - 6th Floor
New York, NY 10005
Attention: Manager, Pollution Insurance
Fax #: (212) 344-2761
If Notice of Loss/Notice of Claim is sent by
fax, please also provide notice by mail.
Any person who knowinaly files a statement of claim containina any false or misleadina
information is subiect to criminal and civil penalties.
DATE OF NOTICE:
INSURED:
CITY OF WINTER SPRINGS
1126 SR 434 EAST
WINTER SPRINGS. FL 32708*
Telephone:
Contact:
BROKER: Morefar Marketing Inc.
501 Carr Road
Wilmington, DE 19809
POLICY INFORMATION:
Policy No.: FPL8084255
Effective Date: November 9, 2002
Limit of Liability: $1,000,000
Each Loss $1,000,000 Total all Losses
Self-Insured Retention/Deductible: $10,000
Expiration Date: November 9, 2003
LOSS INFORMATION:
Insured Location:
Date and Description of Loss:
Date Claim Notice Received:
Date of Claim:
Company/Person Filing Suit:
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COMMERCE AND INDUSTRY INSURANCE COMPANY
(a Stock Company, herein called the Company)
70 PINE STREET
NEW YORK, NEW YORK 10270
STORAGE TANK THIRD-PARTY LIABILITY
CORRECTIVE ACTION AND CLEANUP POLICY
NOTICE
This policy has certain provisions and requirements unique to it and may be different from
other policies the Named Insured may have purchased. This is a Claims-Made-and-Reported
policy with respect to third party off-site liability coverage and cleanup coverage for
aboveground storage tanks, and a Release-Reported form with respect to corrective action
coverage for underground storage tanks. This policy is site-specific: only scheduled tanks at
scheduled locations are covered.
Please read the entire policy carefully to determine the Insured's rights, duties, and what is and
is not covered. Various provisions throughout this policy restrict or exclude coverage.
Defined terms appear in bold face type.
In consideration of the payment of the premium, in reliance upon the statements in the Declarations and
Application made part hereof and subject to all the terms of this Policy, the Company agrees with the
Named Insured as follows:
I. INSURING AGREEMENT
COVERAGE A: THIRD PARTY BODILY INJURY AND PROPERTY DAMAGE. Subject to the
applicable limits of liability and the deductible, the Company agrees to pay Loss on behalf of the Insured
that the Insured is legally obligated to pay as a result of Claims first made against the Insured and
reported to the Company, in writing, during the Policy Period or during the Extended Reporting Period if
applicable, for Pollution Conditions Emanating From the locations designated in Item 5 of the
Declarations which result beyond the boundaries of such locations in Bodily Injury or Property Damage.
The Pollution Conditions must be unexpected and unintended from the standpoint of the Insured and
must commence on or after the Retroactive Date shown in Item 7 of the Declarations.
COVERAGE B: CORRECTIVE ACTION DUE TO UNDERGROUND STORAGE TANK. RELEASES.
Subject to the applicable limits of liability and the deductible, the Company agrees to pay on behalf of the
Insured reasonable and necessary costs that the Insured is legally obligated to pay for Corrective Action
due to ConfIrmed Releases resulting from Pollution Conditions from an Underground Storage Tank
System which are unexpected and unintended from the standpoint of the Insured. The Pollution
Conditions must commence on or after the Retroactive Date shown in Item 7 of the Declarations. Claims
reporting a ConfIrmed Release must be first reported to the Company, in writing, during the Policy
Period or during the Extended Reporting Period, if applicable.
COVERAGE C: CLEANUP DUE TO ABOVEGROUND STORAGE TANK. RELEASES. Subject to the
applicable limits of liability and the deductible, the Company agrees to pay on behalf of the Insured
reasonable and necessary costs that the Insured is legally obligated to pay for Cleanup of Pollution
Conditions from an Aboveground Storage Tank, as a result of a Governmental Order. The Pollution
Conditions must be unexpected and unintended from the standpoint of the Insured and must commence
on or after the Retroactive Date shown in Item 7 of the Declarations. During the Policy Period, or during
the Extended Reporting Period, if applicable, both the Governmental Order must first issue against the
Named Insured and the Claim reporting the Governmental Order must be first reported to the
Company, in writing.
56101(7/93)
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2. When a Claim under Coverage A., Coverage B. or Coverage C. has been made, the Insured
must forward to the Company as soon as practicable after receipt, or receipt by its representative or
agent, of the following:
a. All technical reports, laboratory data, field notes or any other documents
generated by or on behalf of the Insured to investigate or abate a Pollution
Condition or to implement Corrective Action or Cleanup.
For Claims under Coverage B., the Insured shall also forward documentation of
the release detection tests or procedures, such as system tightness tests or site
checks, undertaken to investigate a suspected Pollution Condition and verify that
a Confirmed Release has taken place.
b. All correspondence between the Insured and any third party claimant, including
but not limited to any Implementing Agency;
c. All demands, summons, notices or other processes or papers from a court oflaw,
administrative agency or an investigative body;
d. All expert reports, investigations and data collected by experts retained by the
Insured whether or not the Insured intends to use the material for any purpose;
and
e. Any other information developed or discovered by the Insured concerning the
Claim whether or not deemed by the Insured to be relevant to the Claim.
B. No costs, charges and expenses incurred in the defense, investigation, or adjustment of Claims,
proceedings or suits to which Section 1., Coverage D: Defense applies shall be incurred without
the Company's consent. No costs of preparing, developing, modifying or implementing a
corrective action plan undertaken as part of a covered Corrective Action, shall be incurred
without the Company's consent.
C. The Insured shall not admit or assume any liabilities or settle any Claims without the Company's
consent.
D. The Company may at its discretion investigate any Pollution Condition or Confirmed Release
and settle any Claim under Coverage A. for Loss or any suit or proceeding under Coverage B.
for Corrective Action or under Coverage C. for Cleanup.
E. The Insured, on demand of the Company, shall promptly reimburse the Company for any element
of the Loss or costs for Corrective Action or Cleanup falling within the Insured's deductible, as
described in Section V., LIMIT OF LIABILITY AND DEDucrmLE.
F. The Insured shall cooperate with the Company to the fullest extent possible by providing the
assistance necessary to adjust, investigate and defend the Claim under Coverage A., Coverage B.
and/or Coverage C. The Insured agrees to provide the Company free access to interview any
employee, agent, representative or independent contractor of the Insured and to review any of the
Insured's documents concerning the Claim.
56101(7/93)
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2. The cleanup, pursuant to a Governmental Order from the Implementing Agency and
with the prior written approval of the Company, of a Pollution Condition from one or
more Aboveground Storage Tank(s), including the preparation, development,
modification and implementation of a corrective action plan, and the monitoring,
evaluation and reporting of the results of the implementation of such plan.
E. Confirmed Release means a Pollution Condition from an Underground Storage Tank System
that has been investigated and confirmed by or on behalf of the Insured utilizing a system
tightness check, site check or other procedure approved by the Implementing Agency in
accordance with 40 C.F.R. 280.52 or another applicable federal or state regulation or state statute.
F. Corrective Action means:
1. Response, abatement, investigative, and removal actions resulting from a Confirmed
Release as legally required by Subpart F of the federal underground storage tank
regulations, 40 C.F.R. 280.60 through 280.66, and 280.72, or as legally required by other
applicable federal regulations or by other applicable regulations promulgated by a state
under an underground storage tank program approved by the federal Environmental
Protection Agency in accordance with section 9004 of the Resource Conservation and
Recovery Act of 1976, as amended;
2. The cleanup, pursuant to a written order from the Implementing Agency and with the
prior written approval of the Company, of Regulated Substances in soil or groundwater
due to a Confirmed Release, including the preparation, development, modification and
implementation of a "corrective action plan" as defined in 40 C.F.R. 280.66, and the
monitoring, evaluation and reporting of the results of the implementation of such plan.
G. Emanating From means directly and immediately releasing, dispersing or escaping from and
originating from an Aboveground Storage Tank or an Underground Storage Tank System that
is on or within a location designated in Item 5 of the Declarations.
H. Environmental Laws means one or more of the following statutes, any amendments thereto, any
regulations promulgated thereunder, and any similar statutes, amendments or regulations of any
state or province or political subdivision thereof, of the United States or Canada in effect at the
commencement of the Policy Period: Comprehensive Environmental Response Compensation,
and Liability Act of 1980 (CERCLA), as amended by the Superfund Amendments and Re
authorization Act of 1986 (SARA), 42 U.S.C. 9601-9675; Solid Waste Disposal Act, as amended
by the Resource Conservation and Recovery Act of 1976 (RCRA), 42 U.S.C. 6901-6992K;
Federal Water Pollution Control Act, 33 U.S.C. 1251-1387.
I. Governmental Order means an order, including any governmental directive, lawfully issued
against the Insured by an Implementing Agency or other governmental agency or court having
jurisdiction over the locations designated in Item 5 of the Declarations and acting under authority
granted by Environmental Laws.
J. Implementing Agency means the federal Environmental Protection Agency (E.P.A.) or a state or
local agency having jurisdiction over the Aboveground Storage Tank(s) pursuant to applicable
Environmental Laws, or over the Underground Storage Tank System(s) pursuant to an
underground storage tank program approved by the federal E.P.A. in accordance with section 9004
of the Resource Conservation and Recovery Act of 1976, as amended, or other applicable statute.
K. Insured means the Named Insured, and any director, officer, partner or employee thereof while
acting within the scope ofhis/her duties as such.
56101(7/93)
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I. that are on, within, or under a location designated in Item 5 of the Declarations and that
are designated in Item 6 of the Declarations; and
2. that are used solely to contain Regulated Substances.
Each tank in an Underground Storage Tank System, including associated underground piping
connected to the tank, must have at least ten (10) percent of its volume beneath the surface of the
ground.
IV. EXCLUSIONS
This insurance does not apply to Claims:
A. arising from a Pollution Condition existing prior to the inception of this Policy, if any employee
of the Named Insured responsible for environmental affairs, control or compliance or any
manager, supervisor, officer, director or partner of the Named Insured knew or could have
reasonably foreseen that such Pollution Condition could have been expected to give rise to a
Claim.
This exclusion does not apply to such Pollution Conditions which commenced during the term of
a prior storage tank pollution liability policy issued by the Company or an insurance company
which is a member company of American International Group, Inc. (hereinafter "affiliate"),
provided that:
1. the Insured has maintained storage tank pollution liability insurance with the Company or
its affiliate on a successive and uninterrupted basis for the periods succeeding the
Pollution Condition; and
2. the Insured made full and complete disclosure of such Pollution Condition on each
renewal application for storage tank pollution liability insurance with the Company or its
affiliate.
However, none of the preceding provisions (i) shall restrict or prevent the Company from
exercising its right to cancel or non renew either this Policy or the coverage for a particular
Aboveground Storage Tank or Underground Storage Tank System designated in Item 6 of the
Declarations; or (ii) shall be deemed to reinstate or increase any of the limits of liability shown in
Item 3 of the Declarations.
B. for any punitive, exemplary or multiplied damages or statutory assessments, or any civil,
administrative or criminal fines or penalties.
C. arising from Pollution Conditions based upon or attributable to the Insured's intentional,
knowing, willful or deliberate noncompliance with any statute, regulation, ordinance,
administrative complaint, notice of violation, notice letter, executive order, or instruction of any
governmental agency or body.
D. arising out of the ownership, maintenance, use, operation, loading or unloading of any aircraft,
watercraft, rolling stock, or automobile or any other land motor vehicle, trailer or semi-trailer
designed for travel on public roads including any machinery or apparatus attached thereto.
E. for costs, charges or expenses incurred by the Insured for goods supplied by the Insured or
services performed by the staff and/or salaried employees of the Insured, or its parent, subsidiary
or affiliate, unless such costs, charges or expenses are incurred with the prior written approval of
the Company at its sole discretion.
56101(7/93)
7
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a) with respect to which an Insured under this Policy is also an insured under a
nuclear energy liability policy issued by Nuclear Energy Liability Insurance Association,
Mutual Atomic Energy Liability Underwriters or Nuclear Insurance Association of
Canada, or would be an insured under any such policy but for its termination upon
exhaustion of its limit of liability; or
b) resulting from the Hazardous Properties of Nuclear Material and with respect
to which (i) any person or organization is required to maintain financial protection
pursuant to the Atomic Energy Act of 1954, or any law amendatory thereof, or (ii) the
Insured is, or had this Policy not been issued would be, entitled to indemnity from the
United States of America, or any agency thereof, under any agreement entered into by the
United States of America, or any agency thereof, with any person or organization.
2. for Bodily Injury, Property Damage, Corrective Action or Cleanup resulting from the
Hazardous Properties of Nuclear Material, if
a) the Nuclear Material (i) is at any Nuclear Facility owned by, or operated by or
on behalf of, an Insured or (ii) has been discharged or dispersed therefrom;
b) the Nuclear Material is contained in Spent Fuel or Waste at any time possessed,
handled, used, processed, stored, transported or disposed of by or on behalf of an Insured;
or
c) the Bodily Injury, Property Damage, Corrective Action or Cleanup arises out
of the furnishing by an Insured of services, materials, parts or equipment in connection
with the planning, construction, maintenance, operation or use of any Nuclear Facility,
but if such facility is located within the United States of America, its territories or
possessions or Canada, this exclusion (c) applies only to Property Damage to such
Nuclear Facility and any property thereat.
3. As used in this exclusion:
"Hazardous Properties" include radioactive, toxic or explosive properties;
"Nuclear Material" means Source Material, Special Nuclear Material or By-Product
Material;
"Source Material," "Special Nuclear Material," and "By-Product Material" have the
meanings given them in the Atomic Energy Act of 1954 or in any law, amendatory
thereof;
"Spent Fuel" means any fuel element or fuel component, solid or liquid, which has been
used or exposed to radiation in a Nuclear Reactor;
"Waste" means any waste material (a) containing By-Product Material and (b)
resulting from the operation by any person or organization of any Nuclear Facility
included within the definition of Nuclear Facility under paragraph (a) or (b) thereof;
"Nuclear Facility" means
(a)
any Nuclear Reactor;
56101(7/93)
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interrelated, associated, repeated, or continuous Pollution Conditions, shall be considered one
incident, subject to the "Each Incident" limit of liability and "Aggregate Defense Expense Limit"
of liability shown in Item 3 of the Declarations of the policy in effect when the first such Claim
was made and reported to the Company. Such Claims shall be deemed fIrst reported to the
Company during the policy period in which the fIrst such Claim was fIrst reported to the Company
or an affIliate.
C. The most the Company will pay in defending anyone Claim and all Claims under Section I.,
Coverage D: Defense, is shown in Item 3 of the Declarations as applicable to the "Aggregate
Defense Expense Limit". Each payment or reimbursement the Company makes in defending a
Claim under Section I., Coverage D: Defense, reduces the "Aggregate Defense Expense Limit"
but does not reduce the "Aggregate Limit".
D. For each Claim under Coverage A., Coverage B. or Coverage C., or under any combination of
Coverage A., Coverage B. and or Coverage C., one deductible amount as shown in Item 4 of the
Declarations shall apply collectively both to the "Each Incident" limit of liability and to the
"Aggregate Defense Expense Limit" which are shown in Item 3 of the Declarations. However, the
deductible amount does not reduce either the "Each Incident" limit of liability or the "Aggregate
Defense Expense Limit", unless the Insured fails to reimburse the deductible amount. Such costs
within the deductible amount are to be assumed by the Insured, and any payment of such costs by
the Company is subject to prompt reimbursement by the Insured.
VI. EXTENDED REPORTING PERIOD
The Named Insured shall be entitled to purchase an Extended Reporting Period upon termination of
coverage as defmed herein.
A. A Claim under Coverage A. fIrst made and reported, or a Claim under Coverage B. or Coverage
C. fIrst reported, within the Extended Reporting Period if purchased in accordance with the
provisions contained in Paragraph B. of this Section, will be deemed to have been made and or
reported on the last day of the Policy Period, provided that the Claim arises from a Pollution
Condition that commenced on or after the Retroactive Date shown in Item 7 of the Declarations
and before the end of the Policy Period.
B. The Company shall issue an endorsement providing an Extended Reporting Period of 12 months
from termination of coverage hereunder for all covered locations or any specifIc locations listed in
Item 5 of the Declarations provided that the Named Insured:
1. makes a written request for such endorsement which the Company receives within 30
days after termination of coverage as defIned herein; and
2. pays the additional premium when due. If that additional premium is paid when due, the
Extended Reporting Period may not be canceled, provided that all other terms and
conditions of the Policy are met.
C. Termination of coverage occurs:
1.
At the time of cancellation or nonrenewal of this Policy by the Named Insured or by the
Company; or
56101(7/93)
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D. Action Against Company - No action shall lie against the Company, unless as a condition
precedent thereto, there shall have been full compliance with all of the terms of this Policy, nor
until the amount of the Insured's obligation to pay shall have been finally determined either by
judgment against the Insured after actual trial or by written agreement of the Insured, the
claimant and the Company.
Any person or organization or the legal representative thereof who has secured such judgment or
written agreement shall thereafter be entitled to recover under this Policy to the extent of the
insurance afforded by this Policy. No person or organization shall have any right under this Policy
to join the Company as a party to any action against the Insured to determine the Insured's
liability, nor shall the Company be impleaded by the Insured or his legal representative.
Bankruptcy or insolvency of the Insured or of the Insured's estate shall not relieve the Company
of any of its obligations hereunder.
E. Assignment - This Policy shall not be assigned without the prior written consent of the Company.
Assignment of interest under this Policy shall not bind the Company until its consent is endorsed
thereon.
F. Subrogation - In the event of any payment under this Policy, the Company shall be subrogated to
all the Insured's rights of recovery therefor against any person or organization and the Insured
shall execute and deliver instruments and papers and do whatever else is necessary to secure such
rights. The Insured shall do nothing after a Claim to prejudice such rights.
Any recovery as a result of subrogation proceedings arising out of a Loss or out of costs for
Corrective Action, caused by Pollution Conditions under this Policy after expenses incurred in
such subrogation proceeding are deducted by the party bearing the expense shall accrue to the
Insured and the Company in proportion to each amount actually paid as a result of judgment,
settlement or defense of a Claim for Bodily Injury, Property Damage, Corrective Action, or
Cleanup Costs.
G. Changes - Notice to any agent or knowledge possessed by any agent or by any other person shall
not effect a waiver or a change in any part of this Policy or estop the Company from asserting any
right under the terms of this Policy; nor shall the terms of this Policy be waived or changed, except
by endorsement issued to form a part of this Policy.
H. Sole Agent - The Named Insured first listed in Item 1 of the Declarations shall act on behalf of
all other Insureds, if any, for the payment or return of premium, receipt and acceptance of any
endorsement issued to form a part of this Policy, giving and receiving notice of cancellation or
nonrenewal, and the exercise of the rights provided in the Extended Reporting Period clause.
I. Other Insurance - Where other insurance is available to the Named Insured for Losses or for
costs for Corrective Actions or Cleanups covered under the terms and conditions of the Policy,
the Company's obligation to the Insured shall be as follows:
1. This insurance shall apply as excess insurance over any other valid insurance, whether
collectible or not, be it primary or excess. This excess insurance shall in no way be
increased or expanded as a result of the receivership, insolvency, or inability to pay of any
insurer with respect to both the duty to indemnify and the duty to defend. This also
applies to the Insured while acting as a self-insured for any coverage.
2. Where this insurance is excess insurance, the Company will pay only its share of the
amount of Loss and costs for Corrective Action or Cleanup, if any, that exceeds the total
amount of all such valid insurance, whether collectible or not.
The Insured shall promptly upon request of the Company provide the Company with copies of all
policies potentially applicable against the liability covered by this Policy.
56101(7/93)
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OC;-09-2002 WED 03:49 PM FLORIDA LEAGUE OF CITI~S21
00T 09 2002 13:13 FR rPLIPA
FAX NO. 407 317 7181
~33 lB93 TO 14074259378
t', UO
P.07/1'1
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OCT:09-2002 WED 03:49 PM FLORIDA LEAGUE OF CITI;~1
~.092 13:14 FR FPLIPA
OCT O~1 ..
FAX NU. 4UI jjf fl01
433 1993 TO 14074259878
1l~ 1IQlEDUUi ICflrwl...... "....u1. wilt! lymboI. bll6W
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FAX NO. 407 317 7181
433 1083 TO 1487~2S937e
P. 08
OCT-09-2002 WED 03:50 PH FLORIDA LEAGUE OF CITI;~l
-,-)M.~~ 1~:14 FR FPLIPA
OCT 89 ~I\<.lr;;. oJ
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P.09/J4
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OCT-09-2002 WED 03:50 PH FLORIDA LEAGUE OF CITIES
IPA 321
OCT ~0 2002 13:1~ FR FPL
FAX NO. 407 317 7181
~33 1893 TO 14074258378
P. 09
P.1B/14
U. tiTO""GE 'rANI( l.lOGAnQN SC1ieDU~ Copv anli -tta.---'1 Mllluanal.heots II neoauwy.
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Z. om.. a>M:Ja,. ~
n SPoc P.." .An
t. Int-.IIII,1 Space .
Double W.lllld'Tl1Il(
... ""1ft..., T ank o.~ - UST
t. SlaIiItkl.lln<iII'Ila.y
AaconaIllatla/l (SJA)(lJST.)
L. AuIo".l,b T;aNl GluD"1o
SYll~ IUSTa)
...lnloralllblll4ol1l\cril'tg Qf ABT
'rank Bollom
T. All..... Ti;ht\"llM teel
IlI/Ih I~lm. (~'l
" <<lID
.u1' n1~ &.,-- pa""lI\w.lll\l1
1(, CMCtlle, 8~lheIJa
"'1'lrIII, ~_
I.. OlNr EPAiDEI"
~id ItOCIlIdary
IlOn"~ IVMInI
%. 0i1tlE1I/ttI
PI""'" ~1UI_1"" ......dal
ft. Sill'
c. FblI'gIllt
".,M. Double _bed
N. ~1'll\I.d !ylllhl1ill M.IoI1~1
Z. Ol'-r ~PAIDEP JIflprcwOd
Piping Alaltl1al
D. !"xNmlll ProflClfllll Coaling
E CJP....1tl ~.., anode or
~~ CIJITInt
.e.IaJ.aa I Mil rwwtII'lI!
a. el~ Unel.1k ~Dl;lllr
*Ih II. !'t"lllo/f
J. Int"tillll Met\ilDrIng .
rillllll Fnl8r
I. ~JnlI Monilolfro
... M8d1.~ Une
L..ak o.l.~IOf' S'yolam (US
K. Inter-till., Manllomg II'
cIoubl.. wall pilW'G
V. Suction p.,,1Y\) Child< Val~e
. .
..
FAX NO. 407 317 7181
~33 1~93 TO 14B74259378
P. 10
OCT-09-2002 WED 03:50 PH FLORIDA LEAGUE OF CITIES
IPA 321
OCT 09 2002 13:1~ FR FPL .
P.11/14
14. a'rOAAGI:i TANK.. LOCATION ICHEDUlE: C'..oP\' and .tt.d1_IIlIlRlI ~hMl.1f ,....~.
FGciltty \.0. . : $1:101 1 ~ ______ FIltll1lty Name: CllY WAF
FDr.illty Add,e.: ~rJ!lt.SDMD. Blvd Faoill!y Typo: LOCAL GOVERNMENT
~I~ ~P~8. Fl 3~oe
OJlllral. "-- .111. fdlV1l1 nlll-nM. ,_ nantlltw ollflur.
ST~AQIi T"NK 01:4110N 1ICtt1!DUL. (Calll,letelC'-dlllt w"h aWll1lo1s below
~ . T .. l;
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e Ca"1'ol
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J(. 1f..1ftoMI...
1.. W... 011I UHd Oil
",.. flIal Oil
i'. ClI)I'iIIrio QllWlfl/lf
Q, f'8IIIo!Q.
1'. Nro IIIlrWl eo~olJlld
$. o.lOrir~ Illln'lpOU(ld
T, Hax. !k.b'll/'lw (OF,HCLA.l
U. ~lIIr" Al:i4s
V. Gr~"" 5&t! b~'r 'C Mis
W. "MMIOc...,-b.I>lMIl1dljJllv'a
X. ~a. ptlrOlIlJIT>-bt.:;.
Z. Ol~...,. ~"u~
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(j. AIIGM
,.. Jilt Filet
7.4t'l!l3(1:-JnCl)
~ c-.tro",u,v,.
e.S_1
It. FlboiorgI..,.
,. FRP Clalf .9lMI
~.~
Y. Pol~n.
Z. ()lNlr !PAmEP Approwd
a. c.lhodIo PlGIeCIion
s.et'l'fiDlal ~
H. Oalhodlc Protedion .
lmjltlllbd ell"....
I. Or.ublil WII~8d(CWl.
SulQle W.lwl
R. Doubt.. Wall6d (OW}.
Clulll MIII.lilll
J. (O~1c Llniot In
nnk CPflIlf\lllllar,
V. (0Wlf'jpe1a.. lJST with
81WlOndllIV Ooftllllrlrnent
.. \tlf8INl Llnlno
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A. stll ~ VaMI
N. !\JID contalMlOllt eUclea.
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~. ~l o.UgIIi,
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o\5'r' a11dll1l .. nU. CDft&~
J(. QoI'lOnIltI, S)t1l1wric
MIIIt"t1. ~1Y8
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~roved --ndliry
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B.JlDeI
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F.,Iof. Doutllll wI,1ld
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2. Olher EPJJDEp ~nNod
~'"'" M~...I
D.. ElltemN ProlKllole Coalir\g
E Clfllofth NOrlrJclll llIOde or
Imp_It QJrT'lIr1\
PIDI"17 \JIol~ bioi.......,
Q. E1lCt1on1a Un. Latlk Deltclor
wiltl F'cw ShulOlf
01. InCantUIIII ""'r4lOring .
PlPina fl'MLlIr
e. ~I r.tanltaring
)t. Mechanical U,.,.
lalt o.I8tlor SI/Ifam (US
K. Inllt,.1tl1l Mgnlltll'lnO 01
doul* waf ~
\" 8ucl\1on Pump Chllck VaIv.
bIlI/LIII" ~I~
N. af'l'lu"""'.I~ 14onllOll/l9
Wille
~. 1rt!.rsIiUII MOn/IPring
O. VflPOt Monaorirlg Wello
0, \I1l\.loi1llnllpllC'lfana D/
NiT S~ms
1. Other EIDAJOEP AlJl)lDVefl
D. spec Pili" . AST'
F. Inl4ltlltial $pliCA -
DouIll, W.~ link
M. MAnual TiNl a.ug;,q . UST
I. _UlloIlllMII10'Y
Rec,ollllllllllcn rslR>/US'Tf)
1- A111om1~Ta,*QaugJng
8ptern (USTs,
It. In""Utill Mo,,'\OIil'lQ of AST
Tlnk Ilollolll
T. i\rftlal T tghtr,e.. T ~l
wjl/lIIl'Jtr!~ (U8TI)
11/lJ
OC~-09-2002 WED 03:51 PH FLORIDA LEAGUE OF CITIES
A 321
OCT 09 2n~2 13:15 FR FPLIP
.,.
FAX NO. 407 317 7181
433 1093 TO 1407425937e
P. 11
P.12/14
14. StORACE TANK.. LOCA'1l0N actIaaul.l!: Copy end .lWh addlHDNllltlMlA ""--A'Y.
r.';lciJlIV 1.0. * : mtta_ F~oMy Nllme: PUBLIC SAFETY BUI~OJt'JG
F!lc:llily Addl'6tc: $l...fl1'4 MOSS AO _ FAdIl~ Type: LOCAL GOY;8NMEN1'
.W!NTt!Ft Sf1illL~~8
-~ (Clre~"'/, Own Opt..... LM.. u.. flldlll", Wool own.. pi.. ..1M the owner.
lTJ'OltA<il'!"'.,.. c"n~ kHEO~ (ComJII.w laMdul. willi .ynlbal. .Iaw
>-_.L_ ~ ~ . [,
-- '.. ~ --
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CAnIenll
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c..~lWuhaI
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k. KIIfOM>I11
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fl. f lJ4Il 0tI
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'r. HitL .tW5lanoe (CatOLA)
u. MIri..,lr MIla
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:to ""loCI. ~Irn~-Gall<)
Z. Ollw, I&lihfy
O. NlIW/lJrbe Ojl
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t. C:~I"
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l. 0CIw !PAlDEI'> .App/ewd
Q. CIIIIhodic PrlHeGl..n
Il~OI1l1dal Anode
H. CllhOrlIo PIllIlati'arl .
1~1'II'1IIId Cu"IIft/
r. DIIutM Wlllllld(OW) .
Sillolt "'."1'
11. 0cdlIa Wlllld (DW).
Dull 1.(......,
.J. {LlW)Synlhllia l.ir<<11I
TlInk ~1011
V. (DWjPip.e... US'! ltiilfl
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s. Inlo"" li"~ll
ST/. STI~
7-111&"(t~JlJfJ'l
g..rflll1ft..11I PMt.lIllRI\
A. lid o..ctt Vallie
M. 6p11 CtJo1talN'llnllt1Jckat
N. "low Sllll~rt
O. 'naht Fill
P.l.J.otql Gaugtc.
foIlgh IllVIf Alarm.
Q. omlr !PAmeP Ap(>rv>tld
PI'dhtab'\lf\ M8Ihod
"SIT nDrIn. & .... C'afttL'luellal:l
IC. COftOfM.. Synl~
MeloorMl, a11~
s. Olhfr EPNOEP
IllPl1lVld IeQOtIdlry
DOtIIai"",~ 1}'t11llTl
Z. DirTt'EaIln
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.. Sloel
C. ~rgllt..
'.,U. Doubl1 ~16d
N. AjJproYOd 8ynlheliC Malerial
Z. 0111., EPN!)f;p Ajlp~d
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D. IiJtOlnIl ProtllCli~8 Co1lirla
Eo OfF' with ..~iJfllt.1 Mode 01'
lmpreK1ld au,,",nt
I'lplna luk rw-II~
Q. IfllCll'Onlc Une LAk o..l~Qr
\Mth P'/bwt SllurO/f
J. lnt_HIIlIMortIIoMll .
I''Plng FJllDr
t. l!l(tIIft'\lIIl(onilolf~
H. MechllliClll Ul18
i..Nk DIItctOr S}.otlem (US
IC. I/!\allflllll a.r~,h; '"
doubl. w.A plp10g
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Ink 1....It rw-Ua"
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o. V.pef ~llnllorinCl WtlJI
Q. VlRuiIlnl'l*lJans of
..aT S Ylw"".
Z. 00.. EPM'l!p Approvea
D. sPec PI8lt -ItS(
fT, tnlwlliltal Spacl .
Doub,. Walled T AIIk
M. ~Inual Tank ailUOi~. \.1ST
8. Slallallr..r If'IVWItotV
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L. AulDl7IIlle Tank Gtlll'Qing
Syst..., (Ugr I)
ft. ~ra"~11 Mollllorintl 01 AST
Tank Iollam
Y. Arnual T'IclhIroe.. 'rltll
w/tn I~Qo!Y (llST.l
r 1. /6
'v:
TIES FAX NO, 407 317 7181
OC~ -09-2002 WED 03: 51 PM FLORIDA LEAGUE OF C I 433 I B93 TO 14974259378
IrA 321
oCT 03 2002 13: 15 r:1~ FPL '.
15. Ne there any lankg at this location fh8t Wel'& not incfuded in (he Tank Schedule? ( ) Yes ~
If yoa, pleaKQ cfe8crib~.
P. 12
P. 13/ '.1
",
- -....-.----....-.-....---..
-.._-
._.~~,._----..__..--
------..... ---------....
--
--.--..-----.......----.---...........----------.
16. Do you use an outsidA COl'lflactQr or firm for compliance management servIces? This Includes, but Is not limited
to, equipmttnf InspectJon rtnd monitoring, proper state 8nd local Jf!bulafory paperwori< completIon, and filing, POOling
OBLiges and monlt1/y mOl,lforing reports for you? ( ) Y8$ (L-rNo-
If ~e9, plea.so gIve the nama 3nd phone #, of the firm you uae. _ ___.
-~.__.._---_.._--_....,"'........._-_.--
...--------
17. t)o you L'a. a rtJl1'lote monitoring system, with an outsIde vendor who raceWE!s an alarm when B release occurs
~nl1l$ I'Asponsiblt1 fur notifying the approprlale parties? ( ) Ye. (l).HO .
If Yttl. plessQ glvQ Ihp. Mine of that vendor.
18'-~:y pIo~:~::~::::;~. any lanks WithIn tho ".xl yea.-? ( I Vos (~'
If )fG.lI, list wl'uitn and why Ihe removal Dr replseemenl ,. to occur.
..-..-......-..---..----.---....-
--,
---..--
19. Do. ~ currently n;;lV$ pOilu lion liability ln~ur::1f1CO Coverage for ttll~ tanks ~pplJed for on this application?
(~.5 ( ) No
If <<>, pie... list hal.... the nom. .f th. "",,Ior, ..pIrlng premium, oxplr,(! deducti"'''- retrooctMl dB'" .nd '~I!s
of Ililblllty; or attach :.I copy Qf your Current pOlicy declarallons page. ...,. '-' l.s l..s ~ r cr'\ e "'""'"^ \
-~"""---- .....--,.-.-.----.-,...-
---,-
LIMITS bESJREO: (eacm InCIL1onVagsfegate)
( ) $fiOO,OOO/$1 million K $1 01/11100/$1 mitl/on
( ) $:> mll/lon/$2 million ( ) OTHER:
Qf:DUCT'8lE DESIRED: (otJch ./P&Jant)
( ) $5,000 ( ~10.000 ( ) $25,000 ( ) $50,000
( ) $100,000 ( ) $250,000 ( ) OTHER;_
For Ot\(jlJctlbl~ $25,000 or sbovo, p/eata/nclude your moal current audited financIal statement.
THIt1 APPI.ICATION DOES NOT ClINOTHe APPLICANT TO BUY60R THE COMPANY TO ISSUE THe INSURANce, BUT IT IS
AGREE!> THAT TlIIS FOR'" allALL 8E TH~ - OF TlIE C >lTRACf SHOULD A POliCY BE ISSlJ~D, AND IT WILL BE
ArrACI~ED TO ANO MACE A PART or- THE POLICY. THE UNOI;RSIGNED APPLICANT OECLARE"SIHAT THE STATEMENTS
seT FOR'IlIIN THIS APPLICATION ARE TRUE AND THAT NO MATF.RJAl FAcn; HAV~ 8EEN SUl'PREsseo OR MISSTATEO.
THE API't1CANT FURTHER DeClARES THAT IF THe INFORM.\TlOH 8UPPuED ON THIS APPLICATION CHANGES BElWEEN
THE DATE OF THIS APPLICATION AND THe lIME WHEN l1ie POLICY IS ISsueo, THE APPLICANT WlLllMMEOIATeLY
NOTIFY lHE COMPANY OF SUCH CHANGES, AND THe; COMPANY MAy WITHDRAW OR MOOIFY AfoN OUTST.t.NOING
QUOTAltONS ANO/Of{ AUTHC)R/ZA1'ON OR AGREEMFNT'rO BIND THE INSURANCE.
} $1 mlllion/$2 mill/on
^ _ Slonaturo of brck~ or 8ge1'1I)
0:'""'\ ~ l~~J.- ~L
(Lldenl~umbor 1I~ .Ie)
"S~-(oOD11&lf
(TIIX to. tI)
NOTE; IN SOME ~rA1ES, ANY PERSON WHO I<NOWINGlY ANO WllloIlNTENT TO DEFRAUD ANY INSURANCE COMPANY OR
On1F.~ PERSON FILES AN APPLICATION FOR INSURANCE CONTAININO ANY MATE~IAl.LY FAL.sE INFORMATION. OR
14Ei93{12/~H} ~ "t (0
. .
,~-; '~'t:r-' ',' ~~~~-"'_,.W"',~:'"
.
....
..
OCT-09-2002 WED
~n.n? 13'1~ FR FPLIPA
OCT 8H t!l"""c. .,
CONCEALS, FOR THE PlII'lPOSC OF MlSl.EADINCl, INFORMA liON CONCEIlNING ANY FACT W\TERIAL THEflF.TO, COMMITS A
fRAUDU1.ENT INSl JRANCE ACT, WHICH IS " CRIME.
NOllCE 10 AAICONSAs APPUCAtlTS: 'AAY PERSON WHO KNOWINell Y PRESENTS A FAl"" OIl FRIIUDU[J;NT ClAIM FOR
PA 'fI.tENT OF A LOsS OR IlENEJ'rr, OIlI<NOWINGt Y PRESl'NTS FALSE INFo_TlON IN AN APPLICATION FOR /NSURAIICE
IS GUIL'rY OF A CRIME AND WlY 8E SUBJECT TO FINES AND CONFINEMENT IN PRISON.'
NOTICE TO COLORADO APPLICAtlT8: "IT 18 !JNU,WFUL TO KNOWINGLY PROVIDE FALSE, INCOMPLETE, OR MJSlEAolNG
FACTS OJ. INFORW\TION TO AN INSUIlANcE COMpANY FOR THE PURPOSE OF OEFRAUDINCl OR ATTEMPrlNG TO
DEFRAUD 1 HE COMpANY. PENAl TIES WlY INClUllE IMPRISONMENT, FINES, DENIAL OF INsURANCE, AND CIIIll
DMtACFS. ANY INSUl,^NOE COMPANY OR AGENT OF AN INSURANCE COMpANY WHO KNOWINGLY PROV!OE'$ FAL.'lE.
INCDI.IPU:fl;, OR MISLFMING FAc'IS OR INFORMATION TO A POliCYHOLDER OR CLAIMANT FOR THE PURPose OF
DEFIlAUDlNG OR A1TEMPTINO TO DEFRAUD THe PoI.ICYHOLDER OR ClAIMANT WITH REGARO TO A SETn.EllENT OR
AW.,., PAYABLE PRDI.IIN8URMIcE PkOCceos SHAlL lIE REPOJUED TO TI-Ie COLORADO DIVISION OF INSURANCE
WITHIN ,HI:; DEPARTMENT OF RfiGULATORY AGENCIES..
.
"
,
~;~
ES FAX NO. 407 317 7181
03:51 PM FLORIDA LEAGUE OF CITI321 433 1093 TO 14974259378
P. 13
P.lt4....,4
NOna; To /'LDRIll.<. APPLICANT.: 'ANY PER.ON WHO KNDWINGl Y AND Wlrn INTENT TO INJURE, DS'RAuD, OR
DoCEIVE ANY INSURER FilES A STATEMENT OF ClAIM 011 AN APPLICATION CONTAINING ANY FALSE, INCOMPLeTE OR
M/$I.c.AOING INFORMATION IS GUll,Y OF A FELONY'~ THe THIRD DEGREE.'
NOTlCJ; TO KEImJCKY Al"PI.lCA~",: 'ANY PERSON WHO KNOWINGlY AAO 11Im. I/(TENT TO DEFRAUO ANY INsURANCE
CoMPANY OR OTHER PERSON FILES AN APPlJCAnON FOR INSU~HCE CONTAINING MY WlTERIALLY FAl"E
INFOAMA TlON, OR CONCEALS FOR THE PURPOSE OF MfSlEJ,DING, INFORWlnON CONCERNING ANY FA~ MATERIAL
n-rE"RE 1'0, COMMI rs A FRAUOULENT INSUMNce ACT. WHICH IS A CRfME..
N01'ICE "0 MAl.... APPl.lCANT.: 'IT IS A CRIlIE TO kNOWINGLY PROVIDE FALSE, INCOMPLeTE OR MISlEAOING
INFORMAnON TO AN INS"""""", COMPANY FOR mE PURPOsE OF DEFRAUOINO THE COMPANY. PENALTIES MAY
INCLUDe IMf->RISONMF:Nr, FINes OR A Of;NIAl. OF INSURANCE BENEFITS."
NOTICE "0 MINNESoTA APPLICANT.: 'ANY PERSON WfIO SUBMITS AN APPliCATION OR FilES A ClAIM WITH INTEN r TO
OE~ RAlJo OR HelPS COMMit A fRAUD AGNNST AN INSURER IS GUll TV OF A CRIME:
NOTICE TD NEW JERBl!Y A~PLICAH18: 'ANv P€RSON WHo INCLUDES MY FAlSe OR MIS[J;ADING INFORMATION ON AN
APf'UCATION FOR AN INSURANce POliCY IS SU8J1!CT TO CRIMINAl AND CIVIL PENAlTIES.'
NOTICe To NE"" MElCIco APPLICANT.: 'ANY PERsoN WHO KNOWINGLY PRI;SENTs A FALsE OR FRAuDULENT ClAIM
FON PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTs FALSE INFORMATION IN AN APPLICATION FOR
INSURANCE IS GUlL TV OF A CJllME ANI) MAY SE SUIlJEq TO CIVIl. FINes AND CRIMINAL PENALnss.'
NOTICE To NEW YORK ....PLlCANTs: 'Il/<( PeRSON WHo KNoWINOl Y ANO WITH 'NTENT TO 0EFRAUIl ANv INSulW;ce
COMPANY OR OTIlEIl PERsoN PI[J;S AN AFFllC.<\lIOH FOR I-RANce OR STATEMENT OF ClAIM CONTAINING ANY
MATERIALLY FALSE INFORW\TlON, CONCFALS FOR mE PURPosE OF MISLEADING, INFORMATION CONCEIlNING ANY
FACT MA ll3RlAl rnFRETO, CO"1M/TS A FRAUOUlENT INSURANCE ACT, WHICH Is A CRIME AND SHALL ALsO IlE SUIlJF.CT
TO A CNlL PENAL TV NOT To EJ(CEED FIVE THOUSAND DOllARs AND TI-IE STATED VAlUE OF THE CLAIM FOR EACH SUCH
VIOLATION,.
NOTlCJ; TO OINO ....1'I.IcANTs: 'ANY PERsoN WHO, IIIITH lNTENTTo DEFRAUD OR KNOWING IT-iA THE 18 FACILITATING A
FRAUD AGAINST AN INSURER, SUBMITS AN APPLICATION OR FI[J;s A ClAIM CONTAIN/NO A FAlSE OR oeCE/'nVe
S"fATEMEN1IS GlJIL1YOF INSURANCE FRAuo:
NOTICE To PENNSYlVANIA Al'PUCAllr8: 'AAY PERSON WHO KNOWINGLY AND WITH /NTE~ TO DEFRAUD ANY
INSURMIcE COMPANY OR ornER PERsoN ~1l.E" AN AFPlJCATION FOR INSURANce DR STATEMENT OF Cl.AIM
CONTAIN/NO ANv MIl TFRIALl Y FAlSo INFORMA "ON OR CONCEAlS FOR THe PURPOSE OF MlSlEJ,DINI3, I""ORMA nON
CONCERNiNG ANY ~ACT MAT.IlIAl THEReTO, co~rrs A FMuDULENT INSURANCE ACT. WHICH IS A CRIMe AND
~IJS.1ECl'.S t~U(;H PERSON TO CRIMINAL ANn CIVIL PENAL ile'S..
NOllCE TO VIlIGlNIA ....PlICANT.: 1T IS A CRIME TO KNOWINGLY FROVIDE FALSE, INCOMPLeTE OR MISlEAOING
INfORMATION To AN INEUllANce COMPANY FOR ll-IE PlJRPOSE OF DEFRAUDINI3 THE COMPANY. PENAlTIES INCLUDe
IMPRISONME~r, FINES ANO DENIAL OF INSUMNCE DENEFITS..
7-1{j93Cf2195lJ
If) 1 10
** TOTAl PAr.F.ld **
FLORIDA LEAGUE OF CmES
SPONSORED INSURANCE PROGRAMS
DECLARATIONS
I. DESIGNATED MEMBER: City of Winter Springs
Address: 1126 East State Road 434
Winter Springs, FL 32708
II. COVERAGE PERIOD
From October 1, 2002 to October 1, 2003
12:01 A.M. Standard Time at the address of the Designated Member.
III.AGREEMENT NUMBER
Florida Municipal Insurance Trust (FMIT)
FMIT #0648
IV. COVERAGES INCLUDED
General Liability
Automobile
Property
Workers' Compenstation
V. ESTIMATED ANNUAL PREMIUM
Normal
Premium
Incentive
Credit
Expense
Constant
$ 769,081.00
200.00
$(162,024.00)
~~
Signature of Authorized Representative
Net
Premium
$ 607,257.00
September 25, 2002
Date
FLORIDA MUNICIPAL INSURANCE TRUST
GENERAL /PROFESSIONAL LIABILITY COVERAGE AGREEMENT
DECLARATIONS
I. DESIGNATED MEMBER
City of Winter Springs
Government Description
Municipality
Agreement No.: FMIT #0648
III. COVERAGE PERIOD
From October 1, 2002 to October 1, 2003
the. Designated Member.
12:01 A.M. Standard Time at the address of
Premium
Payroll:
Basis Deductibleffvoe Limit Net Premium
$25,000 DSL $2,000,000 $88,654
6,214,440
$25,000DSL $2,000,000 Included
N/A $25,000 Included
$25,000 DSL $250,000 Included
$25,000 DSL $2,000,000 Included
$25,000 DSL $2,000,000 Included
$25,000 DSL $2,000,000 Included
$25,000 DSL $2,000,000 Included
$25,000 DSL $2,000,000 Included
58
22
IV. General/Professional Liability
1. General Liability
a. Broad Form Property Damage
b. Extra Contractual Legal Expense
c. Fire Legal Liability
d. Medical Attendants'/Medical
Directors' Malpractice Liability
2. Errors and Omissions Liability
a. Supplemental Employment
Practices Liability
b. Employee Benefits Program
Administration Liability
3.
Law Enforcement
Full Time with Arrest Powers:
Clerical:
(
V. This Agreement includes these endorsements and schedules: See Schedule A
VI. ESTIMATED ANNUAL PREMIUM
Normal
Premium
Incentive
Credit
Net
Premium
Florida Municipal Insurance Trust (FMIT)
$96,774
$8,120
$88,654
Florida League of Cities Sponsored Insurance Pr.ograms Since 1977
L
THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS, COVERAGE
FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT.
FMIT GL DEC 1002
Original
Page 1 of 2
09/25/2002
Form #
FMIT IND (10-02)
FMIT GC (10-02)
FMIT DSL (10-02)
FMIT BFPD (10-02)
FMIT ECLE (10-02)
FMIT FLL (10-02)
FMIT MA (10-02)
FMIT EO (10-02)
FMIT LE (10-02)
FMIT SE GL (10-02)
FMIT PA EO (10-02)
(
(
FMIT GL DEe 1002
FMIT GENERAL/PROFESSIONAL LIABILITY COVERAGES
October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List
FMIT #0648
Schedule A
Description
COMMON
Indemnity Agreement
Coverage Agreement
Deductible Stoploss Endorsement Provisions
GENERAL LIABILITY
Broad Form Property Damage
Extra Contractual Legal Expense
Fire Legal Liability
Medical Attendant's/Medical Directors' Malpractice Liability
Errors and Omissions Liability Endorsement
Law Enforcement Liablility Endorsement
Specific Excess Endorsement - General Liability
Prior Acts Endorsement - Errors And Omissions Liability
Page 2 of 2
SPECIFIC EXCESS ENDORSEMENT - GENERAL LIABILITY
This endorsement, when issued by the Florida Municipal Insurance Trust, does not in any
way modify the provisions of the Coverage Agreement. It does extend the monetary limits of
liability, as stated in the Limits of Liability in the Declarations, as set forth below:
It is agreed that the specificlimits of liability are . $2,000,000 (combined single
limit) per occurrence, solely for any liability resulting from entry of a claims bill pursuant to Section
768.28(5) Florida Statutes or liability imposed pursuant to Federal Law, or to any liability resulting
from actions taken outside of the State of Florida where it is. determined by a court of competent
jurisdiction that the liability limitations contained in Section 768.28(5), Florida Statutes, are
inapplicable, if such liability is covered by the Agreement. The limits provided herein are inclusive of
the $100,000 each person and $200,000 each occurrence as set forth in the Declarations of the
Agreement and within the Coverage Agreement itself, but in no way exceed $2,000,000
(combined single limit) per occurrence.
Exclusion W is amended as follows:
To any damages imposed by an act of the legislature, except for claims bills passed by the
legislature pursuant to Section 768.28(5), Florida Statutes, against a member, for damages covered
under the terms of this Agreement.
(
(
FMIT SE GL 1002
Page 1 of 1
FLORIDA MUNICIPAL INSURANCE TRUST
PRIOR ACTS ENDORSEMENT
ERRORS AND OMISSIONS LIABILITY
This Endorsement modifies the Agreement as follows:
Agreement Number: FMIT #0648
Designated Member: City of Winter Springs
Coverage Period: October 1, 2002 to October 1, 2003
Effective Date of Endorsement:
It is noted and agreed that in consideration of the premium charged, coverage for Public
Officials Errors & Omissions Liability is retroactively extended for claims that occurred but
were not reported to the designated member or to the Florida Municipal Insurance Trust until
the effective date of this endorsement, whether or not reported to the prior insurer.
No coverage will be provided by this endorsement:
(
For any claim or suit first made against the designated member before the effective
date of this endorsement, whether or not reported to the prior insurer, or for any
occurrence reported to the prior designated member before the effective date of this
endorsement.
For any occurrence that may create a potential claim that the insured was aware of
prior to the effective date of this endorsement and which was not reported to the
prior insurer.
Limit of Liability:
$1,000,000
Combined Single Limit
Deductible:
$25,000
Retroactive Date:
October 1, 1999
Florida League of Cities Sponsored Insurance Programs Since 1977
(
INITIALS: BBarbieri
DATE: 12/09/02
FMIT PA EO 1002
FLORIDA MUNICIPAL INSURANCE TRUST
COMMERCIAL GENERAL LIABILITY
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FORM NAME: General Conditions Endorsement #1
It is noted and agreed the Exclusion Section of the Agreement is amended as follows for
this endorsement:
A. Exclusion LL is deleted.
B. Exclusion MM is amended to read:
to damage to Real Property, Business Personal Property and Business Income
and Extra Expense arising directly or indirectly out of any loss, damage, claims,
injury, cost or legal obligations, or any other sum, or relating to:
1 . Any act of terrorism, or
2. Any action authorized by a governmental authority or agency for the
purpose of preventing, terminating, countering or responding to any act of
terrorism or for the purpose of preventing or minimizing the consequences
of any act or threat ofterrorism.
(
~~.
Authorized Representative Signature
(
Page 1 of 1
FLORIDA MUNICIPAL INSURANCE TRUST
INDEMNITY AGREEMENT
THIS AGREEMENT, made and entered into this 1st day of October, 1992, by and between the
Florida Municipal Insurance Trust (Trust) and all parties who are now or may hereafter become members of
the Florida Municipal Insurance Trust (member), acting by and through a Board of Trustees of their own
selection. These members of the Florida Municipal Insurance Trust, all local government entities, have
organized and formed a trust, and have agreed to pool their liabilities pursuant to Florida law. NOW,
THEREFORE, for and in consideration of the mutual covenants, promises and obligations herein contained,
which are given to and accepted by each member hereof to the other, the parties to this instrument covenant,
stipulate and agree as follows:
RESPONSIBILITIES OF MEMBER
Each member of the Trust agrees to abide by the following rules and regulations:
I. GENERAL CONDITIONS
A. The member agrees the Board of Trustees, the governing body of the Trust, comprised
entirely of local elected officials, will set up, operate and enforce its own administrative rules,
regulations and by-laws as between the individual members of the Trust and shall otherwise
direct the affairs of the Trust;
(-
B.
The member and the Trust agree all members of the Trust hereby agree that the Board may
admit as members of this Trust only acceptable employers in the state of Florida who have
common governmental interest. The Board or its designee shall be sole judge of whether or
not an applicant shall be admitted to membership;
C. The member agrees to maintain a reasonable loss prevention program in order to provide
the maximum in safety and lawful practices as such may relate to the potential liability
assumed by the Trust under this Agreement or any other agreement, certificate, document,
or other instrument executed by the Trust and the member pursuant to this Agreement;
D. The member agrees to provide immediate notification of such occurrence to the Trust in the
event of an occurrence likely to give rise to a claim within the scope of this Agreement, or
any other agreement, certificate, document or other instrument executed by the Trust and
the member pursuant to this Agreement;
E. The member agrees to promptly make all contributions for coverages arising under this
Agreement, or any other agreement, certificate, document, or other instrument executed by
the Trust and the member pursuant to this Agreement at the time and in the manner directed
by the Board of Trustees. Said contributions may be reduced by any discount, participation
credit, or other contribution reduction program established by the Board of Trustees;
F.
The member agrees in the event of payment of any loss by the Trust on behalf of the
member, the Trust shall be subrogated to the extent of such payment to all the rights of the
member against any party or other entity legally responsible for damages resulting from said
loss, and in such event, the member hereby agrees, on behalf of itself, its officers,
employees, and agents to execute and deliver such instruments and papers as is required,
and do whatever else is reasonably necessary, to secure such right to the Trust, and to
cooperate with and otherwise assist the Trust as may be necessary to effect any recovery
sought by the Trust pursuant to such subrogated rights;
(
FMIT IND 1002
Page 1 of 4
(
/
("
G.
The member agrees the Board of Trustees, its Administrator, and any of their other agents,
servants, employees or attomeys, shall be permitted at all reasonable times and upon
reasonable notice to inspect the property, work places, plants, works, machinery and
appliances covered pursuant to this Agreement or any other agreement, certificate,
document, or other instrument executed by the member and the Trust pursuant to this
Agreement, and shall be permitted at all reasonable times while the member participates in
the Trust, and up to and including two (2) years following the termination of its membership
in the Trust, to examine the members' books, vouchers, contracts, documents and records
of any and every kind which show or tend to show or verify any loss that may be paid or may
have been paid by the Trust on behalf of the member pursuant to this Agreement, or any
other agreement, certificate, document, or other instrument executed by the member and
the Trust pursuant to this Agreement, or which show or verify the accuracy of any
contribution which is paid or payable by the member pursuant to the terms of this
Agreement, or any other agreement, certification, document or any other instrument
executed by the Trust and the member pursuant to this Agreement;
H. The members hereby delegate to the Board of Trustees the responsibility to contract for
handling the administrative and servicing functions of the Trust. The Board may pay a
reasonable fee for such, which shall be negotiated from time to time by the Board of
Trustees. These fees shall be in consideration of all services and expenses contracted for
with the Trust, which services or expenses may include the collecting, disbursing, and
accounting for monies collected, counseling with members as to the safety hazards, claims
handling and investigations, and legal services, actuarial services and accounting services
and for the purpose of providing for excess insurance coverage. Books and records of all
contractors employed by the Trust are to be open to inspection by the Board of Trustees or
their agents at all reasonable times and as otherwise required by law;
I.
The member and the Trust agree the administrator, to be appointed by the Board, shall
deposit to the account of the Trust, at any bank or banks designated by the Board, all
contributions or other monies, as and when collected and said monies shall be disbursed
only as provided by (1) the Trust's Agreement and Declaration of Trust, (2) the rules,
regulations and by-laws of the Board, and (2) the Agreement between the Board and the
administrator;
J. The member and the Trust agree that the Trust is to defend in the name of and on behalf of
the member any claims, suits or other legal proceedings which may at any time be instituted
against the member on account of bodily injury liability, property damage liability, errors and
omissions liability, civil rights liability, personal injury liability or any other such liability,
monetary or otherwise, to the extent such defense and liability has been assumed by the
Trust pursuant to this Agreement or any other agreement, certificate, documents, or other
instrument executed by the Trust and the member pursuant to this Agreement, subject to
any and all of the definitions, terms, conditions and exclusions contained in said
agreements, certificates, documents or other instruments, although such claims, suits,
allegations or demands are wholly groundless, false, fraudulent, and to pay all costs taxed
against the member in any such legal proceedings defended by the Trust or the members,
all interest accruing after entry of judgement in such proceedings, and all expenses incurred
in the investigation, negotiation or defense of such claims, suits, allegations or demands.
Such defense shall be subject to the control of the Trust and its Administrator, which may
make such investigation and settlement of any such claim, suit, or other legal proceeding,
monetary or otherwise, as they deem expedient;
K.
The member agrees the liability of the Trust is specifically limited to the discharge of the
liability of its members assumed pursuant to this Agreement or any other agreement,
certificate, document, or any other instrument executed by the member and the Trust
pursuant to this Agreement;
L. The member agrees the coverage of the Trust does not apply to punitive or exemplary
FMIT IND 1002 Page 2 of 4
damages;
(
M.
The Trust shall operate on a fiscal year from 12:01 a.m. October 1st to 12:01 October 1st of
the succeeding year. Application for continuing membership, when approved in writing by
the Board or their designee, shall constitute a continuing contract for each succeeding fiscal
period unless cancelled by the Board or unless the member shall have resigned or
withdrawn from said Trust by written notice;
N. Unless the Trust and the member otherwise expressly agree in writing, the member agrees
coverage by the Trust for a member under the terms of this Agreement or any other
agreement, certificate, document, or other instrument executed by the member and the
Trust pursuant to this Agreement, shall expire automatically at midnight on the last day of
September of each calendar year;
O. Except as otherwise provided herein, the member and the Trust agree such member's
coverage may be canceled by the Trust or the member at any time upon no less than forty-
five (45) days prior written notice by the Board of Trustees or the Administrator to the
member and to the Division of Workers' Compensation, if applicable, or by the member to
the Trust, stating the date such cancellation shall be effective; however, cancellation by the
member after the initial effective date of coverage (October 1), shall be conditioned upon
Member's payment of an amount equal to ten (10) percent of the premium that is unearned
by the Trust, or the Trust may cancel for non-payment of premium by issuing written notice
of cancellation to the member 10 days before the effective date of cancellation;
P.
The member agrees excess monies remaining after the payment of claims and claim
expenses, and after provision has been made for the payment of open claims and
outstanding reserves, may be distributed by the Board of Trustees to the members
participating in the Trust in such manner as the Trustees shall deem to be equitable;
(
a. The member agrees there will be no disbursements out of the reserve fund established by
the Trust by way of dividends or distributions of accumulated reserves to members until
provision has been made for all obligations against the Trust and except at the discretion of
the Board of Trustees;
R. The member agrees to permit qualified service providers, including attomeys selected by the
Trust, to defend, investigate, settle, and otherwise process and dispose of all claims, suits,
allegations or demands that may result in liability assumed by the Trust on behalf of the
member pursuant to this Agreement, or any other agreement, certificate, document, or other
instrument executed by the Trust or the member pursuant to this Agreement;
S. The member shall make prompt payment of all contributions as required by the Board of
Trustees, said contributions to be determined by said Board. The member shall fully
cooperate with auditors of the Trust to promptly determine final audited contributions. Any
disputes concerning contributions shall be resolved after payment. Any objections
concerning the final audited contribution shall be filed within 60 days of billing of the final
audited contributions. After that time, the audit shall be considered to be final;
T. The member agrees to pay reasonable penalties as determined by the Board of Trustees for
late payment of contributions required under this Agreement, or any other agreement,
certificate, document, or other instrument executed by the member and the Trust pursuant
to this Agreement;
(
U.
The member, through the Board of Trustees, does hereby appoint the Administrator of the
Trust as its agent and attorney-in-fact, to act in its behalf and to execute all necessary
contracts, reports, waivers, agreements, excess insurance contracts, service contracts, and
other documents reasonably necessary to accomplish the purposes and to fulfill the
responsibilities of the Trust; to make or arrange for the payment of claims, claim expenses,
FMIT IND 1002
Page 3 of 4
(
v.
medical expenses, and all other matters required or necessary insofar as they affect the
member's liability under federal or Florida law and insofar as such matters are covered
pursuant to the terms of this Agreement or any other agreement, certificate, document, or
other instrument executed by the member and the Trust pursuant to this Agreement, and by
the rules and regulations now or hereafter promulgated by the Board of Trustees;
The Trust shall determine all questions of the scope of liability coverage, eligibility methods
of providing or arranging for benefits, and all other related matters. It shall have full power to
construe the provisions of this agreement and the other program documents in the terms
used here and therein. Any such determination and any such construction adopted by the
Trust in good faith shall be binding upon all parties hereto and the members, provided such
determination or such construction is consistent with the laws of the State.
The member agrees to abide by all the terms and conditions of this Agreement, the
Participation Agreement, the Trust's By-laws, the rules and regulations, and any other
agreement, certificate, document, or other instrument executed by the Trust and the
member pursuant to the Agreement;
W. The member and the Trust agree the Trust will maintain an excess coverage program and
reserve evaluation to protect the financial stability of the Trust in an amount and manner
determined by a qualified and independent actuary;
X. The member and the Trust agree the Trust will submit to the appropriate governmental
agency annually an audited fiscal year-end financial statement prepared by an independent
certified public accountant;
(~
Y.
The member and the Trust agree that any member who formally applies for membership in
this Trust and is accepted by the Board of Trustees shall thereupon become a party to the
Trust's Agreement and Declaration of Trust and be bound by all of the terms and conditions
contained therein, and said application shall constitute a counterpart of said Agreement and
Declaration of Trust; and
Z. Members duties after loss:
(
FMIT IND 1002
1.
give the Trust prompt written notice of any accident, occurrence or potential claim
along with all relevant information concerning the claim. The member shall have a
continuing duty to provide to the Trust all relevant information promptly as the
member becomes aware of such information; and
cooperate fully with the Trust in defense or settlement of claims or opposition to
claims bills, and in the enforcement of any right of contribution or indemnity; and
forward to the Trust every notice, demand, summons or other process served upon
the member relating to any occurrence, and take no further action concerning the
occurrence without the approval of the Trust or the servicing agent; and
take reasonable steps to prevent additional or cumulative bodily injury, personal
injury or property damage from or arising out of the same or similar conditions or
circumstances; and
not engage in settlement negotiations as to any claim or suit, and the Trust shall
have no obligation to pay the amount of any settlement negotiated or agreed upon
by a member without prior written approval by the Trust or the servicing agent; and
agree to take all reasonable actions, where appropriate, which shall facilitate
settlement of claims; and
agree to responsible counsel selected by the Trust to defend the claim and agree
not to use the designated member's counsel in defense of said action.
2.
3.
4.
5.
6.
7.
Page 4 of 4
FLORIDA MUNICIPAL INSURANCE TRUST
COVERAGE AGREEMENT
In consideration of the payment of the contributions and the covenants and agreements set forth in
the INDEMNITY AND COVERAGE AGREEMENTS, in reliance upon the statements of the APPLICATION,
the DECLARATIONS, and all terms, conditions, limits and other provisions of the COVERAGE
AGREEMENT, the Trust agrees with the member as to the following:
LIMITS OF LIABILITY
Regardless of the number of (1) members under this Agreement, (2) persons or organizations who
sustain injury or damage, or (3) claims made or suits brought on account of bodily injury, property damage
or personal injury, the liability of the Trust is limited as follows:
The total liability of the Trust applicable to "each person" under all coverages and endorsements for
all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees,
and prejudgment or post-judgment interest, sustained by one person or organization as the result of anyone
occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto.
The total liability of the Trust applicable to "each occurrence" under all coverages and
endorsements for all damages, including but not limited to damage awards for derivative claims, taxable
costs, attorneys fees, and prejudgment or post-judgment interest, sustained by more than one person or
organization as the result of anyone occurrence shall not exceed the limit of liability stated in the
Declarations and endorsements thereto.
(
For the purpose of determining the limit of the Trust's liability, all damages arising out of continuous
or repeated exposure to substantially the same general conditions shall be considered as arising out of one
occurrence.
DEFENSE AND SETTLEMENT
In addition to the limits of liability the Trust will settle or defend at its own expense, as it considers
appropriate, any claim or suit demanding money damages covered by this Agreement. The Trust will
defend any suit against a member which alleges a claim for money damages covered by this Agreement
even if such suit is groundless, false or fraudulent. However, the Trust has no duty to defend a member in
any action which on its face alleges facts excluded or not covered by this Agreement.
In the event a suit or other action contains allegations which allege damages which the Trust has a
duty to defend and other allegations which allege damages or other relief that the Trust does not have a
duty to defend, the Trust will defend all allegations subject to the terms, conditions, limits of liability and
exclusions of the Agreement; however, undertaking such defense shall not obligate the Trust to pay any
judgments, settlements or awards which a member becomes legally obligated to pay for allegations to which
coverage does not apply. The Trust's duty to defend ends when applicable Limits of Insurance have been
exhausted.
(
FMIT GC 1002
Page 1 of 10
(
DEFINITIONS
The following definitions apply throughout this Agreement unless modified or excluded:
A. Advertising Injury, means injury arising out of an offense committed during the Agreement period
occurring in the course of the designated member's advertising activities; if such injury arises out of
libel, slander, defamation, violation or right of privacy,'piracy, unfair competition, or infringement of
copyright, title, or slogan.
B. Agreement Territory, means anywhere in the world.
C. Automobile, means a land motor vehicle, trailer or semi-trailer designed for travel on public roads
(including any machinery or apparatus attached thereto), but does not include mobile equipment.
D. Bodily Injury, means bodily injury, disability, disfigurement, sickness or disease or death resulting
from an occurrence and sustained by any person, and any loss, injury or damages sustained by any
person because of bodily injury, which occurs during the period of this Agreement.
E. Completed Operations Hazard, includes bodily injury and property damage arising out of
operations or reliance upon a representation or warranty made at any time with respect thereto, but
only if the bodily injury or property damage occurs after such operations have been completed or
abandoned and occurs away from the premises owned by or rented to the designated member.
"Operations" includes materials, parts or equipment furnished in connection therewith. Operations
shall be deemed completed at the earliest of the following items:
1. When all operations to be performed by or on behalf of the designated member under the
contract have been completed,
(
2.
When all operations to be performed by or on behalf of the designated member at the site
of the operations have been completed, or
3. When the portion of the work out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing an operation for a principal as a part of the same project.
Operations which may require further service or maintenance work, or correction, repair or
replacement because of any defect or deficiency, but which are otherwise complete shall
be deemed complete.
The completed operations hazard does not include bodily injury or property damage arising
out of operations in connection with the transportation of property, unless the bodily injury
or property damage arises out of a condition in or on a vehicle created by the loading or
unloading thereof.
F. Contractual Liability, means liability expressly assumed under a written contract or agreement;
provided, however, that contractual liability shall not be construed as including liability under a
warranty of the fitness or quality of the designated member's products or a warranty that work
performed by or on behalf of the designated member will be done in a workmanlike manner; and
provided, however, that contractual liability shall not be construed as including liability under any
hold harmless agreement or agreement to indemnify any non-public or private person, corporation,
or entity under any contract or agreement.
(
FMIT GC 1002
Page 2 of 10
(
G.
Designated Member, means the entity, organization or constitutional officer named in Item I. or V.
of the Declarations of this Agreement; designated member does not include employees or agents of
that entity or organization.
H. Designated Member's Products, means goods or products manufactured, sold, handled, or
distributed by the designated member or by others trading under his name, including any container
thereof (other than a vehicle), but "designated member's products" shall not include a vending
machine or any other property, rented to or located for use of others but not sold.
I. Elevator, means any hoisting or lowering device to connect floors or landings, whether or not in
service, and all appliances thereof; but does not include an automobile servicing hoist, a material
hoist used in alteration, construction or demolition operations, or an inclined conveyor used
exclusively for carrying property or a dumbwaiter.
J. Employee Benefits Program, means any pension and profit sharing plan; individual retirement
account (IRA) plan; salary reduction plan under Internal Revenue Code 401 (k) or Amendments;
employee stock subscription plan, savings plan; group plan for life, health, dental, disability,
automobile, home owners, or legal services insurance; social security system benefits; workers'
compensation and unemployment insurance; travel and vacation plans; or educational tuition
reimbursement plans created, administered or endorsed by a member.
K. Errors and Omissions, means an actual or alleged error or misstatement or act of omission or
neglect or breach of duty including misconduct or official misconduct by the members in their official
capacity, individually or collectively, or any matter of claims against them solely by reason of their
having served or acted in an official capacity.
L.
Incidental Contract, means a written (a) lease of premises, (b) easement agreement, except in
connection with construction or demolition operations on or adjacent to a railroad, (c) undertaking to
indemnify a municipality required by municipal ordinance, except in connection with work for the
municipality, (d) sidetrack agreement, or (e) elevator maintenance agreement; but does not include
any hold harmless agreement or agreement to indemnify any non-public or private person,
corporation, or entity under any contract or agreement.
(
M. Incidental Medical Malpractice Injury, means bodily injury arising out of the rendering of or failure
to render medical services or treatment by a non-professional during the period of this Agreement,
including the following services:
1. medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or
beverages in connection therewith; or
2. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances.
N. Inverse Condemnation, means a cause of action by a property owner to recover the monetary
value of property that has been taken by the designated member having the power of eminent
domain where no formal exercise of that power has been undertaken and includes any claim
alleging lost profits both future and past.
O. Member, as used herein means:
a. the designated member;
b.
while acting within the scope of his employment, any officer (except constitutional officers),
volunteer, servant, or employee of the designated member, including elected and
appointed officials, and members of Boards or Commissions. However, the coverage so
provided any officer, servant, or employee does not apply to bodily injury to another officer,
servant or employee of the designated member injured in the course of and arising out of
his employment.
(
FMiT GC 1002
Page 3 of 10
(
(
(
The coverage afforded applies separately to each member against whom claim is made or suit is
brought, except with respect to the limits of liability of the Trust; and does not apply to bodily injury
or property damage or personal injury liability arising out of the conduct of any partnership or joint
venture of which a member is a partner or participaht and which is not specified in this Agreement
as a designated member.
P.
Mobile Equipment, means a land vehicle (including any machinery or apparatus attached thereto),
whether or not self propelled, (a) not subject to motor vehicle registration, or (b) maintained for use
exclusively on premises owned by or rented to the designated member, including the ways
immediately adjoining, or (c) designed for use principally off public roads, or (d) designed or
maintained for the sole purpose of affording mobility to equipment of the following types forming an
integral part of or permanently attached to such vehicle: power cranes, shovels, loaders, diggers
and drills; concrete mixers, graders, scrapers, rollers and other road construction or repair
equipment; air compressors, pumps and generators, including spreading, welding and building
cleaning equipment; and geophysical exploration and well servicing equipment.
Q.
Mold, Spores and/or Fungus means any mold, spores and/or fungus of any type of nature
whatsoever that can cause or threaten harm to any living organism (including human health or
human welfare, or the health or welfare of any animal or plant) or can cause or threaten physical
damage, deterioration, loss of use, and/or loss of value or marketability, to any tangible property
whatsoever. This includes, but is not limited to, any type(s) of mold, spores and/or fungus that are
harmful or potentially harmful to health or welfare (such as Stachybotrys and others), or that are
damaging or potentially damaging to tangible property (such as wet or dry rot, mildew and others) or
that can otherwise cause or threaten to cause bodily injury, property damage, personal injury or
advertising injury or any kind whatsoever.
R.
Occurrence, means an event or accident, including continuous or repeated exposure to conditions
which result in bodily injury, property damage or personal injury and not arising from any form of
intentional misconduct.
S. Personal Injury, means injury sustained by any person or organization arising out of one or more
of the following offenses committed during the term of this Agreement. However, this coverage
does not apply to law enforcement operations.
1. False arrest, detention, imprisonment;
2. Wrongful entry or eviction, or other invasion of the right of private occupancy;
3. Publication or utterance:
a) of a libel or slander or other defamatory or disparaging material;
b) in violation of an individual's right or privacy; or
except that publications or utterances in the course of or related to broadcasting,
publishing, or telecasting activities conducted by or on behalf of the designated member
shall not be deemed personal injury;
4. Assault and battery, not committed by or at the direction of the designated member unless
committed for the purpose of protection of persons or property.
T.
Products Hazard, includes bodily injury and property damage arising out of a designated member's
products or reliance upon a presentation or warranty made at any time with respect thereto, but only
if the bodily injury or property damage occurs away from premises owned by or rented to the
designated member and atter physical possession of such products has been relinquished to
others.
FMITGC 1002
Page 4 of 10
U. Property Damage, means (a) physical injury to or destruction of tangible property which occurs
during the policy period, including the loss of use thereof at any time resulting there from, or (b) loss
of use of tangible property which has not been physically injured or destroyed provided such loss of
use is caused by an occurrence during the period of this Agreement.
V. Terrorism means activities against persons, organizations or property of any nature:
1. That involve the following or preparation for the following:
a. Use or threat of force or violence;
b. Commission or threat of a dangerous act; or
c. Commission or threat of an act that interferes with or disrupts an electronic,
communication, information or mechanical system; and
2. When one or both of the following applies:
a. The effect is to intimidate or coerce a government or the civilian population or any
segment thereof, or to disrupt any segment of the economy; or
b. It appears that the intent is to intimidate or coerce a government, or to further
political, ideological, religious, social or economic objectives or to express (or
express opposition to) a philosophy or ideology.
EXCLUSIONS
(
This Coverage Agreement does not apply:
A. to liability assumed by a designated member under an expressed or implied contract or agreement
except an incidental contract or inter-local agreements with other governmental entities; but this
exclusion does not apply to an implied warranty of fitness or quality of the designated member's
products or an implied warranty that work performed by or on behalf of the designated member will
be done in a workmanlike manner;
B. to bodily injury or property damage arising out of the ownership, maintenance, operation, use,
loading or unloading of:
1. any automobile operated by or rented or loaned to any member;
2. any other automobile operated by any person in the course of his employment by any
member; but this exclusion does not apply to the parking of an automobile on premises
owned by, rented to or controlled by the designated member or the ways immediately
adjoining, if such automobile is not owned by or rented or loaned to any member;
3. any vehicle while being used in any pre-arranged or organized racing, speed or demolition
contest or in any stunting activity or in practice or preparation for any contest or activity;
C. to bodily injury or property damage arising out of:
1. the ownership, maintenance, operation, use, loading or unloading of any mobile equipment
while being used in any pre-arranged or organized racing, speed or demolition contest or in
any stunting activity or in practice or preparation for any such contest or activity;
2. the operation or use of any trailer designed for use therewith; or
3. the ownership, maintenance, operation, or use of a skateboard/skate park facility, in-line
skating facility or water theme park;
(
D.
to bodily injury or property damage arising out of the ownership, maintenance, operation, use,
loading or unloading of:
1. any watercraft over twenty six (26) feet in length;
2. any passenger being carried for a consideration while in or upon, entering or alighting from
any watercraft; or
FMIT GC 1002
Page 5 of 10
3. barge or lighter rented by the designated member to others with respect to which the
designated member does not furnish employees to operate and does not have any
operating control;
4. any watercraft while being used in any pre-arranged or organized racing, speed or
demolition contest or in any stunting activity or in practice or preparation for any contest or
activity;
5. any watercraft or structure being used as an artificial reef or similar purpose;
E. to bodily injury or property damage arising out of the ownership, maintenance, operation, use,
loading or unloading of:
1. any aircraft owned or operated by or rented or loaned to any member;
2. any other aircraft operated by any person in the course of his employment by any member;
but this exclusion does not apply to aircraft while parked on premises owned by, rented to
or controlled by the designated member;
F. to any liability arising out of or caused or contributed to by any maintenance, operation, use or
control of or responsibility for any airfield, airport, runway, hangar, building or other property or
facility designed for, used, connected, associated or affiliated with or in any way related to aviation
or aviation activities or operations; provided that liability for services performed or premises located
at or on any airfield, airport or aviation facility not directly related to aviation activities or operations,
and not covered by any other liability insurance, shall not be excluded from coverage by this
exclusion;
G.
any claim for bodily injury, property damage (including the loss of use thereof), personal injury or
advertising injury caused by, contributed to or arising out of the actual or threatened discharge,
dispersal, release, or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals,
electromagnetic radiation, liquids or gases, waste materials or other irritants, pollutants or
contaminants into or upon the land, the atmosphere or any course or body of water, whether above
or below ground.
(
Also, excluded from coverage under this agreement is the process of continued surface and/or
subsurface degradation and deterioration of lead based paint that has been applied to any surface
of any building whether considered commercial or residential.
It is understood and agreed that the intent and effect of this exclusion is to delete from all coverages
afforded by this policy any claim, suit, action, judgment, liability, settlement, defense or expenses
(including any loss, cost, or expense arising out of any governmental direction, order or request that
the member test for, monitor, clean up, remove, contain, treat, detoxify or neutralize pollutants) in
any way arising out of such actual or threatened discharge, dispersal, release or escape, whether
such results from the member's activities or the activities of others, whether or not such a sudden or
gradual, and whether or not such is accidental, intended, foreseeable, fortuitous or inevitable and
wherever such happens;
H. to bodily injury or property damage due to war, whether or not declared, civil war, insurrection,
rebellion and revolution, or to any act or condition incident to any of the foregoing;
I. to any obligation for which any member or any carrier as his insurer may be held liable under any
workers compensation, employers liability, unemployment compensation or disability benefits law,
or under any similar law and including any claims under the Americans with Disabilities Act;
J.
to bodily injury to any employee of the designated member arising out of and in the course of this
employment by the designated member or to any obligation of a member to indemnify another
because of damages arising out of such injury; but this exclusion does not apply to liability assumed
by the designated member under an incidental contract. This exclusion shall include any liability
incurred by a designated member as a result of an alleged wrongful discharge; failure to promote;
demotion or transfer of any employee of the designated member;
(
K. to property damage to property owned or occupied by, leased, or rented to a designated member;
FMIT GC 1002
Page 6 of 10
/'
\
L.
to property damage to premises alienated by the designated member arising out of such premises
or any part thereof;
M. to loss of use of tangible property which has not been physically injured or destroyed resulting from
a delay in lack of performance by or on behalf of the designated member of any contract or
agreement;
N. to property damage to the designated member's products arising out of such products or any part of
such products; to property damage to work performed by or on behalf of the designated member
arising out of the work or any portion thereof, or out of materials, parts or equipment furnished in
connection therewith; and to damages claimed for the withdrawal, inspection, repair, replacement,
or loss of use of the designated member's products or work completed by or for the designated
member or of any property of which such products or work form a part, if such products, work or
property are withdrawn from the market or from use because of any known or suspected defect or
deficiency therein;
o. to any liability from the designated member's completed operations arising out of:
1. loss of sales, customers or profits suffered by a person or entity affected by the actions of
the designated member or its agents including any damages sustained by such person or
entities by virtue of a business interruption; or
2. loss resulting from theft of any property which at the time of loss is not an integral part of a
building or structure including direct loss by pillage and looting occurring during and at the
immediate place of a riot or civil commotion;
P.
to any liability arising in whole, or in part out of
1. any act or omission of a member committed while acting outside the course and scope of
his employment, or committed in bad faith with malicious purpose, or in a manner exhibiting
wanton and willful disregard of human rights, safety or property;
2. any member obtaining remuneration or financial gain to which the member was not legally
entitled;
3. the willful violation of any federal, state or local law, ordinance or regulation committed by
or with the knowledge or consent of any member; or
4. official misconduct by any member;
(
Q. to any liability arising out of or in any way connected with the operation of the principals of eminent
domain, condemnation proceedings, inverse condemnation or takings law, by whatever name
called, whether permanent or temporary, including but not limited to, claims arising out of federal,
state or local land use, environmental, air, ground or water pollution, or health, safety and welfare
laws, ordinances or regulations, claims arising from Ch. 95-181, Laws of Florida, as may be
amended from time to time, or claims arising from activities by or on behalf of a member which
result in permanent or temporary loss of use or value of property, whether such liability accrues
directly against the member, or by virtue of any agreement entered into by or on behalf of the
member;
however, this exclusion does not apply to bodily injury, property damage or personal injury resulting
from a claim against the designated member for inverse condemnation;
the limit of inverse condemnation claims is the amount of liability described in the
GeneraVProfessional Liability section of the Declarations Page or $1,000,000 aggregate per fund
year, whichever is the lesser amount, subject to a deductible of $5,000.00 per occurrence.
R.
to any liability for injury, sickness, disease, death or destruction due to the rendering of or failure to
render any professional service by any doctor, surgeon, dentist, nurse, physician's assistant,
paramedic, emergency medical technician or other medical professional of a designated member;
(
s. to any liability arising out of or in connection with or caused or contributed to by any failure or
inability to supply, in whole or in part, any adequate quantity or quality of power, steam, pressure or
fuel;
FMIT GC 1002 Page 7 of 10
(
T.
to any liability arising out of or caused or contributed to by or connected with any actual or alleged
violation of the Employee Retirement Income Security Act of 1974 (Public Law 93-406) or any
amendment thereto or any similar provision of any local, state or federal law, statutory or common;
U. to any liability arising out of or caused or contributed to by any breakage and/or water overflow of
any dam or reservoir;
V. to any liability for fines, punitive or exemplary damages; or any non compensatory damages or
penalties imposed pursuant to any federal or state anti-trust, civil rights, anti-discrimination, or
racketeer influence and corrupt organization (RICO) laws;
W. to any damages imposed by special act of the Legislature;
X. to loss caused directly or indirectly by nuclear hazard. Nuclear hazard means any nuclear reaction,
radiation, a radioactive contamination, all whether controlled or uncontrolled or however caused, or
any consequence of any of these;
Y. to personal injury arising out of any publication or utterance described in sub-paragraph Q 3 of the
definition of Personal Injury contained in the Definition section of this Agreement (a) if the first
injurious publication or utterance of the same or similar material by or on behalf of the designated
member was made prior to the effective date of this coverage; (b) concerning any organization or
business enterprise, or its products or services, made by or at the direction of any member with
knowledge of the falsity thereof;
Z. to any liability arising out of errors and omissions as defined herein;
c~
AA.
to bodily injury or property damage for which the designated member or his indemnitee may be held
liable;
1.
2.
as an entity or organization engaged in manufacturing, distributing, selling or serving
alcoholic beverages; or
if not so engaged, as an owner or lessor of premises used for such purposes,
if such liability is imposed
a) by, or because of the violation of, any statute, ordinance or regulation pertaining to
the sale, gift, distribution or use of any alcoholic beverages; or
by reason of the selling, serving or giving of any alcoholic beverage to a minor or to
a person under the influence of alcohol or which causes or contributes to the
intoxication of any person.
b)
This exclusion does not apply and coverage is afforded under the Agreement for bodily injury or
property damage claims or liability resulting from the providing or serving of alcoholic beverages
without charge to the public at functions incidental to a designated member's business or activity
otherwise covered under the Agreement or any endorsement to the Agreement;
BB. to any claim, demand or action seeking injunctive, declaratory, writ of mandamus, or any other non-
monetary relief against a designated member or any of its agents;
CC.
(
to any liability arising out of any actual or alleged sexual action, abuse, communicable disease or
employment related claim, defined for purposes of this exclusion as:
1. sexual action includes, but is not limited to, any verbal or non-verbal communication,
behavior or conduct with sexual connotations or purposes, whether for sexual gratification,
intimidation, coercion or other purpose, and regardless of whether such action is alleged to
be intentional or negligent.
2. abuse shall include, but is not limited to, the negligent or intentional infliction of physical,
emotional or psychological injury or harm on any person or persons in the care, custody or
control of any member.
3. communicable disease includes but is not limited to Acquired Immune Deficiency
Syndrome (AIDS), and any venereal disease.
FMIT GC 1002
Page 8 of 10
(
4.
employment related claim includes but is not limited to claims, accusations or charges of
negligent or intentional hiring, placement, training or supervision arising from or related to
actual or alleged sexual action, or any other type of actual or alleged abuse, or a
communicable disease.
However, this exclusion does not apply and coverage is afforded under this Agreement to
bodily injury or personal injury liability which may accrue against the "Designated Member"
as defined within the "Definition" section;
5.
DO. to any liability for injury, loss or damage sustained by any person or entities arising from or in
anyway involving asbestos or other products containing asbestos or to asbestosis or any other
disease including mesothelioma and cancer related to asbestos exposure nor any liability for costs
or expenses incurred in removing, cleaning up or nullifying such asbestos product;
EE. to any liability arising out of errors and omissions as defined herein or other negligent or wrongful
act committed in the administration of any employee benefits program as defined herein, for present
or former employees of the designated member;
FF. to any liability arising out of or caused by or contributed to or connected with alleged violation of the
following:
1. Florida Whistle Blowers Act, Sec. 112.3187, Florida Statutes.
2. Federal "Fair Labor Standards~.
3. Chapter 447, Florida Statutes;
GG. any claim requesting return or reimbursement of a special assessment, tax, service charge or fee or
any other overpayment to the designated member or member;
HH.
(
II.
to any claim for attorneys' fees or costs for any action not covered by this Agreement;
to any damages which accrued or occurred prior to the effective date of this Agreement
notwithstanding the date of the occurrence;
JJ. advertising injury arising out of:
1. Failure of performance of contract, but this exclusion does not apply to the unauthorized
appropriation of ideas upon alleged breach of implied contract, or
2. Infringement of trademark, service mark, or trade name, other than titles or slogans, by use
thereof or in connection with goods, products or services sold, offered for sale, or
advertised, or
3. Incorrect description or mistake in advertising price of goods, products or services sold,
offered for sale or advertised.
KK.
c
Also, with respect to advertising injury:
1. To any member in the business of advertising, broadcasting, or telecasting, or
2. To any injury arising out of any act committed by the member with actual malice.
to any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury
Liability, Products Liability and Completed Operations Hazard arising directly or indirectly out of
1. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly
recognize, process, distinguish, interpret or accept the year 2000 and beyond by:
a. Any of the following, whether belonging to any insured or to others: (a) Computer
application software; (b) Computer networks; (c) Microprocessors (computer chips)
not part of any computer system; (d) Computer operating systems and related
software; (e) Computer hardware, including microprocessors; or (f) Any other
computerized or electronic equipment or components; or
b. Any other products, and any services, data or functions that directly or indirectly
use or rely upon, in any manner, any of the items listed in the preceding paragraph.
2. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair,
replacement or supervision provided or done by you or for you to determine, rectify or
test for, any potential or actual problems described in paragraph a. above.
FMITGC 1002
Page 9 of 10
(
\
LL. to any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury
Liability, for which any designated member or member under this agreement may be held liability
arising out of the actual or threatened occurrence, growth, release, transmission, migration,
dispersal or exposure to mold, spores and/or fungus;
1. Resulting from any actual or threatened exposure to, inhalation, absorption or ingestion of,
or physical contact with mold, spores and/or fungus;
2. Resulting from any actual or threatened mold, spores, and/or fungus upon any real property
or personal property, product or work, premises, site or location, or any other tangible
property, or any designated member or member or any other person(s) or organization(s),
located anywhere in the world;
3. Resulting from any loss, cost or expense for any testing, monitoring, clean-up, treatment or
removal, or neutralization of mold, spores and/or fungus;
MM. to any Bodily Injury Liability Property Damage Liability, Personal Injury Liability and Advertising
Injury Liability arising directly or indirectly out of any loss, damage, claims, injury, cost or legal
obligations, or any other sum, or relating to:
1. Any act of terrorism, or
2. Any action authorized by a governmental authority or agency for the purpose of preventing,
terminating, countering or responding to any act of terrorism or for the purpose of
preventing or minimizing the consequences of any act or threat of terrorism.
OTHER INSURANCE
The coverage afforded by this Agreement is primary, except when stated to apply in excess of or
contingent upon the absence of other insurance. When this coverage is primary and the member has other
insurance which is stated to be applicable to the loss on an excess or contingent basis, the amount of the
( Trust's liability under this Agreement shall not be reduced by the existence of such other insurance.
If all other valid and collectible insurance provides for contribution by equal shares, the Trust shall
not be liable for a greater proportion of such loss than would be payable if each party contributes an equal
share until the share of each party equals the lowest applicable limit of liability under anyone policy or
coverage agreement or the full amount of the loss is paid, and with respect to any amount of loss not so
paid the remaining parties then continue to contribute equal shares of the remaining amount of the loss until
each such party has paid its limit in full or the full amount of the loss is paid.
(
If any such other insurance does not provide for contribution by equal shares, the Trust shall not be
liable for a greater proportion of such loss than the applicable limit of liability under this policy for such loss
bears to the total applicable limit of all valid and collectible insurance against such loss.
FMIT GC 1002
Page 10 of 10
(
DEDUCTIBLE STOP LOSS ENDORSEMENT
PROVISIONS
I.
Member City of Winter Springs
II. Stoploss Coverage Applies
0 A. Workers Compensation & Employers Liability
~ B. General Liability
~ C. Auto Liability
0 D. Property
0 E. Automobile Physical Damage
III. Applicable Stoploss Deductible
A. Workers Compensation & Employers Liability $
( B. General Liability $ 25,000
j
C. Auto Liability $ 25,000
D. Property $
E. Automobile Physical Damage $
IV. Applicable Deductible Stop loss Amount
A. $ 188,303
(
FMIT DSL 1002
Page 1 of 2
The endorsement provides for a limitation on the number of deductibles or amount of loss incurred
by a member under a deductible program as offered by the Florida Municipal Insurance Trust.
I. IT IS AGREED THAT:
A. The Trust's liability to pay claims on behalf of the member under this endorsement applies
only to the members deductible amounts as stated in the Declarations and only atter
satisfaction of the Deductible Stoploss amount as stated in this endorsement.
B. The Trust agrees with the member that the member's obligations under applicable
deductible endorsements cease when the member had paid losses within the deductible
that exceed:
(1) Three (3) times the largest deductible as stated in the Provisions or
(2) the Deductible Stoploss Amount, whichever is greater.
C. The terms of the Trust's Indemnity Agreement and Coverage Agreements remain in full
force and effect, including those with respect to:
(1) the Trust's rights and duties in the defense of claims and
(2) the member's duties in the event of an accident or occurrence, irrespective of the
application of deductible amount or deductible stoploss.
D. The member will immediately report in writing:
(1) all accidents or incidents which may give rise to liability.
(2) all Notice of Claims.
(3) all lawsuits involving a claim for damages.
E. The Trust shall select and retain all defense attorneys and other service providers as
necessary and shall directly control and supervise their activities. All such costs incurred
in these services shall be paid by the Trust.
F. The deductible amount shall include the amount of any payment resulting from a covered
claim in the aggregate up to the deductible amount stated in the declarations. The
member's responsibility under the deductible shall continue even though the contract may
have been cancelled or expired.
G. Investigation and adjustment expenses incurred by the Trust shall be paid by the Trust
and not included in the deductible amount.
H. The Trust may settle or defend any claim as it considers appropriate without the
member's consent regardless of any deductible amount.
I. The Trust is authorized to make reasonable additions, changes, or deletions to these
reporting requirements.
J. Reimbursement of the Trust: The member will reimburse the Trust the invoiced amount
due within 45 days of the invoice date. Failure to pay this sum will result in the revocation
of the member's deductible plan privileges.
K. Recoveries shall be applied to the member's deductible until satisfied.
L.
The Definitions Section of the Trust is amended per this additional definition:
(1) Deductible stop loss is coverage which limits a members deductible payment
obligations to a certain fixed amount.
(
FMIT DSL 1002
Page 2 of 2
(
BROAD FORM PROPERTY DAMAGE
I.
The Coverage section is amended to include the following additional coverage:
As it relates to property damage to property owned, occupied or used by or rented to the
member or in the care, custody or control of the member or as to which the member is for
any purpose exercising physical control and work performed by or on behalf of the
designated member arising out of the work or any portion thereof, or out of materials,
parts or equipment furnished in connection therewith.
(
(
FMIT BFPD 1002
Page 1 of 1
EXTRA CONTRACTUAL LEGAL EXPENSE
I. The Coverage Section is amended to include the following additional coverages:
The Trust will reimburse the member seventy five percent (75%) of the legal fees and
seventy five percent (75%) of the legal assistant fees incurred by the public officer or
officers and reimbursed by the member as a result of an occurrence, up to a maximum of
twenty five thousand dollars ($25,000) per occurrence, or one hundred thousand dollars
($100,000) in the aggregate for the Trust year provided:
a. the occurrence is not otherwise covered by the Trust;
b. the member and the public officer provide the Trust such documentation as is
necessary for the Trust to determine the total amount incurred and reimbursed,
and the eligibility and legitimacy of the reimbursements;
c. in an action, the court finds the member is obliged to reimburse the legal fees and
legal assistant fees incurred by the public officer because the conduct that gave
rise to the action arose out of or in connection with the performance of the officer's
official duties and the action served public purpose; and
d. in an ethics proceeding; it is determined the conduct that gave rise to the
proceeding arose out of or in connection with the performance of the officer's
official duties and the public officer is not found to have committed a breach of the
public trust;
(
e.
coverage is specifically excluded for any occurrence outside the effective dates of
this endorsement.
II. The Definition Section is amended to include the following additional definitions which
shall apply exclusively to this endorsement.
"Action" means a criminal or civil judicial proceeding in a court of law, before a judicial
officer, in which a public officer or a group of public officers of a member are named party in
their personal capacities and in which original subject matter jurisdiction is vested in a
county court or circuit court. "Action" includes any appellate proceedings that arise from
such judicial proceedings and any administrative proceeding before the Florida Public
Employees Relation Commission and Federal Equal Employment Opportunity
Commission, but excludes any other state or local administrative proceedings.
"Attorney" means a person admitted by the Supreme Court of Florida to practice law in
Florida and who is a member in good standing of The Florida Bar. If the member is named
a party in the action or the ethics proceedings, "attorney" excludes the person, such as the
city attorney, appointed by the member to act as the legal advisor to, and attorney and
counselor for, the member and its public officers, such person's deputies or assistants and
other employees, and the partners, associates, and other employees of the law firm in
which such person is a member.
(,
"Ethics Proceeding" means any proceeding, including appellate proceedings, designed to
dispose of an ethics complaint filed with the Florida Commission on Ethics alleging a public
officer or group of public officers of a member has committed a breach of public trust,
except any portion of such proceeding prior to the issuance of a "Determination of
Investigative Jurisdiction and Order to Investigate."
"Legal Assistant" means a person who contributes non-clerical, meaningful legal support to
an attorney; who, under the direct supervision and direction of an attorney, engages in legal
research, case development or planning, prepares or interprets legal documents, or
selects, compiles and uses technical information from references such as digests,
FMIT ECLE 1002
Page 1 of 2
encyclopedias, or practice manuals; and who is certified by the National Association of
Legal Assistants as a "Certified Legal Assistant."
"Legal Assistant Fees" means the fees charged a public officer for the services of a legal
assistant.
"Legal Fees" means fees charged a public officer by an attorney engaged in the practice of
law.
"Occurrence" means conduct or a course of conduct by a public officer or group of public
officers that culminates in an action or ethics proceeding.
"Practice of Law" means legal work performed primarily for the purpose of rendering legal
advise or representation to the member's public officers.
"Public Officer" means any officer or employee of the member who is required to file
financial disclosure pursuant to Sec. 112.3145, Fla. Stat.
(
(
..........,--
FMIT ECLE 1002
Page 2 of 2
FIRE LEGAL LIABILITY
FIRE LEGAL LIABILITY - REAL PROPERTY
With respect to property damage to structures or portions thereof rented to or leased to the
designated member, including fixtures permanently fixed thereto, if such property damage arises
out of fire:
I. The Coverage section is amended to include the following additional coverage:
A. all of the exclusions of the Agreement, other than the Nuclear Energy Liability Exclusion
(Broad Form), are deleted and replaced by the following:
this coverage does not apply to liability assumed by the member under any
contract or agreement.
B. the limit of property damage liability as respects this Fire Legal Liability Coverage - Real
Property is $250,000 each occurrence unless otherwise stated in the schedule of this
endorsement.
C. The Fire Legal Liability Coverage - Real Property shall be excess over any valid and
collectible property insurance (including any deductible portion thereof), available to the
member, such as, but not limit to, Fire, Extended Coverage, Builders' Risk Coverage or
Installation Risk Coverage, and the "Other Insurance" Condition of the Agreement is
amended accordingly.
(
(
FMIT FLL 1002
Page 1 of 1
MEDICAL ATTENDANTS'/MEDICAL DIRECTORS' MALPRACTICE LIABILITY
/
(
I.
The Coverage section is amended to include the following additional coverage:
A. It is agreed that the Trust will pay on behalf of the member all sums which the
member becomes legally obligated to pay as damages because of injury to any
person arising out of the rendering or failure to render, during the period of this
Agreement, professional services by one of the designated member's Medical
Attendants and Medical Director designated pursuant to Section 401.265, Florida
Statutes. The Trust shall hav~ the right and duty to defend any suit against the
member seeking such damages, even if any of the allegations of the suit are
groundless, false or fraudulent, and may make such investigation and such
settlement of any claim or suit as it deems expedient, but the Trust shall not be
obligated to pay any claim or any judgment or to defend any suit after the
applicable limit of the Trust's liability has been exhausted by payment of judgments
or settlements.
II.
EXCLUSIONS
(-
This coverage does not apply to:
A. Any dishonest, fraudulent, criminal or malicious act or omissions of the member,
any partner or employee, any intentional misconduct or intentional act;
B. Liability of the designated member as an employer of others or as the proprietor,
superintendent or executive officer of any hospital, sanitarium, clinic with bed and
board facilities, or other business enterprise;
C. To professional services rendered by physicians and/or nurses; however, this
exclusion does not apply to a Medical Director designated pursuant to Section
401.265, Florida Statutes, when said Director is acting within the scope and in
furtherance of the duties of the Medical Director as outlined in Section 401.265,
Florida Statutes.
D. To any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability,
Advertising Injury Liability, Products Liability and Completed Operations Hazard
arising directly or indirectly out of
a. Any actual or alleged failure, malfunction or inadequacy due to the inability
to correctly recognize, process, distinguish, interpret or accept the year
2000 and beyond by:
(1) Any of the following, whether belonging to any insured or to
others: (a) Computer application software; (b) Computer networks;
(c) Microprocessors (computer chips) not part of any computer
system; (d) Computer operating systems and related software; (e)
Computer hardware, including microprocessors; or (f) Any other
computerized or electronic equipment or components; or
(2) Any other products, and any services, data or functions that
directly or indirectly use or rely upon, in any manner, any of the
items listed in the preceding paragraph.
b. Any advice, consultation, design, evaluation, inspection, installation,
maintenance, repair, replacement or supervision provided or done by you
or for you to determine, rectify or test for, any potential or actual problems
described in paragraph a. above.
(
"
FMIT MA 1002
Page 1 of 1
ERRORS AND OMISSIONS LIABILITY ENDORSEMENT
This endorsement issued by the Trust extends and modifies the provisions of the
Agreement relating to liability for Public Officials Errors and Omissions as set forth below:
It is agreed that as of the effective date hereof, the Agreement is amended in the following
particulars:
I. The Coverage Section is amended to include the following additional coverage:
COVERAGE D - ERRORS AND OMISSIONS LIABILITY
II. The Trust will pay all sums a member becomes legally obligated to pay to any person other
than the member by reason of "Errors and Omissions" as defined in the agreement
committed by a member acting in his official capacity which takes place during the period of
this Agreement, subject to all terms, conditions, exclusions and limits of liability of the
Agreement and this endorsement.
III. The Definition Section is amended to include the following additional definitions which
shall apply exclusively to this endorsement.
A. Member for purposes of coverage under this endorsement shall not include any of
the following individuals, boards, commissions, authorities, units or administrative
departments or agencies of:
(
1. Schools
2. Airports
3. Hospitals
B.
Official Capacity means the capacity of a member while lawfully acting for or on
behalf of the designated member, or while lawfully acting in aid of the duties or
functions which come within the scope of the member's employment by the
designated member.
IV. The Exclusion Section of the Agreement is amended as follows for this endorsement:
A. Exclusion J of the Agreement is amended to read:
J. to bodily injury to any employee of the designated member arising out of
and in the course of employment by the designated member or to any
obligation of a member to indemnify another because of damages arising
out of such injury; but this exclusion does not apply to liability assumed by
the designated member under an incidental contract.
B. Exclusion Z of the Agreement is deleted.
C. The following additional exclusions are included for purposes of this endorsement
only; and this endorsement does not apply to claims for liability as to any member
arising out of the following:
1. based upon or attributable to any member gaining in fact any profit or
advantage to which such member was not legally entitled, including
remuneration paid in violation of law as determined by the courts;
(
FMIT EO 1002
Page 1 of 5
(
(~ j
2.
brought about or contributed to by fraud, dishonesty, or bad faith of a
member; however, notwithstanding the foregoing, the member shall be
protected under the terms of this Agreement as to any claims upon which
suit may be brought against them by reason or any alleged fraud or
dishonesty on the part of any member, unless a judgment or other final
adjudication thereof adverse to such member shall establish that acts of
active or deliberate dishonesty or fraud committed by such member was
material to the cause of action so adjudicated;
to any (a) liability arising out of estimates of probable costs or cost
estimates being exceeded or faulty preparation of bid specifications, or
plans, or (b) injury to, destruction or disappearance of any tangible
property (including money) or the loss of use thereof;
any claim demand or action seeking relief, or redress, in any form other
than money damages, and any costs, fees, expenses or attorneys' fees
relating to such claims;
to any obligation for which a member becomes obligated to pay future
wages as a result of any alleged wrongful employment practice.
To any Bodily Injury Liability, Property Damage Liability, Personal Injury
Liability, Advertising Injury Liability, Products Liability and Completed
Operations Hazard arising directly or indirectly out of
a. Any actual or alleged failure, malfunction or inadequacy due to the
inability to correctly recognize, process, distinguish, interpret or
accept the year 2000 and beyond by:
(1) Any of the following, whether belonging to any insured or
to others: (a) Computer application software; (b)
Computer networks; (c) Microprocessors (computer chips)
not part of any computer system; (d) Computer operating
systems and related software; (e) Computer hardware,
including microprocessors; or (f) Any other computerized
or electronic equipment or components; or
(2) Any other products, and any services, data or functions
that directly or indirectly use or rely upon, in any manner,
any of the items listed in the preceding paragraph.
b. Any advice, consultation, design, evaluation, inspection,
installation, maintenance, repair, replacement or supervision
provided or done by you or for you to determine, rectify or test for,
any potential or actual_problems described in paragraph a. above.
3.
4.
5.
6.
D. Any violation of Constitutional Rights of any person which creates a cause of action
for damages by or on behalf of any such person under anyone or more of the
following Civil Rights Statutes:
(
FMIT EO 1002
United States Code, Title 42, Section 1982
United States Code, Title 42, Section 1983
United States Code, Title 42, Section 1985
United States Code, Title 42, Section 1986
United States Code, Title 42, Section 12101 (ADA)
United States Code, Title 29, Section 2601, et. seq. (FMLA)
Civil Rights Act of 1991
Page 2 of 5
SUPPLEMENTAL EMPLOYMENT PRACTICES LIABILITY
\
In consideration of the additional premium charged, it is hereby noted and agreed that
coverage afforded by this agreement is extended to include Supplemental Employment Practices
claims filed against a Designated Member or Member subject to the terms, conditions and
exclusions of this endorsement and the terms, conditions and exclusions of the agreement.
It is further noted and agreed that for the purposes of this endorsement only, the following
definition shall apply:
"Employment Practice Claims" shall mean a claim relating to a past, present or prospective
employee of the Designated member arising out of an actual or alleged wrongful dismissal,
discharge or termination, either actual or constructive, or employment, employment-related
misrepresentation, wrongful failure to employ or promote, wrongful deprivation of career
opportunity, wrongful discipline; failure to grant tenure or negligent employee evaluation; or
sexual, gender, or workplace harassment (including the alleged creation of a hostile
workplace environment); or unlawful discrimination, whether direct, indirect, intentional or
unintentional; or failure to provide adequate employee policies and procedures.
Exclusion CC4 is amended to read:
employment related claim includes but is not limited to claims, accusations or charges of
negligent hiring, placement, training or supervision arising from or related to actual or
alleged sexual action, or any other type of actual or alleged abuse, or a communicable
disease.
Exclusion CC5 is amended to read:
(
However, this exclusion does not apply and coverage is afforded under this Agreement to
bodily injury or personal injury liability which may accrue against the "Designated Member"
or "Member" as defined within the "Definition" section;
(
FMIT EO 1002
Page 3 of 5
.
EMPLOYEE BENEFITS PROGRAM ADMINISTRATION LIABILITY
I
(
The endorsement issued by the Trust extends and modifies the provision of the Agreement
relating to liability for the administration of employee benefits programs as set forth below:
I. The Coverage Section is amended to include the following additional coverage:
The Trust will pay all sums a member becomes legally obligated to pay by reason of "Errors
and Omissions" as defined in the Agreement, or other negligent act, committed in the
administration of the designated members' employee benefits for present or former
employees, which take place during the period of this Agreement, subject to the terms,
conditions, exclusions and limits of liability of the Agreement and this endorsement.
II. The Definition Section is amended to include the following additional definitions which
shall apply exclusively to this endorsement:
A. "Member" in this endorsement means only the designated member and individuals
serving on boards or commissions for the purpose of administering employee
benefits programs, acting within the scope of their authority by or on behalf of the
designated member except as excluded herein.
III. The Exclusions Section of the Agreement is amended as follows for this endorsement:
A. Exclusion EE is deleted.
B.
The following additional exclusions are included for purposes of this endorsement
only; and this endorsement does not apply to claims for liability as to any member
arising out of the following:
(
1. As a result of dishonest, intentionally fraudulent, criminal or malicious acts
or omissions of any member, however, this exclusion shall not apply to any
member who did not:
a) Personally participate in committing any such act or omission; or
b) Remain passive after having personal knowledge of any such act
or omission.
2. As a result of an intentional violation of any Workers' Compensation,
Unemployment Insurance, Social Security or Disability Benefits law or
administrative interpretation of such laws.
3. As a result of the failure to provide benefits because said benefits are not
properly funded or an insurers failure to comply with the terms of its
contract.
4. As a result of advice given to any employee to participate or not to
participate in any Stock Subscription, Individual Retirement Account, or
Salary Reduction Plan.
5. As a result of the investment or non-investment of employee benefit funds.
6. As a result of the failure of any investment to perform as predicted or
expected by a member.
7. As a result of the termination or failure of any employee benefit plan.
8. As a result of fines, taxes or penalties imposed by law or other matters for
which coverage may not be available under law.
( /
FMIT EO 1002
Page 4 of 5
(
(~/
(
FMIT EO 1002
9.
To any Bodily Injury Liability, Property Damage Liability, Personal Injury
Liability, Advertising Injury Liability, Products Liability and Completed
Operations Hazard arising directlyor indirectly out of
a. Any actual or alleged failure, malfunction or inadequacy due to the
inability to correctly recognize, process, distinguish, interpret or
accept the year 2000 and beyond by:
(1) Any of the following, whether belonging to any insured or
to others: (a) Computer application software; (b)
Computer networks; (c) Microprocessors (computer chips)
not part of any computer system; (d) Computer operating
systems and related software; (e) Computer hardware,
including microprocessors; or (f) Any other computerized
or electronic equipment or components; or
(2) Any other products, and any services, data or functions
that directly or indirectly use or rely upon, in any manner,
any of the items listed in the preceding paragraph.
b. Any advice, consultation, design, evaluation, inspection,
installation, maintenance, repair, replacement or supervision
provided or done by you or for you to determine, rectify or test for,
any potential or actual problems described in paragraph a. above.
Page 5 of 5
(
(~}
c
LAW ENFORCEMENT LIABILITY ENDORSEMENT
This endorsement issued by the Trust extends and modifies the provisions of the
Agreement relating to Law Enforcement Liability as set forth below:
It is agreed that as of the effective date hereof the Agreement is amended in the following
particulars:
This Agreement will provide coverage for losses, including personal injury, arising out of the
course and scope of law enforcement and includes, but is not limited to, false arrest, detention,
malicious prosecution, excessive force and assault and battery.
FMIT LE 1002
Page 1 of 1
FLORIDA MUNICIPAL INSURANCE TRUST
AUTOMOBILE LIABILITY AND PHY$tCAtDAMAGE
DECLARATIONS
Agreement No.: FMIT #0648
I. DESIGNATED MEMBER: City of Winter Springs
II. Government Description
Municipality
III. COVERAGE PERIOD
From October 1, 2002 to October 1, 2003
12:01 A.M. Standard Time at the address of the Designated Member.
Premium
IV. Automobile
1. Automobile Liability
Number of Vehicles:
( 2. Uninsured Motorists Protection
3. Personal Injury Protection
4. Automobile Medical Payments
5. Automobile Physical Damage
Basis e uctl e vpe Iml e remlum
Per Schedule $25,000 DSL $2,000,000 $50,619
153
N/A N/A
$10,000 Included
$1,000 Included
Per Schedule Per Schedule N/A $13,770
D d 'bl IT
L' 't
N t P
V. This Agreement includes these endorsements and schedules: See Schedule B
VI. ESTIMATED ANNUAL PREMIUM
Florida Municipal Insurance Trust (FMIT)
Normal
Premium
$70,571
Incentive
Credit
$6,182
Net
Premium
$64,389
Florida League of Cities Sponsored Insurance Programs Since 1977
(
THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS,
COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT.
FMIT AUTO DEC 1002
Page 1 of 2
12/13/02
Form #
FMIT IND
FMIT GC
FMIT DSL
FMIT AL
FMIT PIP
FMIT AM
FMIT APD
FMIT ARR
FMIT SE AL
(
(
FMIT AUTOMOBILE LIABILITY A'NO PHYSICAL DAMAGE COVERAGES
October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List
City of Winter springs, FMIT #0648
Schedule B
Description
Indemnity Agreement
Coverage Agreement
Deductible Stoploss Endorsement provisions
Automobile Liability
Personal Injury Protection Benefits
Automobile Medical Payments
Automobile Physical Damage Coverage Form
Automobile Reimbursement Coverage
Specific Excess Endorsement - Automobile Liabilty
FMIT AUTO DEe 1002
Page 2 of 2
FLORIDA MUNICIPAL INSURANCE TRUST
INDEMNITY AGREEMENT
THIS AGREEMENT, made and entered into this 1st day of October, 1992, by and between the
Florida Municipal Insurance Trust (Trust) and all parties who are now or may hereafter become members of
the Florida Municipal Insurance Trust (member), acting by and through a Board of Trustees of their own
selection. These members of the Florida Municipal Insurance Trust, all local government entities, have
organized and formed a trust, and have agreed to pool their liabilities pursuant to Florida law. NOW
THEREFORE, for and in consideration of the mutual covenants, promises and obligations herein contained,
which are given to and accepted by each member hereof to the other, the parties to this instrument covenant,
stipulate and agree as follows:
RESPONSIBILITIES OF MEMBER
Each member of the Trust agrees to abide by the following rules and regulations:
I. GENERAL CONDITIONS
A. The member agrees the Board of Trustees, the governing body of the Trust, comprised
entirely of local elected officials, will set up, operate and enforce its own administrative rules,
regulations and by-laws as between the individual members of the Trust and shall otherwise
direct the affairs of the Trust;
(
B.
The member and the Trust agree all members of the Trust hereby agree that the Board may
admit as members of this Trust only acceptable employers in the state of Florida who have
common governmental interest. The Board or its designee shall be sole judge of whether or
not an applicant shall be admitted to membership;
c. The member agrees to maintain a reasonable loss prevention program in order to provide
the maximum in safety and lawful practices as such may relate to the potential liability
assumed by the Trust under this Agreement or any other agreement, certificate, document,
or other instrument executed by the Trust and the member pursuant to this Agreement;
O. The member agrees to provide immediate notification of such occurrence to the Trust in the
event of an occurrence likely to give rise to a claim within the scope of this Agreement, or
any other agreement, certificate, document or other instrument executed by the Trust and..
the member pursuant to this Agreement;
E. The member agrees to promptly make all contributions for coverages arising under this
Agreement, or any other agreement, certificate, document, or other instrument executed by
the Trust and the member pursuant to this Agreement at the time and. in the manner
directed by the Board of Trustees. Said contributions may be reduced by any discount,
participation credit, or other contribution reduction program established by the Board of
Trustees;
F.
The member agrees in the event of payment of any loss by the Trust on behalf of the
member, the Trust shall be subrogated to the extent of such payment to all the rights of the
member against any party or other entity legally responsible for damages resulting from said
loss, and in such event, the member hereby agrees, on behalf of itself, its officers,
employees, and agents to execute and deliver such instruments and papers as is required,
and do whatever else is reasonably necessary, to secure such right to the Trust, and to
cooperate with and otherwise assist the Trust as may be necessary to effect any recovery
sought by the Trust pursuant to such subrogated rights;
(
FMIT INO 1002
Page 1 of 4
G. The member agrees the Board of Trustees, its Administrator, and any of their other agents,
servants, employees or attorneys, shall be permitted at all reasonable times and upon
reasonable notice to inspect the property, work places, plants, works, machinery and
appliances covered pursuant to this Agreement or any other agreement, certificate,
document, or other instrument executed by the member and the Trust pursuant to this
Agreement, and shall be permitted at all reasonable times while the member participates in
the Trust, and up to and including two (2) years following the termination of its membership
in the Trust, to examine the members' books, vouchers, contracts, documents and records
of any and every kind which show or tend to show or verify any loss that may be paid or may
have been paid by the Trust on behalf of the member pursuant to this Agreement, or any
other agreement, certificate, document, or other instrument executed by the member and
the Trust pursuant to this Agreement, or which show or verify the accuracy of any
contribution which is paid or payable by the member pursuant to the terms of this
Agreement, or any other agreement, certification, document or any other instrument
executed by the Trust and the member pursuant to this Agreement;
H. The members hereby delegate to the Board of Trustees the responsibility to contract for
handling the administrative and servicing functions of the Trust. The Board may pay a
reasonable fee for such, which shall be negotiated from time to time by the Board of
Trustees. These fees shall be in consideration of all services and expenses contracted for
with the Trust, which services or expenses may include the collecting, disbursing, and
accounting for monies collected, counseling with members as to the safety hazards, claims
handling and investigations, and legal services, actuarial services and accounting services
and for the purpose of providing for excess insurance coverage. Books and records of all
contractors employed by the Trust are to be open to inspection by the Board of Trustees or
their agents at all reasonable times and as otherwise required by law;
(
I.
The member and the Trust agree the administrator, to be appointed by the Board, shall
deposit to the account of the Trust, at any bank or banks designated by the Board, all
contributions or other monies, as and when collected and said monies shall be disbursed
only as provided by (1) the Trust's Agreement and Declaration of Trust, (2) the rules,
regulations and by-laws of the Board, and (2) the Agreement between the Board and the
administrator;
J. The member and the Trust agree that the Trust is to defend in the name of and on behalf of
the member any claims, suits or other legal proceedings which may at any time be instituted
against the member on account of bodily injury liability, property damage liability, errors and
omissions liability, civil rights liability, personal injury liability or any other such liability,
monetary or otherwise, to the extent such defense and liability has been assumed by the
Trust pursuant to this Agreement or any other agreement, certificate, documents, or other
instrument executed by the Trust and the member pursuant to this Agreement, subject to
any and all of the definitions, terms, conditions and exclusions contained in said
agreements, certificates, documents or other instruments, although such claims, suits,
allegations or demands are wholly groundless, false, fraudulent, and to pay all costs taxed
against the member in any such legal proceedings defended by the Trust or the members,
all interest accruing after entry of judgement in such proceedings, and all expenses incurred
in the investigation, negotiation or defense of such claims, suits, allegations or demands.
Such defense shall be subject to the control of the Trust and its Administrator, which may
make such investigation and settlement of any such claim, suit, or other legal proceeding,
monetary or otherwise, as they deem expedient;
K. The member agrees the liability of the Trust is specifically limited to the discharge of the
liability of its members assumed pursuant to this Agreement or any other agreement,
certificate, document, or any other instrument executed by the member and the Trust
pursuant to this Agreement;
FMIT IND 1002 Page 2 of 4
L. The member agrees the coverage of the Trust does not apply to punitive or exemplary
damages;
M.
The Trust shall operate on a fiscal year from 12:01 a.m. October 1st to 12:01 October 1st of
the succeeding year. Application for continuing membership, when approved in writing by
the Board or their designee, shall constitute a continuing contract for each succeeding fiscal
period unless cancelled by the Board or unless the member shall have resigned or
withdrawn from said Trust by written notice;
N. Unless the Trust and the member otherwise expressly agree in writing, the member agrees
coverage by the Trust for a member under the terms of this Agreement or any other
agreement, certificate, document, or other instrument executed by the member and the
Trust pursuant to this Agreement, shall expire automatically at midnight on the last day of
September of each calendar year;
O. Except as otherwise provided herein, the member and the Trust agree such member's
coverage may be canceled by the Trust or the member at any time upon no less than forty-
five (45) days prior written notice by the Board of Trustees or the Administrator to the
member and to the Division of Workers' Compensation, if applicable, or by the member to
the Trust, stating the date such cancellation shall be effective; however, cancellation by the
member after the initial effective date of coverage (October 1), shall be conditioned upon
Member's payment of an amount equal to ten (10) percent of the premium that is unearned
by the Trust, or the Trust may cancel for non-payment of premium by issuing written notice
of cancellation to the member 10 days before the effective date of cancellation;
P.
The member agrees excess monies remaining after the payment of claims and claim
expenses, and after provision has been made for the payment of open claims and
outstanding reserves, may be distributed by the Board of Trustees to the members
participating in the Trust in such manner as the Trustees shall deem to be equitable;
(
a. The member agrees there will be no disbursements out of the reserve fund established by
the Trust by way of dividends or distributions of accumulated reserves to members until
provision has been made for all obligations against the Trust and except at the discretion of
the Board of Trustees;
R. The member agrees to permit qualified service providers, including attorneys selected by the
Trust, to defend, investigate, settle, and otherwise process and dispose of all claims, suits,
allegations or demands that may result in liability assumed by the Trust on behalf of the
member pursuant to this Agreement, or any other agreement, certificate, document, or other
instrument executed by the Trust or the member pursuant to this Agreement;
S. The member shall make prompt payment of all contributions as required by the Board of
Trustees, said contributions to be determined by said Board. The member shall fully
cooperate with auditors of the Trust to promptly determine final audited contributions. Any
disputes concerning contributions shall be resolved after payment. Any objections
concerning the final audited contribution shall be filed within 60 days of billing of the final
audited contributions. After that time, the audit shall be considered to be final;
T. The member agrees to pay reasonable penalties as determined by the Board of Trustees for
late payment of contributions required under this Agreement, or any other agreement,
certificate, document, or other instrument executed by the member and the Trust pursuant
to this Agreement;
(
U.
The member, through the Board of Trustees, does hereby appoint the Administrator of the
Trust as its agent and attorney-in-fact, to act in its behalf and to execute all necessary
contracts, reports, waivers, agreements, excess insurance contracts, service contracts, and
other documents reasonably necessary to accomplish the purposes and to fulfill the
FMIT IND 1002
Page 3 of 4
responsibilities of the Trust; to make or arrange for the payment of claims, claim expenses,
medical expenses, and all other matters required or necessary insofar as they affect the
member's liability under federal or Florida law and insofar as such matters are covered
pursuant to the terms of this Agreement or any other agreement, certificate, document, or
other instrument executed by the member and the Trust pursuant to this Agreement, and by
the rules and regulations now or hereafter promulgated by the Board of Trustees;
V. The Trust shall determine all questions of the scope of liability coverage, eligibility methods
of providing or arranging for benefits, and all other related matters. It shall have full power to
construe the provisions of this agreement and the other program documents in the terms
used here and therein. Any such determination and any such construction adopted by the
Trust in good faith shall be Qinding upon all parties hereto and the members, provided such
determination or such construction is consistent with the laws of the State.
The member agrees to abide by all the terms and conditions of this Agreement, the
Participation Agreement, the Trust's By-laws, the rules and regulations, and any other
agreement, certificate, document, or other instrument executed by the Trust and the
member pursuant to the Agreement;
W. The member and the Trust agree the Trust will maintain an excess coverage program and
reserve evaluation to protect the financial stability of the Trust in an amount and manner
determined by a qualified and independent actuary;
X. The member and the Trust agree the Trust will submit to the appropriate governmental
agency annually an audited fiscal year-end financial statement prepared by an independent
certified public accountant;
Y.
(
The member and the Trust agree that any member who formally applies for membership in
this Trust and is accepted by the Board of Trustees shall thereupon become a party to the
Trust's Agreement and Declaration of Trust and be bound by all of the terms and conditions
contained therein, and said application shall constitute a counterpart of said Agreement and
Declaration of Trust; and
Z. Members duties after loss:
FMIT IND 1002
1.
give the Trust prompt written notice of any accident, occurrence or potential claim
along with all relevant information concerning the claim. The member shall have a
continuing duty to provide to the Trust all relevant information promptly as the
member becomes aware of such information; and
cooperate fully with the Trust in defense or settlement of claims or opposition to
claims bills, and in the enforcement of any right of contribution or indemnity; and
forward to the Trust every notice, demand, summons or other process served upon
the member relating to any occurrence, and take no further action concerning the
occurrence without the approval of the Trust or the servicing agent; and
take reasonable steps to prevent additional or cumulative bodily injury, personal
injury or property damage from or arising out of the same or similar conditions or
circumstances; and
not engage in settlement negotiations as to any claim or suit, and the Trust shall
have no obligation to pay the amount of any settlement negotiated or agreed upon by
a member without prior written approval by the Trust or the servicing agent; and
agree to take all reasonable actions, where appropriate, which shall facilitate
settlement of claims; and
agree to responsible counsel selected by the Trust to defend the claim and agree not
to use the designated member's counsel in defense of said action.
2.
3.
4.
5.
6.
7.
Page 4 of 4
FLORIDA MUNICIPAL INSURANCE TRUST
COVERAGE AGREEMENT
In consideration of the payment of the contributions and the covenants and agreements set forth in
the INDEMNITY AND COVERAGE AGREEMENTS, in reliance upon the statements of the APPLICATION,
the DECLARATIONS, and all terms, conditions, limits and other provisions of the COVERAGE
AGREEMENT, the Trust agrees with the member as to the following:
LIMITS OF LIABILITY
Regardless of the number of (1) members under this Agreement, (2) persons or organizations who
sustain injury or damage, or (3) claims made or suits brought on account of bodily injury, property damage
or personal injury, the liability of the Trust is limited as follows:
The total liability of the Trust applicable to "each person" under all coverages and endorsements for
all damages, including but not limited to damage awards for derivative claims, taxable costs, attorneys fees,
and prejudgment or post-judgment interest, sustained by one person or organization as the result of any
one occurrence shall not exceed the limit of liability stated in the Declarations and endorsements thereto.
The total liability of the Trust applicable to "each occurrence" under all coverages and
endorsements for all damages, including but not limited to damage awards for derivative claims, taxable
costs, attorneys fees, and prejudgment or post-judgment interest, sustained by more than one person or
organization as the result of anyone occurrence shall not exceed the limit of liability stated in the
Declarations and endorsements thereto.
( For the purpose of determining the limit of the Trust's liability, all damages arising out of continuous
or repeated exposure to substantially the same general conditions shall be considered as arising out of one
occurrence.
DEFENSE AND SETTLEMENT
In addition to the limits of liability the Trust will settle or defend at its own expense, as it considers
appropriate, any claim or suit demanding money damages covered by this Agreement. The Trust will
defend any suit against a member which alleges a claim for money damages covered by this Agreement
even if such suit is groundless, false or fraudulent. However, the Trust has no duty to defend a member in
any action which on its face alleges facts excluded or not covered by this Agreement.
In the event a suit or other action contains allegations which allege damages which the Trust has a
duty to defend and other allegations which allege damages or other relief that the Trust does not have a
duty to defend, the Trust will defend all allegations subject to the terms, conditions, limits of liability and
exclusions of the Agreement; however, undertaking such defense shall not obligate the Trust to ,pay any
judgments, settlements or awards which a member becomes legally obligated to pay for allegations to
which coverage does not apply. The Trust's duty to defend ends when applicable Limits of Insurance have
been exhausted.
FMIT GC 1002
Page 1 of 10
DEFINITIONS
The following definitions apply throughout this Agreement unless modified or excluded:
A. Advertising Injury, means injury arising out of an offense committed during the Agreement
period occurring in the course of the designated member's advertising activities; if such injury arises
out of libel, slander, defa'mation, violation or right of privacy, piracy, unfair competition, or
infringement of copyright, title, or slogan.
B. Agreement Territory, means anywhere in the world.
C. Automobile, means a land motor vehicle, trailer or semi-trailer designed for travel on public
roads (including any machinery or apparatus attached thereto), but does not include mobile
equipment.
D. Bodily Injury, means bodily injury, disability, disfigurement, sickness or disease or death resulting
from an occurrence and sustained by any person, and any loss, injury or damages sustained by
any person because of bodily injury, which occurs during the period of this Agreement.
E. Completed Operations Hazard, includes bodily injury and property damage arising out of
operations or reliance upon a representation or warranty made at any time with respect thereto, but
only if the bodily injury or property damage occurs after such operations have been completed or
abandoned and occurs away from the premises owned by or rented to the designated member.
"Operations" includes materials, parts or equipment furnished in connection therewith. Operations
shall be deemed completed at the earliest of the following items:
1. When all operations to be performed by or on behalf of the designated member under the
contract have been completed,
(
2.
When all operations to be performed by or on behalf of the designated member at the site
of the operations have been completed, or
3. When the portion of the work out of which the injury or damage arises has been put to its
intended use by any person or organization other than another contractor or subcontractor
engaged in performing an operation for a principal as a part of the same project.
Operations which may require further service or maintenance work, or correction, repair or
replacement because of any defect or deficiency, but which are otherwise complete shall
be deemed complete.
The completed operations hazard does not include bodily injury or property damage arising
out of operations in connection with the transportation of property, unless the bodily injury
or property damage arises out of a condition in or on a vehicle created by the loading or
unloading thereof.
F. Contractual Liability, means liability expressly assumed under a written contract or agreement;
provided, however, that contractual liability shall not be construed as including liability under a
warranty of the fitness or quality of the designated member's products or a warranty that work
performed by or on behalf of the designated member will be done in a workmanlike manner; and
provided, however, that contractual liability shall not be construed as including liability under any
hold harmless agreement or agreement to indemnify any non-public or private person, corporation,
or entity under any contract or agreement.
FMIT GC 1002
Page 2 of 10
G. Designated Member, means the entity, organization or constitutional officer named in Item I. or V.
of the Declarations of this Agreement; designated member does not include employees or agents of
that entity or organization.
H. Designated Member's Products, means goods or products manufactured, sold, handled, or
distributed by the designated member or by others trading under his name, including any container
thereof (other than a vehicle), but "designated member's products" shall not include a vending
machine or any other property, rented to or located for use of others but not sold.
I. Elevator, means any hoisting or lowering device to connect floors or landings, whether or not in
service, and all appliances thereof; but does not include an automobile servicing hoist, a material
hoist used in alteration, construction or demolition operations, or an inclined conveyor used
exclusively for carrying property or a dumbwaiter.
J. Employee Benefits Program, means any pension and profit sharing plan; individual retirement
account (IRA) plan; salary reduction plan under Internal Revenue Code 401 (k) or Amendments;
employee stock subscription plan, savings plan; group plan for life, health, dental, disability,
automobile, home owners, or legal services insurance; social security system benefits; workers'
compensation and unemployment insurance; travel and vacation plans; or educational tuition
reimbursement plans created, administered or endorsed by a member.
K. Errors and Omissions, means an actual or alleged error or misstatement or act of omission or
neglect or breach of duty including misconduct or official misconduct by the members in their official
capacity, individually or collectively, or any matter of claims against them solely by reason of their
having served or acted in an official capacity.
L.
Incidental Contract, means a written (a) lease of premises, (b) easement agreement, except in
connection with construction or demolition operations on or adjacent to a railroad, (c) undertaking to
indemnify a municipality required by municipal ordinance, except in connection with work for the
municipality, (d) sidetrack agreement, or (e) elevator maintenance agreement; but does not include
any hold harmless agreement or agreement to indemnify any non-public or private person,
corporation, or entity under any contract or agreement.
(
M. Incidental Medical Malpractice Injury, means bodily injury arising out of the rendering of or failure
to render medical services or treatment by a non-professional during the period of this Agreement,
including the following services:
1. medical, surgical, dental, x-ray or nursing service or treatment or the furnishing of food or
beverages in connection therewith; or
2. the furnishing or dispensing of drugs or medical, dental or surgical supplies or appliances.
N. Inverse Condemnation, means a cause of action by a property owner to recover the monetary
value of property that has been taken by the designated member having the power of eminent
domain where no formal exercise of that power has been undertaken and includes any claim
alleging lost profits both future and past.
O. Member, as used herein means:
a. the designated member;
b. while acting within the scope of his employment, any officer (except constitutional officers),
volunteer, servant, or employee of the designated member, including elected and
appointed officials, and members of Boards or Commissions. However, the coverage so
provided any officer, servant, or employee does not apply to bodily injury to another officer,
servant or employee of the designated member injured in the course of and arising out of
his employment.
FMIT GC 1002 Page 3 of 10
The coverage afforded applies separately to each member against whom claim is made or suit is
brought, except with respect to the limits of liability of the Trust; and does not apply to bodily injury
or property damage or personal injury liability arising out of the conduct of any partnership or joint
venture of which a member is a partner or participant and which is not specified in this Agreement
as a designated member.
P. Mobile Equipment, means a land vehicle (including any machinery or apparatus attached
thereto), whether or not self propelled, (a) not subject to motor vehicle registration, or (b)
maintained for use exclusively on premises owned by or rented to the designated member,
including the ways immediately adjoining, or (c) designed for use principally off public roads, or (d)
designed or maintained for the sole purpose of affording mobility to equipment of the following
types forming an integral part of or permanently attached to such vehicle: power cranes, shovels,
loaders, diggers and drills; concrete mixers, graders, scrapers, rollers and other road construction
or repair equipment; air compressors, pumps and generators, including spreading, welding and
building cleaning equipment; and geophysical exploration and well servicing equipment.
Q. Occurrence, means an event or accident, including continuous or repeated exposure to conditions
which result in bodily injury, property damage or personal injury and not arising from any form of
intentional misconduct.
R. Personal Injury, means injury sustained by any person or organization arising out of one or more
of the following offenses committed during the term of this Agreement. However, this coverage
does not apply to law enforcement operations.
1. False arrest, detention, imprisonment;
2. Wrongful entry or eviction, or other invasion of the right of private occupancy;
(
3.
Publication or utterance:
a) of a libel or slander or other defamatory or disparaging material;
b) in violation of an individual's right or privacy; or
except that publications or utterances in the course of or related to broadcasting,
publishing, or telecasting activities conducted by or on behalf of the designated member
shall not be deemed personal injury;
4. Assault and battery, not committed by or at the direction of the designated member unless
committed for the purpose of protection of persons or property.
S. Products Hazard, includes bodily injury and property damage arising out of a designated
member's products or reliance upon a presentation or warranty made at any time with respect
thereto, but only if the bodily injury or property damage occurs away from premises owned by or
rented to the designated member and after physical possession of such products has been
relinquished to others.
T. Property Damage, means (a) physical injury to or destruction of tangible property which occurs
during the policy period, including the loss of use thereof at any time resulting there from, or (b)
loss of use of tangible property which has not been physically injured or destroyed provided such
loss of use is caused by an occurrence during the period of this Agreement.
FMIT GC 1002
Page 4 of 10
EXCLUSIONS
This Coverage Agreement does not apply:
A. to liability assumed by a designated member under an expressed or implied contract or agreement
except an incidental contract or inter-local agreements with other governmental entities; but this
exclusion does not apply to an implied warranty of fitness or quality of the designated member's
products or an implied warranty that work performed by or on behalf of the designated member will
be done in a workmanlike manner;
(
(
B. to bodily injury or property damage arising out of the ownership, maintenance, operation, use,
loading or unloading of:
1. any automobile operated by or rented or loaned to any member;
2. any other automobile operated by any person in the course of his employment by any
member; but this exclusion does not apply to the parking of an automobile on premises
owned by, rented to or controlled by the designated member or the ways immediately
adjoining, if such automobile is not owned by or rented or loaned to any member;
3. any vehicle while being used in any pre-arranged or organized racing, speed or demolition
contest or in any stunting activity or in practice or preparation for any contest or activity;
C. to bodily injury or property damage arising out of:
1. the ownership, maintenance, operation, use, loading or unloading of any mobile equipment
while being used in any pre-arranged or organized racing, speed or demolition contest or in
any stunting activity or in practice or preparation for any such contest or activity;
2. the operation or use of any trailer designed for use therewith; or
3. the ownership, maintenance, operation, or use of a skateboard/skate park facility, in-line
skating facility or water theme park;
D.
to bodily injury or property damage arising out of the ownership, maintenance, operation, use,
loading or unloading of:
1. any watercraft over twenty six (26) feet in length;
2. any passenger being carried for a consideration while in or upon, entering or alighting from
any watercraft; or
3. barge or lighter rented by the designated member to others with respect to which the
designated member does not furnish employees to operate and does not have any
operating control;
4. any watercraft while being used in any pre-arranged or organized racing, speed or
demolition contest or in any stunting activity or in practice or preparation for any contest or
activity;
5. any watercraft or structure being used as an artificial reef or similar purpose;
E. to bodily injury or property damage arising out of the ownership, maintenance, operation, use,
loading or unloading of:
1. any aircraft owned or operated by or rented or loaned to any member;
2. any other aircraft operated by any person in the course of his employment by any member;
but this exclusion does not apply to aircraft while parked on premises owned by, rented to
or controlled by the designated member;
F.
to any liability arising out of or caused or contributed to by any maintenance, operation, use or
control of or responsibility for any airfield, airport, runway, hangar, building or other property or
facility designed for, used, connected, associated or affiliated with or in any way related to aviation
or aviation activities or operations; provided that liability for services performed or premises located
at or on any airfield, airport or aviation facility not directly related to aviation activities or operations,
and not covered by any other liability insurance, shall not be excluded from coverage by this
exclusion;
FMIT GC 1002
Page 5 of 10
G. any claim for bodily injury, property damage (including the loss of use thereof), personal injury or
advertising injury caused by, contributed to or arising out of the actual or threatened discharge,
dispersal, release, or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals,
electromagnetic radiation, liquids or gases, waste materials or other irritants, pollutants or
contaminants into or upon the land, the atmosphere or any course or body of water, whether above
or below ground and includes all claims involving mold, spores and/or fungus.
Also, excluded from coverage under this agreement is the process of continued surface and/or
subsurface degradation and deterioration of lead based paint that has been applied to any surface
of any building whether considered commercial or residential.
It is understood and agreed that the intent and effect of this exclusion is to delete from all
coverages afforded by this policy any claim, suit, action, judgment, liability, settlement, defense or
expenses (including any loss, cost, or expense arising out of any governmental direction, order or
request that the member test for, monitor, clean up, remove, contain, treat, detoxify or neutralize
pollutants) in any way arising out of such actual or threatened discharge, dispersal, release or
escape, whether such results from the member's activities or the activities of others, whether or
not such a sudden or gradual, and whether or not such is accidental, intended, foreseeable,
fortuitous or inevitable and wherever such happens;
H. to bodily injury or property damage due to war, whether or not declared, civil war, insurrection,
rebellion and revolution, or to any act or condition incident to any of the foregoing;
I. to any obligation for which any member or any carrier as his insurer may be held liable under any
workers compensation, employers liability, unemployment compensation or disability benefits law,
or under any similar law and including any claims under the Americans with Disabilities Act;
(
J.
to bodily injury to any employee of the designated member arising out of and in the course of this
employment by the designated member or to any obligation of a member to indemnify another
because of damages arising out of such injury; but this exclusion does not apply to liability
assumed by the designated member under an incidental contract. This exclusion shall include any
liability incurred by a designated member as a result of an alleged wrongful discharge; failure to
promote; demotion or transfer of any employee of the designated member;
K. to property damage to property owned or occupied by, leased, or rented to a designated member;
L. to property damage to premises alienated by the designated member arising out of such premises
or any part thereof;
M. to loss of use of tangible property which has not been physically injured or destroyed resulting from
a delay in lack of performance by or on behalf of the designated member of any contract or
agreement;
N. to property damage to the designated member's products arising out of such products or any part
of such products; to property damage to work performed by or on behalf of the designated member
arising out of the work or any portion thereof, or out of materials, parts or equipment furnished in
connection therewith; and to damages claimed for the withdrawal, inspection, repair, replacement,
or loss of use of the designated member's products or work completed by or for the designated
member or of any property of which such products or work form a part, if such products, work or
property are withdrawn from the market or from use because of any known or suspected defect or
deficiency therein;
FMIT GC 1002
Page 6 of 10
(
O.
to any liability from the designated member's completed operations arising out of:
1. loss of sales, customers or profits suffered by a person or entity affected by the actions of
the designated member or its agents including any damages sustained by such person or
entities by virtue of a business interruption; or
2. loss resulting from theft of any property which at the time of loss is not an integral part of a
building or structure including direct loss by pillage and looting occurring during and at the
immediate place of a riot or civil commotion;
P.
to any liability arising in whole, or in part out of
1. any act or omission of a member committed while acting outside the course and scope of
his employment, or committed in bad faith with malicious purpose, or in a manner
exhibiting wanton and willful disregard of human rights, safety or property;
2. any member obtaining remuneration or financial gain to which the member was not legally
entitled;
3. the willful violation of any federal, state or local law, ordinance or regulation committed by
or with the knowledge or consent of any member; or
4. official misconduct by any member;
Q.
to any liability arising out of or in any way connected with the operation of the principals of eminent
domain, condemnation proceedings, inverse condemnation or takings law, by whatever name
called, whether permanent or temporary, including but not limited to, claims arising out of federal,
state or local land use, environmental, air, ground or water pollution, or health, safety and welfare
laws, ordinances or regulations, claims arising from Ch. 95-181, Laws of Florida, as may be
amended from time to time, or claims arising from activities by or on behalf of a member which
result in permanent or temporary loss of use or value of property, whether such liability accrues
directly against the member, or by virtue of any agreement entered into by or on behalf of the
member;
however, this exclusion does not apply to bodily injury, property damage or personal injury
resulting from a claim against the designated member for inverse condemnation;
the limit of inverse condemnatiOn claims is the amount of liability described in the
General/Professional Liability section of the Declarations Page or $1,000,000 aggregate per fund
year, whichever is the lesser amount, subject to a deductible of $5,000.00 per occurrence.
R. to any liability for injury, sickness, disease, death or destruction due to the rendering of or failure to
render any professional service by any doctor, surgeon, dentist, nurse, physician's assistant,
paramedic, emergency medical technician or other medical professional of a designated member;
S. to any liability arising out of or in connection with or caused or contributed to by any failure or
inability to supply, in whole or in part, any adequate quantity or quality of power, steam, pressure or
fuel;
T. to any liability arising out of or caused or contributed to by or connected with any actual or alleged
violation of the Employee Retirement Income Security Act of 1974 (Public Law 93-406) or any
amendment thereto or any similar provision of any local, state or federal law, statutory or common;
U. to any liability arising out of or caused or contributed to by any breakage and/or water overflow of
any dam or reservoir;
V. to any liability for fines, punitive or exemplary damages; or any non compensatory damages or
penalties imposed pursuant to any federal or state anti-trust, civil rights, anti-discrimination, or
racketeer influence and corrupt organization (RICO) laws;
W. to any damages imposed by special act of the Legislature;
FMIT GC 1002
Page 7 of 10
X. to loss caused directly or indirectly by nuclear hazard. Nuclear hazard means any nuclear
reaction, radiation, a radioactive contamination, all whether controlled or uncontrolled or however
caused, or any consequence of any of these;
Y. to personal injury arising out of any publication or utterance described in sub-paragraph Q 3 of the
definition of Personal Injury contained in the Definition section of this Agreement (a) if the first
injurious publication or utterance of the same or similar material by or on behalf of the designated
member was made prior to the effective date of this coverage; (b) concerning any organization or
business enterprise, or its products or services, made by or at the direction of any member with
knowledge of the falsity thereof;
Z. to any liability arising out of errors and omissions as defined herein;
AA. to bodily injury or property damage for which the designated member or his indemnitee may be
held liable;
1. as an entity or organization engaged in manufacturing, distributing, selling or serving
alcoholic beverages; or
2. if not so engaged, as an owner or lessor of premises used for such purposes,
if such liability is imposed
a) by, or because of the violation of, any statute, ordinance or regulation pertaining to
the sale, gift, distribution or use of any alcoholic beverages; or
b) by reason of the selling, serving or giving of any alcoholic beverage to a minor or
to a person under the influence of alcohol or which causes or contributes to the
intoxication of any person.
This exclusion does not apply and coverage is afforded under the Agreement for bodily injury or
property damage claims or liability resulting from the providing or serving of alcoholic beverages
without charge to the public at functions incidental to a designated member's business or activity
otherwise covered under the Agreement or any endorsement to the Agreement;
(
to any claim, demand or action seeking injunctive, declaratory, writ of mandamus, or any other
non-monetary relief against a designated member or any of its agents;
CC. to any liability arising out of any actual or alleged sexual action, abuse, communicable disease or
employment related claim, defined for purposes of this exclusion as:
1. sexual action includes, but is not limited to, any verbal or non-verbal communication,
behavior or conduct with sexual connotations or purposes, whether for sexual gratification,
intimidation, coercion or other purpose, and regardless of whether such action is alleged to
be intentional or negligent.
2. abuse shall include, but is not limited to, the negligent or intentional infliction of physical,
emotional or psychological injury or harm on any person or persons in the care, custody or
control of any member.
3. communicable disease includes but is not limited to Acquired Immune Deficiency
Syndrome (AIDS), and any venereal disease.
4. employment related claim includes but is not limited to claims, accusations or charges of
negligent or intentional hiring, placement, training or supervision arising from or related to
actual or alleged sexual action, or any other type of actual or alleged abuse, or a
communicable disease.
5. However, this exclusion does not apply and coverage is afforded under this Agreement to
bodily injury or personal injury liability which may accrue against the "Designated Member"
as defined within the "Definition" section;
SS.
DD.
to any liability for injury, loss or damage sustained by any person or entities arising from or in
anyway involving asbestos or other products containing asbestos or to asbestosis or any other
disease including mesothelioma and cancer related to asbestos exposure nor any liability for costs
or expenses incurred in removing, cleaning up or nullifying such asbestos product;
(
FMIT GC 1002
Page 8 of 10
EE. to any liability arising out of errors and omissions as defined herein or other negligent or wrongful
act committed in the administration of any employee benefits program as defined herein, for
present or former employees of the designated member;
FF. to any liability arising out of or caused by or contributed to or connected with alleged violation of
the following:
1. Florida Whistle Blowers Act, Sec. 112.3187, Florida Statutes.
2. Federal "Fair Labor Standards Act".
3. Chapter 447, Florida Statutes;
GG. any claim requesting return or reimbursement of a special assessment, tax, service charge or fee
or any other overpayment to the designated member or member;
HH. to any claim for attorneys' fees or costs for any action not covered by this Agreement;
II. to any damages which accrued or occurred prior to the effective date of this Agreement
notwithstanding the date of the occurrence;
JJ. advertising injury arising out of:
1. Failure of performance of contract, but this exclusion does not apply to the unauthorized
appropriation of ideas upon alleged breach of implied contract, or
2. Infringement of trademark, service mark, or trade name, other than titles or slogans, by
use thereof or in connection with goods, products or services sold, offered for sale, or
advertised, or
3. Incorrect description or mistake in advertising price of goods, products or services sold,
offered for sale or advertised.
Also, with respect to advertising injury:
1. To any member in the business of advertising, broadcasting, or telecasting, or
( 2. To any injury arising out of any act committed by the member with actual malice.
KK. To any Bodily Injury Liability, Property Damage Liability, Personal Injury Liability, Advertising Injury
Liability, Products Liability and Completed Operations Hazard arising directly or indirectly out of
a. Any actual or alleged failure, malfunction or inadequacy due to the inability to correctly
recognize, process, distinguish, interpret or accept the year 2000 and beyond by:
(1) Any of the following, whether belonging to any insured or to others: (a) Computer
application software; (b) Computer networks; (c) Microprocessors (computer
chips) not part of any computer system; (d) Computer operating systems and
related software; (e) Computer hardware, including microprocessors; or (f) Any
other computerized or electronic equipment or components; or
(2) Any other products, and any services, data or functions that directly or indirectly
use or rely upon, in any manner, any of the items listed in the preceding paragraph.
b. Any advice, consultation, design, evaluation, inspection, installation, maintenance, repair,
replacement or supervision provided or done by you or for you to determine, rectify or test
for, any potential or actual problems described in paragraph a. above.
(
FMIT GC 1002
Page 9 of 10
OTHER INSURANCE
The coverage afforded by this Agreement is primary, except when stated to apply in excess of or
contingent upon the absence of other insurance. When this coverage is primary and the member has
other insurance which is stated to be applicable to the loss on an excess or contingent basis, the amount
of the Trust's liability under this Agreement shall not be reduced by the existence of such other insurance.
If all other valid and collectible insurance provides for contribution by equal shares, the Trust shall
not be liable for a greater proportion of such loss than would be payable if each party contributes an equal
share until the share of each party equals the lowest applicable limit of liability under anyone policy or
coverage agreement or the full amount of the loss is paid, and with respect to any amount of loss not so
paid the remaining parties then continue to contribute equal shares of the remaining amount of the loss
until each such party has paid its limit in full or the full amount of the loss is paid.
If any such other insurance does not provide for contribution by equal shares, the Trust shall not
be liable for a greater proportion of such loss than the applicable limit of liability under this policy for such
loss bears to the total applicable limit of all valid and collectible insurance against such loss.
( )
(
FMIT GC 1002
Page 10 of 10
DEDUCTIBLE STOP LOSS ENDORSEMENT
PROVISIONS
I. Member City of Winter Springs
II. Stop loss Coverage Applies
0 A. Workers Compensation & Employers Liability
gg B. General Liability
gg C. Auto Liability
0 D. Property
0 E. Automobile Physical Damage
III. Applicable Stoploss Deductible
A. Workers Compensation & Employers Liability $
B. General Liability $ 25,000
C. Auto Liability $ 25,000
D. Property $
E. Automobile Physical Damage $
IV. Applicable Deductible Stoploss Amount
A.
$
188,303
FMIT DSL 1002
Page 1 of 2
The endorsement provides for a limitation on the number of deductibles or amount of loss incurred
by a member under a deductible program as offered by the Florida Municipal Insurance Trust.
I. IT IS AGREED THAT:
A. The Trust's liability to pay claims on behalf of the member under this endorsement applies
only to the members deductible amounts as stated in the Declarations and only after
satisfaction of the Deductible Stoploss amount as stated in this endorsement.
B. The Trust agrees with the member that the member's obligations under applicable
deductible endorsements cease when the member had paid losses within the deductible
that exceed:
{1} Three {3} times the largest deductible as stated in the Provisions or
{2} the Deductible Stop loss Amount, whichever is greater.
C. The terms of the Trust's Indemnity Agreement and Coverage Agreements remain in full
force and effect, including those with respect to:
{1} the Trust's rights and duties in the defense of claims and
{2} the member's duties in the event of an accident or occurrence, irrespective of the
application of deductible amount or deductible stoploss.
D. The member will immediately report in writing:
{1} all accidents or incidents which may give rise to liability.
{2} all Notice of Claims.
{3} all lawsuits involving a claim for damages.
(
E.
The Trust shall select and retain all defense attorneys and other service providers as
necessary and shall directly control and supervise their activities. All such costs incurred
in these services shall be paid by the Trust.
F. The deductible amount shall include the amount of any payment resulting from a covered
claim in the aggregate up to the deductible amount stated in the declarations. The
member's responsibility under the deductible shall continue even though the contract may
have been cancelled or expired.
G. Investigation and adjustment expenses incurred by the Trust shall be paid by the Trust
and not included in the deductible amount.
H. The Trust may settle or defend any claim as it considers appropriate without the
member's consent regardless of any deductible amount.
I. The Trust is authorized to make reasonable additions, changes, or deletions to these
reporting requirements.
J. Reimbursement of the Trust: The member will reimburse the Trust the invoiced amount
due within 45 days of the invoice date. Failure to pay this sum will result in the revocation
of the member's deductible plan privileges.
K. Recoveries shall be applied to the member's deductible until satisfied.
L.
The Definitions Section of the Trust is amended per this additional definition:
{1} Deductible stoploss is coverage which limits a members deductible payment
obligations to a certain fixed amount.
(
FMIT DSL 1002
Page 2 of 2
/-
,~,
'",-, /
Automobile~ Schedule
City of Winter Springs, FMIT#0648
10/01/2002 - 10/01/2003
Veh # Eft
Date
Total
Prem
Exp
Date
City # Model
Year
Make
Description
10 # Class Cost
Code New
Liab
PIP
Med
Pay
UM
Comp
Oed
SP
Oed
Coli
Oed
Physical
Damage
10/0112002
10/01/2002
10/01/2002
2 10/01/2002
3 10/01/2002
4 10/01/2002
5 10/01/2002
6 10/01/2002
7 10/01/2002
8 10/01/2002
9 10/01/2002
10 10/01/2002
11 10/01/2002
12 10/0112002
13 10/01/2002
14 10/01/2002
15 10/01/2002
16 10/0112002
17 10/0112002
18 10/0112002
19 10/01/2002
20 10/0112002
21 10/01/2002
12/13/02
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
1999 FORD
1994 FORD
2002 FORD
1998 FORD
1996 FORD
1991 FORD
1995 FORD
2002 FORD
1994 FORD
1992 FORD
1992 E-ONE
1992 E-ONE
1994 FORD
1994 FORD
1982 GRUMMAN
1994 FORD
1996 CHEVROLET
1999 MEDIC MAST
2001 FORD
2001 MEDIC MAST
1988 FORD
NON OWNED AUTOS
HIRED AUTOS
6601
6619
01499
01499
01499
01499
7398
7398
01499
01499
7398
01499
7909
7909
7398
7398
7909
7398
01499
7919
01499
7919
7398
$10,000
$10,000
$22,000
$10,000
$10,000
$10,000
$10,000
$22,000
$10,000
$12,572
$179,000
$179,000
$12,198
$12,198
$132,545
$14,000
$28,515
$134,568
$17,440
$135.468
$11,486
$39
$39
$434
$434
$434
$434
$246
$246
$434
$434
$246
$434
$341
$341
$246
$246
$341
$246
$434
$661
$434
$661
$246
City of Winter Springs, FMIT #0648
$0
$0
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$10
$5
$10
$5
$0
$0
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$0 n/a
$0 n/a
$0 n/a
$0 n/a
$0 $1,000
$0 n/a
$0 nla
$0 nla
$0 n/a
$0 $1,000
$0 n/a
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
Normal Premium
n/a
n/a
n/a
n/a
n/a
$1,000
nla
nla
nla
n/a
nla
nla
$1,000
n/a
$1,000
$1,000
$1,000
$1,000
$1,000
$1,000
$1,000
$1,000
$1,000
$1,000
$1,000
$1,000
nla
n/a
nla
nla
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
n/a
Page
$0
$0
$0
$0
$312
$0
$0
$0
$0
$312
$0
$159
$184
$184
$83
$83
$184
$83
$250
$326
$284
$421
$83
$39
$39
$440
$440
$752
$440
$252
$252
$440
$752
$252
$599
$531
$531
$335
$335
$531
$335
$690
$998
$724
$1,093
$335
$70,571
of 7
-~
AutomobifitSchedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/0112003
Veh # Eft
Date
Total
Prem
6:fe
City # Model
Year
Make
Description
10 # Class Cost
Code New
Llab
PIP
Med
Pay
UM
C8~
SP
Oed
Coli
Oed
Physical
Damage
22 10/0112002
23 10/01/2002
24 10/0112002
25 10/01/2002
26 10/0112002
27 10/0112002
28 10/01/2002
29 10/01/2002
30 10/01/2002
31 10/01/2002
32 10/01/2002
33 10/01/2002
34 10/01/2002
35 10/01/2002
36 10/0112002
37 10/01/2002
38 10/01/2002
39 10/01/2002
40 10/01/2002
41 10/01/2002
42 10/01/2002
43 10/01/2002
44 10/01/2002
12/13/02
10/0112003
10/0112003
10/0112003
10/01/2003
10/0112003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/0112003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
10/01/2003
1989 FORD
1986 CHEVROLET
1994 FORD
1991 FORD
1998 FORD
1999 FORD
2001 FORD
1996 FORD
2002 FORD
1992 FORD
1996 FORD
1997 FORD
1991 FORD
1992 FORD
2000 FORD
1988 FORD
1994 FORD
1988 FORD
2000 VW
1993 MAZDA
2001 VW
1997 FORD
1997 FORD
7919
01499
01499
7398
01499
01499
01499
01499
01499
01499
7398
01499
01499
01499
01499
01499
01499
01499
7398
01499
7398
7398
7398
$49,528
$13,763
$10,000
$10,000
$10,000
$10,000
$21,000
$10,000
$22,000
$10,000
$10,000
$10,000
$10,000
$10,000
$10,000
$10,000
$10,000
$10,000
$23,000
$19,000
$23,000
$17,000
$17,000
$661
$434
$434
$246
$434
$434
$434
$434
$434
$434
$246
$434
$434
$434
$434
$434
$434
$434
$246
$434
$246
$246
$246
City of Winter Springs. FMIT #0648
$10
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$0 $1,000
$0 $1,000
$0 n/a
$0 n/a
- $0 nla
$0 n/a
$0 $1,000
$0 n/a
$0 $1,000
$0 n/a
$0 n/a
$0 n/a
$0 n/a
$0 nla
$0 $1,000
$0 n/a
$0 nla
$0 nla
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
$0 $1,000
Normal Premium
nla
nla
$1,000
$1,000
n/a
nla
n/a
n/a
nla
$1,000
n/a
n/a
n/a
n/a
n/a
n/a
$1,000
nla
n/a
n/a
$1,000
nla
nla
nla
nla
$1,000
$1,000
$1,000
$1,000
$1,000
n/a
n/a
n/a
n/a
nla
nla
$187
$159
$0
$0
$0
$0
$312
$0
$312
$0
$0
$0
$0
$0
$166
$0
$0
$0
$171
$190
$206
$98
$98
n/a
n/a
n/a
n/a
nla
n/a
n/a
n/a
n/a
nla
Page 2 of 7
$859
$599
$440
$252
$440
$440
$752
$440
$752
$440
$252
$440
$440
$440
$606
$440
$440
$440
$423
$630
$458
$350
$350
$70,571
~"
, ,.-/
Automobile Schedule
City of Winter Springs, FMIT #0648
1 0/01/2002 - 1 0/01/2003
Veh# Eft EXfe City # Model Make Description 10# Class Cost Liab PIP Med UM C8::1 SP Coli Physical Total
Date Dae Year Code New Pay Oed Oed Damage Prem
45 10/01/2002 10/0112003 1997 FORD 7398 $17,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
46 10/0112002 10/0112003 1997 FORD 7398 $17,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350
47 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350
48 10/01/2002 10/0112003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
49 10/01/2002 10/0112003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350
50 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
51 10/0112002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
52 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
53 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
54 10/01/2002 10/01/2003 1998 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
55 10/01/2002 10/0112003 1997 FORD 7398 $17,500 $246 $5 $1 $0 '$1,000 n/a $1,000 $98 $350
56 10/01/2002 10/01/2003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
57 10/01/2002 10/01/2003 1992 FORD 7398 $16,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
58 10/01/2002 10/01/2003 1996 MERCURY 7398 $18,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
59 10/01/2002 10/01/2003 1994 PONTIAC 7398 $24,000 $246 $5 $1 $0 $1,000 n/a $1,000 $126 $378
60 10/01/2002 10/0112003 2001 CHEVROLET 01499 $24,500 $434 $5 $1 $0 $1,000 n/a $1,000 $312 $752
61 10/01/2002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
62 10/01/2002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
63 10/01/2002 10/0112003 1993 FORD 7398 $16,000 $246 $5 $1 $0 $1,000 nla $1,000 $98 $350
64 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nla $1,000 $132 $384
65 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
66 10/01/2002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
67 10/01/2002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
Normal Premium $70,571
12/13/02
City of Winter Springs, FMIT #0648
Page 3 of 7
- ~
Automobi'reSchedule
City of Winter Springs, FMIT #0648
1 % 112002 - 1 % 112003
Veh# Eft EX~ City # Model Make Description 10# Class Cost Liab PIP Med UM co~ SP Coli Physical Total
Date Dae Year Code New Pay De Oed Oed Damage Prem
68 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
69 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
70 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
71 1010112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n1a $1,000 $132 $384
72 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n1a $1,000 $132 $384
73 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
74 10/01/2002 10/01/2003 1997 MERC 7398 $24,000 $246 $5 $1 $0 $1,000 n/a $1,000 $126 $378
75 10/0112002 10/0112003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
76 10/0112002 10/0112003 1996 FORD 7398 $17,250 $246 $5 $1 $0 $1,000 n1a $1,000 $98 $350
77 10/0112002 10/0112003 1996 FORD 7398 $18,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
78 10/0112002 10/01/2003 1997 FORD 7398 $17,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
79 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
80 10/0112002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
81 10/0112002 10/0112003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 nfa $1,000 $132 $384
82 10/01/2002 10/0112003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 nfa $1,000 $98 $350
83 10/0112002 10/01/2003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
84 10/01/2002 10/01/2003 1997 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
85 10/0112002 10/0112003 1996 FORD 7398 $18,000 $246 $5 $1 $0 $1,000 nfa $1,000 $98 $350
86 10/0112002 1 % 1/2003 1996 FORD 7398 $18,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
87 1 % 112002 1 % 1/2003 1999 MERCURY 7398 $25,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423
88 10/0112002 10/0112003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423
89 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423
90 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n1a $1,000 $171 $423
Normal Premium $70,571
12/13/02
City of Winter Springs, FMIT #0648
Page 4 of 7
---
AutomobilifSchedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Veh# Eft EXfe City # Model Make Description 10# Class Cost Liab PIP Mad UM CO":? SP Coli Physical Total
Date Da e Year Code New Pay De Oed Oed Damage Prem
91 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423
92 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423
93 10/0112002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423
94 10/01/2002 10/01/2003 2000 FORD 7398 $21,000 $246 $5 $1 $0 $1,000 n/a $1,000 $171 $423
95 10/0112002 10/01/2003 2001 CHEVROLET 7398 $24,500 $246 $5 $1 $0 $1,000 n/a $1,000 $206 $458
96 10/01/2002 10/01/2003 1999 FORD 7398 $20,000 $246 $5 $1 $0 $1,000 n/a $1,000 $132 $384
97 10/01/2002 10/01/2003 1995 TOYOTA 7398 $19,000 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
98 1 % 112002 10/01/2003 1996 FORD 7398 $17,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
99 10/0112002 10/0112003 1986 FORD 7398 $46,000 $246 $5 $1 $0 $1,000 n/a $1,000 $210 $462
100 10/01/2002 10/0112003 1994 FORD 7398 $16,500 $246 $5 $1 $0 $1,000 n/a $1,000 $98 $350
101 10/01/2002 10/01/2003 1992 FORD 01499 $10,000 $434 $5 $1 $0 n/a nla nla $0 $440
102 10/01/2002 10/01/2003 2001 FORD 01499 $21,000 $434 $5 $1 $0 $1,000 nla $1,000 $312 $752
103 10/0112002 10/01/2003 1994 FORD 21499 $18,000 $434 $5 $1 $0 nla n/a n/a $0 $440
104 10/01/2002 10/01/2003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 nla $1,000 $247 $687
105 10/01/2002 10/01/2003 1993 FORD 01499 $10,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
106 10/0112002 10/0112003 1991 FORD 01499 $10,000 $434 $5 $1 $0 nla n/a nla $0 $440
107 10/01/2002 10/01/2003 1993 FORD 01499 $10,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
108 10/01/2002 10/01/2003 1988 FORD 01499 $10,000 $434 $5 $1 $0 nla n/a n/a $0 $440
109 10/0112002 10/01/2003 1996 FORD 01499 $10,000 $434 $5 $1 $0 n/a nla n/a $0 $440
110 10/01/2002 10/01/2003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
111 10/01/2002 10/01/2003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 n/a $1,000 $247 $687
112 10/01/2002 10/01/2003 1999 FORD 21499 $19,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
113 10/0112002 10/0112003 1995 FORD 01499 $10,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
Normal Premium $70,571
12/13/02
City of Winter Springs, FMIT #0648
Page 5 of 7
,-'
AutomobileSchedule
City of Winter Springs, FMIT #0648
10101/2002 - 10101/2003
Veh # Eff
Date
Total
Prem
6:fe
City # Model
Year
Make
Description
10 # Class Cost
Code New
Liab
PIP
Med
Pay
UM
C8:!
SP
Oed
Coli
Oed
Physical
Damage
114 10101/2002
115 10101/2002
116 10101/2002
117 10101/2002
118 10101/2002
119 10101/2002
120 10101/2002
121 10101/2002
122 10101/2002
123 10101/2002
124 10101/2002
125 10101/2002
126 10101/2002
127 10101/2002
128 10101/2002
129 10/0112002
130 10/0112002
131 10101/2002
132 10/0112002
133 10101/2002
134 10101/2002
135 10101/2002
10101/2003
10101/2003
10101/2003
10101/2003
10101/2003
1 0101/2003
10101/2003
10101/2003
1010112003
10101/2003
10101/2003
10101/2003
1010112003
10101/2003
10101/2003
1010112003
10101/2003
10101/2003
1010112003
1010112003
10101/2003
10101/2003
1987 FORD
1985 FORD
1989 DIESEL
1999 FORD
2001 FORD
1998 FORD
2002 STERLING
1999 FORD
1992 FORD
1995 FORD
1992 FORD
1999 FORD
1995 FORD
1993 FORD
1990 FORD
1999 FORD
1993 FORD
2000 FORD
1997 FORD
1986 FORD
1994 FORD
1994 FORD
31499 $19,000
31499 $17,500
21499 $28,000
01499 $19,000
01499 $21,000
01499 $18,000
31499 $180,000
01499 $19,000
01499 $12,000
o $30,000
21459 $12,000
01499 $19,000
01499 $15,000
01499 $13,000
01499 $10,000
01499 $19,000
01499 $13,000
01499 $20,000
01499 $17,000
01499 $40,000
7909 $14,000
01499 $14,000
01499
$530
$530
$434
$434
$434
$434
$530
$434
$434
$564
$434
$434
$434
$434
$434
$434
$434
$434
$434
$341
$434
$434
$6
$6
$5
$5
$5
$5
$6
$5
$5
$7
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$5
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$1
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
nla
nla
nla
nla
nla
nla
nla
$1,000
nla
nla
$0
$0
$0
$0
$312
$0
$551
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
$247
$0
$0
$0
$0
$537
$537
$440
$440
$752
$440
$1,088
$440
$440
$572
$440
$440
$440
$440
$440
$440
$440
$687
$440
$347
$440
$440
12/13/02
City of Winter Springs, FMIT #0648
nla
nla
nla
$1,000
nla
$1,000
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
$1,000
nla
nla
nla
nla
Normal Premium
nla
$1,000
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
$1,000
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
nla
Page 6 of 7
$70,571
-, .-
, ,
Automobire"Schedule
City of Winter Springs, FMIT #0648
10101/2002 - 10101/2003
Veh# Eft EXfe City # Model Make Description 10# Class Cost Liab PIP Med UM co":? SP Coli Physical Total
Date Dae Year Code New Pay De Oed Oed Damage Prem
136 10101/2002 10101/2003 1996 FORD 01499 $16,000 $434 $5 $1 $0 n/a n/a nla $0 $440
137 10101/2002 10101/2003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a nla n/a $0 $440
138 10101/2002 10101/2003 2002 FORD 01499 $22,000 $434 $5 $1 $0 $1,000 n/a $1,000 $312 $752
139 10101/2002 1010112003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 n/a $1,000 $247 $687
140 10101/2002 10101/2003 2000 FORD 01499 $20,000 $434 $5 $1 $0 $1,000 nla $1,000 $247 $687
141 10101/2002 10101/2003 2002 FORD 01499 $22,000 $434 $5 $1 $0 $1,000 n/a $1,000 $312 $752
142 1010112002 10101/2003 1990 JEEP 01499 $10,000 $434 $5 $1 $0 n/a n/a nla $0 $440
143 10101/2002 1010112003 1997 FORD 01499 $17,000 $434 $5 $1 $0 n/a n/a nla $0 $440
144 1010112002 10101/2003 1997 FORD 01499 $17,000 $434 $5 $1 $0 nla n/a nla $0 $440
145 10101/2002 10101/2003 1991 FORD 21499 $18,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
146 10101/2002 10101/2003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
147 1010112002 1010112003 1999 FORD 01499 $19,000 $434 $5 $1 $0 n/a n/a nla $0 $440
148 1010112002 10101/2003 1997 FORD 01499 $17,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
149 10101/2002 10101/2003 1994 FORD 01499 $14,000 $434 $5 $1 $0 n/a n/a n/a $0 $440
150 10101/2002 10101/2003 1988 FORD 01499 $8,000 $434 $5 $1 $0 nla n/a n/a $0 $440
151 10101/2002 10101/2003 1994 FORD 01499 $14,000 $434 $5 $1 $0 n/a n/a nla $0 $440
152 1010112002 10101/2003 1987 FORD 21479 $7,000 $346 $4 $1 $0 nla nla n/a $0 $351
153 1010112002 10101/2003 2001 FORD 01499 $22,000 $434 $5 $1 $0 $1,000 nla $1,000 $312 $752
Total Normal Premiums $54,335 $784 $153 $0 $15,299 $70,571
Incentive Credit
$70,571
-$6,182
$64,389
Normal Premium
Net Premium
12/13/02
City of Winter Springs, FMIT #0648
Page 7 of 7
AUTOMOBILE LIABILITY
This endorsement issued by the Trust extends and modifies the provision of the Agreement
relating to Automobile Liability as set forth below:
It is agreed that as of the effective date hereof the Agreement is amended in the following
particulars:
I. The Coverage section is amended to include the following additional coverage:
The Trust will also pay all sums which the designated member becomes legally obligated to
pay as damages because of:
A. Bodily Injury, or
B. Property Damage
to which this coverage applies, caused by an occurrence and arising out of the ownership,
maintenance or use, including loading and unloading, of a scheduled automobile, including
newly acquired automobiles, which takes place during the period of this Agreement.
II. The Members section VII is amended to include the following additional persons for
purposes of the coverage provided by this endorsement only:
A.
Any other person while using an owned automobile or a hired automobile with the
permission of the designated member, provided his actual operation or (if he is not
operating) his other actual use thereof is within the scope of such permission, but
with respect to bodily injury or property damage arising out of the loading or
unloading thereof, such other person shall be a member only if he is:
(
1. a lessee or borrower of the automobile, or
2. an employee of the designated member or of such lessee or borrower:
B. Any other person or organization but only with respect to his or its liability because
of acts or omissions of a member under the above.
C. None of the following is a member:
1. the owner or lessee (of whom the designated member is a sub-lessee) of
a hired automobile or the owner of a non-owned automobile or any agent
or employee of any such owner or lessee;
2. any person or organization, other than the designated member, with
respect to:
a) a motor vehicle while used with any trailer owned or hired by such
person or organization, or
b) a trailer while used with any motor vehicle owned or hired by such
person or organization;
3.
any person while employed in or otherwise engaged in duties in
connection with an automobile business, other than an automobile
business operated by the designated member.
{
'.
FMIT AL 1002
Page 1 of 2
III. The Definitions section is amended to include the following additional definitions:
A. Automobile Business, means the business or occupation of selling, repairing,
servicing, storing, or parking automobiles;
B. Hired Automobile, means an automobile not owned by the designated member
which is used under contract on behalf of, or loaned to, the designated member,
provided such automobile is not owned by or registered in the name of an
employee or agent of the designated member who is granted an operating
allowance of any sort for the use of such automobile;
C. Non-owned Automobile, means an automobile which is neither an owned
automobile nor a hired automobile;
D. Occurrence, means an event or accident, including continuous or repeated
exposure to conditions which result in bodily injury, property damage or personal
injury and not arising from any form of intentional misconduct.
E. Owned Automobile, means an automobile owned by the designated member;
F. Private Passenger Automobile, means a four wheel private passenger or station
wagon type automobile;
G. Trailer, includes a semi-trailer but does not include mobile equipment.
IV. The Conditions section is amended to include the following additional condition:
A.
Excess Coverage - Hired and Non-Owned Automobiles. With respect to a
hired automobile, or a non-owned automobile, this coverage shall be excess over
any other valid and collectible insurance available to the designated member.
(
V. The Limits of Liability section is amended to include the following:
The above provisions regarding the limits of the Trust's liability apply regardless of the
number of:
A. Owned automobiles;
B. Automobiles involved in the occurrence, or,
C. Automobiles to which this Agreement and all endorsements thereto apply.
The limits of liability for Bodily Injury or Property Damage caused by an occurrence arising
out of the maintenance or use, including loading and unloading of any automobile leased
by the designated member for a period of one (1) year or longer which takes place during
the period of this Agreement, shall be not less than $100,000/$300,000 bodily injury
liability and $50,000 property damage liability.
The Trust's limits of liability shall not be added or stacked by virtue of there being more
than one automobile or member to which this Agreement and all endorsements thereto
might apply.
VI. The Exclusions section is amended as follows:
(
VII.
Exclusion B, items 1. and 2., are deleted.
Schedule of Covered Automobiles attached.
FMIT AL 1002
Page 2 of 2
PERSONAL INJURY PROTECTION BENEFITS
This endorsement issued by the Trust extends and modifies the provIsions of the
Agreement relating to Automobile Liability Personal Injury Protection Benefits as set forth below:
It is agreed that as of the effective date hereof the Agreement is amended in the following
particulars:
I. The Trust will pay, in accordance with the Florida Motor Vehicle No-Fault Law, as
amended, to or for the benefit of the injured person:
A. 80% of medical expenses, and
B. 60% of work loss, and
C. replacement services expenses, and
D. funeral, burial or cremation expenses, incurred as a result of bodily injury, caused
by an accident arising out of the ownership, maintenance or use of a motor
vehicle and sustained by:
1. a member while occupying a motor vehicle or, while a pedestrian through
being struck by a motor vehicle; or
2. any other person while occupying the covered motor vehicle or, while a
pedestrian, through being struck by the covered motor vehicle.
II. EXCLUSIONS
(
III.
(
FMIT PIP 1002
This endorsement does not apply:
A.
to a member while occupying a motor vehicle of which the member is the owner
and which is not a covered motor vehicle under this coverage;
to any person while operating the covered motor vehicle without the express or
implied consent of the member;
to any person, if such person's conduct contributed to his bodily injury under any
of the following circumstances:
1. causing bodily injury to himself intentionally;
2. while committing a felony;
to the member for work loss if an entry in the schedule or declarations indicates
such coverage does not apply;
to any pedestrian, other than the member who is not a legal resident of the State
of Florida;
to any person, other than the member, if such person is the owner of a motor
vehicle with respect to which security is required under the Florida Motor Vehicle
No-Fault Law, as amended;
to any person, other than the member who is entitled to personal injury protection
benefits from the owner or owners of a motor vehicle which is not a covered
motor vehicle under this endorsement or from the owner's insurer;
to any person who sustains bodily injury while occupying a motor vehicle located
for use as a residence or premises.
B.
C.
D.
E.
F.
G.
H.
LIMIT OF LIABILITY; APPLICATION OF DEDUCTIBLE; OTHER INSURANCE
Regardless of the number of persons covered, policies or bonds applicable, vehicles
involved or claims made, the total aggregate limit of personal injury protection benefits
available under the Florida Motor Vehicle No-Fault Law, as amended, from all sources
combined including this Agreement, for all loss and expense incurred by or on behalf of
anyone person who sustains bodily injury as the result of anyone accident shall be
$10,000.00; provided that payment for funeral, cremation or burial expenses included in
the foregoing shall in no event exceed $5,000.
Page 1 of 4
j'N";'~'.\"~""'.--'--'--
'1~""~,~---o;-.",!..-,n:'" ".~.
Any amount payable under this endorsementshall be reduced by the amount of benefits
an injured person has recovered or is entitled to recover for the same elements of loss
under the workers' compensation laws of any state or the Federal Government or the
Medicaid program.
If benefits have been received under the Florida Motor Vehicle No-Fault Law, as
amended, from any insurer for the same items of loss and expenses for which benefits
are available under this agreement, the Trust shall not be liable to make duplicate
payments to or for the benefit of the injured person, but the insurer paying such benefits
shall be entitled to recover from the Trust its equitable pro rata share of the benefits paid
and expenses incurred in processing the claim.
The amount of any deductible stated in the schedule of this amendment shall be
deducted from the total amount of all sums otherwise payable by the Trust with respect
to all loss and expenses incurred by or on behalf of each person to whom the deductible
applies and who sustains bodily injury as the result of anyone accident, and if the total
amount of such loss and expense exceeds such deductible, the total limit of benefits the
Trust is obligated to pay shall then be the difference between such deductible amount
and the applicable limit of the Trust's liability. Such deductible amount shall not be
applied to funeral, cremation or burial expenses.
If an entry in the schedule or declaration so indicates any amount payable under this
Trust to the member shall be reduced by any benefits payable by the Federal
Government to active or retired military personnel and their dependent relatives.
IV. DEFINITIONS
When used in reference to this Section: "bodily injury" means bodily injury, sickness, or
disease, including death at any time resulting there from;
(
"medical expense" means reasonable expenses for necessary medical, surgical, x-ray,
dental, ambulance, hospital, professional nursing and rehabilitative services for prosthetic
devices and for necessary remedial treatment and services recognized and permitted
under the laws of the state for an injured person who relies upon spiritual means through
prayer alone for healing in accordance with his religious beliefs;
"motor vehicle" means any self-propelled vehicle with four or more wheels which is a type
both designed and required to be licensed for use on the highways of Florida and any
trailer or semi-trailer designed for use with such vehicle.
A motor vehicle does not include:
A. a mobile home; or
B. any motor vehicle which is used in mass transit or public school transportation
and designed to transport more than five passengers exclusive of the operator of
the motor vehicle and which is owned by a municipality, a transit or public school
transportation authority, or a political subdivision of the state;
C. except for the purposes of FS 627.7372, any motor vehicle of any type used as a
taxi cab or limousine.
(
"occupying" means in or upon or entering into or alighting from;
"covered motor vehicle" means a motor vehicle:
A. of which the member is the owner, and
B. with respect to which security is required to be maintained under the Florida Motor
Vehicle No-Fault Law, and
C. for which a premium is charged, or which is a trailer, other than a mobile home,
designed for use with a motor vehicle.
FMIT PIP 1002
Page 2 of 4
'.'
"pedestrian" means a person while not an occupant of any self-propelled vehicle;
"owner" means a person or organization who holds the legal title to a motor vehicle, and
also includes:
A. a debtor having the right to possession, in the event a motor vehicle is the subject
of a security agreement, and,
B. a lessee having the right to possession, in the event a motor vehicle is the
subject of a lease with option to purchase and such lease agreement is for a
period of six months or more, and,
C. a lessee having the right to possession, in the event a motor vehicle is the
subject of a lease without option to purchase, and such lease agreement is for a
period of six months or more, and the lease agreement provides that the lessee
shall be responsible for securing insurance;
"work loss" means with respect to the period of disability of the injured person, any loss
of income and earning capacity from inability to work proximately caused by the injury
sustained by the injured person;
"replacement services expenses" means with respect to the period of disability of the
injured person all expenses reasonably incurred in obtaining from others ordinary and
necessary services in lieu of those that, but for such injury, the injured person would have
performed without income for the benefit of his household.
V.
COVERAGE PERIOD; TERRITORY
(
This coverage under this Section applies only to accidents which occur during the period of
this Agreement.
A. in the State of Florida;
B. as respects the member, while occupying the covered motor vehicle outside the
State of Florida but within the United States of America, its territories or
possessions or Canada;
VI.
CONDITIONS
A. Notice. In the event of an accident, written notice of the loss must be given to
the Trust or any of its authorized agents as soon as practicable. If any injured
person or his legal representatives shall institute legal action to recover damages
for bodily injury against a third party, a copy of the summons and complaint or
other process served in connection with such legal action shall be forwarded as
soon as practicable to the Trust by such injured person or his legal representa-
tive.
B. Action Against the Trust. No action shall lie against the Trust unless, as a
condition precedent thereto, there shall have been full compliance with all terms
of this endorsement, not until 30 days after the required notice of accident and
reasonable proof of claim has been filed with the Trust.
C. Proof of Claim; Medical Reports and Examinations; Payments of Claim
Withheld. As soon as practicable the person making the claim shall give to the
Trust written proof of claim, under oath if required, which may include full
particulars of the nature and extent of the injuries and treatment received and
contemplated, and such other information as may assist the Trust in determining
the amount due and payable. Such person shall submit to mental or physical
examinations at the Trust's expense when and as often as the Trust may
reasonably require. A copy of the medical report shall be forwarded to such
person if requested. If the person unreasonably refuses to submit to an
FMIT PIP 1002 Page 3 of 4
examination, the Trust will not be liable for subsequent personal injury protection
benefits. Whenever a person making a claim is charged with committing a felony
the Trust shall withhold benefits until at the trial level the prosecution makes a
formal entry on the record that it will not prosecute the case against the person, the
charge is dismissed or the person is acquitted.
D. Reimbursement and Subrogation, unless prohibited by the Florida Motor Vehicle
No-Fault Law, as amended, and in the event of payment to or for the benefits of
any injured person under this endorsement;
1. the Trust shall be reimbursed to the extent of such payment, exclusive of
reasonable attorney's fees and other reasonable expenses, out of the
proceeds of any settlement OF judgment that may result from the exercise
of any rights of recovery of such person against any person or organization
legally responsible for the bodily injury because of which such payment is
made and the Trust shall have a lien on such proceeds to such extent;
2. the Trust is subrogated to the rights of the person to whom or for whose
benefit such payments were made to the extent of such payments. Such
person shall execute and deliver the instruments and papers and do
whatever else is necessary to secure such rights. Such person shall do
nothing after loss to prejudice such rights.
3. the Trust providing personal injury protection benefits on a private
passenger motor vehicle, as defined in the Florida Motor Vehicle No-Fault
Law, shall be entitled to reimbursement to the extent of the payment of
personal injury protection benefits from the owner or insurer of the owner
of a commercial motor vehicle, as defined in the Florida Motor Vehicle No-
Fault Law, if such injured person sustained the injury while occupying, or
while a pedestrian through being struck by, such commercial motor
vehicle.
Special Provision for Rented or Leased Vehicles. Notwithstanding any
provision of this coverage to the contrary, if a person is injured while occupying, or
through being struck by, a motor vehicle rented or leased under a rental or lease
agreement which does not specify otherwise in bold type on the face of such
agreement, the personal injury protection coverage afforded under the lessor's
policy shall be primary.
(
(
FMIT PIP 1002
E.
Page 4 of 4
AUTOMOBILE MEDICAL PAYMENTS
This endorsement issued by the Trust extends and modifies the provisions of the
Agreement relating to Automobile Medical Payments as set forth below:
It is agreed that as of the effective date hereof the Agreement is amended in the following
particulars:
I. The Trust will pay reasonable expenses incurred for necessary medical and funeral
expenses to or for a member who sustains bodily injury caused by an accident.
II. Limits of Liability. Regardless of the number of covered automobiles, members, claims
made or vehicles involved in the accident, the most the Trust will pay for bodily injury for
each member injured in anyone accident is the limit of Automobile Medical Payments
shown in the Declarations.
III. Additional Definition.
"Occupying" means in, upon, getting in, on, out, or off.
IV. Additional Exclusions. This coverage does not apply to:
E.
bodily injury sustained by a member while occupying a vehicle for primary use
other than as a means of transportation;
bodily injury sustained while occupying or struck by any vehicle owned by,
furnished or available for regular use by the member;
bodily injury to an employee arising out of and in the course of employment;
bodily injury to a member while working in a business of selling, servicing,
repairing or parking autos;
bodily injury caused by declared or undeclared war or insurrection or any of their
consequences;
bodily injury to anyone using a vehicle without a reasonable belief that the person
is entitled to do so.
A.
B.
(
C.
D.
F.
(
,
FMIT AM 1002
Page 1 of 1
:-~
AUTOMOBILE PHYSICAL DAMAGE COVERAGE FORM
Various provisions in this Agreement restrict coverage. Read the entire Agreement
carefully to determine rights, duties and what is and is not covered.
Throughout the Agreement the words "you" and "your" refer to the member shown in the
Declarations. The words "we," "us" and "our" refer to the Trust providing this insurance.
A. COVERAGE
The Trust will pay for direct physical loss or damage to a covered automobile as described
in the Declarations caused by or resulting from any covered cause of loss.
1. Covered Property
Covered property, as used in this coverage part, means any "auto" described in the
schedule which you own, hire, borrow, or lease, including newly acquired autos (refer to
schedule).
2. Covered Causes of Loss
a. Comprehensive Coverage
From any cause except the covered automobile's collision with another object or its
overturn.
(
b.
Collision Coverage
Caused by the covered automobile's collision with another object or its overturn.
c.
Specified Causes of Loss Coverage. Caused by:
1. Fire, lightning or explosion;
2. Theft;
3. The sinking, burning, collision, or derailment of any conveyance
transporting the covered "auto"; or
4. Mischief or vandalism.
B. EXCLUSIONS
1. The Trust will not pay for loss or damage caused directly or indirectly by any of the
following: Such loss or damage is excluded regardless of any other cause or event that
contributes concurrently or in any sequence to the loss.
a. Wear and tear, freezing, mechanical or electrical breakdown unless caused by
other loss covered by this endorsement.
b. Blowouts, punctures or other road damage to tires unless caused by other loss
covered by this endorsement.
c. Loss to tape decks or other sound reproducing equipment not permanently
installed in a covered auto.
(
d.
Loss to tapes, records or other sound reproducing devices designed for use with
sound reproducing equipment.
FMIT APD 1002
Page 1 of 4
C. DEDUCTIBLE
The Trust will not pay for loss or damage in anyone occurrence until the amount of loss
or damage exceeds the deductible shown in the schedule or in the Declarations. We will then pay
the amount of loss or damage in excess of the deductible, up to the applicable Limit of Insurance.
D. LOSS CONDITIONS
The following conditions apply in addition to the common Agreement conditions.
1. Duties in the event of loss or damage
a. Promptly notify the Trust or the Service Agent of any accident or loss and report
how, when and where the accident or loss happened.
b. Do what is reasonably necessary after a loss to protect the covered automobile
from further loss.
c. Submit a proof of loss when required by the Trust.
2. Inspection and Appraisal
(
Permit the Trust to inspect and appraise the damaged property BEFORE its
repair or disposition. If there is a failure to agree as to the amount of loss, either
party may further demand an appraisal of the loss. In such event, both parties
may agree on one competent appraiser to make the final decision or each party
may select his own appraiser and bear his own cost of appraisal, and a
competent and disinterested umpire will be selected to make the final decision.
3. Loss Payment
a.
a. At the Trust's option, it may:
1. Pay for, repair, or replace damaged or stolen property; or
2. For theft, return the stolen property, at its expense. The Trust will pay for
any damage that results to the automobile from the theft.
b. The Trust will pay the lesser of the following amounts:
1. The actual cash value of the damaged or stolen property at the time of
loss.
2. The cost of repairing or replacing the damaged or stolen property with
other of like kind or quality.
c.
For each covered automobile, the Trust's obligation to pay for, repair, return or
replace damaged or stolen property will be reduced by the applicable deductible
shown in the auto schedule.
d.
Loss to any sound receiving or transmitting equipment designed for use as a two-
way mobile radio or telephone or scanning monitor or radar transmitting or
receiving device, including its antennas and other accessories, unless
permanently installed in the automobile or scheduled elsewhere.
(
FMIT APD 1002
Page 2 of 4
4. Other Insurance
a.
For any covered automobile owned or leased, this Agreement is primary.
b.
When this Agreement and other policies covered on the same basis, either
excess or primary, the Trust will pay only its share. Its share is the proportion
that the limit of this Agreement bears to the total of the limits of this Agreement
and all the policies covering on the same basis.
5. Right to Recover
a. If the Trust makes any payment, it shall be subrogated and have the right to
enforce its subrogation rights against any other party who caused the loss or
damage. The member, its agents and employees are required to cooperate with
the Trust in the enforcement of its rights of collection against the party or parties
causing the loss and shall do nothing to jeopardize the rights of the Trust without
the Trust's prior consent and authorization.
E. COVERAGE EXTENSIONS
1. Limited Replacement Cost: We will reimburse the Designed Member for an owned and
scheduled private passenger vehicle that is involved in a covered total loss if the vehicle
has less than 15,000 miles and is within the first 12 months of being scheduled.
2.
Member's Personal Effects: In the event of a covered loss, we will pay a maximum of
$500.00 for member's personal effects while in a scheduled private passenger vehicle
owned by the Designated Member. The covered vehicle must show evidence of forced
entry.
(
3. Auto Lease Coverage: In the event of a covered total loss to a covered auto shown in the
schedule, we will pay any unpaid amount on the lease of your covered auto less:
1) the amount paid under Part D of the agreement; and
2) any:
a. overdue lease payments at the time of the loss:
b. financial penalties imposed under a lease for excessive use, abnormal
wear and tear or high mileage;
c. security deposits not refunded by a lessor;
d. costs for extended warranties, Credit Life insurance, Health, Accident or
Disability insurance purchased with the lease; and
e. carry-over balances from previous leases.
The most we will pay for anyone occurrence is up to $5,000.00. The most we will pay in
any Trust year is up to $10,000.00.
F. DEFINITIONS
Automobile business, means the business or occupation of selling, repairing, servicing, storing, or
parking automobiles.
FMIT APD 1002
Page 3 of 4
Hired Automobile, means an automobile not owned by the designated member which is used
under contract on behalf of, or loaned to, the designated member, provided such automobile is
not owned by or registered in the name of an employee or agent of the designated member who
is granted an operating allowance of any sort for the use of any such automobile.
Owned Automobile, means an automobile owned by the designated member.
Private Passenger Automobile, means a four-wheel private passenger or station wagon type
automobile.
Trailer, includes a semi-trailer but does not include mobile equipment, unless scheduled.
Loss, means direct and accidental damage or loss.
(
(
FMIT APD 1002
Page 4 of 4
RENTAL REIMBURSEMENT COVERAGE
This endorsement issued by the Trust extends and modifies the provisions of the
Agreement relating to Automobile Physical Damage as set forth below.
With respect to coverage provided by this endorsement, the provisions of the Coverage
Form apply unless modified by the endorsement.
A. This endorsement provides only those coverages where a premium is shown in the
Automobile Physical Damage portion of the Schedule. It applies only to a covered "auto"
described or designated in the Schedule.
B. We will pay for rental reimbursement expenses incurred by you for the rental of an "auto"
because of "loss" to a covered "auto". Payment applies in addition to the otherwise
applicable amount of each coverage you have on a covered "auto". No deductibles apply
to this coverage.
C. We will pay only for those expenses incurred during the policy period beginning 24 hours
after the "loss" and ending, regardless of the policy's expiration, with the lesser of the
following number of day:
1. Fourteen (14) days.
or
2.
The number of days reasonably required to repair or replace the covered "auto".
If "loss" is caused by theft, this number of days is added to the number of days it
takes to locate the covered "auto" and return it to you.
(
;
i
D. Our payment is limited to the lesser of the following amounts:
1. Necessary and actual expenses incurred.
2. The maximum payment stated applicable to "anyone day" or "anyone period".
E. This coverage does not apply while there are spare or reserve "autos" available to you for
use in your operations.
If "loss" results from the total theft of a covered "auto" of the private passenger type, we will
pay under this coverage as follows:
Maximum Amount Payable: $25.00 per scheduled automobile per occurrence, or thirty five
hundred dollars ($3,500.00) in the aggregate for the Trust year provided.
(
FMIT ARR 1002
Page 1 of 1
,,,,~,- t;~"-~;;t~i-,
;::'h-~'-:t'-~'H~ -:~
SPECIFIC EXCESS ENDORSEMENT - AUTOMOBILE LIABILITY
This endorsement, when issued by the Florida Municipal Insurance Trust, does not in any
way modify the provisions of the Coverage Agreement. It does extend the monetary limits of
liability, as stated in the Limits of Liability in the Declarations, as set forth below:
It is agreed that the specific limits of liability are $2.000.000 (combined
single limit) per occurrence, solely for any liability resulting from entry of a claims bill pursuant
to Section 768.28(5) Florida Statutes or liability imposed pursuant to Federal Law, or to any
liability resulting from actions taken outside of the State of Florida where it is determined by a
court of competent jurisdiction that the liability limitations contained in Section 768.28(5), Florida
Statutes, are inapplicable, if such liability is covered by the Agreement. The limits provided
herein are inclusive of the $100,000 each person and $200,000 each occurrence as set forth in
the Declarations of the Agreement and within the Coverage Agreement itself,but in no way exceed
$2.000.000 (combined single limit) per occurrence.
Exclusion W is amended as follows:
To any damages imposed by an act of the legislature, except for claims bills passed by the
legislature pursuant to Section 768.28(5), Florida Statutes, against a member, for damages covered
under the terms of this Agreement.
(
FMIT SE AL 1002
Page 1 of 1
DEDUCTIBLE STOPLOSS ENDORSEMENT
PROVISIONS
I. Member City of Winter Springs
II. Stoploss Coverage Applies
0 A. Workers Compensation & Employers Liability
~ B. General Liability
~ C. Auto Liability
0 D. Property
0 E. Automobile Physical Damage
III. Applicable Stoploss Deductible
A. Workers Compensation & Employers Liability $
( ) B. General Liability $ 25,000
}
C. Auto Liability $ 25,000
D. Property $
E. Automobile Physical Damage $
IV. Applicable Deductible Stoploss Amount
A. $ 188,303
(
FMIT DSL 1002
Page 1 of 2
The endorsement provides for a limitation on the number of deductibles or amount of loss incurred
by a member under a deductible program as offered by the Florida Municipal Insurance Trust.
I. IT IS AGREED THAT:
A. The Trust's liability to pay claims -on behalf of the member under this endorsement applies
only to the members deductible amounts as stated in the Declarations and only after
satisfaction of the Deductible Stop loss amount as stated in this endorsement.
B. The Trust agrees with the member that the member's obligations under applicable
deductible endorsements cease when the member had paid losses within the deductible
that exceed:
(1) Three (3) times the largest deductible as stated in the Provisions or
(2) the Deductible Stoploss Amount, whichever is greater.
C. The terms of the Trust's Indemnity Agreement and Coverage Agreements remain in full
force and effect, including those with respect to:
(1) the Trust's rights and duties in the defense of claims and
(2) the member's duties in the event of an accident or occurrence, irrespective of the
application of deductible amount or deductible stoploss.
D. The member will immediately report in writing:
(1) all accidents or incidents which may give rise to liability.
(2) all Notice of Claims.
(3) all lawsuits involving a claim for damages.
(
E.
The Trust shall select and retain all defense attorneys and other service providers as
necessary and shall directly control and supervise their activities. All such costs incurred
in these services shall be paid by the Trust.
F. The deductible amount shall include the amount of any payment resulting from a covered
claim in the aggregate up to the deductible amount stated in the declarations. The
member's responsibility under the deductible shall continue even though the contract may
have been cancelled or expired.
G. Investigation and adjustment expenses incurred by the Trust shall be paid by the Trust
and not included in the deductible amount.
H. The Trust may settle or defend any claim as it considers appropriate without the
member's consent regardless of any deductible amount.
I. The Trust is authorized to make reasonable additions, changes, or deletions to these
reporting requirements.
J. Reimbursement of the Trust: The member will reimburse the Trust the invoiced amount
due within 45 days of the invoice date. Failure to pay this sum will result in the revocation
of the member's deductible plan privileges.
K. Recoveries shall be applied to the member's deductible until satisfied.
L.
The Definitions Section of the Trust is amended per this additional definition:
(1) Deductible stoploss is coverage which limits a members deductible payment
obligations to a certain fixed amount.
(
FMIT DSL 1002
Page 2 of 2
FLORIDA MUNICIPAL INSURANCE TRUST
PROPERTY, ALLIED LINES AND CRIME
DECLARATIONS
I. DESIGNATED MEMBER:
( City of Winter Springs
II. Government Description
Municipality
Agreement No.: FMIT #0648
III. COVERAGE PERIOD
From October 1, 2002
the Designated Member.
to October
1, 2003
12:01 A.M. Standard Time at the address of
Premium
Blanket:
Basis De uctl e I VDe 1m e remlum
$49,573
$1,000 $18,687,980 Included
$1,000 $2,546,260 Included
100%
Replacement
Cost
Yes
No
Per Extension Included
100% $250,000 Included
Per Extension $0 Included
Yes Included
Per Extension $250 Included
Per Extension $0 Included
$0 Per Schedule Included
$0 Per Schedule Included
Per Schedule Included
d 'bl fT
L' it
N tp
IV. Property and Allied Coverages
Real Property
Personal Property
Coinsurance:
Valuation Basis:
Blanket:
Inflation Guard:
Time Element
Business Income
Coinsurance:
Extra Expense
Inland Marine
(
valuable Papers
, Accounts Receivable
Crime
Money & Securities - Loss Inside
- Loss Outside
Bond
Honesty Blanket Bond
V. This Agreement includes these endorsements and schedules: See Schedule C
VI. ESTIMATED ANNUAL PREMIUM
Normal
Premium
Incentive
Credit
Net
Premium
Florida Municipal Insurance Trust (FMIT) $55,081
$5,508
$49,573
(
'.
Florida League of Cities Sponsored Insurance Programs Since 1977
THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS, COVERAGE
FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT,
FMIT PROP DEC 1002
Original
Page 1 of 2
09/25/2002
Form #
FMIT IND (10-02)
FMIT GC (10-02)
FMIT DSL (10-02)
FMIT MPC (10-02)
IL 00 17 (11-98)
IL 02 55 (07-02)
PR-SCHED (01-02)
CP 14 50 (10-00)
FMIT FCR (10-02)
CP 00 90 (07-88)
CP 00 10 (10-00)
FMIT PROP 03 (10-02)
CP 01 25 (06-95)
CP 10 30 (10-00)
FMIT PROP 12 (10-02)
CP 00 50 (10-00)
(~. . \00 32 (10-00)
, IT EBC (10-02)
FMIT IM SCH (10-02)
FMIT PROP 02 (10-02)
CM 00 01 (09-00)
CM 00 66 (09-00)
CM 00 67 (09-00)
FMIT PROP 05 (10-02)
(
FMIT PROP DEC 1002
FMIT PROPERTY AND ALLIED COVERAGES
October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List
FMIT #0648
Schedule C
Description
COMMON
Indemnity Agreement
Coverage Agreement
Deductible Stoploss Endorsement Provisions
Miscellaneous Property Coverages
Common Policy Conditions
Florida Changes - Cancellation And Nonrenewal
PROPERTY
Property Schedule
Radio Or Television Antennas
Fungus Remediation
Commercial Property Conditions
Building And Personal Property Coverage Form
Coverage Extensions
Florida Changes
Causes of Loss - Special Form
Ordinance Or Law Coverage
Extra Expense Coverage Form
Business Income Coverage (Without Extra Expense)
Equipment Breakdown Coverage
INLAND MARINE
Miscellaneous Schedule Of Inland Marine
Inland Marine Floater
Commercial Inland Marine Conditions
Accounts Receivable Coverage Form
Valuable Papers And Records Coverage Form
CRIME
Public Employees Blanket Bond
Page 2 of 2
Miscellaneous Property Coverages
, FMIT #0648
October 1, 2002 - October 1, 2003
Business Income
Loc # Bldg #
001 001
Limit
$250,000
Extra Expense
Loc # Bldg #
001 001
All locations are covered under Coverage Extension 5g.
Valuable Papers
Loc # Bldg #
001 001
All locations are covered under Coverage Extension 5c.
Accounts Receivable
(
Loc # Bldg #
001 001
All locations are covered under Coverage Extension 5f.
Bond Type
Honesty Blanket Bond
Crime/Bond
Bond Limit
$50,000
Coinsurance
100%
Limit
$250,000
Limit
$100,000
Limit
$100,000
Deductible Amount
$0
Money & Securities (Theft, Disappearance & Destruction)
Inside:
OUtside:
Limit
$10,000
$10,000
c
FMIT MPC 1002
Deductible Amount
None
None
Page 1 of 1
09/25/2002
~, ,-~_....,
i
Member's Property Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Location# Address Occuoanev Construction Cause of ~ld9 Cause of Pers
Loss 2!!!L LOSS rroK
Lac Bid 2!!!L
001 001 1126 E. State Rd 434, WS Winter City Hall Complex- City Hall Fire Resistive Special Form $2,662,717 Special Form $1,105,907
Springs,FL
001 002 1126 E. State Rd 434, WS Winter Gas Tank & Pump Non-Combustible Special Form $16,306 $0
Springs,FL
001 003 1126 E. State Rd 434, WS Winter Appex Utility Building Joisted Masonry Special Form $53,550 Special Form $52,500
Springs,FL
002 001 102 Moss Road, WS Winter Springs,FL Fire Station #24 - Fire House Fire Resistive Special Form $540,855 Special Form $138,100
002 002 102 Moss Road, WS Winter Springs,FL Antenna & Radio Tower Non-Combustible Special Form $2,285 $0
003 001 850 Northem Way, WS Winter Springs,FL Fire Station #26 - Fire House Joisted Masonry Special Form $400,336 Special Form $36,800
004 001 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - ConcessionslP&R Joisted Masonry Special Form $309,472 Special Form $12,900
Office
004 002 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Maintenance Garage Non-Combustible Special Form $139,901 Special Form $84,000
004 003 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 22 Concrete Light Non-Combustible Special Form $64,738 $0
Poles
004 004 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 152 Ballfield Non-Combustible Special Form $103,542 $0
Lights
004 005 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 38 Single Fixt, Non-Combustible Special Form $47,242 $0
Site Lighting
004 006 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - 11 Double Fixt, Non-Combustible Special Form $14,998 $0
Site Lighting
004 007 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - Irrigation Sys & Non-Combustible Special Form $119,023 $0
Pumps
004 008 1000 E. S.R. 434, WS Winter Springs,FL Central Winds Park - New Soccer Conc Joisted Masonry Special Form $220,000 $0
StlRestrm
005 001 Torcaso Winter Springs,FL Torcaso Park - New Restrooms Joisted Masonry Special Form $127,000 $0
006 001 Moss Winter Springs,FL Moss Park - New Restrooms Joisted Masonry Special Form $120,000 $0
007 001 Trotwood Winter Springs,FL Trotwood Park - existing restrooms Joisted Masonry . Special Form $84,000 $0
008 001 400 N. Edgemon Ave., WS Winter Senior Center Joisted Masonry Special Form $265,173 Special Form $59,000
Springs, Fe
008 002 400 N. Edgemon Ave., WS Winter Civic Center Joisted Masonry Special Form $192,441 Special Form $42,000
Springs,Fe
009 001 300 Moss Road, WS Winter Springs,FL Police Complex - Police Station Fire Resistive Special Form $1,186,069 Special Form $493,000
Page 1 of 4
09/25/2002
"'----. ,~
Member's''f'foperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Location# Address Occuoancv Construction Cause of ~ldK Cause of Pars
Loss -!!!!L Loss rro~
Loc Bid -!!!!L
010 001 110 N. Flamingo Ave. Winter Springs,FL Public Works - Garage Joisted Masonry Special Form $154,530 Special Form $38,053
010 002 100 N. Flamingo Ave. Winter Springs,FL Public Works - Utility Office Joisted Masonry Special Form $71,556 Special Form $80,000
011 001 N. 1st Street Winter Springs,FL Public Works - Storage Joisted Masonry Special Form $16,438 $0
012 001 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Digesters Fire Resistive Special Form $2,480,844 $0
Springs,FL
012 002 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Chlroine Fire Resistive Special Form $219,300 Special Form $94,700
Springs,FL Contact
012 003 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Filters Fire Resistive Special Form $37,026 Special Form $9,300
Springs,FL
012 005 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Aerator Fire Resistive Special Form $128,214 Special Form $25,000
Springs,FL
012 006 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Plant Ops Fire Resistive Special Form $61,812 Special Form $200,000
Springs,FL
012 007 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Lift Station Non-Combustible Special Form $112,455 $0
Springs,FL
012 008 1560 Winter Springs Blvd, WS Winter East Wastewater Plant #1 - Reclaim Fire Resistive Special Form $481,134 $0
Springs,FL Water Tank
013 001 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Pump House Non-Combustible Special Form $138,433 $0
013 002 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - LP Gas Tank Non-Combustible Special Form $914 $0
013 003 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Ground Level Tank Non-Combustible Special Form $238,663 $0
013 004 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Hydropneumatic Tank Non-Combustible Special Form $46,868 $0
013 005 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Water Well Non-Combustible Special Form $20,397 $0
013 006 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Well #6 Water Plant 2 Non-Combustible Special Form $174,962 $0
013 007 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible Special Form $129,753 $0
013 008 Sheoah Blvd, WS Winter Springs,FL Water Plant #2 - Lift Station Non-Combustible Special Form $97,654 $0
014 001 1000 W SR 434, WS Winter Springs,FL West Wastewater Plant #2 - Water Plant Fire Resistive Special Form $1,985,480 $0
015 001 Bahama Rd, WS Winter Springs,FL Water Plant #3 - LP Gas Tank Non-Combustible Special Form $914 $0
015 002 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Ground Level Tank Non-Combustible Special Form $238,663 $0
015 003 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Well Non-Combustible Special Form $19,789 $0
Page 2 of 4
09/25/2002
~ , ,~
Member'sPfoperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 -10/01/2003
Locatlon# Address Occupancy Construction Cause of ~Idi Cause of Pers
Loss -!!!!!.. Loss rrog
Lac Bid -!!!!!..
015 004 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Water Plant Fire Resistive Special Form $336,362 $0
015 005 Bahama Rd, WS Winter Springs,FL Water Plant #3 - Chlorinator Building Fire Resistive Special Form $66,309 $0
016 001 851 Northern Way Winter Springs,FL Water Plant #1 - E. Water Plant Op. Bldg Fire Resistive Special Form $128,775 Special Form $75,000
016 002 851 Northern Way Winter Springs,FL Water Plant #1 - Chlorine Handling Fire Resistive Special Form $63,257 $0
Facility
016 003 851 Northern Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0
016 004 851 Northern Way Winter Springs,FL Water Plant #1 - Ground Level Tank Non-Combustible Special Form $238,663 $0
017 001 Indian Ridge Seminole Winter Springs,FL Lift Station Non-Combustible Special Form $85,898 $0
018 001 David Street Winter Springs,FL Lift Station Non-Combustible Special Form $76,104 $0
019 001 Hacienda Village Winter Springs,FL Lift Station Non-Combustible Special Form $58,473 $0
020 001 Tanglewood Drive Winter Springs,FL Lift Station Non-Combustible Special Form $91,777 $0
021 001 S. Edgemon Ave Winter Springs,FL Lift Station & Fence Non-Combustible Special Form $343,598 $0
022 001 Panama Circle Winter Springs,FL Lift Station Non-Combustible Special Form $63,446 $0
023 001 Alton & Mockingbird Winter Springs,FL Lift Station Non-Combustible Special Form $89,667 $0
024 001 E. of Wetland 1000's Winter Springs,FL Lift Station Non-Combustible Special Form $53,045 $0
025 001 Club Drive Winter Springs,FL Lift Station Non-Combustible Special Form $56,228 $0
026 001 Dolphin Road Winter Springs,FL Lift Station Non-Combustible Special Form $56,228 $0
027 001 Papaya Lane Winter Springs,FL Lift Station Non-Combustible Special Form $33,462 $0
028 001 Sybilwood Circle Winter Springs,FL Lift Station Non-Combustible Special Form $26,989 $0
029 001 Tuscany Place Winter Springs,FL Lift Station Non-Combustible Special Form $34,095 $0
030 001 Winter Springs Blvd. Winter Springs,FL Lift Station Non-Combustible Special Form $50,605 $0
031 001 Northern Way Winter Springs,FL Lift Station Non-Combustible Special Form $28,500 $0
032 001 Wood Duck Drive Winter Springs,FL Lift Station Non-Combustible Special Form $41,046 $0
033 001 Seneca Blvd Winter Springs,FL Lift Station Non-Combustible Special Form $65,224 $0
034 001 Seneca Blvd Winter Springs,FL Lift Station Non-Combustible Special Form $46,107 $0
035 001 Trotwood Blvd Winter Springs,FL Lift Station Non-Combustible Special Form $44,982 $0
Page 3 of 4
09/25/2002
r--.
~.
Member's Ffoperty Schedule
City of Winter Springs, FMIT #0648
10/01/2002 - 10/01/2003
Locatlon#
Lac Bid
Address
Cause of
LosS
Pers
rro~
...!!!!L
Occuoancy
Construction
Cause of
Loss
~ldH
...!!!!L
036
037
038
039
040
041
042
001 Seneca Blvd & Chelse Winter Springs,FL
001 Shepard Rd. Winter Springs,FL
001 Cherry Creek Circle Winter Springs,FL
001 Vistawilla Drive Winter Springs,FL
001 Nandina Terrace Winter Springs,FL
001 Winter Springs Blvd Winter Springs,FL
001 Various Winter Springs,FL
Lift Station
Lift Station
Lift Station
Lift Station
Lift Station
Oak Forest Wall
Tuscawilla Lighting and Beautification
Improvements
Non-Combustible
Non-Combustible
Non-Combustible
Non-Combustible
Non-Combustible
Joisted Masonry
Non-Combustible
Special Form
Special Form
Special Form
Special Form
Special Form
Special Form
Special Form
$45,955
$46,589
$57,674
$45,010
$49,802
$500,000
$2,000,000
$18,687,980
$0
$0
$0
$0
$0
$0
$0
$2,546,260
Total:
Page 4 of 4
09/2512002
(
\
POLICY NUMBER: 0648-P
COMMERCIAL PROPERTY
CP 14501000
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
RADIO OR TELEVISION ANTENNAS
This endorsement modifies insurance provided under the following:
BUILDING AND PERSONAL PROPERTY COVERAGE FORM
BUILDERS' RISK COVERAGE FORM
CONDOMINIUM ASSOCIATION COVERAGE FORM
CONDOMINIUM COMMERCIAL UNIT-OWNERS COVERAGE FORM
STANDARD PROPERTY POLICY
SCHEDULE*
Premo Bldg.
No. No.
002 002
Limit Of
Insurance
$2,285
Causes Of
Loss Form
Applicable
Special Form Including
Theft
Coinsurance
Percentage
100%
Additional
Premium
Included
*Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara-
tions.
A. The following is added to Covered Property:
Radio or television antennas (including satellite
dishes) and their lead-in wiring, masts or towers,
as described in the Schedule.
B. The following is deleted from Property Not Cov-
ered:
"Radio or television antennas (including satellite
dishes) and their lead-in wiring, masts or towers".
C. Property covered under this endorsement is sub-
ject to all applicable provisions of the Causes of
Loss form indicated in the Schedule, as well as to
the following exclusions:
We will not pay for loss or damage caused by or
resulting from any of the following:
1. Dampness or dryness of atmosphere;
2. Changes in or extremes of temperature; or
3. Rain, snow, ice or sleet.
CP 14501000
Copyright, Insurance Services Office, Inc., 1999
Original
Page 1 of 1
o
Miscellaneous Schedule of Inland Marine
All Miscellaneous mobile equipment items $15,000 or less are covered on a blanket basis.
Watercraft & Scheduled items over $15,000:
Item #
Limit
Description
Blanket Inland Marine
Deductible
1
$500
(
Note: Items valued greater than $50,000:
Deductible is either the listed amount or 2% of the limit. (Whichever is greater)
(
FMIT 1M SCH 1002
Page 1 of 1
THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY.
(
FUNGUS CLEAN UP AND REMOVAL LIMITATION ENDORSEMENT
THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING:
COMMERCIAL PROPERTY COVERAGE PART
SCHEDULE
FUNGUS CLEAN UP AND REMOVAL POLICY LIMIT: $15,000.00
I. The following definitions are added to the policy:
a. The term fungus(i), as used in this endorsement and throughout the entire policy,
includes, but is not limited to, any form or type of mildew, mold, mushroom, rust,
smuts, or yeast, including any allergens, irritants, mycotoxins, or scents,
byproducts, microbial volatile organic compounds produced by or associated
therewith.
b. The term spore(s), as used in this endorsement and throughout the entire policy,
means any reproductive body produced by or arising out of any fungus(i).
II.
a.
We will pay your expenses for testing for, monitoring, abatement, mitigation,
removal, remediation or disposal of:
(
(1) Any fungus(i) or spore(s); or
(2) Any substance, vapor, gas or byproducts produced by or arising out of any
fungus(i) or spore( s )
provided:
(3) Such expense is caused by or results from a Covered Cause of Loss that
occurs during the policy period;
(4) Subject to all other policy conditions, the necessity of such expense is
reported to us in writing within 60 days of the date on which the Covered
Cause of Loss occurs; and
(5) We authorize you to incur such expense.
b.
(1 )
Regardless of the number of claims, insured locations or occurrences, the
most we will pay under this policy, in excess of any applicable deductible,
for the sum of all covered expenses described in 1. above, is the FUNGUS
CLEAN UP AND REMOVAL POLICY LIMIT shown in the SCHEDULE of
this endorsement.
(2) Subject to b.(1) above, the FUNGUS CLEAN UP AND REMOVAL POLICY
LIMIT applies to and includes the costs associated with the replacement of
Covered Property discarded or destroyed as part of the removal or
remediation of fungus or spores.
(
(3)
The FUNGUS CLEAN UP AND REMOVAL POLICY LIMIT is part of, and
not in addition to, the Limit of Insurance applicable to the Covered
Property.
FMIT FCR 1002
Page 1 of 1
IL 00 1711 98
COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions.
(
A. Cancellation
1. The first Named Insured shown in the Declara-
tions may cancel this policy by mailing or deliv-
ering to us advance written notice of cancella-
tion.
2. We may cancel this policy by mailing or deliver-
ing to the first Named Insured written notice of
cancellation at least:
a. 10 days before the effective date of cancel-
lation if we cancel for nonpayment of pre-
mium; or
b. 30 days before the effective date of cancel-
lation if we cancel for any other reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known to
us.
4. Notice of cancellation will state the effective
date of cancellation. The policy period will end
on that date.
5. If this policy is cancelled, we will send the first
Named Insured any premium refund due. If we
cancel, the refund will be pro rata. If the first
Named Insured cancels, the refund may be
less than pro rata. The cancellation will be ef-
fective even if we have not made or offered a
refund.
6. If notice is mailed, proof of mailing will be suffi-
cient proof of notice.
B. Changes
This policy contains all the agreements between
you and us concerning the insurance afforded.
The first Named Insured shown in the Declarations
is authorized to make changes in the terms of this
policy with our consent. This policy's terms can be
amended or waived only by endorsement issued
by us and made a part of this policy.
C. Examination Of Your Books And Records
We may examine and audit your books and re-
cords as they relate to this policy at any time dur-
ing the policy period and up to three years after-
ward.
D. Inspections And Surveys
1. We have the right to:
a. Make inspections and surveys at any time;
(
b. Give you reports on the conditions we find;
and
c. Recommend changes.
2. We are not obligated to make any inspections,
surveys, reports or recommendations and any
such actions we do undertake relate only to in-
surability and the premiums to be charged. We
do not make safety inspections. We do not un-
dertake to perform the duty of any person or
organization to provide for the health or safety
of workers or the public. And we do not warrant
that conditions:
a. Are safe or healthful; or
b. Comply with laws, regulations, codes or
standards.
3. Paragraphs 1. and 2. of this condition apply not
only to us, but also to any rating, advisory, rate
service or similar organization which makes in-
surance inspections, surveys, reports or rec-
ommendations.
4. Paragraph 2. of this condition does not apply to
any inspections, surveys, reports or recom-
mendations we may make relative to certifica-
tion, under state or municipal statutes, ordi-
nances or regulations, of boilers, pressure ves-
sels or elevators.
E. Premiums
The first Named Insured shown in the Declara-
tions:
1. Is responsible for the payment of all premiums;
and
2. Will be the payee for any return premiums we
pay.
F. Transfer Of Your Rights And Duties Under This
Policy
Your rights and duties under this policy may not be
transferred without our written consent except in
the case of death of an individual named insured.
If you die, your rights and duties will be transferred
to your legal representative but only while acting
within the scope of duties as your legal representa-
tive. Until your legal representative is appointed,
anyone having proper temporary custody of your
property will have your rights and duties but only
with respect to that property.
IL 00 1711 98
Copyright, Insurance Services Office, Inc., 1998
Page 1 of 1
o
IL 02 55 07 02
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FLORIDA CHANGES -
CANCELLATION AND NONRENEWAL
This endorsement modifies insurance provided under the following:
BOilER AND MACHINERY COVERAGE PART
CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART
COMMERCIAL INLAND MARINE COVERAGE PART
COMMERCIAL PROPERTY COVERAGE PART
CRIME AND FIDELITY COVERAGE PART
FARM COVERAGE PART
(
A. Paragraph 2. of the Cancellation Common Policy
Condition is replaced by the following:
2. Cancellation For Policies In Effect 90 Days
Or Less
a. If this policy has been in effect for 90 days
or less, we may cancel this policy by mailing
or delivering to the first Named Insured writ-
ten notice of cancellation, accompanied by
the specific reasons for cancellation, at
least:
(1) 10 days before the effective date of
cancellation if we cancel for nonpayment
of premium; or
(2) 20 days before the effective date of
cancellation if we cancel for any other
reason, except we may cancel immedi-
ately if there has been:
(a) A material misstatement or misrepre-
sentation; or
(b) A failure to comply with underwriting
requirements established by the in-
surer.
b. We may not cancel:
(1) On the basis of property insurance
claims that are the result of an act of
God, unless we can demonstrate, by
claims frequency or otherwise, that you
have failed to take action reasonably
necessary as requested by us to prevent
recurrence of damage to the insured
property; or
(
(2) On the basis of filing of claims for partial
loss caused by sinkhole damage, re-
gardless of whether this policy has been
the subject of a sinkhole claim, or on the
basis of the risk associated with the oc-
currence of such a claim. However, we
may cancel this policy if:
(a) The total of such property insurance
claim payments for this policy ex-
ceeds the current policy limits of
coverage for property damage; or
(b) You have failed to repair the struc-
ture in accordance with the engineer-
ing recommendations upon which
any loss payment or policy proceeds
were based.
B. The following is added to the Cancellation Com-
mon Policy Condition:
7. Cancellation For Policies In Effect For More
Than 90 Days
a. If this policy has been in effect for more
than 90 days, we may cancel this policy
only for one or more of the following rea-
sons:
(1) Nonpayment of premium;
(2) The policy was obtained by a material
misstatement;
(3) There has been a failure to comply with
underwriting requirements established
by the insurer within 90 days of the ef-
fective date of coverage;
IL 02 55 07 02
@ ISO Properties, Inc., 2001
Page 1 of 2
o
(
(4) There has been a substantial change in
the risk covered by the policy;
(5) The cancellation is for all insureds under
such policies for a given class of insur-
eds;
(6) On the basis of property insurance
claims that are the result of an act of
God, if we can demonstrate, by claims
frequency or otherwise, that you have
failed to take action reasonably neces-
sary as requested by us to prevent re-
currence of damage to the insured prop-
erty;or
(7) On the basis of filing of claims for partial
loss caused by sinkhole damage, or on
the basis of the risk associated with the
occurrence of such a claim, if:
(a) The total of such property insurance
claim payments for this policy ex-
ceeds the current policy limits of
coverage for property damage; or
(b ) You have failed to repair the struc-
ture in accordance with the engineer-
ing recommendations upon which
any loss payment or policy proceeds
were based.
b. If we cancel this policy for any of these
reasons, we will mail or deliver to the first
Named Insured written notice of cancella-
tion, accompanied by the specific reasons
for cancellation, at least:
(1) 10 days before the effective date of
cancellation if cancellation is for non-
payment of premium; or
(2) 45 days before the effective date of
cancellation if:
(a) Cancellation is for one or more of the
reasons stated in 7.a.(2) through
7.a.(7) above; and
(b) This policy does not cover a residen-
tial structure or its contents; or
(3) 90 days before the effective date of
cancellation if:
(a) Cancellation is for one or more of the
reasons stated in7.a.(2) through
7.a.(7) above; and
(b) This policy covers a residential struc-
ture or its contents.
(
C. The following is added:
NONRENEWAL
1. If we decide not to renew this policy we will mail
or deliver to the first Named Insured written no-
tice of nonrenewal, accompanied by the spe-
cific reason for nonrenewal, at least:
a. 90 days prior to the expiration of the policy if
this policy covers a residential structure or
its contents; or
b. 45 days prior to the expiration of the policy
for all other policies.
2. Any notice of nonrenewal will be mailed or
delivered to the first Named Insured's last mail-
ing address known to us. If notice is mailed,
proof of mailing will be sufficient proof of notice.
3. We may not refuse to renew this policy:
a. On the basis of property insurance claims
that are the result of an act of God, unless
we can demonstrate, by claims frequency or
otherwise, that you have failed to take ac-
tion reasonably necessary as requested by
us to prevent recurrence of damage to the
insured property; or
b. On the basis of filing of claims for partial
loss caused by sinkhole damage, regard-
less of whether this policy has been the
subject of a sinkhole claim, or on the basis
of the risk associated with the occurrence of
such a claim. However, we may refuse to
renew this policy if:
(1) The total of such property insurance
claim payments for this policy exceeds
the current policy limits of coverage for
property damage; or
(2) You have failed to repair the structure in
accordance with the engineering rec-
ommendations upon which any loss
payment or policy proceeds were based.
Page 2 of 2
@ ISO Properties, Inc., 2001
IL 02 55 07 02
o
COMMERCIAL PROPERTY
COMMERCIAL PROPERTY CONDITIONS
This Coverage Part is subject to the following conditions, the Common Policy Conditions and applicable Loss
Conditions and Additional Conditions in Commercial Property Coverage Forms.
(
A. CONCEALMENT, MISREPRESENTATION OR
FRAUD
This Coverage Part is void in any case of fraud by
you as it relates to this Coverage Part at any time.
It is also void if you or any other insured, at any
time, intentionally conceal or misrepresent a mate-
rial fact concerning:
1. This Coverage Part;
2. The Covered Property;
3. Your interest in the Covered Property; or
4. A claim under this Coverage Part.
B. CONTROL OF PROPERTY
Any act or neglect of any person other than you
beyond your direction or control will not affect this
insurance.
The breach of any condition of this Coverage Part
at anyone or more locations will not affect cover-
age at any location where, at the time of loss or
damage, the breach of condition does not exist.
C. INSURANCE UNDER TWO OR MORE
COVERAGES
If two or more of this policy's coverages apply to
the same loss or damage, we will not pay more
than the actual amount of the loss or damage.
D. LEGAL ACTION AGAINST US
No one may bring a legal action against us under
this Coverage Part unless:
1. There has been full compliance with all of the
terms of this Coverage Part; and
2. The action is brought within 2 years after the
date on which the direct physical loss or dam-
age occurred.
E. LIBERALIZATION
If we adopt any revision that would broaden the
coverage under this Coverage Part without addi-
tional premium within 45 days prior to or during the
policy period, the broadened coverage will imme-
diately apply to this Coverage Part.
(
CP 00 90 07 88
F. NO BENEFIT TO BAILEE
No person or organization, other than you, having
custody of Covered Property will benefit from this
insurance.
G.OTHERINSURANCE
1. You may have other insurance subject to the
same plan, terms, conditions and provisions as
the insurance under this Coverage Part. If you
do, we will pay our share of the covered loss or
damage. Our share is the proportion that the
applicable Limit of Insurance under this Cover-
age Part bears to the Limits of Insurance of all
insurance covering on the same basis.
2. If there is other insurance covering the same
loss or damage, other than that described in 1.
above, we will pay only for the amount of cov-
ered loss or damage in excess of the amount
due from that other insurance, whether you can
collect on it or not. But we will not pay more
than the applicable Limit of Insurance.
H. POLICY PERIOD, COVERAGE TERRITORY
Under this Coverage Part:
1. We cover loss or damage commencing:
a. During the policy period shown in the Decla-
rations; and
b. Within the coverage territory.
2. The coverage territory is:
a. The United States of America (including its
territories and possessions);
b. Puerto Rico; and
c. Canada.
Copyright, ISO Commercial Risk Services, Inc., 1983, 1987
o
Page 1 of 2
I. TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
If any person or organization to or for whom we
make payment under this Coverage Part has rights
to recover damages from another, those rights are
transferred to us to the extent of our payment. That
person or organization must do everything neces-
sary to secure our rights and must do nothing after
loss to impair them. But you may waive your rights
against another party in writing:
(
(
1. Prior to a loss to your Covered Property or
Covered Income.
2. After a loss to your Covered Property or Cov-
ered Income only if, at time of loss, that party is
one of the following:
a. Someone insured by this insurance;
b. A business firm:
(1) Owned or controlled by you; or
(2) That owns or controls you; or
c. Your tenant.
This will not restrict your insurance.
Page 2 of 2
Copyright, ISO Commercial Risk Services, Inc., 1983, 1987
CP 00 90 07 88
o
COMMERCIAL PROPERTY
CP 00 10 10 00
BUILDING AND PERSONAL
PROPERTY COVERAGE FORM
Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and
what is and is not covered.
Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The
words "we", "us" and "our" refer to the Company providing this insurance.
Other words and phrases that appear in quotation marks have special meaning. Refer to Section H. - Definitions.
(
A. Coverage
We will pay for direct physical loss of or damage to
Covered Property at the premises described in the
Declarations caused by or resulting from any Cov-
ered Cause of Loss.
1. Covered Property
Covered Property, as used in this Coverage
Part, means the type of property described in
this Section, A.1., and limited in A.2., Property
Not Covered, if a Limit of Insurance is shown in
the Declarations for that type of property.
a. Building, meaning the building or structure
described in the Declarations, including:
(1) Completed additions;
(2) Fixtures, including outdoor fixtures;
(3) Permanently installed:
(a) Machinery and
(b) Equipment;
(4) Personal property owned by you that is
used to maintain or service the building
or structure or its premises, including:
(a) Fire extinguishing equipment;
(b) Outdoor furniture;
(c) Floor coverings; and
(d) Appliances used for refrigerating,
ventilating, cooking, dishwashing or
laundering;
(5) If not covered by other insurance:
(a) Additions under construction, altera-
tions and repairs to the building or
structure;
(b) Materials, equipment, supplies and
temporary structures, on or within
100 feet of the described premises,
used for making additions, altera-
tions or repairs to the building or
structure.
b. Your Business Personal Property located
in or on the building described in the Decla-
rations or in the open (or in a vehicle) within
100 feet of the described premises, consist-
ing of the following unless otherwise speci-
fied in the Declarations or on the Your Busi-
ness Personal Property - Separation of
Coverage form:
(1) Furniture and fixtures;
(2) Machinery and equipment;
(3) "Stock";
(4) All other personal property owned by you
and used in your business;
(5) Labor, materials or services furnished or
arranged by you on personal property of
others;
(6) Your use interest as tenant in improve-
ments and betterments. Improvements
and betterments are fixtures, alterations,
installations or additions:
(a) Made a part of the building or struc-
ture you occupy but do not own; and
(b) You acquired or made at your ex-
pense but cannot legally remove;
(7) Leased personal property for which you
have a contractual responsibility to in-
sure, unless otherwise provided for un-
der Personal Property of Others.
(
CP 00 10 10 00
Copyright, Insurance Services Office, Inc., 1999
Page 1 of 13
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(
c. Personal Property Of Others that is:
(1) In your care, custody or control; and
(2) Located in or on the building described
in the Declarations or in the open (or in a
vehicle) within 100 feet of the described
premises.
However, our payment for loss of or dam-
age to personal property of others will only
be for the account of the owner of the prop-
erty.
2. Property Not Covered
Covered Property does not include:
a. Accounts, bills, currency, deeds, food
stamps or other evidences of debt, money,
notes or securities. Lottery tickets held for
sale are not securities;
b. Animals, unless owned by others and
boarded by you, or if owned by you, only as
"stock" while inside of buildings;
c. Automobiles held for sale;
d. Bridges, roadways, walks, patios or other
paved surfaces;
e. Contraband, or property in the course of
illegal transportation or trade;
f. The cost of excavations, grading, backfilling
or filling;
g. Foundations of buildings, structures, ma-
chinery or boilers if their foundations are be-
low:
(1) The lowest basement floor; or
(2) The surface of the ground, if there is no
basement;
h. Land (including land on which the property
is located), water, growing crops or lawns;
i. Personal property while airborne or water-
borne;
j. Bulkheads, pilings, piers, wharves or docks;
k. Property that is covered under another
coverage form of this or any other policy in
which it is more specifically described, ex-
cept for the excess of the amount due
(whether you can collect on it or not) from
that other insurance;
I. Retaining walls that are not part of a build-
ing;
m. Underground pipes, flues or drains;
(
n. The cost to research, replace or restore the
information on valuable papers and records,
including those which exist on electronic or
magnetic media, except as provided in the
Coverage Extensions;
o. Vehicles or self-propelled machines (includ-
ing aircraft or watercraft) that:
(1) Are licensed for use on public roads; or
(2) Are operated principally away from the
described premises.
This paragraph does not apply to:
(a) Vehicles or self-propelled machines or
autos you manufacture, process or
warehouse;
(b) Vehicles or self-propelled machines,
other than autos, you hold for sale;
(c) Rowboats or canoes out of water at the
described premises; or
(d) Trailers, but only to the extent provided
for in the Coverage Extension for Non-
Owned Detached Trailers.
p. The following property while outside of
buildings:
(1) Grain, hay, straw or other crops;
(2) Fences, radio or television antennas
(including satellite dishes) and their lead-
in wiring, masts or towers, signs (other
than signs attached to buildings), trees,
shrubs or plants (other than "stock" of
trees, shrubs or plants), all except as
provided in the Coverage Extensions.
3. Covered Causes Of Loss
See applicable Causes of Loss Form as shown
in the Declarations.
4. Additional Coverages
a. Debris Removal
(1) Subject to Paragraphs (3) and (4), we
will pay your expense to remove debris
of Covered Property caused by or result-
ing from a Covered Cause of Loss that
occurs during the policy period. The ex-
penses will be paid only if they are re-
ported to us in writing within 180 days of
the date of direct physical loss or dam-
age.
Page 2 of 13
Copyright, Insurance Services Office, Inc., 1999
CP 00 10 10 00
o
(
(2) Debris Removal does not apply to costs
to:
(a) Extract "pollutants" from land or
water; or
(b) Remove, restore or replace polluted
land or water.
(3) Subject to the exceptions in Paragraph
(4), the following provisions apply:
(a) The most we will pay for the total of
direct physical loss or damage plus
debris removal expense is the Limit
of Insurance applicable to the Cov-
ered Property that has sustained loss
or damage.
(b) Subject to (a) above, the amount we
will pay for debris removal expense
is limited to 25% of the sum of the
deductible plus the amount that we
pay for direct physical loss or dam-
age to the Covered Property that has
sustained loss or damage.
(4) We will pay up to an additional $10,000
for debris removal expense, for each lo-
cation, in anyone occurrence of physical
loss or damage to Covered Property, if
one or both of the following circum-
stances apply:
(a) The total of the actual debris removal
expense plus the amount we pay for
direct physical loss or damage ex-
ceeds the Limit of Insurance on the
Covered Property that has sustained
loss or damage.
(b) The actual debris removal expense
exceeds 25% of the sum of the de-
ductible plus the amount that we pay
for direct physical loss or damage to
the Covered Property that has sus-
tained loss or damage.
Therefore, if (4)(a) and/or (4)(b) apply,
our total payment for direct physical loss
or damage and debris removal expense
may reach but will never exceed the
Limit of Insurance on the Covered Prop-
erty that has sustained loss or damage,
plus $10,000.
(
(5) Examples
The following examples assume that
there is no coinsurance penalty.
Example #1
Limit of Insurance
Amount of Deductible
Amount of Loss
Amount of Loss Payable
$ 90,000
$ 500
$ 50,000
$ 49,500
($50,000 - $500)
$ 10,000
Debris Removal Expense
Debris Removal Expense
Payable
($10,000 is 20% of $50,000)
$ 10,000
The debris removal expense is less than
25% of the sum of the loss payable plus
the deductible. The sum of the loss pay-
able and the debris removal expense
($49,500 + $10,000 = $59,500) is less
than the Limit of Insurance. Therefore
the full amount of debris removal ex-
pense is payable in accordance with the
terms of Paragraph (3).
Example #2
Limit of Insurance
Amount of Deductible
Amount of Loss
Amount of Loss Payable
$ 90,000
$ 500
$ 80,000
$ 79,500
($80,000 - $500)
$ 30,000
Debris Removal Expense
Debris Removal Expense
Payable
Basic Amount
Additional Amount
$ 10,500
$ 10,000
The basic amount payable for debris
removal expense under the terms of
Paragraph (3) is calculated as follows:
$80,000 ($79,500 + $500) x .25 =
$20,000; capped at $10,500. The cap
applies because the sum of the loss
payable ($79,500) and the basic amount
payable for debris removal expense
($10,500) cannot exceed the Limit of In-
surance ($90,000).
CP 00 10 10 00
Copyright, Insurance Services Office, Inc., 1999
Page 3 of 13
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(
The additional amount payable for debris
removal expense is provided in accor-
dance with the terms of Paragraph (4),
because the debris removal expense
($30,000) exceeds 25% of the loss pay-
able plus the deductible ($30,000 is
37.5% of $80,000), and because the
sum of the loss payable and debris re-
moval expense ($79,500 + $30,000 =
$109,500) would exceed the Limit of In-
surance ($90,000). The additional
amount of covered debris removal ex-
pense is $10,000, the maximum payable
under Paragraph (4). Thus the total pay-
able for debris removal expense in this
example is $20,500; $9,500 of the debris
removal expense is not covered.
b. Preservation Of Property
If it is necessary to move Covered Property
from the described premises to preserve it
from loss or damage by a Covered Cause
of Loss, we will pay for any direct physical
loss or damage to that property:
(1) While it is being moved or while tempo-
rarily stored at another location; and
(2) Only if the loss or damage occurs within
30 days after the property is first moved.
c. Fire Department Service Charge
When the fire department is called to save
or protect Covered Property from a Covered
Cause of Loss, we will pay up to $1,000 for
your liability for fire department service
charges:
(1) Assumed by contract or agreement prior
to loss; or
(2) Required by local ordinance.
No Deductible applies to this Additional
Coverage.
d. Pollutant Clean Up And Removal
We will pay your expense to extract "pollut-
ants" from land or water at the described
premises if the discharge, dispersal, seep-
age, migration, release or escape of the
"pollutants" is caused by or results from a
Covered Cause of Loss that occurs during
the policy period. The expenses will be paid
only if they are reported to us in writing
within 180 days of the date on which the
Covered Cause of Loss occurs.
-
This Additional Coverage does not apply to
costs to test for, monitor or assess the exis-
tence, concentration or effects of "pollut-
ants". But we will pay for testing which is
performed in the course of extracting the
"pollutants" from the land or water.
The most we will pay under this Additional
Coverage for each described premises is
$10,000 for the sum of all covered ex-
penses arising out of Covered Causes of
Loss occurring during each separate 12
month period of this policy.
e. Increased Cost Of Construction
(1) This Additional Coverage applies only to
buildings to which the Replacement Cost
Optional Coverage applies.
(2) In the event of damage by a Covered
Cause of Loss to a building that is Cov-
ered Property, we will pay the increased
costs incurred to comply with enforce-
ment of an ordinance or law in the
course of repair, rebuilding or replace-
ment of damaged parts of that property,
subject to the limitations stated in e.(3}
through e.(9} of this Additional Cover-
age.
(3) The ordinance or law referred to in e.(2}
of this Additional Coverage is an ordi-
nance or law that regulates the construc-
tion or repair of buildings or establishes
zoning or land use requirements at the
described premises, and is in force at
the time of loss.
(4) Under this Additional Coverage, we will
not pay any costs due to an ordinance or
law that:
(a) You were required to comply with
before the loss, even when the build-
ing was undamaged; and
(b) You failed to comply with.
(5) Under this Additional Coverage, we will
not pay any costs associated with the
enforcement of an ordinance or law
which requires any insured or others to
test for, monitor, clean up, remove, con-
tain, treat, detoxify or neutralize, or in
any way respond to, or assess the ef-
fects of "pollutants".
(
Page 4 of 13
Copyright, Insurance Services Office, Inc., 1999
CP 00101000
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(
(6) The most we will pay under this Addi-
tional Coverage, for each described
building insured under this Coverage
Form, is $10,000 or 5% of the Limit of
Insurance applicable to that building,
whichever is less. If a damaged building
is covered under a blanket Limit of In-
surance which applies to more than one
building or item of property, then the
most we will pay under this Additional
Coverage, for that damaged building, is
the lesser of: $10,000 or 5% times the
value of the damaged building as of the
time of loss times the applicable coin-
surance percentage.
The amount payable under this Addi-
tional Coverage is additional insurance.
(7) With respect to this Additional Coverage:
(a) We will not pay for the Increased
Cost of Construction:
(i) Until the property is actually re-
paired or replaced, at the same or
another premises; and
(ii) Unless the repairs or replacement
are made as soon as reasonably
possible after the loss or damage,
not to exceed two years. We may
extend this period in writing dur-
ing the two years.
(b) If the building is repaired or replaced
at the same premises, or if you elect
to rebuild at another premises, the
most we will pay for the Increased
Cost of Construction, subject to the
provisions of e.(6) of this Additional
Coverage, is the increased cost of
construction at the same premises.
(c) If the ordinance or law requires relo-
cation to another premises, the most
we will pay for the Increased Cost of
Construction, subject to the provi-
sions of e.(6) of this Additional Cov-
erage, is the increased cost of con-
struction at the new premises.
(8) This Additional Coverage is not subject
to the terms of the Ordinance or Law
Exclusion, to the extent that such Exclu-
sion would conflict with the provisions of
this Additional Coverage.
(
CP 00101000
------:"'7 ~..-
(9) The costs addressed in the Loss Pay-
ment and Valuation Conditions, and the
Replacement Cost Optional Coverage,
in this Coverage Form, do not include
the increased cost attributable to en-
forcement of an ordinance or law. The
amount payable under this Additional
Coverage, as stated in e.(6) of this Addi-
tional Coverage, is not subject to such
limitation.
5. Coverage Extensions
Except as otherwise provided, the following Ex-
tensions apply to property located in or on the
building described in the Declarations or in the
open (or in a vehicle) within 100 feet of the de-
scribed premises.
If a Coinsurance percentage of 80% or more
or, a Value Reporting period symbol, is shown
in the Declarations, you may extend the insur-
ance provided by this Coverage Part as follows:
a. Newly Acquired Or Constructed Property
(1) Buildings
If this policy covers Building, you may
extend that insurance to apply to:
(a) Your new buildings while being built
on the described premises; and
(b) Buildings you acquire at locations,
other than the described premises,
intended for:
(i) Similar use as the building de-
scribed in the Declarations; or
(ii) Use as a warehouse.
The most we will pay for loss or damage
under this Extension is $250,000 at each
building.
(2) Your Business Personal Property
(a) If this policy covers Your Business
Personal Property, you may extend
that insurance to apply to:
(i) Business personal property, in-
cluding such property that you
newly acquire, at any location you
acquire other than at fairs, trade
shows or exhibitions;
Copyright, Insurance Services Office, Inc., 1999
o
Page 5 of 13
~
( }
(
(ii) Business personal property, in-
cluding such property that you
newly acquire, located at your
newly constructed or acquired
buildings at the location described
in the Declarations; or
(Hi) Business personal property that
you newly acquire, located at the
described premises.
The most we will pay for loss or
damage under this Extension is
$100,000 at each building.
(b) This Extension does not apply to:
(i) Personal property of others that is
temporarily in your possession in
the course of installing or per-
forming work on such property; or
(ii) Personal property of others that is
temporarily in your possession in
the course of your manufacturing
or wholesaling activities.
(3) Period Of Coverage
With respect to insurance on or at each
newly acquired or constructed property,
coverage will end when any of the
following first occurs:
(a) This policy expires;
(b) 30 days expire after you acquire the
property or begin construction of that
part of the building that would qualify
as covered property; or
(c) You report values to us.
We will charge you additional premium
for values reported from the date you
acquire the property or begin construc-
tion of that part of the building that would
qualify as covered property.
b. Personal Effects And Property Of Others
You may extend the insurance that applies
to Your Business Personal Property to apply
to:
(1) Personal effects owned by you, your
officers, your partners or members, your
managers or your employees. This ex-
tension does not apply to loss or dam-
age by theft.
(2) Personal property of others in your care,
custody or control.
The most we will pay for loss or damage
under this Extension is $2,500 at each de-
scribed premises. Our payment for loss of
or damage to personal property of others
will only be for the account of the owner of
the property.
c. Valuable Papers And Records - Cost Of
Research
You may extend the insurance that applies
to Your Business Personal Property to apply
to your costs to research, replace or restore
the lost information on lost or damaged
valuable papers and records, including
those which exist on electronic or magnetic
media, for which duplicates do not exist.
The most we will pay under this Extension
is $2,500 at each described premises,
unless a higher limit is shown in the Decla-
rations.
d. Property Off-Premises
(1) You may extend the insurance provided
by this Coverage Form to apply to your
Covered Property while it is away from
the described premises, if it is:
(a) Temporarily at a location you do not
own, lease or operate;
(b) In storage at a location you lease,
provided the lease was executed af-
ter the beginning of the current policy
term; or
(c) At any fair, trade show or exhibition.
(2) This Extension does not apply to prop-
erty:
(a) In or on a vehicle; or
(b) In the care, custody or control of your
salespersons, unless the property is
in such care, custody or control at a
fair, trade show or exhibition.
(3) The most we will pay for loss or damage
under this Extension is $10,000.
e. Outdoor Property
You may extend the insurance provided by
this Coverage Form to apply to your outdoor
fences, radio and television antennas (in-
cluding satellite dishes), signs (other than
signs attached to buildings), trees, shrubs
and plants (other than "stock" of trees,
shrubs or plants), including debris removal
expense, caused by or resulting from any of
the following causes of loss if they are Cov-
ered Causes of Loss:
(1) Fire;
(2) Lightning;
(3) Explosion;
(4) Riot or Civil Commotion; or
(5) Aircraft.
Page 6 of 13
Copyright, Insurance Services Office. Inc., 1999
CP 00 10 1000
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(
The most we will pay for loss or damage
under this Extension is $1,000, but not
more than $250 for anyone tree, shrub or
plant. These limits apply to anyone occur-
rence, regardless of the types or number of
items lost or damaged in that occurrence.
f. Non-Owned Detached Trailers
(1) You may extend the insurance that
applies to Your Business Personal
Property to apply to loss or damage to
trailers that you do not own, provided
that:
(a) The trailer is used in your business;
(b) The trailer is in your care, custody or
control at the premises described in
the Declarations; and
(c) You have a contractual responsibility
to pay for loss or damage to the
trailer.
(2) We will not pay for any loss or damage
that occurs:
(a) While the trailer is attached to any
motor vehicle or motorized convey-
ance, whether or not the motor vehi-
cle or motorized conveyance is in
motion;
(b) During hitching or unhitching opera-
tions, or when a trailer becomes ac-
cidentally unhitched from a motor
vehicle or motorized conveyance.
(3) The most we will pay for loss or damage
under this Extension is $5,000, unless a
higher limit is shown in the Declarations.
(4) This insurance is excess over the
amount due (whether you can collect on
it or not) from any other insurance cover-
. ing such property.
Each of these Extensions is additional insurance.
The Additional Condition, Coinsurance, does not
apply to these Extensions.
B. Exclusions And Limitations
See applicable Causes of Loss Form as shown in
the Declarations.
C. Limits Of Insurance
The most we will pay for loss or damage in any
one occurrence is the applicable Limit of Insurance
shown in the Declarations.
The most we will pay for loss or damage to out-
door signs attached to buildings is $1,000 per sign
in anyone occurrence.
(
The limits applicable to the Coverage Extensions
and the Fire Department Service Charge and Pol-
lutant Clean Up and Removal Additional Cover-
ages are in addition to the Limits of Insurance.
Payments under the Preservation of Property Addi-
tional Coverage will not increase the applicable
Limit of Insurance.
D. Deductible
In anyone occurrence of loss or damage (herein-
after referred to as loss), we will first reduce the
amount of loss if required by the Coinsurance
Condition or the Agreed Value Optional Coverage.
If the adjusted amount of loss is less than or equal
to the Deductible, we will not pay for that loss. If
the adjusted amount of loss exceeds the Deducti-
ble, we will then subtract the Deductible from the
adjusted amount of loss, and will pay the resulting
amount or the Limit of Insurance, whichever is
less.
When the occurrence involves loss to more than
one item of Covered Property and separate Limits
of Insurance apply, the losses will not be combined
in determining application of the Deductible. But
the Deductible will be applied only once per occur-
rence.
Example No.1:
(This example assumes there is no coinsurance pen-
alty.)
Deductible:
Limit of Insurance - Bldg. 1:
Limit of Insurance - Bldg. 2:
Loss to Bldg. 1:
Loss to Bldg. 2:
$ 250
$ 60,000
$ 80,000
$ 60,100
$ 90,000
The amount of loss to Bldg. 1 ($60,100) is less
than the sum ($60,250) of the Limit of Insurance
applicable to Bldg. 1 plus the Deductible.
The Deductible will be subtracted from the amount
of loss in calculating the loss payable for Bldg. 1:
-
$ 60,100
250
$ 59,850 Loss Payable - Bldg. 1
The Deductible applies once per occurrence and
therefore is not subtracted in determining the
amount of loss payable for Bldg. 2. Loss payable
for Bldg. 2 is the Limit of Insurance of $80,000.
Total amount of loss payable: $59,850 + 80,000 =
$139,850
CP 00101000
Copyright, Insurance Services Office, Inc., 1999
Page 7 of 13
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Example No.2:
(This example, too, assumes there is no coinsurance
penalty. )
The Deductible and Limits of Insurance are the same
as those in Example NO.1.
Loss to Bldg. 1: $ 70,000
(exceeds Limit of Insurance plus Deductible)
Loss to Bldg. 2: $ 90,000
(exceeds Limit of Insurance plus Deductible)
Loss Payable - Bldg. 1: $60,000
(Limit of Insurance)
Loss Payable - Bldg. 2: $80,000
(Limit of Insurance)
Total amount of loss payable:
$140,000
(
E. Loss Conditions
The following conditions apply in addition to the
Common Policy Conditions and the Commercial
Property Conditions.
1. Abandonment
There can be no abandonment of any property
to us.
2. Appraisal
If we and you disagree on the value of the
property or the amount of loss, either may
make written demand for an appraisal of the
loss. In this event, each party will select a com-
petent and impartial appraiser. The two ap-
praisers will select an umpire. If they cannot
agree, either may request that selection be
made by a judge of a court having jurisdiction.
The appraisers will state separately the value of
the property and amount of loss. If they fail to
agree, they will submit their differences to the
umpire. A decision agreed to by any two will be
binding. Each party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal
and umpire equally.
If there is an appraisal, we will still retain our
right to deny the claim.
3. Duties In The Event Of Loss Or Damage
a. You must see that the following are done in
the event of loss or damage to Covered
Property:
(1) Notify the police if a law may have been
broken.
(2) Give us prompt notice of the loss or
damage. Include a description of the
property involved.
(3) As soon as possible, give us a descrip-
tion of how, when and where the loss or
damage occurred.
(
(4) Take all reasonable steps to protect the
Covered Property from further damage,
and keep a record of your expenses
necessary to protect the Covered Prop-
erty, for consideration in the settlement
of the claim. This will not increase the
Limit of Insurance. However, we will not
pay for any subsequent loss or damage
resulting from a cause of loss that is not
a Covered Cause of Loss. Also, if feasi-
ble, set the damaged property aside and
in the best possible order for examina-
tion.
(5) At our request, give us complete inven-
tories of the damaged and undamaged
property. Include quantities, costs, val-
ues and amount of loss claimed.
(6) As often as may be reasonably required,
permit us to inspect the property proving
the loss or damage and examine your
books and records.
Also permit us to take samples of dam-
aged and undamaged property for in-
spection, testing and analysis, and per-
mit us to make copies from your books
and records.
(7) Send us a signed, sworn proof of loss
containing the information we request to
investigate the claim. You must do this
within 60 days after our request. We will
supply you with the necessary forms.
(8) Cooperate with us in the investigation or
settlement of the claim.
b. We may examine any insured under oath,
while not in the presence of any other in-
sured and at such times as may be rea-
sonably required, about any matter relating
to this insurance or the claim, including an
insured's books and records. In the event of
an examination, an insured's answers must
be signed.
4. Loss Payment
a. In the event of loss or damage covered by
this Coverage Form, at our option, we will
either:
(1) Pay the value of lost or damaged prop-
erty;
(2) Pay the cost of repairing or replacing the
lost or damaged property, subject to b.
below;
(3) Take all or any part of the property at an
agreed or appraised value; or
(4) Repair, rebuild or replace the property
with other property of like kind and qual-
ity, subject to b. below.
Page 8 of 13
Copyright, Insurance Services Office, Inc., 1999
CP 00 10 10 00
o
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We will determine the value of lost or dam-
aged property, or the cost of its repair or re-
placement, in accordance with the applica-
ble terms of the Valuation Condition in this
Coverage Form or any applicable provision
which amends or supersedes the Valuation
Condition.
b. The cost to repair, rebuild or replace does
not include the increased cost attributable to
enforcement of any ordinance or law regu-
lating the construction, use or repair of any
property.
c. We will give notice of our intentions within
30 days after we receive the sworn proof of
loss.
d. We will not pay you more than your financial
interest in the Covered Property.
e. We may adjust losses with the owners of
lost or damaged property if other than you.
If we pay the owners, such payments will
satisfy your claims against us for the own-
ers' property. We will not pay the owners
more than their financial interest in the Cov-
ered Property.
f. We may elect to defend you against suits
arising from claims of owners of property.
We will do this at our expense.
g. We will pay for covered loss or damage
within 30 days after we receive the sworn
proof of loss, if you have complied with all of
the terms of this Coverage Part and:
(1) We have reached agreement with you
on the amount of loss; or
(2) An appraisal award has been made.
5. Recovered Property
If either you or we recover any property after
loss settlement, that party must give the other
prompt notice. At your option, the property will
be returned to you. You must then return to us
the amount we paid to you for the property. We
will pay recovery expenses and the expenses
to repair the recovered property, subject to the
Limit of Insurance.
c- }
(
6. Vacancy
a. Description Of Terms
(1) As used in this Vacancy Condition, the
term building and the term vacant have
the meanings set forth in (1)(a) and
(1)(b) below:
(a) When this policy is issued to a ten-
ant, and with respect to that tenant's
interest in Covered Property, building
means the unit or suite rented or
leased to the tenant. Such building is
vacant when it does not contain
enough business personal property
to conduct customary operations.
(b) When this policy is issued to the
owner or general lessee of a build-
ing, building means the entire build-
ing. Such building is vacant unless at
least 31 % of its total square footage
is:
(i) Rented to a lessee or sub-lessee
and used by the lessee or sub-
lessee to conduct its customary
operations; and/or
(ii) Used by the building owner to
conduct customary operations.
(2) Buildings under construction or renova-
tion are not considered vacant.
b. Vacancy Provisions
If the building where loss or damage occurs
has been vacant for more than 60 consecu-
tive days before that loss or damage oc-
curs:
(1) We will not pay for any loss or damage
caused by any of the following even if
they are Covered Causes of Loss:
(a) Vandalism;
(b) Sprinkler leakage, unless you have
protected the system against freez-
ing;
(c) Building glass breakage;
(d) Water damage;
(e) Theft; or
(f) Attempted theft.
(2) With respect to Covered Causes of Loss
other than those listed in b.(1){a)
through b.(1){f) above, we will reduce
the amount we would otherwise pay for
the loss or damage by 15%.
CP 00 10 10 00
Copyright, Insurance Services Office, Inc., 1999
Page 90f 13
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7. Valuation
We will determine the value of Covered Prop-
erty in the event of loss or damage as follows:
a. At actual cash value as of the time of loss or
damage, except as provided in b., c., d., e.
and f. below.
b. If the Limit of Insurance for Building satis-
fies the Additional Condition, Coinsurance,
and the cost to repair or replace the dam-
aged building property is $2,500 or less, we
will pay the cost of building repairs or re-
placement.
The cost of building repairs or replacement
does not include the increased cost attribut-
able to enforcement of any ordinance or law
regulating the construction, use or repair of
any property. However, the following prop-
erty will be valued at the actual cash value
even when attached to the building:
(1) Awnings or floor coverings;
(2) Appliances for refrigerating, ventilating,
cooking, dishwashing or laundering; or
(3) Outdoor equipment or furniture.
c. "Stock" you have sold but not delivered at
the selling price less discounts and ex-
penses you otherwise would have had.
d. Glass at the cost of replacement with safety
glazing material if required by law.
e. Tenant's Improvements and Betterments at:
(1) Actual cash value of the lost or damaged
property if you make repairs promptly.
(2) A proportion of your original cost if you
do not make repairs promptly. We will
determine the proportionate value as fol-
lows:
(a) Multiply the original cost by the num-
ber of days from the loss or damage
to the expiration of the lease; and
(b) Divide the amount determined in (a)
above by the number of days from
the installation of improvements to
the expiration of the lease.
If your lease contains a renewal option,
the expiration of the renewal option pe-
riod will replace the expiration of the
lease in this procedure.
(3) Nothing if others pay for repairs or re-
placement.
f. Valuable Papers and Records, including
those which exist on electronic or magnetic
media (other than prepackaged software
programs), at the cost of:
(1) Blank materials for reproducing the
records; and
(
(2) labor to transcribe or copy the records
when there is a duplicate.
F. Additional Conditions
The following conditions apply in addition to the
Common Policy Conditions and the Commercial
Property Conditions.
1. Coinsurance
If a Coinsurance percentage is shown in the
Declarations, the following condition applies.
a. We will not pay the full amount of any loss if
the value of Covered Property at the time of
loss times the Coinsurance percentage
shown for it in the Declarations is greater
than the Limit of Insurance for the property.
Instead, we will determine the most we will
pay using the following steps:
(1) Multiply the value of Covered Property at
the time of loss by the Coinsurance per-
centage;
(2) Divide the Limit of Insurance of the
property by the figure determined in Step
(1);
(3) Multiply the total amount of loss, before
the application of any deductible, by the
figure determined in Step (2); and
(4) Subtract the deductible from the figure
determined in Step (3).
We will pay the amount determined in Step
(4) or the limit of insurance, whichever is
less. For the remainder, you will either have
to rely on other insurance or absorb the loss
yourself.
Example No.1 (Underinsurance):
When: The value of the prop-
erty is
The Coinsurance per-
centage for it is
The Limit of Insurance
for it is $
The Deductible is $
The amount of loss is $
Step (1): $250,000 x 80% = $200,000
(the minimum amount of insurance to
meet your Coinsurance requirements)
Step (2): $100,000 + $200,000 = .50
Step (3): $40,000 x .50 = $20,000
Step (4): $20,000 - $250 = $19,750
We will pay no more than $19,750. The remaining
$20,250 is not covered.
$
250,000
80%
100,000
250
40,000
Page 10 of 13
Copyright, Insurance Services Office, Inc., 1999
CP 00101000
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Example No.2 (Adequate Insurance): c. The mortgageholder has the right to receive
( When: The value of the prop- loss payment even if the mortgageholder
erty is $ 250,000 has started foreclosure or similar action on
The Coinsurance per- the building or structure.
centage for it is 80% d. If we deny your claim because of your acts
The Limit of Insurance or because you have failed to comply with
for it is $ 200,000 the terms of this Coverage Part, the mort-
The Deductible is $ 250 gageholder will still have the right to receive
The amount of loss is $ 40,000 loss payment if the mortgageholder:
(1) Pays any premium due under this Cov-
The minimum amount of insurance to meet erage Part at our request if you have
your Coinsurance requirement is $200,000 failed to do so;
($250,000 x 80%). Therefore, the Limit of (2) Submits a signed, sworn proof of loss
Insurance in this Example is adequate and within 60 days after receiving notice
no penalty applies. We will pay no more from us of your failure to do so; and
than $39,750 ($40,000 amount of loss mi- (3) Has notified us of any change in owner-
nus the deductible of $250). ship, occupancy or substantial change in
b. If one Limit of Insurance applies to two or risk known to the mortgageholder.
more separate items, this condition will ap- All of the terms of this Coverage Part will
ply to the total of all property to which the then apply directly to the mortgageholder.
limit applies. e. If we pay the mortgageholder for any loss or
Example No.3: damage and deny payment to you because
of your acts or because you have failed to
When: The value of property is: comply with the terms of this Coverage
Bldg. at Location No.1 $ 75,000 Part:
Bldg. at Location No.2 $ 100,000 (1) The mortgageholder's rights under the
( Personal Property at mortgage will be transferred to us to the
Location No.2 $ 75,000 extent of the amount we pay; and
$ 250,000 (2) The mortgageholder's right to recover
The Coinsurance per- the full amount of the mortgageholder's
centage for it is 90% claim will not be impaired.
The Limit of Insurance
for Buildings and Per- At our option, we may pay to the mortgage-
sonal Property at Loca- holder the whole principal on the mortgage
tion Nos. 1 and 2 is $ 180,000 plus any accrued interest. In this event, your
The Deductible is $ 1,000 mortgage and note will be transferred to us
The amount of loss is: and you will pay your remaining mortgage
Bldg. at Location No.2 $ 30,000 debt to us.
Personal Property at f. If we cancel this policy, we will give written
Location No.2. $ 20,000 notice to the mortgageholder at least:
$ 50,000 (1) 10 days before the effective date of
Step (1): $250,000 x 90% = $225,000 cancellation if we cancel for your non-
(the minimum amount of insurance to payment of premium; or
meet your Coinsurance requirements (2) 30 days before the effective date of
and to avoid the penalty shown below) cancellation if we cancel for any other
Step (2): $180,000 + $225,000 = .80 reason.
Step (3): $50,000 x .80 = $40,000 g. If we elect not to renew this policy, we will
Step (4): $40,000 - $1,000 = $39,000 give written notice to the mortgageholder at
We will pay no more than $39,000. The remaining least 10 days before the expiration date of
$11,000 is not covered. this policy.
2. Mortgageholders
a. The term mortgageholder includes trustee.
( b. We will pay for covered loss of or damage
to buildings or structures to each mortgage-
holder shown in the Declarations in their or-
der of precedence, as interests may appear.
CP 00 10 1000
Copyright, Insurance Services Office, Inc., 1999
Page 11 of 13
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G. Optional Coverages
If shown as applicable in the Declarations, the fol-
lowing Optional Coverages apply separately to
each item.
1. Agreed Value
a. The Additional Condition, Coinsurance,
does not apply to Covered Property to which
this Optional Coverage applies. We will pay
no more for loss of or damage to that prop-
erty than the proportion that the Limit of In-
surance under this Coverage Part for the
property bears to the Agreed Value shown
for it in the Declarations.
b. If the expiration date for this Optional Cov-
erage shown in the Declarations is not ex-
tended, the Additional Condition, Coinsur-
ance, is reinstated and this Optional Cover-
age expires.
c. The terms of this Optional Coverage apply
only to loss or damage that occurs:
(1) On or after the effective date of this
Optional Coverage; and
(2) Before the Agreed Value expiration date
shown in the Declarations or the policy
expiration date, whichever occurs first.
2. Inflation Guard
a. The Limit of Insurance for property to which
this Optional Coverage applied will auto-
matically increase by the annual percentage
shown in the Declarations.
b. The amount of increase will be:
(1) The Limit of Insurance that applied on
the most recent of the policy inception
date, the policy anniversary date, or any
other policy change amending the Limit
of Insurance, times
(2) The percentage of annual increase
shown in the Declarations, expressed as
a decimal (example: 8% is .08), times
(3) The number of days since the beginning
of the current policy year or the effective
date of the most recent policy change
amending the Limit of Insurance, divided
by 365.
(
(
Example:
If: The applicable Limit of
Insurance is $ 100,000
The annual percentage
increase is 8%
The number of days
since the beginning of
the policy year (or last
policy change) is 146
The amount of increase
is $100,000 x .08 x 146
+ 365 = $ 3,200
3. Replacement Cost
a. Replacement Cost (without deduction for
depreciation) replaces Actual Cash Value in
the Loss Condition, Valuation, of this Cov-
erage Form.
b. This Optional Coverage does not apply to:
(1) Personal property of others;
(2) Contents of a residence;
(3) Manuscripts;
(4) Works of art, antiques or rare articles,
including etchings, pictures, statuary,
marbles, bronzes, porcelains and bric-a-
brac; or
(5) "Stock", unless the Including "Stock"
option is shown in the Declarations.
Under the terms of this Replacement Cost
Optional Coverage, tenants' improvements
and betterments are not considered to be
the personal property of others.
c. You may make a claim for loss or damage
covered by this insurance on an actual cash
value basis instead of on a replacement
cost basis. In the event you elect to have
loss or damage settled on an actual cash
value basis, you may still make a claim for
the additional coverage this Optional Cov-
erage provides if you notify us of your intent
to do so within 180 days after the loss or
damage.
d. We will not pay on a replacement cost basis
for any loss or damage:
(1) Until the lost or damaged property is
actually repaired or replaced; and
Page 12 of 13
Copyright, Insurance Services Office, Inc., 1999
CP 00 10 10 00
o
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(2) Unless the repairs or replacement are
made as soon as reasonably possible
after the 1055 or damage.
With respect to tenants' improvements and
betterments, the following also apply:
(3) If the conditions in d.(1) and d.(2) above
are not met, the value of tenants' im-
provements and betterments will be de-
termined as a proportion of your original
cost, as set forth in the Valuation Condi-
tion of this Coverage Form; and
(4) We will not pay for 1055 or damage to
tenants' improvements and betterments
if others pay for repairs or replacement.
e. We will not pay more for 1055 or damage on
a replacement cost basis than the least of
(1), (2) or (3), subject to f. below:
(1) The Limit of Insurance applicable to the
lost or damaged property;
(2) The cost to replace the lost or damaged
property with other property:
(a) Of comparable material and quality;
and
(b) Used for the same purpose; or
(3) The amount actually spent that is nec-
essary to repair or replace the lost or
damaged property.
If a building is rebuilt at a new premises, the
cost described in e.(2) above is limited to
the cost which would have been incurred if
the building had been rebuilt at the original
premises.
f. The cost of repair or replacement does not
include the increased cost attributable to
enforcement of any ordinance or law regu-
lating the construction, use or repair of any
property.
c~
(
4. Extension Of Replacement Cost To
Personal Property Of Others
a. If the Replacement Cost Optional Coverage
is shown as applicable in the Declarations,
then this Extension may also be shown as
applicable. If the Declarations show this Ex-
tension as applicable, then Paragraph
3.b.(1) of the Replacement Cost Optional
Coverage is deleted and all other provisions
of the Replacement Cost Optional Cover-
age apply to replacement cost on personal
property of others.
b. With respect to replacement cost on the
personal property of others, the following
limitation applies:
If an item(s) of personal property of others
is subject to a written contract which gov-
erns your liability for 1055 or damage to that
item(s), then valuation of that item(s} will be
based on the amount for which you are li-
able under such contract, but not to exceed
the lesser of the replacement cost of the
property or the applicable Limit of Insur-
ance.
H. Definitions
1. "Pollutants" means any solid, liquid, gaseous or
thermal irritant or contaminant, including
smoke, vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste includes materials
to be recycled, reconditioned or reclaimed.
2. "Stock" means merchandise held in storage or
for sale, raw materials and in-process or fin-
ished goods, including supplies used in their
packing or shipping.
Page 13 of 13
o
CP 00 10 1000
Copyright, Insurance Services Office, Inc., 1999
THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY.
COVERAGE EXTENSIONS
Unless otherwise specified, your coverage extensions under the Building and Personal Property Coverage
Form CP 00 10 10 00 have been amended as follows:
5. COVERAGE EXTENSIONS
a. Newly ACQuired or Constructed Property - The most we will pay for loss or damage under
this Extension is 50% of the Limit of Insurance for Building and Business Personal Property
shown in the Declarations, but not more than $1,000,000 per location.
1. Insurance under this Extension for each newly acquired or constructed property will
end when any of the following first occurs:
a) This agreement expires.
b) 60 days expire after you acquire or begin to construct the property if in
excess of $1,000,000 (Building and Business Personal Property); or
c) You report values to us.
(
b.
Valuable Papers and Records - Cost of Research - The most we will pay under this
Extension is $10,000 per location, to a maximum of $100,000 per member per occurrence.
c. Outdoor Property/Signs - (other than signs attached to buildings). The most we will pay for
loss or damage to signs under this Extension is $10,000.
d. Ac-r.ounts Receivable - You may extend the insurance that applies to your Business
Personal Property to apply to your records of accounts receivable while they are at a
"covered location." Accounts Receivable are amounts owed to you by those with whom you
deal in operating your business. The most we will pay for loss under this Extension is
$10,000 per location to a maximum of $100,000 per member per occurrence.
e. Extra Expense - You may extend the insurance that applies to your Business Personal
Property to apply to expenses over and above your ordinary business expenses, which are
necessary to avoid or minimize the suspension of business and return to normal operations
after a covered loss to "buildings" or "business personal property" at a "covered location."
The most we will pay for loss under this Extension is $50,000 per location to a maximum of
$500,000 per member per occurrence.
f.
Flood Coverage - Excess of Loss - The most we will pay for loss or damage under this
extension is $500,000 per occurrence excess of the maximum amount of coverage
available from the National Flood Insurance Program per location or $250,000 per location,
whichever is greater. However, in no event shall the liability of the Trust for all losses falling
within the scope of this extension due to anyone flood loss exceed $500,000 in anyone loss
occurrence nor shall the aggregate liability of the Trust for all such losses exceed $500,000
in any Trust year commencing with the effective date of this coverage.
(
FMIT PROP 03 1002
Page 1 of 2
(
( f
(
For the purpose of this coverage the term flood shall mean surface water, waves, tide or
tidal water and the rising (including the overflow or breaking of boundaries) of lakes, ponds,
reservoirs, harbors, streams and similar bodies of water, spray from any of the foregoing,
and water which backs up through sewers or drains. If this policy covers a building, or part
thereof, it shall cover direct loss by flood to foundations, excavations, and all other portions
of said building, or part thereof, even though this Trust by this policy may have excluded
foundations, excavations and such portions of said building, or part thereof, from coverage.
The Trust shall not be liable hereunder for loss by flood to glass, or lettering or
ornamentation thereon, which at the time of such loss may be separately covered as such
against loss by flood under any other policy of insurance.
g.
Piers, wharfs and docks - Coverage is extended to include the Causes of Loss - Basic
Form for scheduled piers, wharfs, and docks. However, we will not pay for loss or damage
caused by the peril of windstorm/hail.
h.
Underground pipes flues, and drains - Coverage is extended to include the Causes of
Loss - Basic Form for scheduled underground pipes, flues, and drains.
i.
Business Interruption - You may extend the insurance that applies to Designated Member
owned and scheduled water treatment and wastewater treatment facilities to apply to
business interruption to a covered cause of loss. The most we will pay in any Trust year
is $50,000.
j.
Police Dogs - We will pay for the in line of duty death of a certified police canine owned
by the Designated Member. The most we will pay under this Extension is $5,000 per
canine. The most we will pay in any Trust year is $5,000.
k.
Terrorism - The most we will pay for loss or damage under this extension is
$5,000,000.00 per occurrence. This extension is limited to scheduled locations to which
coverage applies to real property, personal property, business income and extra expense.
I. -Electronic Data Processing EQuipment (Software) - We will pay for mechanical
breakdown for software at scheduled locations of the Designated Member. Software
means all forms of converted data and/or instruction vehicles employed in your data
processing operation. Also included is the medium on which data is recorded such as
magnetic tapes, hard disk or floppy disks. Software that is the property of others is
covered as long as you are responsible for it.
The most we will pay for a loss under this extension is $10,000.00 per occurrence.
FMIT PROP 03 1002
Page 2 of 2
POLICY NUMBER:
COMMERCIAL PROPERTY
CP 01 25 06 95
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
FLORIDA CHANGES
This endorsement modifies insurance provided under the following:
COMMERCIAL PROPERTY COVERAGE PART
(
A. When this endorsement is attached to the Stan-
dard Property Policy CP 00 99 the term Coverage
Part in this endorsement is replaced by the term
Policy.
B. The following provision applies when a Coinsur-
ance percentage is shown in the Declarations:
Florida law states as follows:
Coinsurance contract: The rate charged in this pol-
icy is based upon the use of the coinsurance
clause attached to this policy, with the consent of
the Insured.
C. The following is added:
If loss or damage to Covered Property is caused
by or results from Windstorm, the following exclu-
sion applies in:
1. Broward County;
2. Dade County;
3. Martin County;
4. Monroe County;
5. Palm Beach County; and
6. All the areas east of the west bank of the Intra-
Coastal Waterway in the Counties of:
a. Indian River; and
b. St. Lucie.
Windstorm Exterior Paint and Waterproofing
Exclusion
We will not pay for loss or damage to:
1. Paint; or
2. Waterproofing material;
applied to the exterior of Buildings.
We will not include the value of paint or
waterproofing material to determine:
a. The amount of the Windstorm or Hail De-
ductible; or
b. The value of Covered Property when apply-
ing the Coinsurance Condition.
(
CP 01 25 06 95
D. The LOSS PAYMENT Condition dealing with the
number of days within which we must pay for cov-
ered loss or damage is replaced by the following:
Provided you have complied with all the terms of
this Coverage Part, we will pay for covered loss or
damage:
(1) Within 20 days after we receive the
sworn proof of loss and reach written
agreement with you; or
(2) Within 30 days after we receive the
swom proof of loss and:
(a) There is an entry of a final judgment;
or
(b) There is a filing of an appraisal
award with us.
E. Sinkhole Collapse
1. Paragraph A.10., SINKHOLE COLLAPSE, of
the Causes of Loss - Basic Form and the
Causes of Loss - Broad Form;
2. Paragraph A.2.c.(8) of COVERED CAUSES
OF LOSS of the Mortgageholders Errors and
Omissions Coverage Form; and
3. Paragraph A.3.h., SINKHOLE COLLAPSE, of
the Standard Property Policy
are replaced by the following:
Sinkhole Collapse, meaning loss or damage
cause,d by the sudden sinking or collapse of
land into underground empty spaces created by
the action of water on limestone or similar rock
formations. This cause of loss does not in-
clude:
a. The cost of filling sinkholes; or
b. Sinking or collapse of land into man-made
underground cavities.
Copyright, ISO Commercial Risk Services, Inc., 1994
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Page 1 of 2
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't.j}','f~}tY'H1
F. Paragraph F.1. of DEFINITIONS of the Causes of
Loss - Special Form is replaced by the following:
1. Sinkhole collapse means the sudden sinking or
collapse of land into underground empty
spaces created by the action of water on lime-
stone or similar rock formations. This cause of
loss does not include:
a. The cost of filling sinkholes; or
b. Sinking or collapse of land into man-made
underground cavities.
Page 2 of 2
Copyright, ISO Commercial Risk Services, Inc., 1994
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CP 01 25 06 95
COMMERCIAL PROPERTY
CP 10 30 10 00
CAUSES OF LOSS - SPECIAL FORM
Words and phrases that appear in quotation marks have special meaning. Refer to Section F. - Definitions.
(H
A. Covered Causes Of Loss
When Special is shown in the Declarations, Cov-
ered Causes of Loss means Risks Of Direct
Physical Loss unless the loss is:
1. Excluded in Section B., Exclusions; or
2. Limited in Section C., Limitations;
that follow.
B. Exclusions
1. We will not pay for loss or damage caused
directly or indirectly by any of the following.
Such loss or damage is excluded regardless of
any other cause or event that contributes con-
currently or in any sequence to the loss.
a. Ordinance Or Law
The enforcement of any ordinance or law:
(1) Regulating the construction, use or
repair of any property; or
(2) Requiring the tearing down of any prop-
erty, including the cost of removing its
debris.
This exclusion, Ordinance Or Law, applies
whether the loss results from:
(1) An ordinance or law that is enforced
even if the property has not been dam-
aged; or
(2) The increased costs incurred to comply
with an ordinance or law in the course of
construction, repair, renovation, remod-
eling or demolition of property, or re-
moval of its debris, following a physical
loss to that property.
b. Earth Movement
(1) Earthquake, including any earth sinking,
rising or shifting related to such event;
(2) Landslide, including any earth sinking,
rising or shifting related to such event;
(3) Mine subsidence, meaning subsidence
of a man-made mine, whether or not
mining activity has ceased;
(4) Earth sinking (other than sinkhole col-
lapse), rising or shifting including soil
conditions which cause settling, cracking
or other disarrangement of foundations
or other parts of realty. Soil conditions
include contraction, expansion, freezing,
thawing, erosion, improperly compacted
soil and the action of water under the
ground surface.
But if Earth Movement, as described in
b.(1) through (4) above, results in fire or
explosion, we will pay for the loss or dam-
age caused by that fire or explosion.
(5) Volcanic eruption, explosion or effusion.
But if volcanic eruption, explosion or ef-
fusion results in fire, building glass
breakage or Volcanic Action, we will pay
for the loss or damage caused by that
fire, building glass breakage or Volcanic
Action.
Volcanic action means direct loss or
damage resulting from the eruption of a
volcano when the loss or damage is
caused by:
(a) Airborne volcanic blast or airborne
shock waves;
(b) Ash, dust or particulate matter; or
(c) Lava flow.
All volcanic eruptions that occur within
any 168 hour period will constitute a sin-
gle occurrence.
Volcanic action does not include the cost
to remove ash, dust or particulate matter
that does not cause direct physical loss
or damage to the described property.
c. Governmental Action
Seizure or destruction of property by order
of governmental authority.
But we will pay for loss or damage caused
by or resulting from acts of destruction or-
dered by governmental authority and taken
at the time of a fire to prevent its spread, if
the fire would be covered under this Cover-
age Part.
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CP 10 30 10 00
Copyright, Insurance Services Office, Inc., 1999
Page 1 of 7
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d. Nuclear Hazard
Nuclear reaction or radiation, or radioactive
contamination, however caused.
But if nuclear reaction or radiation, or radio-
active contamination, results in fire, we will
pay for the loss or damage caused by that
fire.
e. Utility Services
The failure of power or other utility service
supplied to the described premises, how-
ever caused, if the failure occurs away from
the described premises.
But if the failure of power or other utility ser-
vice results in a Covered Cause of Loss, we
will pay for the loss or damage caused by
that Covered Cause of Loss.
This exclusion does not apply to the Busi-
ness Income coverage or to Extra Expense
coverage. Instead, the Special Exclusion in
Paragraph B.4.a.(1) applies to these cover-
ages.
f. War And Military Action
(1) War, including undeclared or civil war;
(2) Warlike action by a military force, includ-
ing action in hindering or defending
against an actual or expected attack, by
any government, sovereign or other au-
thority using military personnel or other
agents; or
(3) Insurrection, rebellion, revolution,
usurped power, or action taken by gov-
ernmental authority in hindering or de-
fending against any of these.
g. Water
(1) Flood, surface water, waves, tides, tidal
waves, overflow of any body of water, or
their spray, all whether driven by wind or
not;
(2) Mudslide or mudflow;
(3) Water that backs up or overflows from a
sewer, drain or sump; or
(4) Water under the ground surface press-
ing on, or flowing or seeping through:
(a) Foundations, walls, floors or paved
surfaces;
(b) Basements, whether paved or not; or
(c) Doors, windows or other openings.
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Page 2 of 7
But if Water, as described in g.(1) through
g.(4) above, results in fire, explosion or
sprinkler leakage, we will pay for the loss or
damage caused by that fire, explosion or
sprinkler leakage.
Exclusions B.1.a. through B.1.g. apply whether
or not the loss event results in widespread
damage or affects a substantial area.
2. We will not pay for loss or damage caused by
or resulting from any of the following:
a. Artificially generated electrical current, in-
cluding electric arcing, that disturbs electri-
cal devices, appliances or wires.
But if artificially generated electrical current
results in fire, we will pay for the loss or
damage caused by that fire.
b. Delay, loss of use or loss of market.
c. Smoke, vapor or gas from agricultural
smudging or industrial operations.
d. (1) Wear and tear;
(2) Rust, corrosion, fungus, decay, deterio-
ration, hidden or latent defect or any
quality in property that causes it to dam-
age or destroy itself;
(3) Smog;
(4) Settling, cracking, shrinking or expan-
sion;
(5) Nesting or infestation, or discharge or
release of waste products or secretions,
by insects, birds, rodents or other ani-
mals.
(6) Mechanical breakdown, including rup-
ture or bursting caused by centrifugal
force. But if mechanical breakdown re-
sults in elevator collision, we will pay for
the loss or damage caused by that ele-
vator collision.
(7) The following causes of loss to personal
property:
(a) Dampness or dryness of atmos-
phere;
(b) Changes in or extremes of tempera-
ture; or
(c) Marring or scratching.
But if an excluded cause of loss that is
listed in 2.d.(1) through (7) results in a
"specified cause of loss" or building glass
breakage, we will pay for the loss or dam-
age caused by that "specified cause of loss"
or building glass breakage.
Copyright, Insurance Services Office, Inc., 1999
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CP 10 30 10 00
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e. Explosion of steam boilers, steam pipes,
steam engines or steam turbines owned or
leased by you, or operated under your con-
trol. But if explosion of steam boilers, steam
pipes, steam engines or steam turbines re-
sults in fire or combustion explosion, we will
pay for the loss or damage caused by that
fire or combustion explosion. We will also
pay for loss or damage caused by or result-
ing from the explosion of gases or fuel
within the furnace of any fired vessel or
within the flues or passages through which
the gases of combustion pass.
f. Continuous or repeated seepage or leakage
of water that occurs over a period of 14
days or more.
g. Water, other liquids, powder or molten
material that leaks or flows from plumbing,
heating, air conditioning or other equipment
(except fire protective systems) caused by
or resulting from freezing, unless:
(1) You do your best to maintain heat in the
building or structure; or
(2) You drain the equipment and shut off the
supply if the heat is not maintained.
h. Dishonest or criminal act by you, any of your
partners, members, officers, managers,
employees (including leased employees),
directors, trustees, authorized representa-
tives or anyone to whom you entrust the
property for any purpose:
(1) Acting alone or in collusion with others;
or
(2) Whether or not occurring during the
hours of employment.
This exclusion does not apply to acts of de-
struction by your employees (including
leased employees); but theft by employees
(including leased employees) is not cov-
ered.
i. Voluntary parting with any property by you
or anyone else to whom you have entrusted
the property if induced to do so by any
fraudulent scheme, trick, device or false
pretense.
j. Rain, snow, ice or sleet to personal property
in the open.
k. Collapse, except as provided below in the
Additional Coverage for Collapse. But if col-
lapse results in a Covered Cause of Loss at
the described premises, we will pay for the
loss or damage caused by that Covered
Cause of Loss.
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CP 10 30 10 00
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I. Discharge, dispersal, seepage, migration,
release or escape of "pollutants" unless the
discharge, dispersal, seepage, migration,
release or escape is itself caused by any of
the "specified causes of loss". But if the dis-
charge, dispersal, seepage, migration, re-
lease or escape of "pollutants" results in a
"specified cause of loss", we will pay for the
loss or damage caused by that "specified
cause of loss".
This Exclusion, I., does not apply to dam-
age to glass caused by chemicals applied to
the glass.
m. Neglect of an insured to use all reasonable
means to save and preserve property from
further damage at and after the time of loss.
3. We will not pay for loss or damage caused by
or resulting from any of the following, 3.a.
through 3.c. But if an excluded cause of loss
that is listed in 3.a. through 3.c. results in a
Covered Cause of Loss, we will pay for the loss
or damage caused by that Covered Cause of
Loss.
a. Weather conditions. But this exclusion only
applies if weather conditions contribute in
any way with a cause or event excluded in
Paragraph 1. above to produce the loss or
damage.
b. Acts or decisions, including the failure to act
or decide, of any person, group, organiza-
tion or governmental body.
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, survey-
ing, siting;
(2) Design, specifications, workmanship,
repair, construction, renovation, remod-
eling, grading, compaction;
(3) Materials used in repair, construction,
renovation or remodeling; or
(4) Maintenance;
of part or all of any property on or off the
described premises.
4. Special Exclusions
The following provisions apply only to the speci-
fied Coverage Forms.
a. Business Income (And Extra Expense)
Coverage Form, Business Income
(Without Extra Expense) Coverage Form,
or Extra Expense Coverage Form
We will not pay for:
(1) Any loss caused directly or indirectly by
the failure of power or other utility ser-
vice supplied to the described premises,
however caused, if the failure occurs
outside of a covered building.
Copyright, Insurance Services Office, Inc., 1999
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Page 3 of7
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But if the failure of power or other utility
service results in a Covered Cause of
Loss, we will pay for the loss resulting
from that Covered Cause of Loss.
(2) Any loss caused by or resulting from:
(a) Damage or destruction of "finished
stock"; or
(b) The time required to reproduce "fin-
ished stock".
This exclusion does not apply to Extra
Expense.
(3) Any loss caused by or resulting from
direct physical loss or damage to radio
or television antennas (including satellite
dishes) and their lead-in wiring, masts or
towers.
(4) Any increase of loss caused by or result-
ing from:
(a) Delay in rebuilding, repairing or re-
placing the property or resuming
"operations", due to interference at
the location of the rebuilding, repair
or replacement by strikers or other
persons; or
(b) Suspension, lapse or cancellation of
any license, lease or contract. But if
the suspension, lapse or cancellation
is directly caused by the "suspen-
sion" of "operations", we will cover
such loss that affects your Business
Income during the "period of restora-
tion" and any extension of the "period
of restoration" in accordance with the
terms of the Extended Business In-
come Additional Coverage and the
Extended Period Of Indemnity Op-
tional Coverage or any variation of
these.
(5) Any Extra Expense caused by or result-
ing from suspension, lapse or cancella-
tion of any license, lease or contract be-
yond the "period of restoration".
(6) Any other consequential loss.
b. Leasehold Interest Coverage Form
(1) Paragraph B.1.a. Ordinance Or Law,
does not apply to insurance under this
Coverage Form.
(2) We will not pay for any loss caused by:
(a) Your cancelling the lease;
(b) The suspension, lapse or cancella-
tion of any license; or
(c) Any other consequential loss.
(
c. Legal Liability Coverage Form
(1) The following exclusions do not apply to
insurance under this Coverage Form:
(a) Paragraph B.1.a., Ordinance Or Law;
(b) Paragraph B.1.c., Governmental
Action;
(c) Paragraph B.1.d., Nuclear Hazard;
(d) Paragraph B.1.e., Utility Services;
and
(e) Paragraph B.1.f., War And Military
Action.
(2) The following additional exclusions apply
to insurance under this Coverage Form:
(a) Contractual Liability
We will not defend any claim or
"suit", or pay damages that you are
legally liable to pay, solely by reason
of your assumption of liability in a
contract or agreement. But this ex-
clusion does not apply to a written
lease agreement in which you have
assumed liability for building damage
resulting from an actual or attempted
burglary or robbery, provided that:
(i) Your assumption of liability was
executed prior to the accident;
and
(ii) The building is Covered Property
under this Coverage Form.
(b) Nuclear Hazard
We will not defend any claim or
"suit", or pay any damages, loss,
expense or obligation, resulting from
nuclear reaction or radiation, or
radioactive contamination, however
caused.
C. Limitations
The following limitations apply to all policy forms
and endorsements, unless otherwise stated.
1. We will not pay for loss of or damage to prop-
erty, as described and limited in this section. In
addition, we will not pay for any loss that is a
consequence of loss or damage as described
and limited in this section.
a. Steam boilers, steam pipes, steam engines
or steam turbines caused by or resulting
from any condition or event inside such
equipment. But we will pay for loss of or
damage to such equipment caused by or
resulting from an explosion of gases or fuel
within the furnace of any fired vessel or
within the flues or passages through which
the gases of combustion pass.
Page 4 of 7
Copyright, Insurance Services Office, Inc., 1999
CP 10 30 10 00 . 0
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b. Hot water boilers or other water heating
equipment caused by or resulting from any
condition or event inside such boilers or
equipment, other than an explosion.
c. The interior of any building or structure, or
to personal property in the building or struc-
ture, caused by or resulting from rain, snow,
sleet, ice, sand or dust, whether driven by
wind or not, unless:
(1) The building or structure first sustains
damage by a Covered Cause of Loss to
its roof or walls through which the rain,
snow, sleet, ice, sand or dust enters; or
(2) The loss or damage is caused by or
results from thawing of snow, sleet or ice
on the building or structure.
d. Building materials and supplies not attached
as part of the building or structure, caused
by or resulting from theft.
However, this limitation does not apply to:
(1) Building materials and supplies held for
sale by you, unless they are insured un-
der the Builders Risk Coverage Form; or
(2) Business Income coverage or Extra
Expense coverage.
e. Property that is missing, where the only
evidence of the loss or damage is a short-
age disclosed on taking inventory, or other
instances where there is no physical evi-
dence to show what happened to the prop-
erty.
f. Property that has been transferred to a
person or to a place outside the described
premises on the basis of unauthorized in-
structions.
2. We will not pay for loss of or damage to the
following types of property unless caused by
the "specified causes of loss" or building glass
breakage:
a. Valuable papers and records, such as
books of account, manuscripts, abstracts,
drawings and card index systems, including
those which exist on film, tape, disc, drum,
cell or other data processing, recording or
storage media. Valuable papers and re-
cords do not include prepackaged software
programs.
b. Animals, and then only if they are killed or
their destruction is made necessary.
c. Fragile articles such as statuary, marbles,
chinaware and porcelains, if broken. This
restriction does not apply to:
(1) Glass; or
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CP 10 30 1000
~1"
(2) Containers of property held for sale.
d. Builders' machinery, tools and equipment
owned by you or entrusted to you, provided
such property is Covered Property.
However, this limitation does not apply:
(1) If the property is located on or within 100
feet of the described premises, unless
the premises is insured under the Build-
ers Risk Coverage Form; or
(2) To Business Income coverage or to
Extra Expense coverage.
3. The special limit shown for each category, a.
through d., is the total limit for loss of or dam-
age to all property in that category. The special
limit applies to anyone occurrence of theft, re-
gardless of the types or number of articles that
are lost or damaged in that occurrence. The
special limits are:
a. $2,500 for furs, fur garments and garments
trimmed with fur.
b. $2,500 for jewelry, watches, watch move-
ments, jewels, pearls, precious and semi-
precious stones, bullion, gold, silver, plati-
num and other precious alloys or metals.
This limit does not apply to jewelry and
watches worth $100 or less per item.
c. $2,500 for patterns, dies, molds and forms.
d. $250 for stamps, tickets, including lottery
tickets held for sale, and letters of credit.
These special limits are part of, not in addition
to, the Limit of Insurance applicable to the
Covered Property.
This limitation, C.3., does not apply to Business
Income coverage or to Extra Expense cover-
age.
4. We will not pay the cost to repair any defect to
a system or appliance from which water, other
liquid, powder or molten material escapes. But
we will pay the cost to repair or replace dam-
aged parts of fire extinguishing equipment if the
damage:
a. Results in discharge of any substance from
an automatic fire protection system; or
b. Is directly caused by freezing.
However, this limitation does not apply to Busi-
ness Income coverage or to Extra Expense
coverage.
Copyright, Insurance Services Office, Inc., 1999
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Page 5 of 7
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O. Additional Coverage - Collapse
The term Covered Cause of Loss includes the Ad-
ditional Coverage - Collapse as described and lim-
ited in 0.1. through 0.5. below.
1. With respect to buildings:
a. Collapse means an abrupt falling down or
caving in of a building or any part of a build-
ing with the result that the building or part of
the building cannot be occupied for its in-
tended purpose;
b. A building or any part of a building that is in
danger of falling down or caving in is not
considered to be in a state of collapse;
c. A part of a building that is standing is not
considered to be in a state of collapse even
if it has separated from another part of the
building;
d. A building that is standing or any part of a
building that is standing is not considered to
be in a state of collapse even if it shows
evidence of cracking, bulging, sagging,
bending, leaning, settling, shrinkage or ex-
pansion.
2. We will pay for direct physical loss or damage
to Covered Property, caused by collapse of a
building or any part of a building that is insured
under this Coverage Form or that contains
Covered Property insured under this Coverage
Form, if the collapse is caused by one or more
of the following:
a. The "specified causes of loss" or breakage
of building glass, all only as insured against
in this Coverage Part;
b. Decay that is hidden from view, unless the
presence of such decay is known to an in-
sured prior to collapse;
c. Insect or vermin damage that is hidden from
view, unless the presence of such damage
is known to an insured prior to collapse;
d. Weight of people or personal property;
e. Weight of rain that collects on a roof;
f. Use of defective material or methods in
construction, remodeling or renovation if the
collapse occurs during the course of the
construction, remodeling or renovation.
However, if the collapse occurs after con-
struction, remodeling or renovation is com-
plete and is caused in part by a cause of
loss listed in 2.a. through 2.e., we will pay
for the loss or damage even if use of defec-
tive material or methods, in construction,
remodeling or renovation, contributes to the
collapse.
(
The criteria set forth in 1.a. through 1.d. do not
limit the coverage otherwise provided under
this Causes of Loss Form for the causes of
loss listed in 2.a., 2.d. and 2.e.
3. With respect to the following property:
a. Outdoor radio or television antennas (in-
cluding satellite dishes) and their lead-in
wiring, masts or towers;
b. Awnings, gutters and downspouts;
c. Yard fixtures;
d. Outdoor swimming pools;
e. Fences;
f. Piers, wharves and docks;
g. Beach or diving platforms or appurte-
nances;
h. Retaining walls; and
i. Walks, roadways and other paved surfaces;
if the collapse is caused by a cause of loss
listed in 2.b. through 2.1., we will pay for loss or
damage to that property only if:
a. Such loss or damage is a direct result of the
collapse of a building insured under this
Coverage Form; and
b. The property is Covered Property under this
Coverage Form.
4. If personal property abruptly falls down or
caves in and such collapse is not the result of
collapse of a building, we will pay for loss or
damage to Covered Property caused by such
collapse of personal property only if:
a. The collapse was caused by a Cause of
Loss listed in 2.a. through 2.f. above;
b. The personal property which collapses is
inside a building; and
c. The property which collapses is not of a
kind listed in 3. above, regardless of
whether that kind of property is considered
to be personal property or real property.
The coverage stated in this Paragraph 4. does
not apply to personal property if marring and/or
scratching is the only damage to that personal
property caused by the collapse.
Collapse of personal property does not mean
cracking, bulging, sagging, bending, leaning,
settling, shrinkage or expansion.
5. This Additional Coverage, Collapse, will not
increase the Limits of Insurance provided in
this Coverage Part.
Page 6 of 7
Copyright, Insurance Services Office, Inc., 1999
CP 10 301000
o
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E. Additional Coverage Extensions
1. Property In Transit
This Extension applies only to your personal
property to which this form applies.
a. You may extend the insurance provided by
this Coverage Part to apply to your personal
property (other than property in the care,
custody or control of your salespersons) in
transit more than 100 feet from the de-
scribed premises. Property must be in or on
a motor vehicle you own, lease or operate
while between points in the coverage terri-
tory.
b. Loss or damage must be caused by or
result from one of the following causes of
loss:
(1) Fire, lightning, explosion, windstorm or
hail, riot or civil commotion, or vandal-
ism.
(2) Vehicle collision, upset or overturn.
Collision means accidental contact of
your vehicle with another vehicle or ob-
ject. It does not mean your vehicle's con-
tact with the road bed.
(3) Theft of an entire bale, case or package
by forced entry into a securely locked
body or compartment of the vehicle.
There must be visible marks of the
forced entry.
c. The most we will pay for loss or damage
under this Extension is $5,000.
This Coverage Extension is additional insur-
ance. The Additional Condition, Coinsurance,
does not apply to this Extension.
2. Water Damage, Other Liquids, Powder Or
Molten Material Damage
If loss or damage caused by or resulting from
covered water or other liquid, powder or molten
material damage loss occurs, we will also pay
the cost to tear out and replace any part of the
building or structure to repair damage to the
system or appliance from which the water or
other substance escapes. This Coverage Ex-
tension does not increase the Limit of Insur-
ance.
(
CP 10 30 1000
3. Glass
a. We will pay for expenses incurred to put up
temporary plates or board up openings if
repair or replacement of damaged glass is
delayed.
b. We will pay for expenses incurred to re-
move or replace obstructions when repair-
ing or replacing glass that is part of a build-
ing. This does not include removing or re-
placing window displays.
This Coverage Extension, E.3., does not in-
crease the Limit of Insurance.
F. Definitions
"Specified Causes of Loss" means the following:
Fire; lightning; explosion; windstorm or hail;
smoke; aircraft or vehicles; riot or civil commotion;
vandalism; leakage from fire extinguishing equip-
ment; sinkhole collapse; volcanic action; falling ob-
jects; weight of snow, ice or sleet; water damage.
1. Sinkhole collapse means the sudden sinking or
collapse of land into underground empty
spaces created by the action of water on lime-
stone or dolomite. This cause of loss does not
include:
a. The cost of filling sinkholes; or
b. Sinking or collapse of land into man-made
underground cavities.
2. Falling objects does not include loss or damage
to:
a. Personal property in the open; or
b. The interior of a building or structure, or
property inside a building or structure,
unless the roof or an outside wall of the
building or structure is first damaged by a
falling object.
3. Water damage means accidental discharge or
leakage of water or steam as the direct result
of the breaking apart or cracking of a plumbing,
heating, air conditioning or other system or ap-
pliance (other than a sump system including its
related equipment and parts), that is located on
the described premises and contains water or
steam.
Copyright, Insurance Services Office, Inc., 1999
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Page 7 of 7
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ORDINANCE OR LAW COVERAGE
This endorsement modifies insurance provided in the BUILDING AND PERSONAL PROPERTY COVERAGE
FORM.
A. If a Covered Cause of Loss occurs to covered
Building property, we will pay:
1. For loss or damage caused by
enforcement of any ordinance or law that:
a. Requires the demolition of parts of the
same property not damaged by a
Covered Cause of Loss;
b. Regulates the construction or repair of
buildings, or establishes zoning or land
use requirements at the described
premises; and
c. Is in force at the time of loss.
(
2. The increased cost to repair, rebuild or
construct the property caused by
enforcement of building, zoning or land use
ordinance or law. If the property is repaired
or rebuilt, it must be intended for similar
occupancy as the current property, unless
otherwise required by zoning or land use
ordinance or law.
3. The cost to demolish and clear the site of
undamaged parts of the property caused
by enforcement of the building, zoning or
land use ordinance or law.
B. However, we will not pay under this
endorsement for the costs associated with the
enforcement of any ordinance or law which
requires any insured or others to test for,
monitor, clean up, remove, contain, treat,
detoxify, or neutralize, or in any way respond
to, or assess the effects of "pollutants."
c. We will not pay for increased construction
costs under this endorsement:
(
1. Until the property is actually repaired or
replaced, at the same premises or
elsewhere; and
FMIT PROP 12 1002
2. Unless the repairs or replacement are
made as soon as reasonably possible atter
the loss or damage, not to exceed 2 years.
We may extend this period in writing during
the 2 years.
D. We will not pay more:
1. If the property is repaired or replaced on
the same premises, than the amount you
actually spend to:
a. Demolish and clear the site; and
b. Repair, rebuild or construct the property
but not for more than property of the
same height, floor area and style on the
same premises.
2. If the property is not repaired or replaced
on the same premises, than:
a. The amount you actually spend to
demolish and clear the site of the
described premises; and
b. The cost to replace, on the same
premises, the damaged or destroyed
property with other property:
(1) Of comparable material and quality;
(2) Of the same height, floor area and
style; and
(3) Used for the same purpose.
3. For all loss or damage in any occurrence
than the Limit of Insurance applicable to the
covered Building property and no more
than 25% over the actual loss to the
property at any scheduled location.
E. The terms of this endorsement apply
separately to each building to which the
endorsement applies.
Page 1 of 1
(
(
FLORIDA MUNICIPAL INSURANCE TRUST
MEMBER'S STATEMENT OF VALUES
MUNICIPAL
PROPERTY
Member City of Winter Sprinqs
FMIT # 0648
Headquarters Address 1126 East State Rd. 434 Winter Springs, FL 32708
Form of Coverage
IXl
o
Replacement Cost applies to Items
Agreed Amount applies to Items
Coinsurance
o
90% 1KI
100% Blanket Rate Effective
Causes of loss for which rates are requested:
o
IXl
o
o
Other (Specify)
Other (Specify)
Basic
Special
Basic Coverage may apply to specified locations. Refer to the Schedule of Property Locations.
This statement of values form must be filed annually.
MEMBER:
All values submitted are accurate to the best of my knowledge and belief.
Authorized Signature
Date
PROP-STMTVAL (1/93)
09/25/2002
COMMERCIAL PROPERTY
CP 00 50 10 00
EXTRA EXPENSE COVERAGE FORM
Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and
what is and is not covered.
Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The
words "we", "us" and "our" refer to the Company providing this insurance.
Other words and phrases that appear in quotation marks have special meaning. Refer to Section E. - Definitions.
c-
A. Coverage
We will pay the actual and necessary Extra Ex-
pense you sustain due to direct physical loss of or
damage to property at premises which are de-
scribed in the Declarations and for which an Extra
Expense Limit of Insurance is shown in the Decla-
rations. The loss or damage must be caused by or
result from a Covered Cause of Loss. With respect
to loss of or damage to personal property in the
open or personal property in a vehicle, the de-
scribed premises include the area within 100 feet
of the site at which the described premises are lo-
cated.
With respect to the requirements set forth in the
preceding paragraph, if you occupy only part of the
site at which the described premises are located,
your premises means:
a. The portion of the building which you rent,
lease or occupy; and
b. Any area within the building or on the site at
which the described premises are located, if
that area services, or is used to gain access
to, the described premises.
1. Extra Expense
Extra Expense means necessary expenses you
incur during the "period of restoration" that you
would not have incurred if there had been no
direct physical loss or damage to property:
a. To avoid or minimize the "suspension" of
business and to continue "operations":
(1) At the described premises; or
(2) At replacement premises or at tempo-
rary locations, including:
(a) Relocation expenses; and
(b) Costs to equip and operate the re-
placement or temporary locations;
b. To minimize the "suspension" of business if
you cannot continue "operations"; or
c. (1) To repair or replace any property; or
(
'\
(2) To research, replace or restore the lost
information on damaged valuable pa-
pers and records;
to the extent it reduces the amount of loss
that otherwise would have been payable
under this Coverage Form.
2. Covered Causes Of Loss
See applicable Causes of Loss Form as shown
in the Declarations.
3. Additional Coverages
a. Alterations And New Buildings
We will pay for the actual and necessary
Extra Expense you incur due to direct
physical loss or damage at the described
premises caused by or resulting from any
Covered Cause of Loss to:
(1) New buildings or structures, whether
complete or under construction;
(2) Alterations or additions to existing build-
ings or structures; and
(3) Machinery, equipment, supplies or build-
ing materials located on or within 100
feet of the described premises and:
(a) Used in the construction, alterations
or additions; or
(b) Incidental to the occupancy of new
buildings.
b. Civil Authority
We will pay for the actual and necessary
Extra Expense you incur caused by action
of civil authority that prohibits access to the
described premises due to direct physical
loss of or damage to property, other than at
the described premises, caused by or re-
sulting from any Covered Cause of Loss.
This coverage will apply for a period of up to
three consecutive weeks from the date of
that action.
CP 00 50 10 00
Copyright, Insurance Services Office, Inc., 1999
Page 1 of 3
o
c~
4. Coverage Extension
You may extend the insurance provided by this
Coverage Part as follows:
NEWLY ACQUIRED LOCATIONS
a. You may extend your Extra Expense Cov-
erage to apply to property at any location
you acquire other than fairs or exhibitions.
b. The most we will pay for loss under this
Extension is $100,000 at each location.
c. Insurance under this Extension for each
newly acquired location will end when any of
the following first occurs:
(1) This policy expires;
(2) 30 days expire after you acquire the
property; or
(3) You notify us of how you want this cov-
erage to apply to that location.
We will charge you additional premium from
the date you acquire the property.
This Extension is additional insurance.
B. Exclusions And Limitations
See applicable Causes of Loss Form as shown in
the Declarations.
C. Limits Of Insurance
The most we will pay for loss in anyone occur-
rence is the applicable Limit of Insurance shown in
the Declarations.
The limit applicable to the Coverage Extension is
in addition to the Limits of Insurance.
Payments under the following Additional Cover-
ages will not increase the applicable Limit of Insur-
ance:
1. Alterations and New Buildings; or
2. Civil Authority.
D. Loss Conditions
The following conditions apply in addition to the
Common Policy Conditions and the Commercial
Property Conditions.
1. Appraisal
If we and you disagree on the amount of loss,
either may make written demand for an ap-
praisal of the loss. In this event, each party will
select a competent and impartial appraiser.
The two appraisers will select an umpire. If they
cannot agree, either may request that selection
be made by a judge of a court having jurisdic-
tion. The appraisers will state separately the
amount of loss. If they fail to agree, they will
submit their differences to the umpire. A deci-
sion agreed to by any two will be binding. Each
party will:
a. Pay its chosen appraiser; and
(
Page 2 of 3
b. Bear the other expenses of the appraisal
and umpire equally.
If there is an appraisal, we will still retain our
right to deny the claim.
2. Duties If You Incur Extra Expense
a. You must see that the following are done if
you incur Extra Expense:
(1) Notify the police if a law may have been
broken.
(2) Give us prompt notice of the direct
physical loss or damage. Include a de-
scription of the property involved.
(3) As soon as possible, give us a descrip-
tion of how, when, and where the direct
physical loss or damage occurred.
,
(4) Take all reasonable steps to protect the
Covered Property from further damage,
and keep a record of your expenses
necessary to protect the Covered Prop-
erty, for consideration in the settlement
of the claim. This will not increase the
Limit of Insurance. However, we will not
pay for any subsequent loss or damage
resulting from a cause of loss that is not
a Covered Cause of Loss. Also, if feasi-
ble, set the damaged property aside and
in the best possible order for examina-
tion.
(5) As often as may be reasonably required,
permit us to inspect the property proving
the loss or damage and examine your
books and records.
Also permit us to take samples of dam-
aged and undamaged property for in-
spection, testing and analysis, and per-
mit us to make copies from your books
and records.
(6) Send us a signed, sworn proof of loss
containing the information we request to
investigate the claim. You must do this
within 60 days after our request. We will
supply you with the necessary forms.
(7) Cooperate with us in the investigation or
settlement of the claim.
(8) If you intend to continue your business,
you must resume all or part of your "op-
erations" as quickly as possible.
b. We may examine any insured under oath,
while not in the presence of any other in-
sured and at such times as may be rea-
sonably required, about any matter relating
to this insurance or the claim, including an
insured's books and records. In the event of
an examination, an insured's answers must
be signed.
Copyright, Insurance Services Office, Inc., 1999
o
CP 00 50 10 00
3. Limits On Loss Payment
We will not pay more for Extra Expense than
the percentages shown in the Declarations
times the Limit of Insurance.
When the "period of restoration" is:
a. 30 days or less, the first percentage applies.
b. 60 days or less, but more than 30 days, the
second percentage applies.
c. More than 60 days, the third percentage
applies.
Example: The Limit of Insurance is $ 100,000
The percentages
shown in the Declara-
tions are 40%-80%-100%
The "period of restoration"
~ ~~ys
The amount of Extra
Expenses incurred is $ 90,000
(
We will not pay more than $100,000
times 80% (the percentage applicable
for a "period of restoration" of 31-60
days), or $80,000. The remaining
$10,000 is not covered.
4. Loss Determination
a. The amount of Extra Expense will be de-
termined based on:
(1) All expenses that exceed the normal
operating expenses that would have
been incurred by "operations" during the
"period of restoration" if no direct physi-
cal loss or damage had occurred. We
will deduct from the total of such ex-
penses:
(a) The salvage value that remains of
any property bought for temporary
use during the "period of restoration",
once "operations" are resumed; and
(b) Any Extra Expense that is paid for by
other insurance, except for insurance
that is written subject to the same
plan, terms, conditions and provi-
sions as this insurance; and
(2) All necessary expenses that reduce the
Extra Expense otherwise incurred.
b. We will reduce the amount of your Extra
Expense loss to the extent you can return
"operations" to normal and discontinue such
Extra Expense.
(
c. If you do not resume "operations", or do not
resume "operations" as quickly as possible,
we will pay based on the length of time it
would have taken to resume "operations" as
quickly as possible.
5. Loss Payment
We will pay for any loss within 30 days after we
receive the proof of loss, if you have complied
with all of the terms of this Coverage Part and:
a. We reach agreement with you on the
amount of loss; or
b. An appraisal award has been made.
E. Definitions
1. "Operations" means your business activities
occurring at the described premises.
2. "Period of Restoration" means the period of
time that:
a. Begins with the date of direct physical loss
or damage caused by or resulting from any
Covered Cause of Loss at the described
premises; and
b. Ends on the earlier of:
(1) The date when the property at the de-
scribed premises should be repaired,
rebuilt or replaced with reasonable
speed and similar quality; or
(2) The date when business is resumed at a
new permanent location.
"Period of restoration" does not include any in-
creased period required due to the enforce-
ment of any ordinance or law that:
(1) Regulates the construction, use or re-
pair, or requires the tearing down of any
property; or
(2) Requires any insured or others to test
for, monitor, clean up, remove, contain,
treat, detoxify or neutralize, or in any
way respond to, or assess the effects of
"pollutants".
The expiration date of this policy will not cut
short the "period of restoration".
3. "Pollutants" means any solid, liquid, gaseous or
thermal irritant or contaminant, including
smoke, vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste includes materials
to be recycled, reconditioned or reclaimed.
4. "Suspension" means the slowdown or cessa-
tion of your business activities.
CP 00 50 10 00
Copyright, Insurance Services Office, Inc., 1999
Page 3 of 3
o
COMMERCIAL PROPERTY
CP 00 32 10 00
BUSINESS INCOME (WITHOUT EXTRA EXPENSE)
COVERAGE FORM
Various provisions in this policy restrict coverage. Read the entire policy carefully to determine rights, duties and
what is and is not covered.
Throughout this policy the words "you" and "your" refer to the Named Insured shown in the Declarations. The
words "we", "us" and "our" refer to the Company providing this insurance.
Other words and phrases that appear in quotation marks have special meaning. Refer to Section G. - Definitions.
(-
A. Coverage
Coverage is provided as described below for one
or more of the following options for which a Limit of
Insurance is shown in the Declarations:
(i) Business Income including
"Rental Value".
(Ii) Business Income other than
"Rental Value".
(iii) "Rental Value".
If option (i) above is selected, the term Business
Income will include "Rental Value". If option (iii)
above is selected, the term Business Income will
mean "Rental Value" only.
If Limits of Insurance are shown under more than
one of the above options, the provisions of this
Coverage Part apply separately to each.
We will pay for the actual loss of Business Income
you sustain due to the necessary "suspension" of
your "operations" during the "period of restoration".
The "suspension" must be caused by direct physi-
cal loss of or damage to property at premises
which are described in the Declarations and for
which a Business Income Limit of Insurance is
shown in the Declarations. The loss or damage
must be caused by or result from a Covered
Cause of Loss. With respect to loss of or damage
to personal property in the open or personal prop-
erty in a vehicle, the described premises include
the area within 100 feet of the site at which the de-
scribed premises are located.
With respect to the requirements set forth in the
preceding paragraph, if you occupy only part of the
site at which the described premises are located,
your premises means:
(i) The portion of the_building which
you rent, lease or occupy; and
(Ii) Any area within the building or on
the site at which the described
premises are located, if that area
services, or is used to gain ac-
cess to, the described premises.
(
CP 00 32 10 00
1. Business Income
Business Income means the:
a. Net Income (Net Profit or Loss before in-
come taxes) that would have been earned
or incurred; and
b. Continuing normal operating expenses
incurred, including payroll.
For manufacturing risks, Net Income includes
the net sales value of production.
2. Covered Causes Of Loss
See applicable Causes of Loss Form as shown
in the Declarations.
3. Additional Coverages
a. Expenses To Reduce Loss
In the event of a covered loss of Business
Income, we will pay necessary expenses
you incur, except the cost of extinguishing a
fire, to avoid further loss of Business In-
come. The total of our payment for Busi-
ness Income loss and Expenses to Reduce
Loss will not be more than the Business In-
come loss that would have been payable
under this Coverage Form (after application
of any Coinsurance penalty) if the Expenses
to Reduce Loss had not been incurred. This
coverage does not increase the Limit of In-
surance.
The Coinsurance condition does not apply
specifically to such Expenses to Reduce
Loss, but it is used as described above to
determine the total amount payable.
b. Civil Authority
We will pay for the actual loss of Business
Income you sustain caused by action of civil
authority that prohibits access to the de-
scribed premises due to direct physical loss
of or damage to property, other than at the
described premises, caused by or resulting
from any Covered Cause of Loss. This cov-
erage begins 72 hours after the time of that
action, and will apply for a period of up to
three consecutive weeks from the date on
which the coverage begins.
Copyright, Insurance Services Office, Inc., 1999
o
Page 1 of 7
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c. Alterations And New Buildings
We will pay for the actual loss of Business
Income you sustain due to direct physical
loss or damage at the described premises
caused by or resulting from any Covered
Cause of Loss to:
(1) New buildings or structures, whether
complete or under construction;
(2) Alterations or additions to existing build-
ings or structures; and
(3) Machinery, equipment, supplies or build-
ing materials located on or within 100
feet of the described premises and:
(a) Used in the construction, alterations
or additions; or
(b) Incidental to the occupancy of new
buildings.
If such direct physical loss or damage de-
lays the start of "operations", the "period of
restoration" will begin on the date "opera-
tions" would have begun if the direct physi-
cal loss or damage had not occurred.
d. Extended Business Income
(1) Business Income Other Than "Rental
Value"
If the necessary "suspension" of your
"operations" produces a Business In-
come loss payable under this policy, we
will pay for the actual loss of Business
Income you incur during the period that:
(a) Begins on the date property (except
"finished stock") is actually repaired,
rebuilt or replaced and "operations"
are resumed; and
(b) Ends on the earlier of:
(i) The date you could restore your
"operations", with reasonable
speed, to the level which would
generate the business income
amount that would have existed if
no direct physical loss or damage
had occurred; or
(ii) 30 consecutive days after the
date determined in (1)(a) above.
However, Extended Business Income
does not apply to loss of Business In-
come incurred as a result of unfavorable
business conditions caused by the im-
pact of the Covered Cause of Loss in
the area where the described premises
are located.
(
Loss of Business Income must be
caused by direct physical loss or dam-
age at the described premises caused
by or resulting from any Covered Cause
of Loss.
(2) "Rental Value"
If the necessary "suspension" of your
"operations" produces a "Rental Value"
loss payable under this policy, we will
pay for the actual loss of "Rental Value"
you incur during the period that:
(a) Begins on the date property is actu-
ally repaired, rebuilt or replaced and
tenantability is restored; and
(b) Ends on the earlier of:
(i) The date you could restore tenant
occupancy, with reasonable
speed, to the level which would
generate the "Rental Value" that
would have existed if no direct
physical loss or damage had oc-
curred; or
(ii) 30 consecutive days after the
date determined in (2)(a) above.
However, Extended Business Income
does not apply to loss of "Rental Value"
incurred as a result of unfavorable busi-
ness conditions caused by the impact of
the Covered Cause of Loss in the area
where the described premises are lo-
cated.
Loss of "Rental Value" must be caused
by direct physical loss or damage at the
described premises caused by or result-
ing from any Covered Cause of Loss.
4. Coverage Extension
If a Coinsurance percentage of 50% or more is
shown in the Declarations, you may extend the
insurance provided by this Coverage Part as
follows:
NEWLY ACQUIRED LOCATIONS
a. You may extend your Business Income
Coverage to apply to property at any loca-
tion you acquire other than fairs or exhibi-
tions.
b. The most we will pay for loss under this
Extension is $100,000 at each location.
c. Insurance under this Extension for each
newly acquired location will end when any of
the following first occurs:
(1) This policy expires;
(2) 30 days expire after you acquire or begin
to construct the property; or
(3) You report values to us.
Page 2 of 7
Copyright, Insurance Services Office, Inc., 1999
CP 00 32 10 00
o
(
We will charge you additional premium for
values reported from the date you acquire
the property.
This Extension is additional insurance. The
Additional Condition, Coinsurance, does not
apply to this Extension.
B. Exclusions And Limitations
See applicable Causes of Loss Form as shown in
the Declarations.
C. Limits Of Insurance
The most we will pay for loss in anyone occur-
rence is the applicable Limit of Insurance shown in
the Declarations.
The limit applicable to the Coverage Extension is
in addition to the Limit of Insurance.
Payments under the following Additional Cover-
ages will not increase the applicable Limit of Insur-
ance:
1. Alterations and New Buildings;
2. Civil Authority;
3. Extended Business Income;
4. Expenses to Reduce Loss.
D. Loss Conditions
The following conditions apply in addition to the
Common Policy Conditions and the Commercial
Property Conditions.
1. Appraisal
If we and you disagree on the amount of Net
Income and operating expense or the amount
of loss, either may make written demand for an
appraisal of the loss. In this event, each party
will select a competent and impartial appraiser.
The two appraisers will select an umpire. If they
cannot agree, either may request that selection
be made by a judge of a court having jurisdic-
tion. The appraisers will state separately the
amount of Net Income and operating expense
or amount of loss. If they fail to agree, they will
submit their differences to the umpire. A deci-
sion agreed to by any two will be binding. Each
party will:
a. Pay its chosen appraiser; and
b. Bear the other expenses of the appraisal
and umpire equally.
If there is an appraisal, we will still retain our
right to deny the claim.
2. Duties In The Event Of Loss
a. You must see that the following are done in
the event of loss:
(1) Notify the police if a law may have been
broken.
(
(2) Give us prompt notice of the direct
physical loss or damage. Include a de-
scription of the property involved.
(3) As soon as possible, give us a descrip-
tion of how, when, and where the direct
physical loss or damage occurred.
(4) Take all reasonable steps to protect the
Covered Property from further damage,
and keep a record of your expenses
necessary to protect the Covered Prop-
erty, for consideration in the settlement
of the claim. This will not increase the
Limit of Insurance. However, we will not
pay for any subsequent loss or damage
resulting from a cause of loss that is not
a Covered Cause of Loss. Also, if feasi-
ble, set the damaged property aside and
in the best possible order for examina-
tion.
(5) As often as may be reasonably required,
permit us to inspect the property proving
the loss or damage and examine your
books and records.
Also permit us to take samples of dam-
aged and undamaged property for in-
spection, testing and analysis, and per-
mit us to make copies from your books
and records.
(6) Send us a signed, sworn proof of loss
containing the information we request to
investigate the claim. You must do this
within 60 days after our request. We will
supply you with the necessary forms.
(7) Cooperate with us in the investigation or
settlement of the claim.
(8) If you intend to continue your business,
you must resume all or part of your "op-
erations" as quickly as possible.
b. We may examine any insured under oath,
while not in the presence of any other in-
sured and at such times as may be rea-
sonably required, about any matter relating
to this insurance or the claim, including an
insured's books and records. In the event of
an examination, an insured's answers must
be signed.
3. Limitation - Electronic Media And Records
We will not pay for any loss of Business In-
come caused by direct physical loss of or dam-
age to Electronic Media and Records after the
longer of:
a. 60 consecutive days from the date of direct
physical loss or damage; or
CP 00 3210 00
Copyright, Insurance Services Office, Inc., 1999
Page 3 of 7
o
-~"'" r. .~~!,. , >
,,'
(
b. The period, beginning with the date of direct
physical loss or damage, necessary to re-
pair, rebuild or replace, with reasonable
speed and similar quality, other property at
the described premises due to loss or dam-
age caused by the same occurrence.
Electronic Media and Records are:
(1) Electronic data processing, recording or
storage media such as films, tapes,
discs, drums or cells;
(2) Data stored on such media; or
(3) Programming records used for elec-
tronic data processing or electronically
controlled equipment.
Example No.1:
A Covered Cause of Loss damages a com-
puter on June 1. It takes until September 1
to replace the computer, and until October 1
to restore the data that was lost when the
damage occurred. We will only pay for the
Business Income loss sustained during the
period June 1 - September 1. Loss during
the period September 2 - October 1 is not
covered.
Example No.2:
A Covered Cause of Loss results in the loss
of data processing programming records on
August 1. The records are replaced on Oc-
tober 15. We will only pay for the Business
Income loss sustained during the period
August 1 - September 29 (60 consecutive
days). Loss during the period September 30
- October 15 is not covered.
4. Loss Determination
a. The amount of Business Income loss will be
determined based on:
(1) The Net Income of the business before
the direct physical loss or damage oc-
curred;
(2) The likely Net Income of the business if
no physical loss or damage had oc-
curred, but not including any Net Income
that would likely have been earned as a
result of an increase in the volume of
business due to favorable business con-
ditions caused by the impact of the Cov-
ered Cause of Loss on customers or on
other businesses;
(3) The operating expenses, including pay-
roll expenses, necessary to resume "op-
erations" with the same quality of service
that existed just before the direct physi-
calloss or damage; and
(
(
(4) Other relevant sources of information,
including:
(a) Your financial records and account-
ing procedures;
(b) Bills, invoices and other vouchers;
and
(c) Deeds, liens or contracts.
b. Resumption Of Operations
We will reduce the amount of your Business
Income loss to the extent you can resume
your "operations", in whole or in part, by us-
ing damaged or undamaged property (in-
cluding merchandise or stock) at the de-
scribed premises or elsewhere.
c. If you do not resume "operations", or do not
resume "operations" as quickly as possible,
we will pay based on the length of time it
would have taken to resume "operations" as
quickly as possible.
5. Loss Payment
We will pay for covered loss within 30 days af-
ter we receive the sworn proof of loss, if you
have complied with all of the terms of this Cov-
erage Part and:
a. We have reached agreement with you on
the amount of loss; or
b. An appraisal award has been made.
E. Additional Condition
COINSURANCE
If a Coinsurance percentage is shown in the Dec-
larations, the following condition applies in addition
to the Common Policy Conditions and the Com-
mercial Property Conditions.
We will not pay the full amount of any loss if the
Limit of Insurance for Business Income is less
than:
a. The Coinsurance percentage shown for
Business Income in the Declarations; times
b. The sum of:
(1) The Net Income (Net Profit or Loss
before income taxes), and
(2) Operating expenses, including payroll
expenses,
that would have been earned or incurred
(had no loss occurred) by your "operations"
at the described premises for the 12
months following the inception, or last pre-
vious anniversary date, of this policy
(whichever is later).
Page 4 of 7
Copyright, Insurance Services Office, Inc., 1999
o
CP 00 32 10 00
(-
Instead, we will determine the most we will pay us-
ing the following steps:
1. Multiply the Net Income and operating expense
for the 12 months following the inception, or
last previous anniversary date, of this policy by
the Coinsurance percentage;
2. Divide the Limit of Insurance for the described
premises by the figure determined in Step 1;
and
3. Multiply the total amount of loss by the figure
determined in Step 2.
We will pay the amount determined in Step 3 or
the limit of insurance, whichever is less. For the
remainder, you will either have to rely on other in-
surance or absorb the loss yourself.
In determining operating expenses for the purpose
of applying the Coinsurance condition, the follow-
ing expenses, if applicable, shall be deducted from
the total of all operating expenses:
1. Prepaid freight - outgoing;
2. Returns and allowances;
3. Discounts; -
4. Bad debts;
5. Collection expenses;
6. Cost of raw stock and factory supplies con-
sumed (including transportation charges);
7. Cost of merchandise sold (including transporta-
tion charges);
8. Cost of other supplies consumed (including
transportation charges);
9. Cost of services purchased from outsiders (not
employees) to resell, that do not continue under
contract;
10. Power, heat and refrigeration expenses that do
not continue under contract (if Form CP 15 11
is attached);
11. All ordinary payroll expenses or the amount of
payroll expense excluded (if Form CP 15 10 is
attached); and
12. Special deductions for mining properties (royal-
ties unless specifically included in coverage;
actual depletion commonly known as unit or
cost depletion - not percentage depletion; wel-
fare and retirement fund charges based on
tonnage; hired trucks).
(
Example, No.1 (Underinsurance):
When: The Net Income and operating expenses
for the 12 months following the inception,
or last previous anniversary date, of this
policy at the described premises would
have been $400,000
The Coinsurance percentage
is 50%
The Limit of Insurance is $150,000
The amount of loss is $ 80,000
Step 1: $400,000 x 50% = $200,000 (the mini-
mum amount of insurance to meet your
Coinsurance requirements)
Step 2: $150,000 + $200,000 = .75
Step 3: $ 80,000 x .75 = $60,000
We will pay no more than $60,000. The remain-
ing $20,000 is not covered.
Example No.2 (Adequate Insurance):
When: The Net Income and operating expenses
for the 12 months following the inception,
or last previous anniversary date, of this
policy at the described premises would
have been $400,000
The Coinsurance percentage
is 50%
The Limit of Insurance is $200,000
The amount of loss is $ 80,000
The minimum amount of insurance to meet your
Coinsurance requirement is $200,000 ($400,000 x
50%). Therefore, the Limit of Insurance in this Ex-
ample is adequate and no penalty applies. We will
pay no more than $80,000 (amount of loss).
F. Optional Coverages
If shown as applicable in the Declarations, the fol-
lowing Optional Coverages apply separately to
each item.
1. Maximum Period Of Indemnity
a. The Additional Condition, Coinsurance,
does not apply to this Coverage Form at the
described premises to which this Optional
Coverage applies.
b. The most we will pay for loss of Business
Income is the lesser of:
(1) The amount of loss sustained during the
120 days immediately following the be-
ginning of the "period of restoration"; or
(2) The Limit of Insurance shown in the
Declarations.
CP 00 32 10 00
Copyright, Insurance Services Office, Inc., 1999
Page 5 of 7
o
2. Monthly Limit Of Indemnity
a. The Additional Condition, Coinsurance,
does not apply to this Coverage Form at the
described premises to which this Optional
Coverage applies.
b. The most we will pay for loss of Business
Income in each period of 30 consecutive
days after the beginning of the "period of
restoration" is:
(1) The Limit of Insurance, multiplied by
(2) The fraction shown in the Declarations
for this Optional Coverage.
Example
When:
The Limit of Insurance is
The fraction shown in the
Declarations for this
Optional Coverage is
The most we will pay for
loss in each period of 30
consecutive days is:
$120,000 x 1/4 = $30,000
If, in this example, the
actual amount of loss is:
Days 1-30
Days 31-60
Days 61-90
$120,000
1/4
c
$40,000
20,000
30.000
$90,000
We will pay:
Days 1-30
Days 31-60
Days 61-90
(
$30,000
20,000
30.000
$80,000
The remaining $10,000 is not covered.
3. Business Income Agreed Value
a. To activate this Optional Coverage:
(1) A Business Income ReportlWork Sheet
must be submitted to us and must show
financial data for your "operations":
(a) During the 12 months prior to the
date of the Work Sheet; and
(b) Estimated for the 12 months imme-
diately following the inception of this
Optional Coverage.
(2) The Declarations must indicate that the
Business Income Agreed Value Optional
Coverage applies, and an Agreed Value
must be shown in the Declarations. The
Agreed Value should be at least equal
to:
(a) The Coinsurance percentage shown
in the Declarations; multiplied by
(b) The amount of Net Income and op-
erating expenses for the following 12
months you report on the Work
Sheet.
b. The Additional Condition, Coinsurance, is
suspended until:
(1) 12 months after the effective date of this
Optional Coverage; or
(2) The expiration date of this policy;
whichever occurs first.
c. We will reinstate the Additional Condition,
Coinsurance, automatically if you do not
submit a new Work Sheet and Agreed
Value:
(1) Within 12 months of the effective date of
this Optional Coverage; or
(2) When you request a change in your
Business Income Limit of Insurance.
d. If the Business Income Limit of Insurance is
less than the Agreed Value, we will not pay
more of any loss than the amount of loss
multiplied by:
(1) The Business Income Limit of Insur-
ance; divided by
(2) The Agreed Value.
Example
When:
The Limit of Insurance is
The Agreed Value is
The amount of loss is
$100,000 + $200,000 = .50
.50 x $80,000 = $40,000
$100,000
$200,000
$80,000
Step (a):
Step (b):
We will pay $40,000. The remaining
$40,000 is not covered.
4. Extended Period Of Indemnity
Under Paragraph A.3.d., Extended Business
Income, the number "30" in Subparagraphs
(1)(b) and (2)(b) is replaced by the number
shown in the Declarations for this Optional
Coverage.
G. Definitions
1. "Finished Stock" means stock you have manu-
factured.
"Finished stock" also includes whiskey and al-
coholic products being aged, unless there is a
Coinsurance percentage shown for Business
Income in the Declarations.
"Finished stock" does not include stock you
have manufactured that is held for sale on the
premises of any retail outlet insured under this
Coverage Part.
Page 6 of 7
Copyright, Insurance Services Office, Inc., 1999
CP 00 32 1000
o
2. "Operations" means:
a. Your business activities occurring at the
described premises; and
b. The tenantability of the described premises,
if coverage for Business Income including
"Rental Value" or "Rental Value" applies.
3. "Period of Restoration" means the period of
time that:
a. Begins 72 hours after the time of direct
physical loss or damage caused by or re-
sulting from any Covered Cause of Loss at
the described premises; and
b. Ends on the earlier of:
(1) The date when the property at the de-
scribed premises should be repaired,
rebuilt or replaced with reasonable
speed and similar quality; or
(2) The date when business is resumed at a
new permanent location.
"Period of restoration" does not include any in-
creased period required due to the enforce-
ment of any ordinance or law that:
(1) Regulates the construction, use or re-
pair, or required the tearing down of any
property; or
c-
(
(2) Requires any insured or others to test
for, monitor, clean up, remove, contain,
treat, detoxify or neutralize, or in any
way respond to, or assess the effects of
"pollutants" .
The expiration date of this policy will not cut
short the "period of restoration".
4. "Pollutants" means any solid, liquid, gaseous or
thermal irritant or contaminant, including
smoke, vapor, soot, fumes, acids, alkalis,
chemicals and waste. Waste includes materials
to be recycled, reconditioned or reclaimed.
5. "Rental Value" means the:
a. Total anticipated rental income from tenant
occupancy of the premises described in the
Declarations as furnished and equipped by
you,and
b. Amount of all charges which are the legal
obligation of the tenant(s) and which would
otherwise be your obligations, and
c. Fair rental value of any portion of the de-
scribed premises which is occupied by you.
6. "Suspension" means:
a. The slowdown or cessation of your busi-
ness activities; or
b. That a part or all of the described premises
is rendered untenantable, if coverage for
Business Income including "Rental Value"
or "Rental Value" applies.
CP 00 3210 00
Copyright, Insurance Services Office, Inc., 1999
Page 7 of 7
o
FLORIDA MUNICIPAL INSURANCE TRUST
EQUIPMENT BREAKDOWN COVERAGE SCHEDULE
COMMERCIAL PACKAGE POLICY
Subject to any applicable limits on the Declarations of Building and Personal Property Coverage Form
FMIT PROP DEC 1002, the Equipment Breakdown Limit is the most we will pay for loss or damage arising
from anyone Accident.
These coverages apply to all locations covered on the policy, unless otherwise specified.
I.
Coverages
Limits
Equipment Breakdown Limit
Subject to the Real and Personal Property Limit
described on FMIT PROP DEC 1002 or $50,000,000,
whichever is less.
Property Damage
Included in above
Business Income
Not covered unless CP 00 32 10 00 (Business Income
Coverage Form) is attached. If covered, then this
schedule follows form.
Extra Expense
$50,000 per location to a maximum of $500,000 per
member per occurrence
Data Restoration
$200,000
$100,000
$100,000
$100,000
$100,000
$200,000
Expediting Expense
(
Hazardous Substances
Spoilage
Computer Equipment
CFC Refrigerants
Service Interruption
Follows business income, extra expense, and spoilage
limits as applicable.
Demolition & Increased Cost
of Construction
$500,000
II. Deductibles
Direct Coverages
Subject to the Real and Personal Property deductible
shown on FMIT PROP DEC 1002.
Indirect Coverages
Subject to the appropriate Time Element deductible
shown on the FMIT PROP DEC 1002.
III.
Other Conditions
Unless the interruption exceeds 24 hours, we will not pay for any loss under Service Interruption.
(
"Covered equipmenf' does not include equipment primarily used to generate electric power,
however, this exclusion does not apply to emergency generators.
FMIT EBC 1002
Page 10f6
THIS ENDORSEMENT CHANGES THE AGREEMENT. PLEASE READ IT CAREFULLY.
EQUIPMENT BREAKDOWN ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUILDING AND PERSONAL PROPERTY COVERAGE FORM
CAUSES OF LOSS-BASIC FORM
CAUSES OF LOSS--SPECIAL FORM
A. The BUILDING AND PERSONAL PROPERTY COVERAGE FORM is modified as follows:
ADDITIONAL COVERAGES
The following is added to 4. ADDITIONAL COVERAGES:
Equipment Breakdown
(1) We will pay for loss caused by or resulting from an "accidenr to "covered equipment." As used in
this Additional Coverage, an "accidenr means direct physical loss as follows:
(a) mechanical breakdown, including rupture or bursting caused by centrifugal force;
(b) artificially generated electrical current, including electric arcing, that disturbs
electrical devices, appliances or wires;
(c) explosion of steam boilers, steam pipes, steam engines or steam turbines owned or
leased by you, or operated under your control;
(d) loss or damage to steam boilers, steam pipes, steam engines or steam turbines caused
by or resulting from any condition or event inside such equipment; or
(e) loss or damage to hot water boilers or other water heating equipment caused by or
resulting from any condition or event inside such boilers or equipment.
(
(2)
(
Unless otherwise shown in a Schedule, the following coverages also apply to loss caused by or
resulting from an "accident" to "covered equipment." These coverages do not provide additional
amounts of insurance.
(a) Expediting Expenses
With respect to your damaged Covered Property, we will pay, up to $200,000 unless
otherwise shown in a Schedule, the reasonable extra cost to:
(i) make temporary repairs; and
(ii) expedite permanent repairs or permanent replacement.
(b) Hazardous Substances
We will pay for the additional cost to repair or replace Covered Property because of
contamination by a "hazardous substance." This includes the additional costs to clean up
or dispose of such property.
Additional costs mean those beyond what would have been required had no "hazardous
substance" been involved.
The most we will pay for loss or damage under this coverage, including actual loss of
Business Income you sustain, necessary Extra Expense you incur and loss under
Spoilage coverage, if shown as covered, is $100,000 unless otherwise shown in a
Schedule.
(c) Spoilage
(i) We will pay for your loss of "perishable goods" due to spoilage.
(ii) We will also pay for your loss of "perishable goods" due to contamination from the
release of refrigerant, including but not limited to ammonia.
(iii) We will also pay any necessary expenses you incur to reduce the amount of loss
under this coverage. We will pay for such expenses to the extent that they do not
exceed the amount of loss that otherwise would have been payable under this
coverage.
FMIT EBC 1002
Page 2 of6
(
(
(3)
f!"1
i ?,\~'1":',
(d)
(iv) If you are unable to replace the "perishable goods" before its anticipated sale, the
amount of our payment will be determined on the basis of the sales price of the
"perishable goods" at the time of the "accident," less discounts and expenses you
otherwise would have had. Otherwise our payment will be determined in
accordance with the Valuation condition.
The most we will pay for loss or damage under this coverage is $100,000 unless
otherwise shown in a Schedule.
Computer Equipment
We will pay for loss or damage caused by or resulting from an "accident" to "computer
equipment."
The most we will pay for loss or damage under this coverage, including actual loss of
Business Income you sustain and necessary Extra Expense you incur, if shown as
covered, is $100,000 unless otherwise shown in a Schedule. Computers used primarily to
control or operate "covered equipment" are not subject to this limit.
Data Restoration
We will pay for your cost to research, replace and restore data, including programs and
operating systems, that is lost or corrupted due to an "accident." The most we will pay for
loss or damage under this coverage is $100,000 unless otherwise shown in a Schedule.
CFC Refrigerants
We will pay for the additional cost to repair or replace Covered Property because of the
use or presence of a refrigerant containing CFC (chlorofluorocarbon) substances. This
means the additional cost to do the least expensive of the following:
(i) Repair the damaged property and replace any lost CFC refrigerant;
(ii) Repair the damaged property, retrofit the system to accept a non-CFC refrigerant
and charge the system with a non-CFC refrigerant; or
(iii) Replace the system with one using a non-CFC refrigerant.
Additional costs mean those beyond what would have been required had no CFC
refrigerant been involved.
The most we will pay for loss or damage under this coverage, including actual
loss of Business Income you sustain, necessary Extra Expense you incur and
loss under Spoilage coverage, if shown as covered, is $200,000 unless otherwise
shown in a Schedule.
Service Interruption
Any insurance provided for Business Income, Extra Expense and Spoilage is extended to
apply to loss caused by or resulting from an "accident" to equipment that is owned by a
utility, landlord, or other supplier with whom you have a contract to provide you with any of
the following services: electrical power, communications, waste disposal, air conditioning,
refrigeration, heating, gas, air, water or steam.
(e)
(f)
(g)
CONDITIONS
(a) Suspension
When any "covered equipment" is found to be in, or exposed to a dangerous condition,
any of our representatives may immediately suspend the insurance against loss from an
"accident" to that "covered equipment." We can do this by mailing or delivering a written
notice of suspension to your address as shown in the Declarations, or at the address
where the equipment is located. Once suspended in this way, your insurance can be
reinstated only by an endorsement for that "covered equipment." If we suspend your
insurance, you will get a pro rata refund of premium. But the suspension will be effective
even if we have not yet made or offered a refund.
(b) Jurisdictional Inspections
If any property that is "covered equipment" under this endorsement requires inspection to
comply with state or municipal boiler and pressure vessel regulations, we agree to
perform such inspection on your behalf.
(c) Environmental, Safety and Efficiency Improvements
If "covered equipmenf' requires replacement due to an "accident," we will pay your
additional cost to replace with equipment that is better for the environment, safer or more
efficient than the equipment being replaced.
FMIT EBC 1002
Page 3 of6
(
(4)
.(
(d)
FMIT EBC 1002
However, we will not pay more than 125% of what the cost would have been to repair or
replace with like kind and quality. This condition does not increase any of the applicable
limits. This condition does not apply to any property to which Actual Cash Value applies.
Coinsurance
If indicated in a Schedule, specified coverages may be subject to coinsurance. We will not
pay for the full amount of your loss if the applicable limit is less than the product of the
specified coinsurance percentage times the value of the property subject to the coverage
at the time of the loss. Instead, we will determine what percentage this calculated product
is compared to the applicable limit and apply that percentage to the gross amount of loss.
We will then subtract the applicable Deductible. The resulting amount, or the applicable
limit, is the most we will pay. We will not pay for the remainder of the loss.
EXAMPLE 1 (Underinsurance)
When:
The value of "perishable goods" at the location of loss at the time of the "accidenr is
$200,000.
The Spoilage Limit is $100,000 @ 80% Coinsurance.
The actual loss under Spoilage Coverage resulting from the "accidenr is $40,000.
The Spoilage Deductible is $5,000.
Step 1: $200,000 X 80% = $160,000
Step 2: $100,000/$160,000 = .625
Step 3: $40,000 x.625 = $25,000
Step 4: $25,000 - $5,000 = $20,000
The total Spoilage loss recovery, after deductible, would be $20,000. For the remainder,
you will either have to rely on other insurance or absorb the loss yourself.
EXAMPLE 2 (Adequate insurance)
When:
The value of "perishable goods" at the location of loss at the time of the "accidenr is
$100,000.
The Spoilage Limit is $100,000 @ 80% Coinsurance.
The actual loss under Spoilage Coverage resulting from the "accidenr is $40,000.
The Spoilage Deductible is $5,000.
Step 1: $100,000 X 80% = $80,000
Step 2: $100,000/$80,000 = 1.25
Coinsurance does not apply.
Step 3: $40,000 - $5,000 = $35,000
The total Spoilage loss recovery, after deductible, would be $35,000.
DEDUCTIBLE
The deductible in the Declarations applies unless a separate Equipment Breakdown deductible is
shown in a Schedule. If a separate Equipment Breakdown deductible is shown, the following
applies.
Only as regards Equipment Breakdown Coverage, provision D. DEDUCTIBLE is deleted and
replaced with the following:
If deductibles vary by type of "covered equipmenr and more than one type of equipment is
involved in any "one accident," the highest deductibles will apply.
(a) Direct and Indirect Coverages
Unless otherwise shown in the Schedule, the Direct Coverages Deductibles apply to all
loss or damage covered by this endorsement, with the exception of those coverages
subject to the Indirect Coverages Deductibles as noted below.
Unless more specifically indicated in the Schedule, the Indirect Coverages Deductibles
apply to Business Income and Extra Expense.
(b) Application of Deductibles
(i) Dollar Deductibles
We will not pay for loss or damage resulting from any "one accidenr until the
amount of loss or damage exceeds the applicable Deductible shown in the
Schedule. We will then pay the amount of loss or damage in excess of the
applicable Deductible, up to the applicable Limit of Insurance, after any deduction
required by the Coinsurance condition or the Agreed Value Optional Coverage.
(ii) Time Deductible
Page 4 of6
If a time deductible is shown in the Schedule, we will not be liable for any loss
occurring during the specified number of hours or days immediately following the
"accident." If a time deductible is expressed in days, each day shall mean twenty-
four consecutive hours.
(iii) Multiple of Average Daily Value (ADV)
If a deductible is expressed as a number times ADV, that amount will be
calculated as follows:
The ADV (Average Daily Value) will be the Business Income (as defined in any
Business Income coverage that is part of this policy) that would have been
earned had no "accidenr occurred during the period of interruption of business
divided by the number of working days in that period. No reduction shall be made
for the Business Income not being earned, or in the number of working days,
because of the "accidenf' or any other scheduled or unscheduled shutdowns
during the period of interruption. The ADV applies to all locations included in the
valuation of the loss.
The number indicated in the Schedule shall be multiplied by the ADV as
determined above. The result shall be used as the applicable deductible.
(iv) Percentage of Loss Deductibles
If a deductible is expressed as a percentage of loss, we will not be liable for the
indicated percentage of the gross amount of loss or damage (prior to any
applicable deductible or coinsurance) insured under the applicable coverage. If
the dollar amount of such percentage is less than the indicated minimum
deductible, the minimum deductible will be the applicable deductible.
(5) DEFINITIONS
(a) "Boilers and Vessels" means:
(
(
FMIT EBC 1002
(i)
(ii)
Any boiler, including attached steam, condensate and feedwater piping; and
Any fired or unfired pressure vessel subject to vacuum or internal pressure other
than the static pressure of its contents.
This term does not appear elsewhere in this endorsement, but may appear in a
Schedule.
"Computer equipmenr means Covered Property that is electronic computer or
other data processing equipment, including "media" and peripherals used in
conjunction with such equipment.
"Covered equipment," unless otherwise specified in a Schedule, means Covered
Property built to operate under vacuum or pressure, other than weight of
contents, or used for the generation, transmission or utilization of energy.
"Hazardous substance" means any substance other than ammonia that has been
declared to be hazardous to health by a governmental agency.
"Media" means all forms of electronic, magnetic and optical tapes and discs for
use in any electronic computer or electronic data processing equipment.
"One accidenr means: If an initial "accidenr causes other "accidents," all will be
considered "one accident." All "accidents" that are the result of the same event
will be considered "one accident."
"Perishable Goods" means personal property maintained under controlled
conditions for its preservation, and susceptible to loss or damage if the controlled
conditions change.
"Production Machinery" means any machine or apparatus that processes or
produces a product intended for eventual sale. However, "production machinery"
does not mean any fired or unfired pressure vessel other than a cylinder
containing a movable plunger or piston.
This term does not appear elsewhere in this endorsement, but may appear in a
Schedule.
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Page 5of6
B. THE CAUSES OF LOSS - BASIC FORM or SPECIAL FORM is modified as follows:
(1 )
(2)
(3)
(
(
\
(4)
All exclusions and limitations apply except:
(a) In the Causes of Loss-- Special Form:
(i) Exclusions B.2.a., B.2.d.(6) and B.2.e.; and
(ii) Limitations C.1.a. and C.1.b.
(b) In the Causes of Loss-- Basic Form: Exclusions B.2.a., B.2.d. and B.2.e.
The exclusions are modified as follows:
(a) If the Causes of Loss - Basic Form applies, the following is added to Exclusion B.2.:
Depletion, deterioration, corrosion, erosion, wear and tear, or other gradually developing
conditions. But if loss or damage from an "accident" results, we will pay for that resulting
loss or damage.
(b) The following is added to Exclusion B.1.g.(1):
However, if electrical "covered equipmenf' requires drying out because of the above, we
will pay for the direct expenses of such drying out subject to the applicable Limit of
Insurance and deductible for Building or Business Personal Property, whichever applies.
(c) If the Causes of Loss-Special Form applies, as respects this endorsement only, the last
paragraph of Exclusion B.2.d. is deleted and replaced with the following:
But if an excluded cause of loss that is listed in 2.d.(1) through (7) results in an "accident,"
we will pay for the loss or damage caused by that "accident."
None of the following is "covered equipment":
(a) structure, foundation, cabinet, compartment or air supported structure or building;
(b) insulating or refractory material;
(c) sewer piping, underground vessels or piping, or piping forming a part of a sprinkler
system;
(d) water piping other than boiler feedwater piping, boiler condensate return piping or water
piping forming a part of a refrigerating or air conditioning system;
(e) vehicle, aircraft, floating vessel or any equipment mounted on such vehicle, aircraft or
floating vessel. However, any property that is stationary, permanently installed at a
covered location and that receives electrical power from an external power supplier will
not be considered a vehicle, aircraft or floating vessel;
(f) dragline, excavation or construction equipment; or
(g) equipment manufactured by you for sale.
We will not pay under this endorsement for loss or damage caused by or resulting from:
(a) your failure to use all reasonable means to protect the "perishable goods" from damage
following an "accidenf';
(b) any defect, virus, loss of data or other situation within "media." But if loss or damage from
an "accident" results, we will pay for that resulting loss or damage; or
(c) any of the following tests:
a hydrostatic, pneumatic or gas pressure test of any boiler or pressure vessel; or
an insulation breakdown test of any type of electrical equipment.
With respect to Service Interruption coverage and, if shown as covered, Spoilage coverage, we
will also not pay for loss or damage caused by or resulting from: fire; lightning; windstorm or hail;
explosion (except for steam or centrifugal explosion); smoke; aircraft or vehicles; riot or civil
commotion; vandalism; sprinkler leakage; falling objects; weight of snow, ice or sleet; freezing or
collapse.
With respect to Service Interruption coverage and, if shown as covered, Business Income and
Extra Expense coverages, we will also not pay for delay in resuming operations due to the need to
reconstruct or rein put data or programs on "media."
(5)
(6)
The most we will pay for loss or damage under this endorsement is the applicable Limit of
Insurance shown in the Declarations. Coverage provided under this endorsement does not
provide an additional amount of insurance.
FMIT ESC 1002
Page 6of6
'1ti,'d
"~:i''{~?J~~'f;:\~'",
(
INLAND MARINE FLOATER
Various provisions in this Agreement restrict coverage. Read the entire Agreement carefully to determine
rights, duties and what is and is not covered.
Throughout this policy, the words "you" and ''your" refer to the Designated Member shown in the
Declarations. The words "we," "us," and "our" refer to the Company providing this insurance.
A. COVERAGE
We will pay for direct physical loss of or damage only to Covered Property, which is described in the
schedule and for which a Limit of Insurance is shown, except those Causes of Loss listed in the Exclusions.
1. Covered Property.
Covered property as used in this Coverage Part, means the following types of property for which a
limit is shown:
a) Miscellaneous Equipment,
b) Antiques and Objects of Art.
2. Property Not Covered.
(
a)
b)
c)
d)
e)
f)
Property that you rent or lease to others;
Property that is waterbome except scheduled watercraft and accessories;
Property that is or will be a permanent part of a building or structure;
Self-propelled vehicles that are designed for highway use;
Aircraft; .
Contraband or property in the course of illegal transportation or trade.
B. EXCLUSIONS
1. We will not pay for a "loss" caused directly or indirectly by any of the following. Such "loss"
is excluded regardless of any other cause or event that contributes concurrently or in any
sequence to the "loss."
a) Earth Movement
Any earth movement (other than sinkhole collapse) such as an earthquake, landslide, mine
subsidence or earth sinking, rising or shifting.
We will pay for loss or damage by fire or explosion.
b) Govemmental Action
Seizure or destruction of property by order of governmental authority.
But we will pay for acts of destruction ordered by govemmental authority and taken at the
time of a fire to prevent its spread will be paid for if the fire would be covered under this
Coverage Part.
(
FMIT PROP 02 1002
Page 1 of4
c) Nuclear Hazard
Nuclear reaction or radiation, or radioactive contamination, however caused.
We will pay for loss or damage caused by fire.
d) War and Military Action
1) War, including undeclared or civil war;
2) Warlike action by a military force, including action in hindering or defending
against an actual or expected attack, by any govemment, sovereign or
other authority using military personnel or other agents; or
3) Insurrection, rebellion, revolution, usurped power, or action taken by
governmental authority in hindering or defending against any of these.
2. We will not pay for loss or damage caused by or resulting from any of the following:
a) Artificially generated electric current, including electric arcing, that disturbs electrical
devices, appliances or wires.
b)
But if loss or damage by fire results, we will pay for that resulting loss or damage.
(
1)
2)
3)
4)
5)
6)
7)
8)
9)
10)
Wear and tear;
Rust, corrosion, fungus, decay, deterioration, hidden or latent defect or any
quality in property that causes it to damage or destroy itself;
Smog;
Settling, cracking, shrinking or expansion;
Animals and vermin, including animals, birds and fish and vermin such as
moths, mice and insects;
Mechanical breakdown, including rupture or bursting caused by centrifugal
force;
Dampness or dryness of atmosphere;
Changes in or extremes of temperature;
Marring, scratching, pitting, or other affects of normal use; or
Erosion, dry rot, or mold.
c) Explosion of steam boilers, steam pipes, steam engines, or steam turbines owned
or leased by you, or operated under your control.
We will pay for resulting loss or damage if loss or damage by fire or combustion explosion
results. We will also pay for loss or damage caused by or resulting from the explosion of
gases or fuel within the furnace of any fired vessel or within the flues or passages through
which the gases of combustion pass.
d) Dishonest or criminal acts by you, any of your partners, employees, directors,
trustees, authorized representatives, or anyone to whom you entrust the property
for any purpose; acting alone or in collusion with others; whether or not occurring
during the hours of employment.
This exclusion does not apply to acts of destruction by your employees. Theft by
employees is not covered.
(
Voluntary parting with any property by you or anyone else to whom you have
entrusted the property if induced to do so by any fraudulent scheme, trick, device or
false pretense.
FMIT PROP 02 1002
Page 2 of4
'.'.'--::!'~'1<,''''t',~"::\-''7
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(
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e)
Rain, snow, ice or sleet to covered property in the open.
f) Neglect. You must take all reasonable steps to protect your property when it is
threatened with loss or damage. After a loss, you must also take all reasonable
steps to protect your property from further loss or damage. If you fail to do so, we
won't cover any loss that results from your "neglect."
g) Property being worked on. We won't cover loss or damage to "personal property"
that is being worked on, altered or repaired if the loss or damage is the direct result
of the work that is being performed.
h) Pollution and Contamination. We won't cover loss or damage caused by or
resulting from the release, discharge or dispersal of "pollutants" unless the release,
discharge or dispersal is itself caused by fire, lighting, windstorm or hail, "explosion",
riot or civil commotion, vehicles or aircraft, vandalism and malicious mischief,
"sprinkler leakage", water damage, freezing, collapse of a building, rain or snow, or
falling objects.
But if loss or damage results, we will pay for resulting damage caused by a cause of loss
specified above.
i) Glass breakage and surface damage. We will not cover breakage of glass or other
fragile property or any loss or damage from chipping, marring, breaking, cracking or
scratching. However, we will cover:
c-
1)
2)
3)
Breakage of lenses or scientific instruments;
Breakage or damage to cameras, musical instruments and stained glass;
and
Breaking, chipping, marring or scratching caused directly by fire, lightning,
windstorm, "explosion," aircraft, strike, riot and civil commotion, vandalism
or malicious mischief, "flooding," "theft" or attempted "theft," collapse of a
building or other structure or an "accident" to a vehicle carrying the Covered
Property .
j) Antiques and Fine Arts. We will not cover any property which has been removed or
on joint account with or belonging to others for which you may be liable in the event
of loss or damage while on your premises, in transit or on exhibition.
k) Mysterious Disappearance. We will not cover losses caused by or resulting from
the mysterious disappearance of property or an inventory shortage.
C. LIMITS OF INSURANCE
The most we will pay for loss or damage in anyone occurrence is the applicable Limit of Insurance shown in
the schedule.
If the schedule shows a coverage limit for one item, the limit shown is agreed to be the value of the item and
the most we will pay if the item is lost or totally destroyed.
We will also pay reasonable expenses you incur in removing the damaged Covered Property if debris
removal is necessary after a "Covered Cause of Loss."
(
FMIT PROP 021002
Page 3 of4
';!'i!; ~,fI"F'" ,< '7';t
tq!"ii!~liw "',,:,
The most we will pay for debris removal is 25% of the amount we pay for direct loss or damage to Covered
Property before the application of any deductible. And payment of debris removal will not increase the
applicable coverage limit.
D. DEDUCTIBLE
We will not pay for loss or damage in anyone occurrence until the amount of loss or damage exceeds the
Deductible shown in the Declarations. We will then pay the amount of loss or damage in excess of the
Deductible, up to the applicable Limit of Insurance.
E. ADDITIONAL CONDITIONS
1. Newly Acquired Special Property. If you acquire any additional special property of the kind
already described in the Declarations for this Policy, we will automatically cover that property
for up to $10,000.
We will cover the additional items for up to 30 days after you acquire them or until the policy
ends, whichever is sooner.
You agree to notify us as soon as possible of the value of the additional items and pay an
additional premium from the date you acquire them.
2. Policy Period, Coverage Territory. Under this Coverage Part:
a) We cover loss or damage commencing:
(
1)
2)
During the policy period shown in the Declarations; and
Within the coverage territory.
b) The coverage territory is:
1) The United States of America (including its territories and possessions);
2) Puerto Rico; and
3) Canada.
(
FMIT PROP 021002
Page 4 of 4
COMMERCIAL INLAND MARINE
CM 00 01 09 00
COMMERCIAL INLAND MARINE CONDITIONS
The following conditions apply in addition to the Common Policy Conditions and applicable Additional Conditions in
Commercial Inland Marine Coverage Forms:
LOSS CONDITIONS
A. Abandonment
There can be no abandonment of any property to
us.
(
B. Appraisal
If we and you disagree on the value of the property
or the amount of 1055, either may make written
demand for an appraisal of the 1055. In this event,
each party will select a competent and impartial
appraiser. The two appraisers will select an um-
pire. If they cannot agree, either may request that
selection be made by a judge of a court having ju-
risdiction. The appraisers will state separately the
value of the property and amount of 1055. If they
fail to agree, they will submit their differences to
the umpire. A decision agreed to by any two will be
binding. Each party will:
1. Pay its chosen appraiser; and
2. Bear the other expenses of the appraisal and
umpire equally.
If there is an appraisal, we will still retain our right
to deny the claim.
C. Duties In The Event Of Loss
You must see that the following are done in the
event of 1055 or damage to Covered Property:
1. Notify the police if a law may have been bro-
ken.
2. Give us prompt notice of the 1055 or damage.
Include a description of the property involved.
3. As soon as possible, give us a description of
how, when and where the 1055 or damage oc-
curred.
4. Take all reasonable steps to protect the Cov-
ered Property from further damage, and keep a
record of your expenses necessary to protect
the Covered Property, for consideration in the
settlement of the claim. This will not increase
the Limit of Insurance. However, we will not pay
for any subsequent 1055 or damage resulting
from a cause of 1055 that is not a Covered
Cause of Loss. Also, if feasible, set the dam-
aged property aside and in the best possible
order for examination.
5. You will not, except at your own cost, voluntarily
make a payment, assume any obligation, or in-
cur any expense without our consent.
(
CM 00 01 09 00
6. As often as may be reasonably required, permit
us to inspect the property proving the 1055 or
damage and examine your books and records.
Also permit us to take samples of damaged
and undamaged property for inspection, testing
and analysis, and permit us to make copies
from your books and records.
7. We may examine any insured under oath, while
not in the presence of any other insured and at
such times as may be reasonably required,
about any matter relating to this insurance or
the claim, including an insured's books and re-
cords. In the event of an examination, an in-
sured's answers must be signed.
8. Send us a signed, sworn proof of 1055 contain-
ing the information we request to settle the
claim. You must do this within 60 days after our
request. We will supply you with the necessary
forms.
9. Immediately send us copies of any demands,
notices, summonses or legal papers received
in connection with the claim or suit.
10. Cooperate with us in the investigation or set-
tlement of the claim.
D. Insurance Under Two Or More Coverages
If two or more of this policy's coverages apply to
the same loss or damage, we will not pay more
than the actual amount of the 1055 or damage.
E. Loss Payment
1. We will give notice of our intentions within 30
days after we receive the sworn proof of loss.
2. We will not pay you more than your financial
interest in the Covered Property.
3. We may adjust losses with the owners of lost
or damaged property if other than you. If we
pay the owners, such payments will satisfy your
claim against us for the owners' property. We
will not pay the owners more than their financial
interest in the Covered Property.
4. We may elect to defend you against suits aris-
ing from claims of owners of property. We will
do this at our expense.
Copyright, Insurance Services Office, Inc., 1999
o
Page 1 of 3
c-
5. We will pay for covered loss or damage within
30 days after we receive the sworn proof of
loss if you have complied with all the terms of
this Coverage Part and:
a. We have reached agreement with you on
the amount of the loss; or
b. An appraisal award has been made.
6. We will not be liable for any part of a loss that
has been paid or made good by others.
F. Other Insurance
1. You may have other insurance subject to the
same plan, terms, conditions and provisions as
the insurance under this Coverage Part. If you
do, we will pay our share of the covered loss or
damage. Our share is the proportion that the
applicable Limit of Insurance under this Cover-
age Part bears to the Limits of Insurance of all
insurance covering on the same basis.
2. If there is other insurance covering the same
loss or damage, other than that described in 1.
above, we will pay only for the amount of cov-
ered loss or damage in excess of the amount
due from that other insurance, whether you can
collect on it or not. But we will not pay more
than the applicable Limit of Insurance.
G. Pair, Sets Or Parts
1. Pair Or Set
In case of loss or damage to any part of a pair
or set we may:
a. Repair or replace any part to restore the
pair or set to its value before the loss or
damage; or
b. Pay the difference between the value of the
pair or set before and after the loss or dam-
age.
2. Parts
In case of loss or damage to any part of Cov-
ered Property consisting of several parts when
complete, we will only pay for the value of the
lost or damaged part.
H. Recovered Property
If either you or we recover any property after loss
settlement, that party must give the other prompt
notice. At your option, the property will be returned
to you. You must then return to us the amount we
paid to you for the property. We will pay recovery
expenses and the expenses to repair the recov-
ered property, subject to the Limit of Insurance.
(
Page 2 of 3
"';T<1';'t':!'!I
I. Reinstatement Of Limit After Loss
The Limit of Insurance will not be reduced by the
payment of any claim, except for total loss or dam-
age of a scheduled item, in which event we will re-
fund the unearned premium on that item.
J. Transfer Of Rights Of Recovery Against Others
To Us
If any person or organization to or for whom we
make payment under this Coverage Part has rights
to recover damages from another, those rights are
transferred to us to the extent of our payment. That
person or organization must do everything neces-
sary to secure our rights and must do nothing after
loss to impair them. But you may waive your rights
against another party in writing:
1. Prior to a loss to your Covered Property.
2. After a loss to your Covered Property only if, at
time of loss, that party is one of the following:
a. Someone insured by this insurance; or
b. A business firm:
(1) Owned or controlled by you; or
(2) That owns or controls you.
This will not restrict your insurance.
GENERAL CONDITIONS
A. Concealment, Misrepresentation Or Fraud
This Coverage Part is void in any case of fraud, in-
tentional concealment or misrepresentation of a
material fact, by you or any other insured, at any
time, concerning:
1. This Coverage Part;
2. The Covered Property;
3. Your interest in the Covered Property; or
4. A claim under this Coverage Part.
B. Control Of Property
Any act or neglect of any person other than you
beyond your direction or control will not affect this
insurance.
The breach of any condition of this Coverage Part
at anyone or more locations will not affect cover-
age at any location where, at the time of loss or
damage, the breach of condition does not exist.
C. Legal Action Against Us
No one may bring a legal action against us under
this Coverage Part unless:
1. There has been full compliance with all the
terms of this Coverage Part; and
2. The action is brought within 2 years after you
first have knowledge of the direct loss or dam-
age.
Copyright, Insurance Services Office, Inc., 1999
o
CM 00 01 09 00
~F~"-":;}_
D. No Benefit To Bailee
No person or organization, other than you, having
custody of Covered Property will benefit from this
insurance.
E. Policy Period
We cover loss or damage commencing:
1. During the policy period shown in the Declara-
tions; and
2. Within the coverage territory.
F. Valuation
The value of property will be the least of the follow-
ing amounts:
1. The actual cash value of that property;
(
(
"
eM 00 01 09 00
2. The cost of reasonably restoring that property
to its condition immediately before loss or
damage; or
3. The cost of replacing that property with sub-
stantially identical property.
In the event of loss or damage, the value of prop-
erty will be determined as of the time of loss or
damage.
Copyright, Insurance Services Office, Inc., 1999
o
Page 3 of 3
COMMERCIAL INLAND MARINE
CM 00 66 09 00
ACCOUNTS RECEIVABLE COVERAGE FORM
c
Various provisions in this policy restrict coverage.
Read the entire policy carefully to determine rights,
duties and what is and is not covered.
Throughout this policy, the words "you" and "your"
refer to the Named Insured shown in the Declarations.
The words "we", "us" and "our" refer to the Company
providing this insurance.
Other words and phrases that appear in quotation
marks have special meaning. Refer to Section E -
Definitions.
A. Coverage
1. We will pay:
a. All amounts due from your customers that
you are unable to collect;
b. Interest charges on any loan required to
offset amounts you are unable to collect
pending our payment of these amounts;
c. Collection expenses in excess of your nor-
mal collection expenses that are made nec-
essary by the loss or damage; and
d. Other reasonable expenses that you incur
to re-establish your records of accounts re-
ceivable;
that result from Covered Causes of Loss to
your records of accounts receivable.
2. Property Not Covered
Coverage does not apply to:
a. Records of accounts receivable in storage
away from the "premises" shown in the
Declarations; or
b. Contraband, or property in the course of
illegal transportation or trade.
3. Covered Causes Of Loss
Covered Causes of Loss means RISKS OF
DIRECT PHYSICAL LOSS OR DAMAGE to
your records of accounts receivable except
those causes of loss listed in the Exclusions.
(
CM 00 66 09 00
4. Additional Coverage - Collapse
We will pay for direct loss or damage caused
by or resulting from risks of direct physical loss
or damage involving collapse of all or part of a
building or structure caused by one or more of
the following:
a. Fire; lightning; windstorm; hail; explosion;
smoke; aircraft; vehicles; riot; civil commo-
tion; vandalism; leakage from fire extin-
guishing equipment; sinkhole collapse; vol-
canic action; breakage of building glass;
falling objects; weight of snow, ice or sleet;
water damage; earthquake; all only as in-
sured against in this Coverage Form;
b. Hidden decay;
c. Hidden insect or vermin damage;
d. Weight of people or 'personal property;
e. Weight of rain that collects on a roof;
f. Use of defective materials or methods in
construction, remodeling or renovation if the
collapse occurs during the course of the
construction, remodeling or renovation.
This Additional Coverage does not increase the
Limits of Insurance provided in this Coverage
Form.
5. Coverage Extension
REMOVAL
If you give us written notice within 10 days of
removal of your records of accounts receivable
because of imminent danger of loss or dam-
age, we will pay for loss or damage while they
are:
a. At a safe place away from your "premises";
or
b. Being taken to and returned from that place.
This Coverage Extension is included within the
Limit of Insurance applicable to the "premises"
from which the records of accounts receivable
are removed.
B. Exclusions
1. We will not pay for loss or damage caused
directly or indirectly by any of the following.
Such loss or damage is excluded regardless of
any other cause or event that contributes con-
currently or in any sequence to the loss.
Copyright, Insurance Services Office, Inc., 1999
o
Page 1 of 4
( -
a. Governmental Action
Seizure or destruction of property by order
of governmental authority.
But we will pay for loss or damage caused
by or resulting from acts of destruction or-
dered by governmental authority and taken
at the time of a fire to prevent its spread if
the fire would be covered under this Cover-
age Form.
b. Nuclear Hazard
(1) Any weapon employing atomic fission or
fusion; or
(2) Nuclear reaction or radiation, or radioac-
tive contamination from any other cause.
But if nuclear reaction or radiation, or
radioactive contamination results in fire,
we will pay for the direct loss or damage
caused by that fire if the fire would be
covered under this Coverage Form.
c. War And Military Action
(1) War, including undeclared or civil war;
(2) Warlike action by a military force, includ-
ing action in hindering or defending
against an actual or expected attack, by
any government, sovereign or other au-
thority using military personnel or other
agents; or
(3) Insurrection, rebellion, revolution,
usurped power or action taken by gov-
ernmental authority in hindering or de-
fending against any of these.
Exclusions B.1.a. through B.1.c. apply whether
or not the loss event results in widespread
damage or affects a substantial area.
2. We will not pay for loss or damage caused by
or resulting from any of the following:
a. Delay, loss of use, loss of market or any
other consequential loss.
b. Dishonest or criminal act committed by:
(1) You, any of your partners, employees,
directors, trustees, or authorized repre-
sentatives;
(2) A manager or a member if you are a
limited liability company;
(3) Anyone else with an interest in the prop-
erty, or their employees or authorized
representatives; or
(
Page 2 of 4
(4) Anyone else to whom the property is
entrusted for any purpose.
This exclusion applies whether or not such
persons are acting alone or in collusion with
other persons or such acts occur during the
hours of employment.
This exclusion does not apply to Covered
Property that is entrusted to others who are
carriers for hire or to acts of destruction by
your employees. But theft by employees is
not covered.
c. Alteration, falsification, concealment or
destruction of records of accounts receiv-
able done to conceal the wrongful giving,
taking or withholding of money, securities or
other property.
This exclusion applies only to the extent of
the wrongful giving, taking or withholding.
d. Bookkeeping, accounting or billing errors or
omissions.
e. Electrical or magnetic injury, disturbance or
erasure of electronic recordings that is
caused by or results from:
(1) Programming errors or faulty machine
instructions;
(2) Faulty installation or maintenance of
data processing equipment or compo-
nent parts;
(3) An occurrence that took place more than
100 feet from your "premises"; or
(4) Interruption of electrical power supply,
power surge, blackout or brownout if the
cause of such occurrence took place
more than 100 feet from your "prem-
ises".
But we will pay for direct loss or damage
caused by lightning.
f. Voluntary parting with any property by you
or anyone entrusted with the property if in-
duced to do so by any fraudulent scheme,
trick, device or false pretense.
g. Unauthorized instructions to transfer prop-
erty to any person or to any place.
h. Neglect of an insured to use all reasonable
means to save and preserve property from
further damage at and after the time of loss.
3. We will not pay for loss or damage that re-
quires any audit of records or any inventory
computation to prove its factual existence.
Copyright, Insurance Services Office, Inc., 1999
o
eM 00 66 09 00
c -
4. We will not pay for 1055 or damage caused by
or resulting from any of the following. But if 1055
or damage by a Covered Cause of Loss re-
sults, we will pay for the 1055 or damage
caused by that Covered Cause of Loss.
a. Weather Conditions. But this exclusion only
applies if weather conditions contribute in
any way with a cause or event excluded in
Paragraph 1. above to produce the 1055 or
damage.
b. Acts or decisions, including the failure to act
or decide, of any person, group, organiza-
tion or governmental body.
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, survey-
ing, siting;
(2) Design, specifications, workmanship,
repair, construction, renovation, remod-
eling, grading, compaction;
(3) Materials used in repair, construction,
renovation or remodeling; or
(4) Maintenance;
of part or all of any property wherever lo-
cated.
d. Collapse except as provided in the Addi-
tional Coverage - Collapse Section of this
Coverage Form.
C. Limits Of Insurance
The most we will pay for 1055 or damage in any
one occurrence is the applicable Limit of Insurance
shown in the Declarations.
D. Additional Conditions
1. Determination Of Receivables
General Condition F. Valuation in the Com-
merciallnland Marine Conditions is replaced by
the following:
a. If you cannot accurately establish the
amount of accounts receivable outstanding
as of the time of 1055 or damage, the follow-
ing method will be used:
(1) Determine the total of the average
monthly amounts of accounts receivable
for the 12 months immediately preceding
the month in which the 1055 or damage
occurs; and
(2) Adjust that total for any normal fluctua-
tions in the amount of accounts receiv-
able for the month in which the 1055 or
damage occurred or for any demon-
strated variance from the average for
that month.
(
CM 00 66 09 00
b. The following will be deducted from the total
amount of accounts receivable, however
that amount is established:
(1) The amount of the accounts for which
there is no 1055 or damage;
(2) The amount of the accounts that you are
able to re-establish or collect;
(3) An amount to allow for probable bad
debts that you are normally unable to
collect; and
(4) All unearned interest and service
charges.
2. Recoveries
The following is added to Loss Condition H.
Recovered Property in the Commercial Inland
Marine Conditions:
You will pay us the amount of all recoveries you
receive for 1055 or damage paid by us. But any
recoveries in excess of the amount we have
paid belong to you.
3. The following conditions apply in addition to the
Commercial Inland Marine Conditions and the
Common Policy Conditions:
a. Coverage Territory
We cover records of accounts receivable:
(1) Within your "premises"; and
(2) Away from your "premises" while in
transit or within premises of others if
those premises are located or the transit
is within:
(a) The United States of America
(including its territories and posses-
sions );
"\
(b) Puerto Rico; and
(c) Canada.
b. Coinsurance
If a Coinsurance percentage is shown in the
Declarations, the following condition ap-
plies.
Copyright, Insurance Services Office, Inc., 1999
o
Page 3 of 4
"':'F~,?'~ }~"l.~}'-
We will not pay the full amount of any 1055 if
the value of all accounts receivable, except
those in transit, at the time of 1055 times the
Coinsurance percentage shown for it in the
Declarations is greater than the Limit of In-
surance for Coverage Applicable at All Lo-
cations.
Instead, we will determine the most we will
pay using the following steps:
(1) Multiply the value of all accounts receiv-
able, except those in transit, at the time
of 1055 by the Coinsurance percentage;
(2) Divide the Limit of Insurance for Cover-
age Applicable at All Locations by the
figure determined in Step (1); and
(3) Multiply the total amount of 1055 by the
figure determined in Step (2).
l
Page 4 of 4
We will pay the amount determined in Step
(3) or the Limit of Insurance, whichever is
less. For the remainder, you will either have
to rely on other insurance or absorb the 1055
yourself.
This condition will not apply to records of
accounts receivable in transit, interest
charges, excess collection expenses or ex-
penses to re-establish your records of ac-
counts receivable.
c. Protection Of Records
Whenever you are not open for business,
and except while you are actually using the
records, you must keep all records of ac-
counts receivable in receptacles that are
described in the Declarations.
E. Definitions
"Premises" means that interior portion of the build-
ing at the address shown in the Declarations that
you occupy for your business.
Copyright, Insurance Services Office, Inc., 1999
o
eM 00 66 09 00
COMMERCIAL INLAND MARINE
CM 00 67 09 00
VALUABLE PAPERS AND RECORDS COVERAGE FORM
(~-
Various provisions in this policy restrict coverage.
Read the entire policy carefully to determine rights,
duties and what is and is not covered.
Throughout this policy, the words "you" and "your"
refer to the Named Insured shown in the Declarations.
The words "we", "us" and "our" refer to the Company
providing this insurance.
Other words and phrases that appear in quotation
marks have special meaning. Refer to Section F -
Definitions.
A. Coverage
We will pay for direct physical loss of or damage to
Covered Property from any.of the Covered Causes
of Loss.
1. Covered Property, as used in this Coverage
Form, means "valuable papers and records"
that are your property or property of others in
your care, custody or control.
2. Property Not Covered
Covered Property does not include:
a. Property not specifically declared and de-
scribed in the Declarations if such property
cannot be replaced with other property of
like kind and quality;
b. Property held as samples or for delivery
after sale;
c. Property in storage away from the "prem-
ises" shown in the Declarations; or
d. Contraband, or property in the course of
illegal transportation or trade.
3. Covered Causes Of Loss
Covered Causes of Loss means RISKS OF
DIRECT PHYSICAL LOSS OR DAMAGE to
Covered Property except those causes of loss
listed in the Exclusions.
(
CM 00 67 09 00
4. Additional Coverage - Collapse
We will pay for direct loss or damage caused
by or resulting from risks of direct physical loss
or damage involving collapse of all or part of a
building or structure caused by one or more of
the following:
a. Fire; lightning; windstorm; hail; explosion;
smoke; aircraft; vehicles; riot; civil commo-
tion; vandalism; leakage from fire extin-
guishing equipment; sinkhole collapse; vol-
canic action; breakage of building glass;
falling objects; weight of snow, ice or sleet;
water damage; earthquake; all only as in-
sured against in this Coverage Form;
b. Hidden decay;
c. Hidden insect or vermin damage;
d. Weight of people or personal property;
e. Weight of rain that collects on a roof;
f. Use of defective materials or methods in
construction, remodeling or renovation if the
collapse occurs during the course of the
construction, remodeling or renovation.
This Additional Coverage does not increase the
Limits of Insurance provided in this Coverage
Form.
5. Coverage Extensions
a. Removal
If you give us written notice within 10 days
of removal of your "valuable papers and re-
cords" because of imminent danger of loss
or damage, we will pay for loss or damage
while it is:
(1) At a safe place away from your "prem-
ises"; or
(2) Being taken to and returned from that
place.
This Coverage Extension is included within
the Limits of Insurance applicable to the
"premises" from which the Covered Prop-
erty is removed.
Copyright, Insurance Services Office, Inc., 1999
o
Page 1 of 4
( -
b. Away From Your Premises
We will pay up to $5,000 for loss or damage
to Covered Property while it is away from
your "premises".
But if a higher Limit of Insurance is speci-
fied in the Declarations, the higher limit will
apply.
The limit for this Coverage Extension is ad-
ditional insurance.
B. Exclusions
1. We will not pay for loss or damage caused
directly or indirectly by any of the following.
Such loss or damage is excluded regardless of
any other cause or event that contributes con-
currently or in any sequence to the loss.
a. Governmental Action
Seizure or destruction of property by order
of governmental authority.
But we will pay for loss or damage caused
by or resulting from acts of destruction or-
dered by governmental authority and taken
at the time of a fire to prevent its spread if
the fire would be covered under this Cover-
age Form.
b. Nuclear Hazard
(1) Any weapon employing atomic fission or
fusion; or
(2) Nuclear reaction or radiation, or radioac-
tive contamination from any other cause.
But if nuclear reaction or radiation, or
radioactive contamination results in fire,
we will pay for the direct loss or damage
caused by that fire if the fire would be
covered under this Coverage Form.
c. War And Military Action
(1) War, including undeclared or civil war;
(2) Warlike action by a military force, includ-
ing action in hindering or defending
against an actual or expected attack, by
any government, sovereign or other au-
thority using military personnel or other
agents; or
(3) Insurrection, rebellion, revolution,
usurped power or action taken by gov-
ernmental authority in hindering or de-
fending against any of these.
(
Page 2 of 4
Exclusions B.1.a. through B.1.c. apply whether
or not the loss event results in widespread
damage or affects a substantial area.
2. We will not pay for loss or damage caused by
or resulting from any of the following:
a. Delay, loss of use, loss of market or any
other consequential loss.
b. Dishonest or criminal act committed by:
(1) You, any of your partners, employees,
directors, trustees, or authorized repre-
sentatives;
(2) A manager or a member if you are a
limited liability company;
(3) Anyone else with an interest in the prop-
erty, or their employees or authorized
representatives; or
(4) Anyone else to whom the property is
entrusted for any purpose.
This exclusion applies whether or not such
persons are acting alone or in collusion with
other persons or such acts occur during the
hours of employment.
This exclusion does not apply to Covered
Property that is entrusted to others who are
carriers for hire or to acts of destruction by
your employees. But theft by employees is
not covered.
c. Errors or omissions in processing or copy-
ing.
But we will pay for direct loss or damage
caused by resulting fire or explosion if these
causes of loss would be covered by this
Coverage Form.
d. Electrical or magnetic injury, disturbance or
erasure of electronic recordings.
But we will pay for direct loss or damage
caused by lightning.
e. Voluntary parting with any property by you
or anyone entrusted with the property if in-
duced to do so by any fraudulent scheme,
trick, device or false pretense.
f. Unauthorized instructions to transfer prop-
erty to any person or to any place.
g. Neglect of an insured to use all reasonable
means to save and preserve property from
further damage at and after the time of loss.
Copyright, Insurance Services Office, Inc., 1999
o
eM 00 67 09 00
{
3. We will not pay for loss or damage caused by
or resulting from any of the following. But if loss
or damage by a Covered Cause of Loss re-
sults, we will pay for the loss or damage
caused by that Covered Cause of Loss.
a. Weather Conditions. But this exclusion only
applies if weather conditions contribute in
any way with a cause or event excluded in
Paragraph 1. above to produce the loss or
damage.
b. Acts or decisions, including the failure to act
or decide, of any person, group, organiza-
tion or governmental body.
c. Faulty, inadequate or defective:
(1) Planning, zoning, development, survey-
ing, siting;
(2) Design, specifications, workmanship,
repair, construction, renovation, remod-
eling, grading, compaction;
(3) Materials used in repair, construction,
renovation or remodeling; or
(4) Maintenance;
of part or all of any property wherever lo-
cated.
d. Collapse except as provided in the Addi-
tional Coverage - Collapse Section of this
Coverage Form.
e. Wear and tear, any quality in the property
that causes it to damage or destroy itself,
gradual deterioration; insects, vermin or ro-
dents.
C. Limits Of Insurance
The most we will pay for loss or damage in any
one occurrence is the applicable Limit of Insurance
shown in the Declarations.
D. Deductible
We will not pay for loss or damage in anyone oc-
currence until the amount of the adjusted loss or
damage before applying the applicable Limits of
Insurance exceeds the Deductible shown in the
Declarations. We will then pay the amount of the
adjusted loss or damage in excess of the Deducti-
ble, up to the applicable Limit of Insurance.
E. Additional Conditions
1. Valuation - Specifically Declared Items
The following is added to General Condition F.
Valuation in the Commercial Inland Marine
Conditions:
The value of each item of property that is spe-
cifically declared and described in the Declara-
tions is the applicable Limit of Insurance shown
in the Declarations for that item.
(~
(
2. Recoveries
The following is added to Loss Condition H.
Recovered Property in the Commercial Inland
Marine Conditions:
If either you or we recover any property atter
loss settlement, that party must give the other
prompt notice. At your option, the property will
be returned to you. If so, your loss or damage
will be readjusted based on the amount you re-
ceived for the property recovered, with allow-
ance for recovery expenses incurred.
3. The following conditions apply in addition to the
Commercial Inland Marine Conditions and the
Common Policy Conditions:
a. Coverage Territory
We cover property:
(1) Within your "premises"; and
(2) Away from your "premises" while i~
transit or within premises of others If
those premises are located or the transit
is within:
(a) The United States of America
(including its territories and posses-
sions );
(b) Puerto Rico; and
(c) Canada.
b. Protection Of Records
Whenever you are not open for business,
and except while you are actually using the
property, you must keep all "valuable pa-
pers and records" in receptacles that are
described in the Declarations.
F. Definitions
1. "Valuable papers and records" means in-
scribed, printed or written documents, manu-
scripts or records, including abstracts, books,
deeds, drawings, films, maps or mortgages.
But "valuable papers and records" does not
mean "money" or "securities", converted data,
programs or instructions used in your data
processing operations, including the materials
on which the data is recorded.
2. "Premises" means that interior portion of the
building at the address shown in the Declara-
tions that you occupy for your business.
3. "Money" means:
a. Currency, coins and bank notes whether or
not in current use; and
b. Travelers checks, register checks and
money orders held for sale to the public.
Page 3 of 4
o
CM 00 67 09 00
Copyright, Insurance Services Office, Inc., 1999
~)"'''::_~:-!'l!'"TT-
,-,,-;,-," .,.-
4. "Securities" means negotiable and non-
negotiable instruments or contracts represent-
ing either "money" or other property and in-
cludes:
a. Tokens, tickets, revenue and other stamps
whether or not in current use; and
b. Evidences of debt issued in connection with
credit or charge cards, which cards are not
of your own issue;
but does not include "money".
(
(
Page 4 of 4
Copyright, Insurance Services Office, Inc., 1999
eM 00 67 09 00
o
PUBLIC EMPLOYEES BLANKET BOND
The Trust, in consideration of the payment of the premium, and subject to the Declarations made a
part hereof, the General Agreement, Conditions and Limitations and other terms of this Bond,
agrees, in accordance with such of the Insuring Agreements hereof as are specifically designated by
the insertion of an amount of indemnity in the Declarations, to indemnify the Obligee for the use and
benefit of the Insured for:
INSURING AGREEMENTS
Honesty Blanket Bond Coverage
1. Loss sustained by the Insured through any fraudulent or dishonest act or acts committed by
any of the Employees, acting alone or in collusion with others, during the Bond Period, to an
amount not exceeding in the aggregate the amount stated in the Declarations applicable to
this Insuring Agreement 1.
Honesty Blanket Position Bond Coverage
2. Loss sustained by the Insured through any fraudulent or dishonest acts or acts committed
by any of the Employees, acting alone or in collusion with others, during the Bond Period,
the amount of Indemnity on each of such Employees being the amount stated in the
Declarations applicable to this Insuring Agreement 2.
Faithful Performance Blanket Bond Coverage
3.
Loss caused to the Insured through the failure of any of the Employees, acting alone or in
collusion with others, to perform faithfully his duties or to account properly for all monies and
property received by virtue of his position or employment during the Bond Period, to an
amount not exceeding in the aggregate the amount stated in the Declarations applicable to
this Insuring Agreement 3.
(
Faithful Performance Blanket Position Bond Coverage
4. Loss caused to the Insured through the failure of any Employee, acting alone or in collusion
with others, to perform faithfully his duties or to account properly for all monies and property
received by virtue of his position or employment during the Bond Period, the amount of
indemnity on each such Employees being the amount stated in the Declarations applicable
to this Insuring Agreement 4.
GENERAL AGREEMENT
Loss Under Prior Bond
(
If the coverage of an Insuring Agreement of this Bond is substituted for any prior bond carried by the
Insured or by any predecessor in interest of the Insured which prior bond is terminated, canceled or
allowed to expire as of the time of such substitution, the Trust agrees that such Insuring Agreement
applies to loss sustained by, or caused to, the Insured, as the case may be, prior to or during the
Bond Period, provided that such loss is discovered after the beginning of the Bond Period and prior
to the expiration of three years from the cancellation of this Bond as an entirety and that such loss
would have been recoverable by the Insured or such predecessor under such prior bond except for
the fact that the time within which to bring suit, action or proceeding of any kind thereunder had
expired, and provided further:
FMIT PROP 05 1002
Page 1 of4
(
(1 )
The indemnity afforded by this General Agreement shall be a part of and not in
addition to the amount of coverage afforded by the applicable Insuring Agreement
of this Bond; and
(2) Such loss would have been covered under such Insuring Agreement had such
Insuring Agreement with its agreements, conditions and limitations as of the time of
such substitution been in force when the acts or defaults causing such loss were
committed; and
(3) Recovery under such Insuring Agreement on account of such loss shall in no event
exceed the amount which would have been recoverable under such Insuring
Agreement in the amount for which it is written as of the time of such substitution,
had such Insuring Agreement been in force when such acts or defaults were
committed, or the amount which would have been recoverable under such prior
bond had such prior bond continued in force until the discovery of such loss if the
latter amount be smaller.
THE FOREGOING INSURING AGREEMENTS AND GENERAL AGREEMENT ARE SUBJECT TO
THE FOLLOWING CONDITIONS AND LIMITATIONS
Definitions
Section 1. The following terms, as used in this Bond, shall have the respective meanings stated in
this Section:
(
"Employee" as used in Insuring Agreements 1 and 2 means a person while in the employ of the
Insured during the Bond Period who is not required by law to give bond conditioned for the faithful
performance of his duties and who is a member of the staff or personnel of the Insured, but does not
mean any Treasurer, Finance Officer, or Tax Collector by whatever title known.
"Employee" as used in Insuring Agreements 3 and 4 means a person while in the employ of the
Insured during the Bond Period who is not required by law to furnish an Individual Bond to qualify for
office and who is a member of the staff or personnel of the Insured but does not mean any
Treasurer, Finance Officer, Law Enforcement Officer, or Tax Collector by whatever title known.
Unidentifiable Employee
Section 2. In case a loss is alleged to have been caused to the Insured through acts or defaults by
an Employee covered under an applicable Insuring Agreement of this Bond, while such Insuring
Agreement is in full force and effect and the Insured shall be unable to designate the specific
Employee causing such loss, the Insured shall nevertheless have the benefit of such Insuring
Agreement provided that the evidence submitted reasonably establishes that the loss was in fact
caused by such Employee through such acts or defaults and provided, further, that regardless of the
number of such Employees concerned or implicated in such loss, the aggregate liability of the Trust
for any such loss shall not exceed the amount stated in the Declarations applicable to such Insuring
Agreement.
Exclusion
(
Section 3. This Bond does not cover any loss sustained by, or caused to, the Insured under
circumstances whereby and to the amount which the Obligee or the Insured voluntarily undertakes
or is obligated by law to exonerate or indemnify any of the Employees against liability incurred by
them in the performance of their duties. This bond does not cover damages for which the Insured is
legally liable as a result of (a) the deprivation or violation of the civil rights of any person by an
Employee; or (b) the tortious conduct of an Employee, except conversion of property of other parties
held by the Insured in any capacity.
FMIT PROP 05 1002
Page 2 of 4
The Trust shall not be liable under the Bond for loss sustained by any party other than the Insured as
a result of any act or omission of an Employee whether or not such act or omission occurred in the
performance of the duties by the Employee.
Limits of Liability
Section 4. Indemnification by the Trust for any loss under Insuring Agreement 1 or 3 shall not
reduce the Trust's liability for other losses under the applicable Insuring Agreement, whenever
sustained; provided, however, that the Trust's total liability under each such Insuring Agreement for
any loss caused by any Employee or in which such Employee is concerned or implicated is limited to
the applicable amount of indemnity specified in the Declarations.
Indemnification by the Trust for any loss under Insuring Agreement 2 or 4 shall not reduce the Trust's
liability for other losses under the applicable Insuring Agreement, whenever sustained; provided,
however, the Trust's total liability under each such Insuring Agreement as to each Employee is
limited to the applicable amount of indemnity specified in the Declarations.
Regardless of the number of years this Bond shall continue in force and the number of premiums
which shall be payable or paid, the limit of the Trust's liability as specified in the Declarations shall
not be cumulative from year to year or period to period.
Limit of Liability Under This Bond and Any Prior Bond
(
Section 5. With respect to loss under Insuring Agreement 1 or 3 caused by any Employee or in
which such Employee is concerned or implicated for which is chargeable to such Employee as
provided in Section 2 of this Bond and with respect to loss under Insuring Agreement 2 or 4 caused
by any Employee or which is chargeable to such Employee as provided in Section 2 of this Bond and
with respect to loss under any Insuring Agreement which occurs partly during the Bond Period and
partly during the period of other bonds issued by the Trust to the Insured or to any predecessor in
interest of the Insured and terminated or cancelled or allowed to expire and in which the period
specified therein for bringing suit, action or proceeding of any kind, or if no such period is specified
therein, then within the period prescribed by the applicable statute of limitations, has not expired at
the time such loss thereunder is discovered, the total liability of the Trust under this Bond and under
such other bonds shall not exceed, in the aggregate, the amount carried under this applicable
Insuring Agreement of this Bond on such loss or the amount available to the Insured under such
other bonds, as limited by the terms and conditions thereof, for any such loss if the latter amount be
larger.
Deductibles
Section 6. It is agreed that:
(a) The Trust shall not be liable under Insuring Agreement 1 or 3 on account of loss through
acts or defaults committed at any time, whether before or after this endorsement is effective,
by any Employee or in which such Employee is concerned or implicated, unless the amount
of such loss, after deducting the net amount of all reimbursement and recovery, including
any cash deposit taken by the Insured, obtained or made by the Insured, other than from
any bond or policy of insurance issued by a surety or insurance company and covering such
loss, or by the Trust on account thereof prior to payment by the Trust of such loss, shall be
in excess of SEE DECLARATIONS PAGE and then for such excess only, but in no event for
more than the amount of insurance carried under Insuring Agreement 1 or 3 on such loss.
(b) The Trust shall not be liable under Insuring Agreement 2 or 4 on account of loss through
acts or defaults committed at any time, whether before or after this endorsement is effective,
by any Employee, unless the amount of such loss, after deducting the net amount of all
reimbursement and recovery, including any cash deposit taken by the Insured, obtained or
made by the Insured, other than from any bond or policy of insurance issued by a surety or
FMIT PROP 051002
Page 3 of 4
~"Y:,?
Y""I;J.,'.'~""'~~'-,,
insurance company and covering such loss, or by the Trust on account thereof prior to
payment by the Trust of such loss, shall be in excess of SEE DECLARATIONS PAGE and
then for such excess only, but in no event for more than the amount of insurance carried on
such Employee under Insuring Agreement 2 or 4. If more than one Employee is concemed
or implicated in such loss, such deductible amount shall apply to each Employee so
concerned or implicated.
(c) In no event shall the Trust be liable under any Insuring Agreement, as modified by this
endorsement, for more than the amount specified in the Declarations as applicable to such
Insuring Agreement subject.
(d) The Insured shall, within the time and in the manner prescribed in the Policy, give the Trust
notice of any loss of the kind covered by Insuring Agreement 1, 2, 3, or 4, whether or not the
Trust is liable therefor or for any part thereof, upon the request of the Trust shall file with it a
brief statement giving the particulars concerning such loss.
Cancellation
Section 7. This Bond shall be deemed canceled as to any Employee:
(a) Immediately upon discovery by the Obligee or the Insured of any act on the part of such
Employee which would constitute a liability of the Trust under the applicable Insuring
Agreement covering such Employee;
(b) Upon the death, resignation or removal of such Employee; or
(c)
At 12:01 a.m. upon the effective date specified in a written notice mailed to the Obligee and
the Insured. Such date shall be not less than thirty days after the date of mailing. The
mailing by the Trust of notice as aforesaid to the Obligee and the Insured shall be sufficient
proof of notice. Delivery of such written notice by the Trust shall be equivalent to mailing.
(
This Bond may be canceled by the Obligee or the Insured by mailing to the Trust written notice
stating when thereafter the cancellation shall be effective. This Bond maybe canceled by the Trust
by mailing to the Obligee and the Insured written notice stating when, not less than thirty days
thereafter, such cancellation shall be effective. The mailing of notice as aforesaid shall be sufficient
proof of notice. Delivery of such written notice either by the Obligee or the Insured or by the Trust
shall be equivalent to mailing. If the Obligee or the Insured cancels, earned premium shall be
computed pro-rata. If the Trust cancels, earned premium shall be computed pro rata. Premium
adjustments may be made at the time cancellation is effective or as soon as practicable after
cancellation becomes effective, but payment or tender of unearned premium is not a condition of
cancellation.
If any of the cancellation provisions set forth in either or both of the foregoing paragraphs of this
Section are prohibited or made void by any law controlling the construction of this Bond, such
provisions to the extent they are so prohibited or made void shall be deemed to be nullified and of no
effect.
Legal Proceedings
(
Section 8. No suit, action or proceeding of any kind to recover on account of loss under this Bond
shall be brought after the expiration of three years from the cancellation of this Bond as an entirety
provided, however, that if such limitation for bringing suit, action or proceeding is prohibited or made
void by any law controlling the construction of this Bond, such limitation shall be deemed to be
amended so as to be equal to the minimum period of the limitation permitted by such law.
FMIT PROP 051002
Page 4 of 4
FLORIDA MUNICIPAL INSURANCE TRUST
WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGE AGREEMENT
DECLA RATIONS
Agreement No.: FMIT #0648
I. DESIGNATED MEMBER: City of Winter Springs
II. Government Description
Municipality
III. COVERAGE PERIOD
From October 1, 2002 to October 1, 2003
12:01 A.M. Standard Time at the address of the Designated Member.
IV. A. Wor~ers Compensation Insurance: Part One of the Agreement applies to the Workers Compensation
Law of the state of Florida:
(
B. Employers Liability Insurance: Part Two of the Agreement applies to work in each state listed in item
IVA The limits of our liability under Part Two are: Bodily Injury by Accident$ 1,000,000 each accident
Bodily Injury by Disease $ 1, 000,000 policy limit
Bodily Injury by Disease $ 1,000,000 each employee
C. Other States Insurance: if any
D. This Agreement includes these endorsements and schedules: See Schedule D
V. ESTIMATED ANNUAL PREMIUM
Florida Municipal Insurance Trust (FMIT)
Normal
Premium
$546,655
Expense
Constant
$200
Incentive
Credit
$142,214
Net
Premium
$404,641
Florida League of Cities Sponsored Insurance Programs Since 1977
THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS. TOGETHER VV1TH THE
COMMON CONDITIONS. COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE
NUMBERE:O AGREEMENT.
(
FMIT we DEC 1002
Page 1 of2
12/13/02
(
(
~~CC:i-~_..~.
FMIT WORKERS COMPENSATION AND EMPLOYERS LIABILITY COVERAGES
October 1, 2002 - October 1, 2003 Scheduled Coverage Forms List
City of Winter Springs, FMIT #0648
Schedule D
Form Number:
FMIT IND 1002
FMIT WC EL 1002
WC 00 00 01 EXT
FMIT we DEe 1002
Description:
Indemnity Agreement
Coverage Agreement Workers Compensation and Employers Liability
Item 4 - Extension of Information Page
Page 2 of2
FLORIDA MUNICIPAL INSURANCE TRUST
INDEMNITY AGREEMENT
THIS AGREEMENT, made and entered into this 1st day of October, 1992, by and between the
Florida Municipal Insurance Trust (Trust) and all parties who are now or may hereafter become members of
the Florida Municipal Insurance Trust (member), acting by and through a Board of Trustees of their own
selection. These members of the Florida Municipal Insurance Trust, all local government entities, have
organized and formed a trust, and have agreed to pool their liabilities pursuant to Florida law. NOW
THEREFORE, for and in consideration of the mutual covenants, promises and obligations herein contained,
which are given to and accepted by each member hereof to the other, the parties to this instrument covenant,
stipulate and agree as follows:
RESPONSIBILITIES OF MEMBER
Each member of the Trust agrees to abide by the following rules and regulations:
I. GENERAL CONDITIONS
A. The member agrees the Board of Trustees, the governing body of the Trust, comprised
entirely of local elected officials, will set up, operate and enforce its own administrative rules,
regulations and by-laws as between the individual members of the Trust and shall otherwise
direct the affairs of the Trust;
B.
The member and the Trust agree all members of the Trust hereby agree that the Board may
admit as members of this Trust only acceptable employers in the state of Florida who have
common governmental interest. The Board or its designee shall be sole judge of whether or
not an applicant shall be admitted to membership;
(
C. The member agrees to maintain a reasonable loss prevention program in order to provide
the maximum in safety and lawful practices as such may relate to the potential liability
assumed by the Trust under this Agreement or any other agreement, certificate, document,
or other instrument executed by the Trust and the member pursuant to this Agreement;
D. The member agrees to provide immediate notification of such occurrence to the Trust in the
event of an occurrence likely to give rise to a claim within the scope of this Agreement, or
any other agreement, certificate, document or other instrument executed by the Trust and
the member pursuant to this Agreement;
E. The member agrees to promptly make all contributions for coverages arising under this
Agreement, or any other agreement, certificate, document, or other instrument executed by
the Trust and the member pursuant to this Agreement at the time and in the manner
directed by the Board of Trustees. Said contributions may be reduced by any discount,
participation credit, or other contribution reduction program established by the Board of
Trustees;
F. The member agrees in the event of payment of any loss by the Trust on behalf of the
member, the Trust shall be subrogated to the extent of such payment to all the rights of the
member against any party or other entity legally responsible for damages resulting from said
loss, and in such event, the member hereby agrees, on behalf of itself, its officers,
employees, and agents to execute and deliver such instruments and papers as is required,
and do whatever else is reasonably necessary, to secure such right to the Trust, and to
cooperate with and otherwise assist the Trust as may be necessary to effect any recovery
sought by the Trust pursuant to such subrogated rights;
FMIT IND 1002 Page 1 of4
~---"--~"-',~' _..~.... ""~~'----'-'- ;:'.1'
G. The member agrees the Board of Trustees, its Administrator, and any of their other agents,
servants, employees or attorneys, shall be permitted at all reasonable times and upon
reasonable notice to inspect the property, work places, plants, works, machinery and
appliances covered pursuant to this Agreement or any other agreement, certificate,
document, or other instrument executed by the member and the Trust pursuant to this
Agreement, and shall be permitted at all reasonable times while the member participates in
the Trust, and up to and including two (2) years following the termination of its membership
in the Trust, to examine the members' books, vouchers, contracts, documents and records
of any and every kind which show or tend to show or verify any loss that may be paid or may
have been paid by the Trust on behalf of the member pursuant to this Agreement, or any
other agreement, certificate, document, or other instrument executed by the member and
the Trust pursuant to this Agreement, or which show or verify the accuracy of any
contribution which is paid or payable by the member pursuant to the terms of this
Agreement, or any other agreement, certification, document or any other instrument
executed by the Trust and the member pursuant to this Agreement;
H. The members hereby delegate to the Board of Trustees the responsibility to contract for
handling the administrative and servicing functions of the Trust. The Board may pay a
reasonable fee for such, which shall be negotiated from time to time by the Board of
Trustees. These fees shall be in consideration of all services and expenses contracted for
with the Trust, which services or expenses may include the collecting, disbursing, and
accounting for monies collected, counseling with members as to the safety hazards, claims
handling and investigations, and legal services, actuarial services and accounting services
and for the purpose of providing for excess insurance coverage. Books and records of all
contractors employed by the Trust are to be open to inspection by the Board of Trustees or
their agents at all reasonable times and as otherwise required by law;
(
I.
The member and the Trust agree the administrator, to be appointed by the Board, shall
deposit to the account of the Trust, at any bank or banks designated by the Board, all
contributions or other monies, as and when collected and said monies shall be disbursed
only as provided by (1) the Trust's Agreement and Declaration of Trust, (2) the rules,
regulations and by-laws of the Board, and (2) the Agreement between the Board and the
administrator;
J. The member and the Trust agree that the Trust is to defend in the name of and on behalf of
the member any claims, suits or other legal proceedings which may at any time be instituted
against the member on account of bodily injury liability, property damage liability, errors and
omissions liability, civil rights liability, personal injury liability or any other such liability,
monetary or otherwise, to the extent such defense and liability has been assumed by the
Trust pursuant to this Agreement or any other agreement, certificate, documents, or other
instrument executed by the Trust and the member pursuant to this Agreement, subject to
any and all of the definitions, terms, conditions and exclusions contained in said
agreements, certificates, documents or other instruments, although such claims, suits,
allegations or demands are wholly groundless, false, fraudulent, and to pay all costs taxed
against the member in any such legal proceedings defended by the Trust or the members,
all interest accruing after entry of judgement in such proceedings, and all expenses incurred
in the investigation, negotiation or defense of such claims, suits, allegations or demands.
Such defense shall be subject to the control of the Trust and its Administrator, which may
make such investigation and settlement of any such claim, suit, or other legal proceeding,
monetary or otherwise, as they deem expedient;
K.
The member agrees the liability of the Trust is specifically limited to the discharge of the
liability of its members assumed pursuant to this Agreement or any other agreement,
certificate, document, or any other instrument executed by the member and the Trust
pursuant to this Agreement;
(
FMIT IND 1002
Page 2 of 4
L. The member agrees the coverage of the Trust does not apply to punitive or exemplary
damages;
M. The Trust shall operate on a fiscal year from 12:01 a.m. October 151 to 12:01 October 151 of
the succeeding year. Application for continuing membership, when approved in writing by
the Board or their designee, shall constitute a continuing contract for each succeeding fiscal
period unless cancelled by the Board or unless the member shall have resigned or
withdrawn from said Trust by written notice;
N. Unless the Trust and the member otherwise expressly agree in writing, the member agrees
coverage by the Trust for a member under the terms of this Agreement or any other
agreement, certificate, document, or other instrument executed by the member and the
Trust pursuant to this Agreement, shall expire automatically at midnight on the last day of
September of each calendar year;
O. Except as otherwise provided herein, the member and the Trust agree such member's
coverage may be canceled by the Trust or the member at any time upon no less than forty-
five (45) days prior written notice by the Board of Trustees or the Administrator to the
member and to the Division of VVorkers' Compensation, if applicable, or by the member to
the Trust, stating the date such cancellation shall be effective; however, cancellation by the
member after the initial effective date of coverage (October 1), shall be conditioned upon
Member's payment of an amount equal to ten (10) percent of the premium that is unearned
by the Trust, or the Trust may cancel for non-payment of premium by issuing written notice
of cancellation to the member 10 days before the effective date of cancellation;
P.
The member agrees excess monies remaining after the payment of claims and claim
expenses, and after provision has been made for the payment of open claims and
outstanding reserves, may be distributed by the Board of Trustees to the members
participating in the Trust in such manner as the Trustees shall deem to be equitable;
(
Q. The member agrees there will be no disbursements out of the reserve fund established by
the Trust by way of dividends or distributions of accumulated reserves to members until
provision has been made for all obligations against the Trust and except at the discretion of
the Board of Trustees;
R. The member agrees to permit qualified service providers, including attomeys selected by the
Trust, to defend, investigate, settle, and otherwise process and dispose of all claims, suits,
allegations or demands that may result in liability assumed by the Trust on behalf of the
member pursuant to this Agreement, or any other agreement, certificate, document, or other
instrument executed by the Trust or the member pursuant to this Agreement;
S. The member shall make prompt payment of all contributions as required by the Board of
Trustees, said contributions to be determined by said Board. The member shall fully
cooperate with auditors of the Trust to promptly determine final audited contributions. Any
disputes conceming contributions shall be resolved after payment. Any objections
concerning the final audited contribution shall be filed within 60 days of billing of the final
audited contributions. After that time, the audit shall be considered to be final;
T. The member agrees to pay reasonable penalties as determined by the Board of Trustees for
late payment of contributions required under this Agreement, or any other agreement,
certificate, document, or other instrument executed by the member and the Trust pursuant
to this Agreement;
U. The member, through the Board of Trustees, does hereby appoint the Administrator of the
Trust as its agent and attorney-in-fact, to act in its behalf and to execute all necessary
contracts, reports, waivers, agreements, excess insurance contracts, service contracts, and
other documents reasonably necessary to accomplish the purposes and to fulfill the
FMIT IND 1002 Page 3 of4
~:;:;;:;:!:-.J~'2-.:;;;;'
,
responsibilities of the Trust; to make or arrange for the payment of claims, claim expenses,
medical expenses, and all other matters required or necessary insofar as they affect the
member's liability under federal or Florida law and insofar as such matters are covered
pursuant to the terms of this Agreement or any other agreement, certificate, document, or
other instrument executed by the member and the Trust pursuant to this Agreement, and by
the rules and regulations now or hereafter promulgated by the Board of Trustees;
V. The Trust shall determine all questions of the scope of liability coverage, eligibility methods
of providing or arranging for benefits, and all other related matters. It shall have full power to
construe the provisions of this agreement and the other program documents in the terms
used here and therein. Any such determination and any such construction adopted by the
Trust in good faith shall be binding upon all parties hereto and the members, provided such
determination or such construction is consistent with the laws of the State.
The member agrees to abide by all the terms and conditions of this Agreement, the
Participation Agreement, the Trust's By-laws, the rules and regulations, and any other
agreement, certificate, document, or other instrument executed by the Trust and the
member pursuant to the Agreement;
W. The member and the Trust agree the Trust will maintain an excess coverage program and
reserve evaluation to protect the financial stability of the Trust in an amount and manner
determined by a qualified and independent actuary;
X. The member and the Trust agree the Trust will submit to the appropriate governmental
agency annually an audited fiscal year-end financial statement prepared by an independent
certified public accountant;
Y.
(
The member and the Trust agree that any member who formally applies for membership in
this Trust and is accepted by the Board of Trustees shall thereupon become a party to the
Trust's Agreement and Declaration of Trust and be bound by all of the terms and conditions
contained therein, and said application shall constitute a counterpart of said Agreement and
Declaration of Trust; and
Z. Members duties after loss:
FMIT IND 1002
1.
give the Trust prompt written notice of any accident, occurrence or potential claim
along with all relevant information concerning the claim. The member shall have a
continuing duty to provide to the Trust all relevant information promptly as the
member becomes aware of such information; and
cooperate fully with the Trust in defense or settlement of claims or opposition to
claims bills, and in the enforcement of any right of contribution or indemnity; and
forward to the Trust every notice, demand, summons or other process served upon
the member relating to any occurrence, and take no further action concerr1ing the
occurrence without the approval of the Trust or the servicing agent; and
take reasonable steps to prevent additional or cumulative bodily injury, personal
injury or property damage from or arising out of the same or similar conditions or
circumstances; and
not engage in settlement negotiations as to any claim or suit, and the Trust shall
have no obligation to pay the amount of any settlement negotiated or agreed upon by
a member without prior written approval by the Trust or the servicing agent; and
agree to take all reasonable actions, where appropriate, which shall facilitate
settlement of claims; and
agree to responsible counsel selected by the Trust to defend the claim and agree not
to use the designated member's counsel in defense of said action.
2.
3.
4.
5.
6.
7.
Page 4 of 4
FLORIDA MUNICIPAL INSURANCE TRUST
COVERAGE AGREEMENT
WORKERS COMPENSATION AND EMPLOYERS LIABILITY
I. In consideration of the payment of the contributions and the covenants and agreements
set forth in the INDEMNITY AND COVERAGE AGREEMENTS, in reliance upon the
statements of the APPLICATION, the DECLARATIONS, and all terms, conditions, limits
and other provisions of the COVERAGE AGREEMENT, the Trust agrees with the member
as to the following:
LIMITS OF LIABILITY
Regardless of the number of (1) members under this Agreement, (2) persons or
organizations who sustain injury or damage, or (3) claims made or suits brought on account of
bodily injury, property damage or personal injury, the liability of the Trust is limited as follows:
The total liability of the Trust applicable to "each person" under all coverages and
endorsements for all damages, including but not limited to damage awards for derivative claims,
taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by one
person or organization as the result of anyone occurrence shall not exceed the limit of liability
stated in the Declarations and endorsements thereto.
(
The total liability of the Trust applicable to "each occurrence" under all coverages and
endorsements for all damages, including but not limited to damage awards for derivative claims,
taxable costs, attorneys fees, and prejudgment or post-judgment interest, sustained by more than
one person or organization as the result of anyone occurrence shall not exceed the limit of liability
stated in the Declarations and endorsements thereto.
For the purpose of determining the limit of the Trust's liability, all damages arising out of
continuous or repeated exposure to substantially the same general conditions shall be considered
as arising out of one occurrence.
DEFENSE AND SETTLEMENT
In addition to the limits of liability the Trust will settle or defend at its own expense, as it
considers appropriate, any claim or suit demanding money damages covered by this Agreement.
The Trust will defend any suit against a member which alleges a claim for money damages
covered by this Agreement even if such suit is groundless, false or fraudulent. However, the Trust
has no duty to defend a member in any action which on its face alleges facts excluded or not
covered by this Agreement.
In the event a suit or other action contains allegations which allege damages which the
Trust has a duty to defend and other allegations which allege damages or other relief that the
Trust does not have a duty to defend, the Trust will defend all allegations subject to the terms,
conditions, limits of liability and exclusions of the Agreement; however, undertaking such defense
shall not obligate the Trust to pay any judgments, settlements or awards which a member
becomes legally obligated to pay for allegations to which coverage does not apply. The Trust's
duty to defend ends when applicable Limits of Insurance have been exhausted.
(
FMIT we EL 1002
Page 1 of 5
II. WORKERS COMPENSATION
A. The member and the Trust agree that the Trust will pay any sum a member
becomes legally obligated to pay under the workers compensation laws of the state
of Florida, including Employers liability as discussed within Coverage B attached
hereto for accidents which occur during the period of this Agreement; and the Trust
further agrees to pay all administration assessments as may be required in
accordance with Florida Law;
B. The Trust is to defend in the name of and on behalf of the members any suits or
other proceedings which may at any time be instituted against them on account of
injuries or death within the purview of the Florida Workers Compensation Law or on
the basis of Employers liability, including suits or other proceedings alleging such
injuries and demanding damages or compensation therefore, although such suits,
other proceedings, allegations or demands are wholly groundless, false, or
fraudulent, and to pay all costs taxed against members in any legal proceeding
defended by the members, all interest accruing after entry of judgment and all
expenses incurred for investigation, negotiation or defense;
C. Liability of the Trust to the employees of any employer is specifically limited to such
obligations as are imposed by the Florida law against the employer for workers
compensation and/or employers liability as provided in Coverage B. The Trust's
liability is further limited to only the obligations it assumes under this Agreement;
D. The member agrees the Trust shall not be liable for any additional compensation
imposed by Section 440.54, and Section 440.15 (12), Florida Statutes; and
D.
The member agrees that the Board is authorized to set aside from the contributions
and monies collected a reasonable sum for the operating or administrative
expenses of the Trust. All remaining funds collected during anyone fiscal year of
the Trust shall be set aside and shall be used only for the following purposes:
payment of a fee for the administrator and claims agent for said Trust; payment for
claims, expenses, payments of compensation to employees covered by this
contract, including but not limited to settlements, awards, judgements, legal fees,
and costs in contested cases; payment of administrative and other assessments as
required by Florida law; payment of cost of all bonds; actuarial, and auditing
expenses required of the Trust or its agency or employees under Florida law; or
other reasonable operating costs or expenses necessary for the administration of
the Trust.
(
E. Other States Coverage: The Trust will reimburse the member for the benefits
required by the Workers Compensation law of that state. If the member has
worked on the effective date of this Agreement in any state other than Florida,
coverage will not be afforded for that state unless the Trust is notified within thirty
(30) days.
F. This agreement requires you to release certain employment and wage information
maintained by the State of Florida pursuant to federal and state unemployment
compensation laws except to the extent prohibited or limited under federal law. By
entering into this agreement, you consent to the release of the information. We will
safeguard the information and maintain its confidentiality. We will limit use of the
information to verifying compliance with the terms of the agreement.
FMIT we EL 1002
Page 2 of 5
III. COVERAGE B - EMPLOYERS LIABILITY AGREEMENT
A. The member and Trust agree the following definitions apply to the Employers
Liability Agreement unless modified or excluded:
1. "Bodily Injury" means bodily injury, disability, disfiguration, sickness or
disease or death resulting there from sustained by any person, and any
loss, injury or damages sustained by any other person because of bodily
injury, which occurs during the period of this Agreement;
2. "Designated Member" means the entity or organization named in this
application. Designated member does not include employees or agents of
the entity or organization; and
3. The term "Member" as used in this part means:
(a) The designated member;
(b) V\hlile acting within the scope of his employment, any officer,
employee, or volunteer of the designated member;
4. Occurrence, means an event or accident, including continuous or repeated
exposure to conditions which result in bodily injury, property damage or
personal injury and not arising from any form of intentional misconduct.
B.
The member and the Trust agree the Trust will pay all sums which a member
becomes legally obligated to pay as damages because of bodily injury to an
employee of the designated member arising out of and in the course of the injured
employee's employment by the designated member, provided said bodily injury is
covered by this Employers Liability Agreement;
(
C. The member and the Trust agree the Trust will pay damages only to the extent
where recovery is permitted by Chapter 440.11, Florida Statutes, and Section
768.28, Florida Statutes, including damages:
1. For which a member becomes liable to a third party by reason of claim or
suit against the member by the third party to recover the damages claimed
against the member as result of injury to an employee of the designated
member;
2. For care of loss and loss of services; and
3. For consequential bodily injury to 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 the member;
D. In addition to the limits of liability the Trust will settle or defend at its own expense,
as it considers appropriate, any claim or suit demanding money damages covered
by this Agreement. However, the Trust has no duty to defend a member in any
action, which on its face alleges facts excluded or not covered by this Agreement;
E. The member and the Trust agree regardless of the number of (1) members under
this Agreement, (2) persons or organizations who sustain injury or damage, or (3)
claims made or suits brought on account of bodily injury or property damage or
personal injury, the liability of the Trust is limited as follows:
1.
The total liability of the Trust under all coverages and endorsements for all
damages, including, but not limited to, damages for derivative claims, or
FMIT we EL 1002
Page 3 of 5
taxable costs, attorneys fees, and prejudgment interest or post-judgment
interest, sustained by one person or organization as the result of anyone
occurrence shall not exceed $1,000,000 bodily injury by accident per
accident, $1,000,000 bodily injury by disease per disease, and $1,000,000
bodily injury by disease aggregate limits;
2. The total aggregate liability of the Trust under all coverages for all
damages, including, but not limited to damages for derivative claims, or
taxable costs, attorneys' fees, and prejudgment interest or post-judgment
interest sustained by more than one person or organization as the result of
anyone occurrence shall not exceed the limit of liability as stated herein
as applicable to "each accident or disease;" and
3. For the purpose of determining the limit of the Trust's liability, all damages
arising out of continuous or repeated exposure to substantially the same
general conditions shall be considered as arising out of one occurrence;
F. The member and the Trust agree that no liability is afforded by the Trust as follows:
1. To liability assumed by a member under any contract or agreement;
2. To any liability arising in whole, or in part out of:
(a) Any act or omission of a member committed while acting outside
the course and scope of his employment, or committed in bad
faith with malicious purpose, or in a manner exhibiting wanton and
willful disregard of human rights, safety or property;
(b)
Any member obtaining remuneration or financial gain to which the
member was not legally entitled;
(
(c)
The willful violation of any federal, state or local law, ordinance or
regulation committed by or with the knowledge or consent of any
member; or
(d) Malfeasance by any member;
Except that any fact pertaining to anyone member shall not be imputed to
any other member for the purpose of determining the application of these
exclusions;
3. To any liability or injury, sickness, disease, death, or destruction due to the
rendering of or failure to render any professional service by any doctor,
surgeon, dentist, nurse or agents or employee of a designated member;
4. To any liability for punitive or exemplary damages; or any non-
compensatory damages or penalties imposed pursuant to any federal or
state anti-trust, civil rights, anti-discrimination, or racketeer influence and
corrupt organization (RICO) laws;
5. To any damages imposed by act of the Legislature;
6. To bodily injury or property damage for which the member or his
indemnitee may be held liable;
(a)
As a person or organization engaged in the business or
manufacturing, distributing, selling or serving alcoholic beverages,
or
FMIT we EL 1002
Page 4 of 5
(b) If not so engaged, as an owner or lessor of premises used for
such purposes, if such liability is imposed:
i. By, or because of the violation of any statute, ordinance or
regulation pertaining to the sale, gift, distribution or use of
any alcoholic beverages, or
ii. By reason of the selling, serving or giving of any alcoholic
beverage to a minor or to a person under the influence of
alcohol or which causes or contributes to the intoxication
of any person.
7. To any liability arising out of any actual or alleged sexual action, abuse,
communicable disease or employment related claim, defined for purposes
of this exclusion as:
(a) Sexual action includes, but is not limited to, any verbal or non-
verbal communication, behavior or conduct with sexual
connotations or purposes, whether for sexual gratification,
discrimination, intimidation, coercion or other purpose, and
regardless of whether such action is alleged to be intentional or
negligent;
(b) Abuse shall include, but is not limited to, the negligent or
intentional infliction of physical, emotional or psychological injury
or harm to any person or persons in the care, custody, or control
of any member;
(c)
Communicable disease includes, but is not limited to, Acquired
Immune Deficiency Syndrome (AIDS) and any venereal disease;
and
(
(d) Employment related claim includes, but is not limited to, claims,
accusations or charges of negligent or intentional hiring,
placement, training or supervision arising from or related to actual
or alleged sexual action, or any other type of actual or alleged
abuse, or a communicable disease;
8.
To any liability for injury, loss or damage sustained by any person or
entities as a result of exposure to asbestosis or any other disease
including mesothelioma and cancer related to asbestos exposure;
9.
Bodily injury which is intentionally caused or aggravated by the member or
members. Coverage is also excluded for any claim alleging gross
negligence. Further, cover is also excluded for claims in which it is alleged
that the Designated Member or a fellow employee acted in such a manner
that it was substantially certain that injury or death would result;
10.
Bodily injury to any employee while employed in violation of the law or
engaged in any conduct in violation of law with the actual knowledge of
any of the executive officers of the designated member; and
11.
To any obligation imposed by a workers compensation, occupational
disease, unemployment compensation or disability benefits law or any
similar law.
FMIT we EL 1002
Page 5 of 5
V\ORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
EXTENSION OF INFORMATION PAGE
ITEM 4. CONTINUED
CLASSIFICATION OF OPERATIONS
FL-9
LOC. 1
Total Payroll:
FL
8,769,360
From 10/01/2002
To 10/01/2003
STREET or Road MAINTENANCE OR
BEAUTIFICATION & Drivers
WATERWORKS OPERATION & Drivers
SEWAGE DISPOSAL PLANT OPERATION &
Drivers
FIREFIGHTERS & Drivers
POLICE OFFICERS & Drivers
(
AUTOmobile SERVICE OR REPAIR CENTER
1& Drivers
CLERICAL OFFICE EMPLOYEES NOC
PARK NOC - ALL EMPLOYEES & Drivers
MUNICIPAL, TOWNSHIP, COUNTY OR
STATE EMPLOYEE NOC
Employer Safety Premium Credit
Drug-Free Workplace Credit
Total After Credits
Experience Modification
Final
STANDARD PREMIUM
Advance Discount
Normal Premium
Expense Constant
Incentive Credit
(
'- -.
Net Premium
we 00 00 01A
CODE
NO.
5509
7520
7580
POLICY NO. FMIT #0648
PAGE NO. 1
Estimated Total
Annual
Remuneration
Rates Per
$100 of
Remun-
eration
487,47E 11.08
724,622 6.24
557,45E 4.5C
-
7704 1,645,062 10.6E
7720 2,563, 92C 10. 6E
8380
108,262
6.95
8810 1,922,00~ 0.65
9102
9410
9765
9841
9898
006:3
0900
439,74E 10.01
320,BOE 15.01
0.020
0.050
0.980
Estimated Annual Premiums
Subject to
Modification All Other
54,013
45,21E
25,08E
175,693
273,827
7,524
12,493
44,019
48,153
-13,720
-33,615
638,689
-12,774
625,915
-79,260
546,655
20C
-142,214
404,641
12/13/02
0 Administration/
Marketing
0 Risk Control
if Underwriting
Property & Casualty
Health
Post Office Box 530065
125 East Colonial Drive
Orlando, FL 32853-0065
800-445-6248
407-425-9142
Suncom 344-0725
Fax 407-425-9378
0 Health Claims
Post Office Box 538140
Orlando, FL 32853-8140
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Workers'
Compensation Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
0 Property & Liability
Claims
Post Office Box 538135
Orlando, FL 32853-8135
800-756-3042
407-245-0725
Suncom 344-0725
Fax 407-425-9378
FLORIDA LEAGUE OF CITIES, INC.
PUBLIC RISK SERVICES
October 18, 2002
Mr. Ronald W. McLemore
City of Winter Springs
1126 East State Road 434
Winter Springs, FI. 32708
Re: Signed Application
Dear Mr. McLeMore:
./--------..
/ \
~
Enclosed is your signed application to the Florida Municipal Insurance Trust. Please
keep this with your Insurance Package. We will also be keeping one in our file.
Thank You,
9Il~t. ~
Margaret E. Gross, CPCU
Public Risk Service
Enclosure
Florida Municipal Insurance Trust