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Res No 188-14-14282RESOLUTION NO.188-14-14282 A Resolution authorizing the City Manager to execute the renewed insurance policies with the Florida Municipal Insurance Trust (FMIT), Preferred Governmental Insurance Trust (PGIT),and ACE American Insurance Company for the 2014 -2015 Fiscal Year. WHEREAS,the City,through itsAgentofRecord,Brown&Brown,hassolicitedand received quotes for Property,Crime,InlandMarine,General Liability,Law Enforcement Liability,Automobile Liability,Automobile Damage Insurance,Workers'Compensation Insurance,PublicOfficialsand Employment Practices Liability Insurance from carriers authorized to write such insurance from at least three sources,if available;and WHEREAS,the renewal quote from FMIT for the continuation of the existing coverage,provides the best coverage option to meet the City's needs;and WHEREAS,the City Administration recommends that the City continue coverage with the FloridaLeagueofCities through FMIT for Workers'Compensation Coverage for the 2014-2015 Fiscal Yearbasedupon the current proposal;and WHEREAS,the renewal quote fromPGITforthe continuation of the existinglinesof coverageprovides the best coverage optionsto meet theCity'sexistingneeds;and WHEREAS,the CityAdministration recommends that the City continue coveragewith the PGIT forProperty,Crime,Inland Marine,General Liability,Law Enforcement Liability, Automobile Liability,andAutomobileDamageInsuranceCoveragefor the 2014-2015 Fiscal Yearbasedupon the current proposal;and WHEREAS,therenewalquotefrom ACE for Public Officials and Employment Practices Liability Insurance provides thebest coverage optionsfortheCity'sneeds;and WHEREAS,theCity Administration recommends thattheCityrenewits coverage with ACE for Public Officials and Employment Practices Liability Insurance forthe 2014-2015 Fiscal Yearbaseduponthe current proposal; NOW THEREFORE BE IT RESOLVED BY THE MAYOR AND CITY COMMISSION OF THE CITY OF SOUTH MIAMI,FLORIDA THAT: Section I.TheCity Commission herebyauthorizestheCity Manager toexecutethe renewalinsurancepoliciesfor Workers'Compensationwith FMIT forthe 2014-2015 Fiscal Year. Section 2.The City Commission hereby authorizes the City Manager to execute the renewal insurance policy for Property,Crime,Inland Marine,General Liability, Pg.2 of Res.No.188-14-14282 Law Enforcement Liability,Automobile Liability,and Automobile DamageInsurance with PGIT for the 2014-2015 Fiscal Year. Section 3.The City Commission hereby authorizes the CityManager to execute the insurance policy for Public Officials and Employment Practices Liability Insurance with ACE for the 2014-2015 Fiscal Year. Section 4.This resolution shalltakeeffectimmediatelyupon adoption. PASSED AND ADOPTED this 16thlay of SeptembelOK ST:APPROVED: /}l WkJkP CITY CLERK ^~^Y MAYOR* READ AND/APHROVED AS TO/FOllM,COMMISSION VOTE:5-0 language)legality and/1^XEp^©ftTTHEREOF://I Mayor Stoddard:Yea ViceMayorHarris:Yea Commissioner Welsh:Yea Commissioner Liebman: Commissioner Edmond Yea CITY ATTORNEY ///Yea Soutlf Miami THE CITY OF PLEASANT LIVING CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM To: From: Date: Subject: Background: The Honorable Mayor &Members of the City Commission Steven Alexander,City Manager September 16,2014 Agenda ItemNo. Worker's Compensation,Property,General Liability, Automobile,Public Officials and Employment Practices Insurance TheCity solicited and received proposalsfor the City's Workers' Compensation,Property,General Liability Automobile,PublicOfficials and Employment PracticesInsurance coverage for FY 2014-2015 from carriers currently writing municipal business in South Florida.The following table summarizes the responses received. FMIT Insurance Description FMIT Property Coverage 125,734 Inland Marine Included Equipment Breakdown Coverage Included Crime andBond Coverage Included GeneralLiabilityCoverage 72,671 PoliceProfessional Liability Coverage 161,536 Automobile Coverage 82,834 FMIT Property,Auto and General Liability Total 442,775 Workers Compensation 214,533 FMITTotal Premium 657,308 South*1 Miami THE CITY OF PLEASANT LIVING CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM PGIT Insurance Description Property Coverage Inland Marine Equipment Breakdown Coverage CrimeandBond Coverage General Liability Coverage Police Professional Liability Coverage Automobile Coverage Automobile Physical Damage PGIT Property,Auto and General Liability Total Workers Compensation PGIT Total Premium PGIT 130,713 2,883 Included 750 88,993 64,983 67,395 29,369 385,086 270,593 655,679 In addition to the package quotations summarized above,the City received independent quotes foritsPublicOfficials&Employment Practices Liability coverage.A Comparison of the two quotations is summarized in the table below. ACE American Insurance Description Total Premium LimitofLiability $1,000,000 Crisis Management Fund $25,000 Deductible/SIR EachClaim: PublicOfficials/PublicEntity Liability -$100,000 Employment Practices Liability -$150,000 ZoningClaims -$250,000 National Union Fire Insurance Company Total Premium LimitofLiability $1,000,000 Deductible/SIR Each Claim: PublicOfficials/PublicEntity Liability -$100,000 Employment Practices Liability-$100,000 Zoning Claims -$500,000 $49,135.57 $51,776.00 Soutfr Miami THE CITY OF PLEASANT LIVING Amount: Attachments: CITY OF SOUTH MIAMI OFFICE OF THE CITY MANAGER INTER-OFFICE MEMORANDUM The City Manager recommends that the City renew its Workers' Compensation policywith FMIT fora total premium of $214,533.FMIT offers the most competitive rates for Workers'Compensation Insurance. The City continues to receive the company's preferred rating because of the continuing coverage,including a5%credit for itsDrug Free Work Placepolicy and a 2%credit for its Safety Policy. TheCity Manager recommends that the City renew itspolicywith PGIT forits Property,General Liabilityand Automobile Insurance coverage for a total premiumof$425,086.As set forthabove,the PGIT proposal contains the most favorable rates for these lines of coverage. TheCity Manager further recommends that the City renew itspolicywith ACE American Insurance Company for the Public Officials and Employment Practices Liabilitypolicyfora premium of$49,135.57.The ACE package represents a better valuein premium and potential savings in deductibles. The breakdown of the total premium costs for alllines of insurance is set forth below: FMIT Workers'Compensation $214,533 PGIT General Liability,Property &Automobile $385,086 ACE Public Officials and Employment Practices $49,135.57 Total Premium $648,754.57 Proposed Resolution Proposal Package from FMIT Proposal Package from Brown &Brown o Department ofInsuranceandFinancial Services FLORIDA MUNICIPAL INSURANCE TRUST WORKERS'-COMPENSATION AND EMPLOYERS'LIABILITY Proposal for 2014-2015 Cityof South Miami LIMIT OF LIABILITY: Workers'Compensation:Statutory Employers'Liability:$1,000,000 Each Accident $1,000,000 By Disease $1,000,000 Aggregate by Disease Deductible:$0 Total Payroll:$7,823,596 *DrugFree Workplace Credit(5%)Yes 'Safety Credit(2%)Yes Experience Modification 10/1/14 1.02 NET PREMIUM:$214,533 Premium calculation includes 5%Drugfree Credit and 2%Safety Credit -Requires receipt of approved applications. Department of Insurance and Financial Services PROPERTY COVERAGE FLORIDA MUNICIPAL INSURANCE TRUST Proposal for 2014-2015 City of South Miami Real&Personal Property ElectronicDataProcessing: -Equipment: -Software: -Equipment Breakdown: Limit $21,514,166 Included in Contents Included in Contents Included in Contents Coinsurance: Values: Valuation Basis: Coverage Form: Deductibles: Agreed Amount 80% Replacement Cost Special $5,000 Per Occurrence -Real&Personal Property,Other Property NamedStormDeductibleis5%ofthe scheduled Building,Personal Property, Other Property(includingpropertyin the open)and Business Income.The percentages are calculated using the Schedule of Values onfilewithFMIT.The NamedStormdeductibleiscalculatedseparatelyandapplied individually toeach Building,Personal Property,Other Propertyand Business Income.The minimum deductibleis5%ofthe scheduled valueorthe stated Property deductible,whichever isgreater. Business Income waiting period is72 hours. PROPERTY COVERAGE EXTENSIONS: >Excess Flood Coverage $4,500,000 o Flood Zones A&V deductible is excess of NFIP o Other Flood Zones -$100,000 deductible >Terrorism $5,000,000 >Unintentional Errors&Omissions $250,000 >Newly Acquired or Constructed Property $2,000,000 >Newly Acquired Business Personal Property $500,000 >Business Income $500,000 >Extra Expense $1,000,000 >Valuable Papers &Records $500,000 >Signs -Not attached toBuildings $25,000 o Vehicular damage to signs $10,000 Maximum >Accounts Receivable $500,000 >Police Dogs &Horses oDeathinlineofduty $15,000 o Annual Maximum $30,000 >ElectronicData Processing Equipment(Software)$250,000 >Antiques &Objects of Art oPerItem $15,000 oAnnualMaximum $250,000 >OffPremisesPower Failure $100,000 >Pollutant CleanUp&Removal $100,000 >FungusCleanUp&Removal $25,000 >Personal Property OffPremises $250,000 >Personal Property ofOthers $50,000 >Preservation of Property $100,000 >Service Interruption Coverage $100,000 >Property In Transit $250,000 >Recertification of Equipment/Fire Extinguisher Recharge $250/Day >Debris Removal 25%ofLoss >Building OrdinanceCoverage,Including Demolition 25%ofLoss >Miscellaneous Unscheduled Fixtures $25,000/$100,000 >Leasehold interest $100,000 >Arson Reward $5,000 INLAND MARINE COVERAGE: BLANKET INLAND MARINE EQUIPMENT-Items $15,000 or Less Limit:$1,000,000 Deductible:$500 Blanket Inland Marine coverage is defined as:Coverage for all unscheduled Inland Marine equipment,Emergency Portable Equipment and Communications Equipment valued at $15,000 orlessis subject to $500 deductible. (Note:Ail Watercraft mustbescheduled.) Coverage Basis:Actual Cash Value EQUIPMENT BREAKDOWN COVERAGE Subject to any applicable limitsonthe Property,AlliedLines and Crime Declarations,the Equipment Breakdown Limitis the most wewill pay for loss or damage arising from any "one accident." These coverages applytoall locations covered on the policy,unless otherwise specified. I.Coverages Limits Equipment Breakdown Business Income Extra Expense Expediting Expense Hazardous Substances Spoilage Data Restoration "Fungus,"WetRot,DryRotAnd Bacteria Service Interruption* Water Damage II.Deductibles Direct Coverages Indirect Coverages III.Other Conditions Subject to the Real and Personal Property Limit described in proposal or $50,000,000,whichever is less. Subject tothe Business income Limit described in proposal. Subject totheExtra Expense Limit described in proposal. $1,000,000 $500,000 $500,000 $500,000 $25,000 Subject to Business Income, Extra Expense,and Spoilage Limits Includedin Property Coverage. SubjecttotheRealand Personal Propertydeductible described in proposal. SubjecttotheTimeElementdeductibledescribedinproposal. "Unless the interruption exceeds24hours,we will notpayforanylossunderService Interruption. "Covered equipment"does not include "electrical generating equipment";however,this exclusion does not apply to emergency generators. GENERAL LIABILITY COVERAGE Comprehensive General Liability Limits Limit PerOccurrence:$1,000,000 Annual Aggregate:Unlimited Deductible:$0 NOTE:Public Officials E&O/Employment Practices Liability isnot included aspartofthisquote Police Professional Liability Limits Limit PerOccurrence:$1,000,000 Annual Aggregate:Unlimited Deductible:$0 Note:ForMembersthatchooseadeductible -Membersareonlyresponsibleforthedeductibleifa judgment or settlement occurs.Legal expensesare outside the deductible and paid solely bytheTrust for General Liability and /orAutomobile Liability.__ Important Note:Thedeletionofanyoftheabovecoveragesdoesnot automatically reducethe premium.Thesepremiumsare basedonalloftheabovecoverages.Anydeletionsofcoverage will altertheexperience modification factororiginally used and may result ina higher premium. ADDITIONAL BENEFITS: >Defense Costs paidin addition topolicylimits >Premises Operations >Products/Completed Operations >ContractualLiability (Designated Contracts Only) >Owners &Contractors'Protective Liability >Personal InjuryLiability >HostLiquorLiability >IncidentalMedicalMalpractice Liability >Watercraft Liability >FireLegal Liability -Maximum $500,000 inany one Trust Year >BroadFormProperty Damage -Maximum $500,000 inany one Trust Year >Advertising InjuryLiability >Skate FacilityLiability >Extra Contractual Legal Expense -$100,000 Limit o (EEOC,Florida CommissiononHumanRelations,Ethics) >No-fault Sewer Backup Expense -$100,000 Limit >Crisis Intervention >HRHelpline-FullLegal Support andOnline Services >Bert Harris Act/Inverse Condemnation -$300,000 Limit.(Higher limits are available.) oDeductibleis$5,000orthe policy deductible,whicheveris greater. >Cyber Coverages including Privacy,Network Security and Data Breach -$250,000 Annual Aggregate.Claims Made. >Cyber Risk Management Tools Web Site. AUTOMOBILE COVERAGE Limits Comprehensive Automobile Liability $1,000,000 Deductible:$0 Personal Injury Protection $10,000 Deductible:$0 Automobile Physical Damage Comprehensive Coverage $1,000 Deductible Collision Coverage $1,000Deductible Note:"Vehicles with$0 value on schedule provided were not included in the quote for APD.' Coverage Includes: >Hired&Non-OwnedLiability >Rental Reimbursement -scheduled vehicles >Lease Differential -scheduled vehicles >Limited Replacement Cost -ownedprivate passenger vehicles,SUVs,PickupTrucks >Member's Personal Effects Note:ForMembersthat choose adeductible-Membersare only responsible forthedeductibleifa judgment or settlement occurs.Legal expenses areoutsidethedeductibleandpaidsolelybytheTrust forGeneral Liability and/or Automobile Liability. CRIME &BOND COVERAGE Limits Bond Coverage: Employee Theft -Per Loss $100,000 Deductible:$1,000 Faithful Performance -Per Loss $100,000 Deductible:$1,000 Finance Director $100,000 Deductible:$0 Crime Coverage: Computer andFunds Transfer Fraud $100,000 Deductible:$1,000 Coverage Line Real&Personal Property Inland Marine EquipmentBreakdownCoverage Crime&Bond Coverage General Liability Coverage Police Professional Liability Automobile Coverage Total FMIT Premium PREMIUM SUMMARY Annual Premium $125,734 INCLUDED INCLUDED INCLUDED $72,671 $161,536 $82,834 $442,774 Note:Coveragesummaries provided hereinare intended asan outline ofcoverageonlyandare necessarily brief.Intheeventofloss,allterms,conditions,andexclusionsofactualAgreementand/or Policies will apply. INTEREST FREE INSTALLMENT PLAN First Installment Second Installment Third Installment Fourth Installment 25%minimum due 25%minimum due 25%minimum due 25%minimum due October1,2014 January1,2015 April 1,2015 July1,2015 Payment willbeforwardedtotheFlorida League ofCitiesin Tallahassee Insurance Proposal Submitted Especially For: City of South Miami Policy Term: 10/01/14 to 10/01/15 Date of Presentation: 09/15/2014 Presented By: Robert Hollander Executive Vice President Brown &Brown -Miami Division INSURANCE INTRODUCTION Wewouldliketotakethe opportunity tothankyouforallowingustoworkclosely withyouinourefforttodevelopacomprehensiveRiskSolutionProgramforyour business.Brown&Brown,Inc.isthelargestindependentagencyorganizationin Florida and the 6th largest in the US.The company provides a variety of insurance products and services to corporate,institutional,professional and individual clients.Headquartered in Daytona Beachand Tampa,Brown&Brownis publicly traded ontheNew York Stock Exchange (BRO)andhas been included in Forbes' listofthe"200BestSmallCompaniesin America".Thecompanyhandlesclients' premiums in excess of12 Billion annually andhasin excess of 6,500 employees. We have insurance professionals who specialize in evaluating and protecting your personal assets -home,auto,watercraft and life. We also have an experienced employee benefits department who can assist you withgrouphealth,disability,life and dental. While sizeisnotthesole criteria for choosing an insurance agent,it does enable us to offer our clients clout in the marketplace and unmatched service capabilities. Please feel free to visit our website at www.bbinsurance.com This proposal contains onlya general description ofthe coverage(s)and does not constitute apolicyor contract.Please refertoyourpolicyforthe actual termsandconditions.ThisProposalisbasedupontheexposuresmadeknown to this Agency;any changes in these exposures should be reported promptly to Brown &Brown of Florida,Inc. ACCOUNT SERVICING TEAM Robert Hollander Executive Vice President 305-364-7818 rholIander@bbmia.com Nancye Batista,AAI Account Manager 305-364-7816 nbatista@bbmia.com Alexandra Sarria Claims Representative 305-364-7812 asarrial @ bbmia.com Jessica Urbina Account Manager Associate 305-364-7866 jurbina@bbmia.com [INSURANCB 14900 NW 79th Court,Suite 200 Miami Lakes,FL 33016 Telephone:1-800-432-8844,(305)364-7800 or (305)714-4400 Fax:(305)714-4401 TABLE OF CONTENTS I.Marketing Efforts II.Schedule of Named Insureds III.Coverage Sections o Property o Inland Marine o Crime o Commercial General Liability o Law Enforcement o Commercial Automobile oPublicOfficial/EmploymentPracticesLiability IV.Summary V.Illustrations and Definitions SCHEDULE OF NAMED INSUREDS City of South Miami Thislist includes all ofthe named insured's we presently haveonyour policies.Should any revisionstothislistingberequired,please notifyourofficeimmediately. Please Verify the Accuracy of Each Name and Update List,If Needed. PROPOSED PROPERTY COVERAGE Insurer: Preferred Governmental Insurance Trust Not Rated by A.M.Best Location of Premises: Per Schedule Attached Description of Property: BlanketBuilding&ContentsLimit,perattachedschedule $22,673,917 ValuesInsuredareUltimatelyChosenbytheClientInview of thecontinuallychangingcost of constructionandbuildingmaterials,westronglysuggestthatyoureviewyourpropertyvaluesannually. ANY changesintheoccupancy ofaninsuredlocationshouldbereportedtoourofficeimmediately. Clianges inoccupancycanpotentiallyreduceor negate thecoverage afforded by your property policy. Description of Coverages Proposed: Policy Form: Building &Personal Property Coverage Form--Special Causes of Loss: Special Form:ExcludingEarthquake/EarthMovement Coinsurance: Building &Personal Property:N/A Valuation: Replacement Cost 6 PROPOSED PROPERTY COVERAGE Continued Property Extensions of Coverage: Forafull description of terms,definitions and conditions,please refertothe policy documents. Limit Coverage Accounts Receivable Additional Expense Animals Loss of Business Income Debris Removal Demolition,Ordinance and ICC Expediting Expense Fire Department Charges Fungus Cleanup Expense Lawns,Plants,Trees and Shrubs New Locations Personal Property of Employees Pollution Cleanup Expense Preservation of Property Recertification Service Interruption Coverage Transit Errors and Omissions Vehicle Property Coverage $250,000 $100,000 $l,000/$5,000 $500,000 $250,000 $500,000 $55,000 $25,000 $10,000/$20,000 $25,000 $2,000,000 $25,000/$50,000 $25,000/$50,000 $250,000 $10,000 $100,000 $250,000 $250,000 $0 Unit; 001 002 003 004 005 006 007 009 010 SCHEDULE OF COVERED PROPERTY Description Address Roof Shape Auto Inspection Station 5907 S.W.70th Street SOUTH MIAMI,FL 33143 Flat CAA head start center 6125 SW 68 STREET SOUTHMIAMI,a 33143 Flat PuWic Works Office Building 4795 5.W.75th Avenue SOUTH MIAMI,R 33143 Hip Storage/Motor Pool Office 4795 SAV.75th Avenue SOUTHMIAMI,a 33143 Rat Solid Waste Kdg -5BayShop 4795 S.W.75th Avenue SOUTHMIAMI,a 33143 Shed City Garage 4795 S.W.75th Avenue SOUTH MIAMI,a 33143 Flat Citys Repair Shop 4795 S.W.75th Avenue SOUTH MIAMI.FL 33143 Unknown PoliceStorage Bsdg 4795 S.W.75th Avenue SOUTH MIAMI,a 33143 Flat Roof Pitch Rat Rat Low (v 10) Rat Low(<10) Lov/<<10) Unknown Rat DanteB.FascellPark/TennisProShop fe Restroom Bldg 8600 RED ROAD SOUTH MIAMI,a 33143 Flat Dante B.Fascell Park -2 Gazebos 8600 RED ROAD SOUTHMIAMI,a 33143 Rat Pyramid Medium{10to30) Year Built Const Type 1995 111-foHC 1970 119 -JM 1968 119-JM 1994 131-FR 152-IIC 1994 111-MNC 119-JM 1994 119-JM 1967 131-FR 152 -l*C Eff.Date Term Date Building Value Contents Value Total Insured Value RoofCoveringI Covering ReplacedIRoofYr Bit 10/01/2014 10/01/2015 $44,000 SO $44,000 Tar and Gravel 10/01/2014 10/01/2015 S471,200 $5,487 $476,687 Builtuproof w/out gravel! 10/01/2014 10/01/2015 $281,200 $7,318 $2S8.5IE Tar and Gravel 10/01/2014 10/01/2015 $54,000 $0 $54,00<] Built-up Tar &Gravel 10/01/2014 10/01/2015 $185,250 SO $185,250 Tar and Gravel 10/01/2014 10/01/2015 $560,500 $0 $560,500 Tar and Gravel 10/01/2014 10/01/2015 $63,000 $59,267 $122,267 Unknown 10/01/2014 10/01/2015 $18,900 $0 $18,900 Built-ilt-up Tar&Gravel 10/01/2014 10/01/2015 $95,880 $0 $95,880 Built-up Tar a Gravel 10/01/2014 10/01/2015 $65,000 $0 $65,000 Asphalt Shingle SCHEDULE OF COVERED PROPERTY Continued Unit# uescnprion Address rear outre tn.uate |fumoing vatue Total Insured Value Const Type Term Date|Contents Value Roof Shape |Roof Pitch RoofCovering I Covering Replaced 1 Roof Yr Bit 011 DanteB.FascellPark-6 Har TruTennisCourts (S6,500 fewTfEDROAD"" SOUTH MIAMI,a 33143 10/01/2014 $123,50C S123,50C 152-IC 10/01/2015 $0 H/A H/A H/A 012 DanteB.FacsellPark/Playground($6,500Contents 8T00lfEDROAD SOUTH MIAMI,a 33143 10/01/2014 $104,000 $104,000 101 -Frame 10/01/2015 $0 H/A 1 H/A H/A I 013 DanteB.FascellPark-2 Racquetball Courts 8600 REDROAD SOUTHMIAMI,a 33143 10/01/2014 $28,665 $28,665 111-MHC 10/01/2015 $0 H/AIH/A H/A I 014 Dante B.Fascell Park -1 Basketball Court 8600 RED ROAD SOUTH MIAMI,a 33143 10/01/2014 $13,000 S13,OOC 111-MHC 10/01/2015 $0 H/A H/A H/A I 015 Dante B.Fascell -1 Tiki Hut 8600 REDROAD SOUTHMIAMI,a 33143 10/01/2014 $10,000 $10,000 119 -JM 10/01/2015 $0 Unknown Unknown Unknown I 016 DanteB.FascellCommunityStorage 8600 REDROAD SOUTHMIAMI,a 33143 1967 10/01/2014 $63,000 S63,00C 131-FR 10/01/2015 SO Flat Rat Built-up Tar&Gravel 1 1 017 Fuchs ParkPavilion($4550 Contents Included) 6445 SW 81 STREET SOUTH MIAMI,a 33143 1995 10/01/2014 $31,000 $35,55C 101 -Frame 10/01/2015 S4.55G Hip Medium (10to30)Asphalt Shingles I 018 Fuchs Park -Bathroom 6445 SW 81 STREET SOUTHMIAMI,a 33143 10/01/2014 $84,000 S84.00C 119-JM 10/01/2015 $0 Flat 1 Rat Unknown I 019 FuchsParkPlayground&Swing Sets 6445 SW 81 STREET SOUTHMIAMI,a 33143 10/01/2014 $70,769 $70,76$ 119-JM 10/01/2015 $0 H/A H/A H/A 020 PalmerPark-Field Storage Building 6445 5W 81 STREET SOUTHMIAMI,a 33143 1977 10/01/2014 $45,500 S45.50C 152 -HC 10/01/2015 $0 Rat Rat Built-up TarSt Gravel SCHEDULE OF COVERED PROPERTY Continued Unit# Description Year Built Eff.Date Building Value Address Const Type Term Date Contents Value Roof Shape 1 Roof Pitch Roof Covering 1 Covering Replaced 1 Roof Yr Bit 021 PalmerParkFootballStorage Bldg 6701 SW67TH AVE!IUE SOUTHMIAMI,a 33143 1977 10/01/2014 $75,000 $120,730 119 -JM 10/01/2015 $45,730 Flat IRat Built-up Tar ft Gravel 022 Palmer Park Football Storage Room 6701SW67THAVEIIUE SOUTHMIAMI,a 33143 1995 10/01/2014 $33,000 $52,500 119 -JM 10/01/2015 $19,500 Rat j Rat Built-up Tar ft Gravel |1 023 Palmer Park Field House 6100SW67THAVEHUE SOUTH MIAMI,a 33143 1977 10/01/2014 S115,620 5124,767 119-JM 10/01/2015 $9,147 Hip 1 Low(<10)Asphalt Shingle I I 024 Palmer Park Playground 6701SV/67THAVEIIUE SOUTH MIAMI,a 33143 10/01/2014 $26,000 $26,00C 101-Frame 10/01/2015 $0 H/A 1 H/A ll/A 1 025 Palmer Park/1200FTOf5FT High Fence 6701SV/67THAVEHUE SOUTH MIAMI,a 33143 10/01/2014 $13,000 S13.00C 152-HC 10/01/2015 $0 H/AIH/A H/A 1 026 PalmerPark-1000FTOf10FTHighFence 6701SW67THAVEJIUE SOUTH MIAMI,a 33143 10/01/2014 $16,900 $16,90C 152-HC 10/01/2015 $0 H/A |H/A H/A 027 Palmer Park-Restroom Bldg 6701 SW67THAVEHUE SOUTH MIAMI,a 33143 1977 10/01/2014 $84,600 S84.60C 119 -JM 10/01/2015 $0 Flat Rat Built-up Tar ft Gravel 028 PalmerPark-ConcessionBldg 6701 SW 67THAVEIIUE SOUTH MIAMI,a 33143 1977 10/01/2014 $54,000 S54.00C 119-JA1 10/01/2015 $0 Flat |Rat Built-up Tarft Gravel I 029 Office /Police Substation 6900 SW59TH PUCE SOUTH MIAMI,a 33143 2000 10/01/2014 $0 $28,665 119-JM 10/01/2015 $28,665 Flat 1 Rat Built-up Tarft Gravel 1 030 Brewer Park-2 Racquetball Courts 6300 SW56THSTREET SOUTHMIAMI,a 33143 10/01/2014 $28,665 $28.66! 119 -JM 10/01/2015 $0 _ H/A |H/A ll/A I 10 SCHEDULE OF COVERED PROPERTY Continued Unit 8 Description Year Built Eff.Date Building Value Trt Address Const Type Term Date Contents Value Roof Shape |Roof Pitch Roof Covering |Covering Replaced |Roof Yr Bit 031 Brewer Park -1/2 Basketball Court 6300 SW56TH STREET SOUTH MIAMI,a 33143 10/01/2014 $13,00C S13,O0C 119-JM 10/01/2015 $C H/A |H/A I I 032 BrewerPark-PlaygroundandSwingSet 6300 SW56TH STREET SOUTH MIAMI,a 33143 10/01/2014 $34,125 $34,125 152 -HC 10/01/2015 $0 H/A |H/A H/A 033 Brewer Park -2 Tennis Courts 6300 SV/56TH STREET SOUTH MIAMI,a 33143 10/01/2014 $52,000 $52,O0C 119-JM 10/01/2015 SO H/A |11/A H/A 034 Brewer Park-460FTOf10FTHighFence 6300 SV/56TH STREET SOUTHMIAMI,a 33143 10/01/2014 $7,800 $7,80C 152 -HC 10/01/2015 $0 H/A |ll/A tl/A I 035 BrewerPark-360FTOf5FTHighFence 6300 SW56TH STREET SOUTH MIAMI,a 33143 10/01/2014 $3,900 $3,90C 152 -HC 10/01/2015 $0 H/A H/A H/A 036 MurrayPark-2Shade Structures 5800 SW 66 STREET SOUTH MIAMI,FL33143 10/01/2014 $2,000 S2,0DC 119-JM 10/01/2015 $0 H/AIH/A H/A I 037 MurrayPark/Community Center 6701 SW 58PLACE SOUTHMIAMI,a 33143 1985 10/01/2014 $360,000 $360,00(3 111 -MHC 10/01/2015 SO Pyramid |/tedium (10 to 30)Metal I 038 Hope Butler Activity Center 6701 SW 58 PUCE SOUTH MIAMI,a 33143 1985 10/01/2014 $271,680 $271768C 119-JM 10/01/2015 $0 Pyramid Medium (10to30)Metal 1 039 Office/Police Substation 5975 SUHSET DRIVE SOUTHMIAMI,a 33143 10/01/2014 $0 $32}50C 119 -JM 10/01/2015 $32,500 Unknown I Unknown Unknown I 040 City Hall/Police 6130 SUHSET DRIVE SOUTH MIAMI,a 33143 1956 10/01/2014 $3,839,900 $4,235,372 119 -JM 10/01/2015 $395,472 Flat Flat Built-up Tar &Gravel 2005 11 SCHEDULE OF COVERED PROPERTY Continued Unit * Description Year Built Eff.Date .Building Value Address Const Type Term Date Contents Value Roof Shape 1 Roof Pitch Roof Covering I Covering Replaced 1 RoofYr Bit 041 Silva MartinBldg 6130 SUHSETDRIVE SOUTH MIAMI,a 33143 1935 10/01/2014 S420,18C 5476.88* 119-JM 10/01/2015 $56,706 Hip Medium(10to30)AsphaltShingle 2000 1 042 SouthMiami Comm Center /Gym 5800 SW 66 STREET SOUTHMIAMI,a 33143 2003 10/01/2014 $3,218,560 $3,608,56C 111 -MIIC 10/01/2015 S39O,O00 Flat Flat Built-up Tar ft Gravel 2003 043 Jean Willis Park /Gazebo 7220 SV/61ST COURT SOUTH MIAMI,a 33143 10/01/2014 $19,500 $19,500 101•Frame 10/01/2015 $0 Pyramid I Medium (10to 30)Asphalt Shingle 044 Marhsall Williamson Park /Gazebo 6121 SW 68 STREET SOUTH MIAMI,a 33143 10/01/2014 S65,000 $65,000 152 -HC 10/01/2015 $0 Pyramid 1 Unknown AsphaltShingle 1 045 •Marshal WilliamsonPark/PlaygioundandSwingSet 6121 SW 68 STREET SOUTH MIAMI,a 33143 10/01/2014 $32,500 S32.50C 152 •IK. 10/01/2015 SO H/A 1 ll/A H/AI 046 Marshal Williamson Park /3 Benches 6121SW68STREET SOUTH MIAMI,a 33143 10/01/2014 $1,170 $1,170 152 -HC 10/01/2015 so H/A ll/A H/A 1 047 Marshall Williamson Park -2 Tennis Courts 6121 SW68STREET SOUTH MIAMI,a 33143 10/01/2014 $52,000 $52,00C 111 -MHC 10/01/2015 $0 H/A H/A H/A 049 All America Park /3 Picnic Tables 6820SV/64AVBIUE SOUTH MIAMI,a 33143 10/01/2014 $7,000 $7,000 152-HC 10/01/2015 so H/A H/A ll/A 1 050 GirlScout Property 6609 SW 60 STREET SOUTH MIAMI,FL 33143 1965 10/01/2014 $234,060 $234,060 J19 -JM 10/01/2015 $0 Hip 1 Medium (10 to 30)Asphalt Shingle 1 051 Parking Garage 5829 5.W.73 Street SOUTH MIAMI,a 33143 2000 10/01/2014 $8,435,520 $8,435,520 131-FR 10/01/2015 $0 Flat |Rat Concrete Tile 1 12 052 054 055 056 057 058 059 060 061 SCHEDULE OF COVERED PROPERTY Continued Description Address Roof Shape Dison Park •Picnic Table SW58THAVEaSW80ST SOUTHMIAMI,a 33143 H/A Dison Park -Gazebo SW58THAV£aSW80ST SOUTHMIAMI,a 33143 Roof Pitch H/A Pyramid Medium{10to30) Marshall Williamson Park/4 Picnic Tables 6121 SW 68 STREET SouthMiami,FL 33143 H/A POLICE SUB STATIOH 6726 SW59 PUCE SOUTH MIAMI,a 33143 Flat ll/A Rat BUS SHELTER HSIDEOFSUHSETDRftAPPROXSW 60 AVE SOUTH MIAMI,a 33143 Unknown Unknown BUSSHELTER 11SIDEOFSUIiSETDR APPROX 100FTWOF5W67AVE SOUTHMIAMI,a 33143 Unknown Unknown BUSSHELTER SSIDEOFSUIISET DRAPPROX100FTEOFSW67AVE SOUTHMIAMI,a 33143 Unknown Unknown BUS SHELTER S SIDE OFSUI ISET DRg S MIAMI CITY HALL SITE (6130 SOUTHMIAMI,a 33143 Unknown Unknown BUS SHELTER £SIDEOF SW 62AVEftAPPROXSW67ST SOUTH MIAMI,.a 33143 Unknown Unknown MurrayParkPool,SplashPool,Restroom 6121 S.W.68th Street South Miami,FL 33143 Flat Year Built Const Type 152 -HC 152-HC 152-HC 1980 119-JM 152 -IK 152-IK 152-HC 152 •HC 152-HC 2014 119-JM 13 Eff.Date Term Date Building Value Contents Value Total Insured Value Roof Covering Covering Replaced Roof Yr Bit 10/01/2014 10/01/2015 $2,000 $0 $2,000 H/A 10/01/2014 10/01/2015 $25,000 SO $25,00C AsphaltShingle 10/01/2014 10/01/2015 S3,I20 $0 $3,120 H/A 10/01/2014 10/01/2015 SO $26,000 $26,000 Tar and Gravel 10/01/2014 10/01/2015 $50,000 S50,00C Unknown 10/01/2014 10/01/2015 $50,000 $0 $50,00C Unknown 10/01/2014 10/01/2015 $50,000 $0 $50,000 Unknown 10/01/2014 10/01/2015 $50,000 50 S50,00C Unknown 10/01/2014 10/01/2015 $50,000 $0 $50,00C Unknown 10/01/2014 10/01/2015 $1,384,411 $0 $1,384,411 2014 Total:$21,593,575 $1,080,342 $22,673,917 PROPOSED PROPERTY COVERAGE Continued... Deductible: All Other Perils:$2,500Per Occurrence -Building&Contentsand Extensions of Coverage Named Windstorm:5%PerOccurrence-Subjectto$15,000Minimum Flood:$2,500PerFloodexceptzonesA,Vexcessof NFBP,whether purchased ornot Coverage Enhancements: Boiler &Machinery $22,673,917 Flood-PerOccurrenceandAggregate $1,000,000 NOTE:Detached walls,fences,radio and TV antennas,trees,shrubs,plants free-standing property improvements suchas athletic equipment,windscreens,lightpoles,satellite dishes orsignsare notcoveredunlessspecificallyscheduledonthepolicy. Property and Extensions of Coverage include,but are not limited to the following exclusions: •Earthquake/Earth Movement •Terrorism •Electronic Data •Electronic Date Recognition •Asbestos •Pollution •Fungus •War,Nuclear •OrdinanceorLaw-LimitedperExtensionsofCoverage Note:The PGIT property program isa shared limit.The limits purchased areaper occurrence limitandintheeventan occurrence exhausts thelimit purchased byPGITonbehalfofthe members,paymenttoyoufora covered losswillbe reduced pro-rata basedonthe amounts of coveredlossbyallmembersaffectedbytheoccurrence. 14 WINDSTORM &HAIL DEDUCTIBLE SAMPLE ILLUSTRATION FLAT DEDUCTIBLE vs.PERCENTAGE Windstorm and Hail Deductible This deductible would applytoaclaimfor damage caused by windstorm. Building Replacement Cost FlatDed.2%Ded.3%Ded.5%Ded. Bldg #1 -$1,000,000 $5,000 $20,000 $30,000 $50,000 Bldg #2-$2,000,000 $5,000 $40,000 $60,000 $100,000 Bldg #3-$3,000,000 $5,000 $60,000 $90,000 $150,000 Bldg #4-$4,000,000 $5,000 $80,000 $120,000 $200,000 TOTALS: Value -$10,000,000 $20,000 $200,000 $300,000 $500,000 Percentage wind deductibles are calculated asa percentage ofthe total replacement value. Thedeductibleforallotherperils applies toan"occurrence",notperbuilding. 15 SCHEDULE OF COVERED PROPERTY PROPOSED INLAND MARINE COVERAGE Insurer: Preferred Governmental Insurance Trust Not Rated by A.M.Best Description of Property:Values of Insurance: Parking Meter Equipment $417,896.00 Causes of Loss: SpecialForm:ExcludingFloodandEarthquake Loss of Use coverage is not automatically included Valuation: Actual Cash Value Deductible: $1,000 Exclusions Include But Are Not Limited To: Hood Earthquake/Earth Movement Terrorism Biological or Chemical Materials Electronic Data Electronic Date Recognition Asbestos 16 PROPOSED CRIME COVERAGE Insurer: Preferred Governmental Insurance Trust NotRatedbyA.M.Best Type of Policy: Combination Crime Limits of Coverage: EmployeeDishonesty Incl.FaithfulPerformance$100,000 Per Loss Covers lossof money,securities andother property byemployee dishonesty atall premises of the insured. ForgeryorAlteration $100,000 Covers lossbyforgeryor alteration of checks,drafts,and promissory notes(exceptbyanemployee)thataremadeordrawnbytheinsuredor his agent. ComputerFraudIncludingFundsTransferFraud$100,000 Coversagainsttheftof money,securities,orpropertybyusinga computertotransfercoveredpropertyfromtheinsured'spremisesor banktoanotherpersonorplace.Nocoverageisprovidedfortheftof informationorfor computer vandalism. Other Coverages Available: C.Theft,Disappearance andDestruction D.RobberyandSafe Burglary E.Premises Burglary G.Extortion H.Premises Theft and Robbery Outside I.Lessees of Safe Deposit Boxes J.Securities Deposited withOthers Deductibles: Employee Dishonesty $1,000 Forgery or Alteration $1,000 Computer Fraud $1,000 17 PROPOSED GENERAL LIABILITY COVERAGE Insurer: Preferred Governmental Insurance Trust NotRatedByA.M.Best Type of Form: CommercialGeneral Liability -Occurrence Form Limits of Liability: BodilyInjury&Property Damage $1,000,000 Each Occurrence Liability N/A General Aggregate Included Products &Completed Operations Aggregate PersonalInjury&Advertising Included Any One Personor Injury Organization DamagetoPremises Included Any One Fire Leased/Rented to You BodilyInjuryand Property N/A Per Occurrence Damage Deductible HigherLiability Limits may be Available Upon Request Exposure Basis: Class Basis Amount Municipality Payroll $4,058,046 Be sure toget Certificates of Insurance with "Adequate"Limits and Coverage from Subcontractors,to avoid being charged as though Subcontractors were your Employees. Coverage Enhancements: Herbicide&Pesticide-$1,000,000AggregateLimit Exclusions include but are not limited to: •Pollution •Asbestos •Mold •Fungus,Bacteria •Lead •Nuclear •Medical Payments •NoFaultSewerBack-Up •Liquor Liability •CopyrightorPatentInfringement 18 PROPOSED EMPLOYEE BENEFITS LIABILITY COVERAGE Insurer: Preferred Governmental Insurance Trust NotRatedbyA.M.Best Coverage Form: Occurrence Limits of Liability: $1,000,000 Per Person N/A Aggregate Deductible: N/A Employee Benefits Liability: Topayonyour behalf allsumswhichyoushallbecomelegallyobligatedto payonaccountofanyclaimmadeagainstyoubyanemployee,former employee,orthebeneficiariesorlegalrepresentativesthereofandcausedby anynegligentact,errororomissionofyours,oranypersonforwhoseactsyou arelegallyliableintheadministrationofyourEmployeeBenefitsProgram. 19 PROPOSED LAW ENFORCEMENT LIABILITY COVERAGE Insurer: Preferred Governmental Insurance Trust Not Rated byA.M.Best Type of Form: Occurrence Limits of Liability: Per Person $1,000,000 Per Occurrence $1,000,000 Aggregate N/A Deductible: N/A Exposure Basis: Class Basis Amount Law Enforcement Number of Officers 50 Full Time 0 Part Time 2 Volunteers 20 PUBLIC OFFICIALS &EMPLOYMENT PRACTICES LIABILITY COVERAGE Insurer: AceAmericanInsuranceCompany Rated A+XVByA.M.Best Co. Type of Form: Claims Made ExtendedReportingPeriod:12 monthsfor 100%oflastannualpremium Limits of Liability: EachClaim $1,000,000 Aggregate $1,000,000 DefenseCostsare Within Limit of Liability -Cappedat$1,000,000 Deductible: $100,000 Public Officials Liability -Public Entity Liability-1A2and IB $150,000 EachEmploymentPractices Violation -1C $250,000 Retention applies toallZoning Claims Exclusions Include But Are Not Limited To: NetworkSecurityorPrivacyLiabilityExclusion Bond Exclusion False Claims Act Exclusion ^Specimen policyincludingexclusionsandconditionsdeliveredwithproposal 21 PROPOSED COMMERCIAL AUTOMOBILE COVERAGE Insurer: Preferred Governmental Insurance Trust NotRatedByA.M.Best Limits of Liability: BodilyInjury&Property Damage Liability $1,000,000 CombinedSingle Limit Liability Coverage Provided For:Symbol#:1 Any Auto PersonalInjuryProtection $10,000EachPerson-Symbol #:5 (Florida No-Fault)Owned Auto Subject toNo Fault MedicalPayments $NotEachPerson-Symbol Included Uninsured Motorists Non-Stacked $Not Per Accident Included PhysicalDamage:Per Scheduled Vehicles Collision $1,000 Deductible Comprehensive $1,000 Deductible PhysicalDamageCoverage Provided For:Symbol #:7&8 Scheduled Autos Only and Hired All Newor Replacement Vehicles Must Be Autos Only Reported Immediately soasto avoid any possible gapin coverage HigherLimits ofLiabilityMayBeAvailableUponRequest Description of Vehicles: Please See Attached Schedule of Automobiles -144 Total Units Coverage Enhancements: •Hired Auto Liability •Non-Owned Auto Liability •Hired Physical Damage Limit:$75,000 Subject todeductible NOTE:Thevehicleslistedonthispolicymustbeownedby,titledtoorleasedtotheNamedInsured. 22 VEHICLE SCHEDULE Unit#Make Model/Description Department ALEff Comp Ded Comp Eff Term Value ••; Qty Year VIN#Vehicle Type AL Term Coll Ded CollEff Coll Twm valuation Type APD Rptd 001 STMCLNRTRLR 10/01/14 :v.;h"na'••;••.•.:$0 1 1987 1287 Trailer -NO 10*01/15 NA N/A| 001 DUMP TRUCK 10/01/14 $1,000 ;10701/14.10701/15 525,000 1 1993 3377 Heavy Track 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|$25,00( 002 RECYCLE TRUCK 10/01/14 -$1,000 10/01/14 3001/15 ^$31,000 1 1990 7192 Heavy Truck 10l01ft5 $1,000 10701/14 10/01/15 Actual Cash)S3l,00( 002 BUCKET TRUCK 10/01/14 ••^NA.-^::in;':-:i':vS :•-:-.••••.•••••.•.•••$0 1 1990 411 Heavy Truck 10/01/15 NA N/A| 003 TRUCK 10/01/14 HOQO 10/01714 10/01/15 $39,000 1 2001 1520 Heavy Truck 10/01/15 $1,000 1G/D1/14 10/01/15 Actual Cash]$39.00( 004 PICKUP 10/01/14 •$1,000 a :icfl)i/i4 10/01/15 S19.0OO 1 2001 3262 LightTruck 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash!S19.00C 005 Volvo WXR64 10/01/14 .v!$ii00D=:-10701/14-10/01/15 ::$35,000 1 2003 4V2EC6UE93N34S46S Garbage Truck 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash)S35,00( 006 TRASH TRUCK 10/01/14 :;^1;QO)•{10/01/14;10/01/15 •S32.000 1 2005 7533 Garbage Truck 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|$32.00( 007 TRASH CRANE 10/01/14 j;$1,000 ><10/01/14 10701/15 ;$32,000 1 2004 662 Garbage Truck 10/01/15 $1,000 10701/14 10/01/15 Actual Cash]S32.00C 008 F450 BUCKETTRUCK 10/01/14 $1,000 10701/14 -10/01/15 ;•:•'•'•'.:••$26,000 1 2004 6749 Heavy Truck 10/01/15 $1,000 10701/14 10/01/15 Actual Cash|$26,00£ 009 TRAILER 10/01/14 $1,000 10701/14 -10/01/15 xv:^;-:n---;->-::>/••••.:;'-sio,qoo 1 2004 1773 Trailer -NO 10/01/15 $1,000 10701/14 10/01/15 Actual Cash]SIO.OQt 009 CROWN VICTORIA POLICE 10/01/14 :'=u\iiNA-:/>:;::0m$&;&:-i^^$0 1 1997 8963 Police Car 10/01/15 NA N/A| 010 3WHLCYCLE 10/01/14 :st^HXj ;•10701/14 10701/15 •;:-:;^:>^^::-iS7.500 1 2004 4182 ExtraLight Service 10/01/15 $1,000 10/01/14 10/01/15 Actual Cashl $7,50{ 011 GARBAGE TRUCK Non Police 10/01/14 ::$i,ooo :-.10/01/14 10/01/15.;:$35,000 1 2004 5VCEC6LF24H200G02 Garbage Truck 10/01/15 $1,000 10701/14 10/01/15 Actual Cashf $35,00( 012 CROWN VICTORIA POLICE 10/01/14 $1,000 10701/14^li0ffM/tS..'•••••)'•:•••::••:.\;:319,322 1 2005 9240 Police Car 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|S19.3Z 012 SWEEPER 10/01/14 •;NA :.:••v;-h:-::;\;:;;';;:us:.'m$o t 1997 2272 Heavy Truck 10/01/15 NA M/A| 013 RANGER PICKUP 1G/QV14 ^:NA '.••-•:?;:•••?-i;^:^::?:^;.-$o 1 1997 483 LightTruck 10701/15 NA N/A| 013 CROWN VICTORIA POLICE 10/01/14 ^1,000 1GV01/14 10701/15 ::.'C^^V:':;;:;^519,322 1 2005 9247 Police Car 10/01/15 $1,000 10701/14 10/01/15 Actual Cash|S19.32: 014 PICKUP 10/01/14 ^':-:«;NA.':}:.-::--':.^^^:k:•.•:':-SO 1 1998 5084 Light Truck 10/01/15 NA N/A| 014 CROWN VICTORIA POLICE 10/01/14 :$i,ooo :10701/14 10/01/15 .-;-;:v;;:r:-:v;-V:-$19,322 1 2005 9249 Police Car 10/01/15 $1,000 10701/14 10/01/15 Actual Cashl $19,32: 015 CROWN VICTORIA POLICE 10701/14 :;NA k\-\-:\--w;-:-\-:-::^ri:W 1 1993 7544 Police Car 10-01/15 NA N/A| 23 VEHICLE SCHEDULE Continued Unit#Make Model/Description Department ALEff Comp Ded Comp Eff Term Value Qty Year V1N#Vehicle Type AL Term Coll Ded Coll Eff Coll Tprm Valuation La-TaY££_M APD Rptd 015 CROWN VICTORIA POLICE 10/01/14 :>$1,000:-10701/14 10701/15 $19,322 1 2005 9250 Police Car fQ'Ot/15 $1,000 10/01/14 10/01/15 Aclual Cash|$19,32: 01 a CROWN VICTORIA POLICE 10/01/14 :^S1;000'^10/01/14 10/01/15 '--.••••,"=•.;::;,.:::..:.$19,322 i 2005 9252 Police Car 10/01/15 $1,000 10/01/14 10/01/15 Aclual CashJ $19,32: 016 CROWN VICTORIA POLICE 10/01/14 vO::-:NAv3:;:V.:-:•.•;•-.;-•,;;•;;•••=$o 1 1998 7545 Police Car 10/01/15 NA N/A| 017 CROWN VICTORIA POLICE 10701/14 :aJ$1*JpQ;l;-;10701/14 10701/15 :-r---.:-..-:-.i'"\^$19,322 1 2005 9253 Police Car 10/01/15 $1,000 10701/14 10/01/15 Actual Cashl $19,32: 017 CROWN VICTORIA POLICE 10/01/14 K:NA;-^i;'K?X^'-'.:^-;r-.-.;;•;,•;:•-,••:$o 1 1998 7547 Police Car 10/01/15 NA N/A| 018 F250 PICKUP POLICE 10/01/14 ^$1,000^:10/01/14 10/Q1/15.:;-••••••O-.,$23,000 t 2005 8300 Police Car 10/01/15 $1,000 107*01/14 10/01/15 Actual Cashl S23.G0C 019 EXPEDITION 10/01/14 •^$1,000^10/01/14 i0&t/15 •-$22,500 1 2005 8547 LightTruck 10/01/15 $1,000 10701/14 10/01/15 Actual Cash|S22.50C 020 TRASH TRUCK 10/01/14 •8$*.€QD:A 10701/14 10/01/15 •:vV;^-;;:;:.:r.$47.Q00 1 2007 7296 Garbage Truck 10/01/15 $1,000 10701/14 10701/15 Actual Cash|S47,00C 020 F250 PICKUP 10701/14 W-N/V;^•:^\^^--c:::,--/:-'$0 1 1999 1506 LightTruck 10/01/15 NA N/A| 021 F150 PICKUP 10701/14 '^;:NAi;^:-B^w;f ^--::v$o 1 1999 1507 LightTruck 10/01/15 NA N/A| 021 TRASH CRANE 10/01/14 :$isooo i:10/01/14 10701/15 ^:-^"A[/::.-.^--:&$<a0Q 1 2006 8936 Garbage Truck 10/01/15 $1,000 10/01/14 10/01/15 Actual Cashl $4S,00C 022 RANGER PICKUP 10/01/14 V-$i,ooo 10/01/14;10/01/15 $21,500 1 2006 8007 LightTruck 10701/15 $1,000 10701/14 10701/15 Actual Cash|$21,50C 022 CROWN VICTORIA POUCE 10/01/14 ^mky^:::•.:i::'-:-:::.-::v.'---:.'-.-:-S0 1 1999 2389 Police Car 10/01/15 NA N/A| 023 CROWN VICTORIA POUCE 1G/01/14 wn*~::i-i:-.-..v.-^w ••••:••$0 1 1999 2390 PoaceCar 10/01/15 NA N/A| 023 CROWN VICTORIA POLICE 10/01/14 $1,000 -10/01/14 10701/15 •::;::\:-^\^$22,000 1 2006 3762 Police Car 10701/15 $1,000 10/01/14 10/01/15 Actual Cash|S22.O0C 024 CROWN VICTORIA POUCE 10701/14 $1,000 10/01/14 10701/15 ^2,000 1 2000 3763 PoftceCar tQ/01/15 $1,000 10/01/14 10/01/15 Actual Cashl $22,00( 024 CROWN VICTORIA POLICE 10/01/14 :NA ••"•••'^';V:.:,:::=.:-;-$0 1 1999 2394 Police Car 10/01/15 NA N/A| 025 CROWN VICTORIA POLICE 10/01/14 $1,000 10701/14 10/01/15 $22,000 1 2006 3764 Police Car 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|$22,0QC 025 CROWN VICTORIA POLICE 10701/14 '•:•NA •'--.^':'-:!$0 1 1999 2395 Police Car 10/01/15 NA N/A| 026 CROWN VICTORIA POLICE 10701/14 $1,000 10/01/14 10/01/15 $22,000 1 2006 3761 Police C3r 10/01/15 $1,000 10701/14 10/01/15 Actual Cashl S22.00C 027 CROWN VICTORIA POLICE 10/01/14 $1,000 10/01/14 10/01/15 $22,000 1 2006 3760 Police Car 10/01/15 $1,000 10/01/14 10701/15 Actual Cash|$22t0Q( 24 VEHICLE SCHEDULE Continued Unit#Make Model/Description Department ALEff Comp Ded Cprnp.Eff Term:1 Value| Qty Year VIN#Vehicle Type AL Term Coll Ded Coll Eff Coll iTf"Tff j valuation 1 Tyrc APDRptd 027 EC015 PASS VAN 10701/14 NA -V:;;e-;v-r;-:$0 1 1999 6489 Bus <20 Pass.No 10701/15 NA N/A| 028 CROWN VICTORIA POLICE 10/01/14 •$itooo ,••;10701714 10701/15 --v:-\.v-:V;o:a>v-:iv.:-:;"522.oqo 1 2006 3759 Police Car 10/01/15 $1,000 10701/14 10/01/15 Aclual Cash|S22.0EK 029 CROWN VICTORIA POUCE 10/01/14 :;$1,0Q0,--.10701/14;10701/15 ;r-::.$i-MS:^-$22,000 1 2006 3758 Pofice Car 10/01/15 51,000 10701/14 10/01/15 Actual Cash|$22,00( 030 CROWN VICTORIA POLICE 10/01/14 V $1,000:c :ic/qi/i4j 10701/15 ;::•}:,-:;i::M;r';.v;;$22,000 1 2006 3757 Police Car 10/01/15 $1,000 10701/14 10/01/15 Actual Cash|S22.00C 031 RANGER PICKUP 10/01/14 .'••.51.000:::.VlO/pt/14;10/01/15;:>V;V:::V:-;vvr-519,800 1 2007 9505 LightTruck 10701/15 $1,000 10701/14 10/01/15 Actual Cash|S19,80C 032 CREW CAB TRUCK 10/01/14 :$1.00Q^10701/14:10/01/15 C"'-.-^-.::;r^::..-.$22,000 1 2007 1FFA'W30P17EA4733 LightTruck 10701/15 $1,000 10/01/14 10701/15 Actual Cash]$22,G0( 033 F250 PICKUP 10/01/14 -•;nao-:::-{;A;i::^;•;i-;:>;-::v;»t^--'•••••$c 1 2001 1259 LightTruck 10/01/15 NA N/A| 033 CROWN VICTORIA POUCE 10/01/14 ;:$.i,poo.•>;10fl)i/l4-io/pi/15->-.!•:.•$25,000 1 2007 4579 Police Car 10701/15 $1,000 10701/14 10/01/15 Actual Cash)$25,00C 034 TRASH TRUCK 10701/14 $1,000.v Vl07p1/1^;10701/15 S:->:"--f-V:-!-.(!r*.:-.=v!;'.V.545.CI0O 1 2007 5792 Garbage Truck 10/01/15 $1,000 10701/14 10/01/15 Actual Cash)S45.G0S 035 E-450 PASS VAN 10701/14 V:$tobo -.;1C7bi/l4t ;10/0i/15 ::^^a;::^;^:;:^$26jdoo 1 2007 6867 Medium Truck 10/01/15 51,000 10/01/14 10/01/15 Actual Cash|$26,00( 036 F250 4X2 TRUCK 10/01/14 v^i/joo.:•'•10/01/14 10701/15 ::v:k;v=7^:;\:\::;;v;$3'otipno 1 2008 8133 Ugh!Truck 10701/15 $1,000 10/01/14 10/01/15 Actual Cash|$30.00* 037 CROWN VICTORIA POUCE 10/01/14 i^qqo;^•10/01/14 10/01/15 $25,000 1 2007 260 Police Car 10/01/15 $1,000 10701/14 10/01/15 Actual Cash|$25v00£ 038 PICKUP 10/01/14 •:i!-':NAM-;V*£;i&}&&:-:'::;"J'-'::.'':.-'--v--:$0 1 2001 3263 UghtTruck 10/01/15 NA N/A| 038 CROWN VICTORIA POLICE 10/01/14 51.000 10701/14-;io/pi/i5 ^:^U^U^>;V$25,000 1 2007 261 Police Car 10/01/15 $1,000 10*01/14 10/01/15 Actual Cash)S25,O0C 039 CROWN VICTORIA POLICE 10/01/14 :$1,000 10/01/14:10/01/15 •^'•"^:;n^;::^:'525,ooo 1 2007 262 Police Car 10/01/15 $1,000 10701/14 10/01/15 Actual Cash|$25,00( 039 S-10 10/01/14 Vr;lm-:-••••;-^--.r:::-=-S!$fl 1 1994 S4S7 Ught Truck 10/01/15 NA N/A| 040 CROWN VICTORIA POUCE 10/01/14 ^51,000::10701/14 10/01/15 $25,000 1 2007 263 Police Car 10/01/15 51,000 10/01/14 10/01/15 Actual Cash|S25.00C 040 EXCURSION 10/01/14 ^nvv-;.••v-v:?::v .•:•::.:^-;;$p 1 2001 7437 Ught Truck 10/01/15 NA N/A| 041 CROWN VICTORIA POLICE 10/01/14 •:JMm--:.:".--;V>h;••:.:'"..'^S0 1 2001 3403 Police Car 10/01/15 NA N/A| 041 CROWN VICTORIA POUCE 1Q'G1/14 S1.DQ0 10701/14 10/01/15 -:S25.000 1 2007 264 Police Car 10701/15 51,000 10/01/14 10/01/15 Actual Cash]S25.00C 042 CROWN VICTORIA POLICE 10/01/14 $1,000 10701/14 10/01/15 $25,000 1 2007 1644 Posice Car 10/01/15 51.000 1C/01/14 10/01/15 Actual Cash|S25.0OC 25 VEHICLE SCHEDULE Continued Unit*Make Model/Description Department ALEff Comp Ded Comp Eff Term |Value -=.h:;': Qty Year VIN#Vehicle Type AL Term Coll Ded Coll Eff Coll Term valuation ,..TYf?e APD Rptd 042 crown Victoria POLICE 10/01/14 NA 'T ••"'::oh 1,=,..:,..•h50 1 2001 3404 Police Car 10/01/15 NA N/A| 043 F450 SUPER PICKUP 10/01/14 51.000 ^10701/14 10/01/15 V -::540.000 1 2007 7463 Medium Truck 10/01/15 $1,000 10/01/14 10/01/15 Actual CasnT S40,00( 044 CROWN VICTORIA POLICE 10/01/14 NA >"•••ft::h;-;-:^|^;-.:.h :-;•••-^o 1 2001 3408 Police Car 10/01/15 NA |N/A| 044 E-350VAN 10/01/14 :$1,000^:10^)1/14;10701/15 >:••-;:'.•'•'•'$28,000 1 2003 9179 LightTruck 10/01/15 $1,000 10701/14 io/oi/t5 Actual Cashl S28.00C 045 F250 PICKUP 10/01/14 :$1,000:.;!10701/14 10/01/15 ••-:•$24,000 1 2003 4733 Ughi Truck 10701/15 $1,000 10/01/14 10701/15 Actual Casn|S24,(XK 045 F250 PICKUP POLICE 10/01/14 •:--"-NA;;:.:•::-?-::r>:-•••.r-r.-*-.••,^.>::v$0 1 2001 8077 Police Car 10701/15 NA N/A| 046 TRASH TRUCK 10/01/14 :•$1,000^iomim 10^01/15 $45,000 1 2009 6166 Garbage Truck 1&'01/15 51,000 10/01/14 10/01/15 Actual Cash|S45.00C 046 PICKUP 10/01/14 ^NA'r:;?•!l:'=-S"0 •:'•:'.•:••"•Vsv".%:-:>'i0 1 1997 7334 Light Truck 10/01/15 NA N/A| 047 PICKUP 10/01/14 $1,000 :10/01/14 10701/15 :;S22.000 1 2008 4732 LightTruck 10/01/15 51,000 10701/14 10/01/15 Aclual Cash|$22>00( 048 E350VAN 10/01/14 :v./na;;;-.':V^::-[:r--ii.:i-'•';-';50 1 1991 153 Ugh*Truck 10/01/15 NA N/A| 048 WATER TRUCK 10701/14 •.•;V;;§i,qpp.::";10701/14 10/01/15 ^vhv^i/^h--531,000 1 2008 6415 Heavy Truck 10/01/15 $1,000 10/01/14 10/01/15 Actual Cashl S31,00C 049 15 PASS VAN 10/01/14 ?:^$1j&Q(teV'10/01/14 10/01/15 ••>:--^:-h:i':;::-:J$25,0PP 1 2008 6821 Bus <20 Pass.No 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|$25,00( 050 15 PASS VAN 1Q?01/!4 $1,000 n 1^01/14:10701/15 $25,000 1 2008 6820 Bus <20 Pass,No 10701/15 $1,000 10/01/14 10/01/15 Aclual Cash|$25,0CK 051 EXPEDITION 10/01/14 .si,ooo ;^10/01/14;10701/15;;h :525.000 1 2008 6696 LightTruck 10/01/15 51,000 10701/14 10/01/15 Actual Cash|S25.00C 052 15 PASS VAN 10/01/14 51,000 lO/OlW :10701/15 h:h:-::h-:-.::hh:§25,000 1 20G9 9530 Bus <2Q Pass,No 10/01/15 51.000 10701/14 10701/15 Aclual Cashl $25>S0( 053 CROWN VICTORIA POLICE 10701/14 :$1,000 10/01/14:10/01/15 $27,000 1 2009 1415 Police Car 10/01/15 S1.000 10/01/14 10701/15 Actual Cashl $27,0Q{ 054 CROWN VICTORIA POLICE 10/01/14 ;51,000 10701/14 10701/15 ;;527,000 1 2009 1416 Police Car 10701/15 $1,000 10/01/14 10/01/15 Actual Cashl S27,00( 055 CROWN VICTORIA POLICE 10/01/14 51,000 .10/01/14 10/01/15 527.000 1 2009 1417 Poiice Car 10/01/15 $1,000 10/01/14 10/01/15 Aclual Cash|527.00C 056 DUMP TRUCK 10/01/14 51,000 10/01/14 10/01/15 533.000 1 2010 7808 Heavy Truck 10/01/15 51.000 10/01/14 10/01/15 Actual Cashl $33,00* 057 F250 10/01/14 51.000 10/01/14 10/01/15 525.000 1 2009 1331 LightTruck 10701/15 $1,000 10701/14 10701/15 Actual C3Sh|S25.00C 058 GARBAGE TRUCK 10/01/14 .S1.000 10/01714 10/01/15 540.000 1 2009 9492 Garbage Truck 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|540.00* 26 VEHICLE SCHEDULE Continued Unit*Make Model/Description Department ALEff Comp Ded Comp Eff Term \•v \>Value v:;;>; Qty Year VIN#Vehicle Type AL Term Coll Ded Colt Eff Coll Term |valuation APD Rptcl 059 Ford CrownVictoriaPolice Interceptors 10/01/14 51,000 :10701/14 10701/15 :525,340 1 2010 1FABP7BV2AX141487 Pofice Car 10/01/15 51000 10701/14 10701/15 Actual Cash|S25.34C 060 Ford CrownVictoriaPoliceInterceptor 10/01/14 51.000 •-iO70i/14:10701/15 :•:525.340 1 2010 2FABP7BV4AX141491 Police Car 10/01/15 $1,000 10701/14 10701/15 Actual Cash)525,34* 061 Ford CrownVictoriaPolice Interceptor 10701/14 :$itooo •••:.iww.t<R-10/01/15 '•••'••-••••••.y.--::.:525,340 1 2010 2FABP7BV4AX141488 Police Car 10701/15 51,000 10/01/14 10/01/15 Aclual Cash|525.34C 062 Ford CrownVictoriaPolice interceptor 10701/14 $1,000-:;ioVoi/i4 10/01/15 •;-\'••<V ,S 525,340 1 2010 2FABP7BV6AX141489 PoSceCar 10/01/15 S1,000 10701/14 10701/15 Actual Cash)S25.34C 063 Ford CrownVictoriaPolice interceptor 10701/14 '•^,PQQ:vr 10701/14 10/01/15 •^•:.---\--V"f525,340 1 2010 2FABP7BV2AX141490 Police Car 10/01/15 $1,000 10701/14 10/01/15 Actual Cash|S25,34( 064 Ford CrownVictoriaPolice Interceptor 10/01/14 >>si,ooo;:i ,10*01/14 10701/15:••^i--C-;:-:::.'?>525,340 1 2010 2FABP7BV6AX141492 Police Car 10/01/15 51.000 107O1/14 10/01/15 Actual Cash|525.34C 065 Ford CrownVictoriaPoliceInterceptor 10701/14 ?;:si^po:K;:l0/qi/l4 10/01/15 •^•^'•:-;\::^+&sffli 1 2010 2FABP7BV8AX141493 Police Car 10701/15 51.000 10/01/14 10/01/15 Actual Cash|S25,34( 066 Ford Crown Victoifa Police interceptor 10701/14 j^si,ooo;;r 10/01/14 10701/15 r--^;;^-•:>$25^o 1 2010 2FA8P7BV5AX1421813 Police Car 10/01/15 51,000 10701/14 10/01/15 Actual Cash)S25.34C 067 Ford CrownVictoriaPoliceInterceptor 1001/14 ;51,000 10701/14 10/01/15 525,340 1 2010 2FABP7BV0AX14148S Police Car 10/01/15 S1.000 10701/14 10/01/15 Actual Casli|525.34C 068 GEM E2 10/01/14 \5t,000 ••;•:10/01/1$:i|10/pi[/15:':.•*•••-''V-$14,575 1 2011 5ASCPGA42BF055341 ExtraLight Service 10/01/15 51,000 10701/14 10701/15 Actual Cash)S14.57J 059 Ford Crown Victoria 10701/14 $1,000 ;10/01/14 ;io/oi/i5:^•^:.:-:.']V:-v:.531,479 1 2011 2FAB7BV5BX166594 Police Car 10/01/15 51.000 10/01/14 10701/15 Actual Cashl 531,47« 070 Ford Crown Victoria 10/01/14 v.;Si,ooo,.^y 10/01/14:1Q«J1/1§:•:mf:mi[^^mm 1 2011 2FABP7BV7BX166578 Police Car 10/01/15 51.000 10/01/14 10701/15 Actual Cash)531,47< 071 Ford Crown Victoria 10/01/14 •WSllOQOlH:10701/14 10701/15 '=-:-;:'•'•i!-:^:53t;479 1 2011 2FABP73V46X166604 Police Car 10/01/15 S1.000 10701/14 10701/15 Actual Cash|S31,47< 072 Ford Crown Victoria 10/01/14 ;Si.000-19(0.1/14 ;i0/p1/15 $31,47? 1 2011 2FABP73V0BX166597 Police Car 10/01/15 S1,000 10/01/14 10/01/15 Actual Cash|531t47< 073 Ford Crown Victoria 10/01/14 S1.000 ^Ib70^l4v 010/01/15 -1-529,725 1 2011 2FABP7BV8BX159445 Police Car 10/01/15 51,000 10/01/14 10/01/15 Aclual Cashj 529.72? 074 Ford Crown Victoria 10701/14 51,000 10701/14)iomii^v>ro;:v^>:-lv'$29,725 1 2011 2FABP7BV9BX166596 Polfca Car 10/01/15 S1.00Q 10/01/14 1CV01/15 Aclual Cash)529,72^ 075 Ford Crown Victoria 10701/14 S1.000 10/01/14 10/01/15;x:-:.m--':•-::-^529,725 1 2011 2FABP7BV1BX166569 Ponce Car 10/01/15 51,000 10/01/14 10701/15 Actual Cash|S29.72! 076 Ford Econoflne 15 Passenger Van Non Police 10/01/14 51,000 10701/14:10701/15;•;:.V:^:--\:•••-:$23,473 1 2012 1FBSS38L4CDB30778 Bus <20 Pass,No 10/01/15 S1.000 10/01/14 10701/15 Actual Cash|S23.47 • 077 Ford Crown Victoria Police 10/01/14 51.000 10/01/14-10701/15 ••My---:••'•:.;V ;••::,"526,500 1 2011 2FABP7BV6BX157175 Po&ce Car 10/01/15 51.000 1O'01/14 10/01/15 Actual Cash|526S5QC 078 Ford Crown Victoria Pofice 10/01/14 S1.000 10/01/14J 10/01/15 526.500 1 2011 2FABP7BV8BX157176 PoOce Car 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|S26.50C 079 Ford Crown Victoria Police 10701/14 51.000 10/01/14:10/01/15 526,500 1 2011 2FABP7BVB3X157177 Police Car 10/01/15 51.000 10701/14 10/01/15 Actual Cash]S25.50C 27 VEHICLE SCHEDULE Continued Unit??Make Model/Description Department •aTeT~Comp Ded Comp Eff Term |Value ;V Qty Year VJN#Vehicle Type ALTerm Coll Ded Coll Eff Coll T*»rm I valuation APD Rptd 060 Ford Crown Victoria Police 10/01/14 :••S1.QO0 '<•;••tO/01/14 10/01/15 -;;-:-••-••••526.500 1 2011 2FABP7BV1BX157178 Police Car 10701/15 51,000 10/01/14 10/01/15 Actual Casn|526.50C 081 Ford Crown Victoria Police 10/01/14 51.000 v:10/01/14 10/01/15 ~V:i:'.\.0^^\::"526,500 1 2011 2FABP7BV3BX157179 Police Car 10701/15 51,000 10/01/14 10/01/15 Actual Cash|S26,5G£ 082 Ford Crown Victoria PcSce 10/01/14 51.000;>^tp/01/14 10/01/15 ^"•^^-•••N"-::526,500 1 2011 2FABP7BV2BX162583 Police Car 10/01/15 51,000 10/01/14 10/01/15 Actual Cash|526.50C 083 Ford .Ranger PickUp Non Police.10/01/14 •:-;v;'na;:^:;;:i-vU-i;••'•::-:.-':--.'-':-v;-i50 1 1998 1FT2R11X6WYA59706 LightTruck 10701/15 NA N/A| 084 Nissan AltiimaXE4dr Non Police 10/01/14 •:\):l'm-.:r',^•,:-;;i:-y .;.s•••..•-::vSo 1 20GO 1N4DLO1D6YC212203 Private Passenger 10701/15 NA N/A| 085 Ford F250PickUp Non Police 10/01/14 :U;M;NA=:;&•:-.--.:.--.-vjS0 t 2004 1FTNW21P24EAD4216 LightTruck 10/01/15 NA N/A| 086 Chrysler 300 Non Police 10701/14 :-K':HA'"Lc ::\:\:-:-::-:'••••'-''•••••••••'•V'M 1 2005 2C3JA43R75H505771 Private Passenger 10/01/15 NA N/A| 087 International Trasn 10/01/14 -n:::;NA;;;.VK ••••.•••••.•••.•:x-.:',:;-$o 1 2006 1HTMMAAR46H172991 Heavy Truck 10/01/15 NA N/A| 088 Ford Crown Victoria Non Police 10701/14 •-F'NA:..-^l::^:^:l-:.'y:--:<\':.v :-o-------^-:••••.';:so 1 2009 1FAH971V59X124118 Private Passenger 10/01/15 NA N/A| 089 GMC Sweeper Schwarze 10701/14 \V-."NA::-;"^^'•^•v--''^£0 1 2009 JSOC4W166970G1079 Medium Truck 10/01/15 NA N/A| 090 Ford Crown Victoria Police 10/01/14 =51,000 •:10/01/14 aip/pi/isj :m^MM-i:v::-526,000 1 2010 2FABP7BV7AX142814 Police Car 10/01/15 51,000 10/01/14 10/01/15 Aclual Cash)S26,00C 091 Auto Car ACX Garbage Truck 10/01/14 \;51.000 :10701/14 10/01/15 ^>-M^r>--$269,409 1 2013 5VCACR8FSDH215134 Garbage Truck 10701/15 51,000 10/01/14 10/01/15 Actual Cash]5269.4G< 092 Freighillner M2-105 Crane Truck Non-Police 10/01/14 :-isf'S1,000.;-'':::10/01/14 10701/15 ;•-§154,442 1 2013 1FVACXBS1DHFE4262 Heavy Truck 10/01/15 51,000 10/01/14 10/01/15 Actual Cash|5154,44: 093 GEM 2P Non-Police 10/01/14 .51.000 10/01/14 tO/01/15 513,499 1 2013 52CG2AGA3O0G03228 Private Passenger 10/01/15 $1,000 10/01/14 10/01/15 Actual Cash|513,49$ 094 Tandem Trailer 10701/14 NA 50 1 2008 IS907X1698MS82128 Trailer -NO 10/01/15 NA Actual Cashj 095 Tandem Trailer 10/01/14 NA SO 1 2008 IS9071608M982129 Trailer-NO 1&-01/15 NA Actual Cash) 096 Trailer Trailer -Bade up trailer 10/01/14 NA SO 1 2013 200904 Trailer-NO 10701/15 NA Actual Cashl 097 Trailer CVR 10/01/14 NA SO 1 2008 1S907X1678M982130 Trailer-NO 10/01/15 NA Actual Cash| 098 Ford Crown Victoria 10/01/14 NA 50 1 1998 2FAFP71W5WX137543 Private Passenger 10701/15 NA Actual Cash| 099 Tandem TRAILER-TANDEM -Tag XB2331 10/01/14 NA 50 1 2008 IS907X1698M982129 Trailer -NO 10701/15 NA Actual Cashl 100 Trailer Post 256-Tag #XB5488 POLICE 10/01/14 NA 50 1 2000 5RTBE1216BD023363 Trailer -NO 10/01/15 NA Actual Casn| 28 VEHICLE SCHEDULE Continued Unit*Make Model/Description Department ALEff Comp Ded Comp Eff Term -.r ;Vajue- Qty Year VIN#Vehicle Type AL Term Coll Ded Coll Eff Coll valuation Tvne APD Rptd 101 Trailer Trailer -TBD-Back up trailer 10/01/14 *""NA -:••':•:•':SO 1 2013 200905 Trailer-NO 10701/15 NA Actual Cash] 102 Trader *l S*XA PW 10/01/14 =•:•NA •i-=-=^:-i:..-.^\.-.;$Q 1 2008 Tracer-NO 10/01/15 NA Actual Cash| 103 Trailer T*fl*:mcKQ PW 10701/14 v NA :::r:-=-^-.v^r;:;'V;;:>$0 1 2013 213959 Tracer-NO 10/01/15 NA Actual Cash| 104 Ford interceptor PoSce 10701/14 •$1,000 10701/14 .10701/15 •:•{:•••••.•^::-:-)^v::$35,000 1 2014 1FAHP2MT7EG120008 Pofice Car 10/01/15 S1.000 10701/14 10701/15 31Cash Value S35,00( 105 Ford Interceptor Polce 10701/14 S1.00O :10701/14.10701/15 •"Vv.:ht^<(;;^,0op 1 2014 1FAHP2MT9EG120009 PoSce Car 10701/15 §1,000 10701/14 10701/15 31Cash Value $35,O0C 106 Ford Interceptor PoSce 10701/14 S1.000 •10701/14 10/01/15 •y^-v^vmsm 1 2014 1FAHP2MT7EG120011 Police Car 10/01/15 $1,000 10/01/14 10701/15 j|Cash Value S35,00{ 107 Ford Interceptor PoSce 10/01/14 $1,000 10701/14 10701/15 i.':•••';::;;^;:s^-i$35,ooo 1 2014 1FAHP2MT0EG120013 PoSce Car 10701/15 $1,000 10701/14 10Y01/15 jlCashVatue|$35,00( 108 Ford Interceptor Poice 10/01/14 '••"•$1,000 iG/qi/14;107D1/15 •;---;>'^^.:'-^^-1535,000 1 2014 1FAHP2rv4T5EG12001Q PoSce Car 10/01/15 $1,000 10701/14 10701/15 3fC3ShValue|$35,00C 109 Harfey Oa idson Motorcycle PoSce 10701/14 .si.ooo 10701/14 =10/01/15;;-:^-r:^v-':=^-r!934J0PP 1 2014 1HD1FRM13EB625699 Motorcycle 10/01/15 $1,000 10/01/14 10701/15 |$34,0OC 110 Harfey Da ridson Motorcycle PoSce 10701/14 ^$1,000 10701/14;lO^Ol/^v}i^^:^;;::'"-::S34,000 1 2014 1HD1FHM14EB624933 Motorcycle 10/01/15 $1,000 10701/14 1G/QT/15 $34,00{ 111 Ford Interceptor PoSce 10/01/14 HSi.000::;10701/14 10/01715;;,;S33,220 1 2014 1FM5K6AR7EGC49837 Police Car 10/01/15 S1.000 10/01/14 10701/15 jiCashV3iue|$33,220 112 Toyota Prius Code Enforcement 10/01/14 $1,000::10701/14 10701/15 ;ViS2l,312 1 2014 JTDKDTB32E1567950 Private Passenger 10/01/15 $1,000 10/01/14 10701/15 ilCash Value]$21,311 113 Toyota Prius Code Enforcement 10/01/14 •$1,000 •iC/01/14 /10/01/15 /A-:L.v---r:iv:;^--;M$21^12 1 2014 JTDKDTB30E1074963 Private Passenger 10/01/15 StOOO 10701/14 10701/15 ilCashValue|$21,31; 114 Toyota Prius Code Enforcement 10701/14 .;si,ooo 10701/14;!10/01/15 ^N:.^"<V S21.312 1 2014 JTDKDTB39E1074332 Private Passenger 10/01/15 $1,000 10/01/14 10/01/15 HCashValue|$21,31: 115 GEM E4 PoSce 10701/14 ;;;$1^00;:10701/14 10101/15 ^•^•:.^:.-:7;'-$14,371 1 2014 52CG4AGA6E0010816 Private Passenoer 10/01/15 S1.000 10/01/14 10701/15 ilCash Value]$14,37" 162 Ford Interceptor Police 10701/14 •'•:*:.--:«a:;:-.'.";10701/14 10701/15.%-:B^.:V:-::':«35,ooo 1 2014 1FAHP2MT9EG120012 Police Car 10/01/15 51,000 1G7Q1/14 10VQ1/15 (1 Cash Value)S35.O0C 167 insalert Traffic Trailer Pofice 10/01/14 •-::^!!*A-:•:•,•=•v::-^f-^-::y-:y-\'-:$o 1 2010 1B9AF511XAP825356 Trailer 10/01/15 NA 1 168 Kend Trailer PoSce 10/01/14 '••^-NA-;:V o^UU;-^::;.';-;':50 1 2011 KT7X12001S0482680 Trailer 10/01/15 NA 1 Total $3,025,308 APD Rptd 53,025.308 *Vehicle Schedule:Total number of covered units:139 99Unitsinclude comprehensive andcollisionperschedule 29 SUMMARY OF PROPOSED PREMIUMS Premiums as Proposed:^Expiring Renewal Property Including Boiler &Machinery General Liability Automobile Inland Marine Crime/Fidelity Law Enforcement Liability Public Officials Employment Practices Liability Premium Fees Taxes&Surcharges Total Premium Fees Taxes &Surcharges Total Premium Fees Taxes &Surcharges Total Premium Fees Taxes &Surcharges Total Premium Fees Taxes&Surcharges Total Premium Fees Taxes&Surcharges Total Premium Fees Taxes&Surcharges Total $130,713.00 N/A N/A $130,713.00 $58,992.00 N/A •N/A $58,992.00 $92,505.00 N/A N/A $92,505.00 $2,633.00 N/A N/A $130,713.00 N/A N/A $130,713.00 $88,993.00 N/A N/A $88,993.00 $96,764.00 N/A N/A $96,764.00 $2,883.00 N/A N/A $2,633.00 $750.00 N/A N/A $2,883.00 $750.00 N/A N/A $750.00 $49,090.00 N/A N/A $750.00 $64,983.00 N/A N/A $64,983.00 $48,505.00 N/A 630.57 $49,135.57 $49,090.00 $45,071.00 N/A 946.49 $46,017.49 TOTAL $380,700.49 $434,221.57 *ExpiringPremiumreflectsannualizedpremiumsonanymidtermpolicychanges Feesshownabovemaybefullyearned at policyinception 30 Payment Option: PGITPackage:50%Down,25%dueat75daysand25%due@166days POL/EPL -Fullpaymentatinception-Financingmaybeavailable A25%MinimumEarnedPremiumappliestothe following policies: Preferred Governmental Package Quotes Subject To: •SignedandinitialedPGITandAcord applications •SignedAceandAcordApplications-POL&EPL •SignedPGIT UM FormandSignaturePage •Automobile procedure andpolicy concerning 15 passenger vans Quotation is valid until the effective date of the policy. This proposal is based upon the exposures to loss made known to the Agency,and is for illustration only.Any changes in these exposures (i.e.,new operations,new products,additional states of hire,etc.)need tobe prompdy reported tousin order that proper coverage(s)maybepurinto place.All physical exposures insured byour policies must be owned bythe named insured.This proposal contains only a general description of the coverage(s)and does not constitute a policy/contract.For complete policy information,including exclusions,limitations,and conditions,refer tothe policy document. 31 COMPANY COVERAGE BEST RATING ADMITTED Preferred Governmental Insurance Commercial Property,Crime,Not Rated Yes Trust Inland Marine,General Liability,Law Enforcement Liability,Commercial Automobile Ace American Insurance Co.Public Official/EPL A++XV Yes GENERAL RATING These rating classifications reflect BEST'S opinion ofthe relative position ofeach company in comparison with others,based upon averages within the Property-Casualty insurance industry. Theyare reflective ofoverall company services and standing withinthe industry. A++,A+*** B++,B+** NR Superior Excellent Very Good Not Rated B,B-*** C++,C+*** Good Fair Marginal FINANCIAL SIZE CATEGORY TheFinancialSizeCategoryisanindicationofthesizeofanInsurerandisbasedonreported Policyholders'surplusplusconditionalorTechnicalReserveFunds,suchasmandatory securities valuationreserve,otherinvestmentandoperatingcontingencyfundsand/or miscellaneousvoluntaryreservesreportedasliabilities. ($In thousands) Class I $Upto $1,000 Class II $1,000 To $2,000 Class UI $2,000 To $5,000 Class IV $5,000 To $10,000 Class V $10,000 To $25,000 Class VI $25,000 To $50,000 Class Vll $50,000 To $100,000 Class VIII $100,000 To $250,000 Class IX $250,000 To $500,000 Class X $500,000 To $750,000 Class XI $750,000 To $1,000,000 Class XII $1,000,000 To $1,250,000 Class XUI $1,250,000 To $1,500,000 Class XIV $1,500,000 To $2,000,000 Class XV $2,000,000 To $More Thisinformationhasbeenprovidedtoyousothatconsiderationisgiventothefinancial condition of ourproposedcarriers.Thefinancial information disclosedisthemostrecent available to Brown and Brown of Florida Inc -Miami Division. 32 COMPENSATION Inadditiontothecommissionorfeesreceivedbyusfor assistance withtheplacement,servicing,claims handling,or renewal of your insurance coverage's,other parties,suchasexcessand surplus lines brokers, wholesale brokers,reinsurance intermediaries,underwriting managers and similar parties,someofwhichmay beownedinwholeorin part byBrown&Brown,Inc.,mayalsoreceive compensation fortheirrolein providing insurance products orservicestoyou pursuant totheir separate contracts with insurance or reinsurance carriers.Additionally,itis possible thatwe,orour corporate parents or affiliates,may receive contingent payments or allowances from insurers basedon factors whicharenot client-specific,suchasthe performance and/or sizeofan overall bookof business produced withan insurer.We generally donotknowif sucha contingent payment willbemadebya particular insurer,orthe amount ofanysuch contingent payments,until the underwriting year is closed.That compensation is partially derived from your premium dollars,after being combined (or "pooled")withthe premium dollars of other insureds that have purchased similar typesof coverage.Wemay also receive invitations to programs sponsored and paid for by insurance carriers to inform brokers regarding their products and services,including possible participation in company- sponsored eventssuchas trips,seminars,and advisory council meetings,based uponthe total volumeof businessplacedwiththe carrier youselect.Wemay,on occasion,receiveloansorcreditfrom insurance companies.Additionally,inthe ordinary course of business,we may receive and retain interest on premiums you pay from the date we receive them until the date the premiums are remitted tothe insurance company or intermediary.In the event that we assist with placement and other details of arranging for the financing of your insurance premium,wemay also receive a fee from the premium finance company. WholesaleBroker/ManagingGeneralAgent:PublicRiskUnderwriters This intermediary is owned in whole or part by Brown &Brown,Inc.,the parent company of Brown &Brown of Florida,Inc.-Miami Division.Brown &Brown entities operate independently and are not required to utilize other companies owned by Brown &Brown,Inc.,but routinely do so.In addition to providing access tothe insurance company,the Wholesale Insurance Broker /Managing General Agent may provide additional services including,butnot limited to:underwriting;loss control;risk placement;coverage review;claims coordination with insurance company;and policy issuance.Compensation paid for those services may be up to 15%ofthe premium youpayfor coverage,and any compensation paid forthose services is derived from your premium payment. Should youhaveany questions,or require any additional information,please contact this officeat 1-800-889-0799 orif you prefer,submit your question or request online at http://www.bbinsurance.com/customerinquiry.shtml. 33 PROPOSAL VARIANCE Changes that needtobe made prior to binding: 34 MINIMUM AND DEPOSIT PREMIUM MINIMUM EARNED PREMIUM The following terms are often misunderstood,particularly among insureds or producers not accustomedtodealingwithsurpluslinesinsurance companies.Itisimportantthatthedefinitions are understood. MINIMUM AND DEPOSIT Thisisthe amount of premium dueat inception.Although the policy is subject to adjustment based onarateper exposure unit,under no circumstances will the annual earned premium be less than the minimum premium.Therefore,the policy may generate an additional premium on audit,but not a return. Ifsucha policy is cancelled mid-term,the earned premium isthe GREATER ofthe annual minimum times the short rate or pro-rata factor,orthe actual earned as determined by audit, subjecttoashortratepenaltyifapplicable. MINIMUM EARNED PREMIUM A minimum earned premium endorsement can be attached to either a flat charge policy oran adjustable policy.In either case,this amount is the LEAST that will be retained bythe insurance company once the policy goesintoeffect.The amount retained wouldbethe GREATER of the annual earned premium whether calculated ona pro-rate orshortratebasis,orthe minimum earned premium. FLAT CANCELLATIONS Surplus lines insurance companies normally do not allow flat cancellations.Once the policy isin effect,some premium willbeearned. Ifyouneedfurtherexplanation,pleasedonothesitatetocontactus. 35 CLAIM REPORTING GUIDELINES Make Brown &Brown,Inc.aware ofany and all incidents immediately after they occur,whether itbeanauto accident,atheft,slip&fall,even aminor incident that appears willhaveno future activity.Donotwaitforapolicereport. Gather as much concrete information as possible.For example,police reports,company incident reports,conversationlogs,medicalsandpictures-anythingthatmayassistinthehandlingof yourclaim.Sendthisinformationeitherby mail,e-mailorfaxto: Brown &Brown of Florida,Inc.-Miami Division Alexandra Sarria,Commercial Claim Specialist 14900 NW 79 Court,Suite 200 Miami Lakes,FL 33016 Phone:(305)364-7812 Fax:(305)714-4401 E-Mail:ASarrial@bbmia.com Ifyouhaveanyquestionsorincuranyproblems,pleasecontactourofficeandwewillbegladto assistyouinanywaywecan. 36 DEFINITIONS 37 Coinsurance Agreed Value Replacement Cost &Actual Cash Value Inflation Guard Coverage Extensions & Additional Coverages Basic Form Broad Form PROPERTY DEFINITIONS Mostbuildingandbusinesspersonalpropertypolicieshavea coinsurance clause, which requires the insured tocarry insurance equal toatleasta specified percentageoftheactualcashvalueoftheproperty.Ifalossoccurs,anditis determined thatthe amount of insurance carried islessthanthe amount required,a penaltycouldbeplacedontheinsured.(Example Attached) Whentheagreedvalueoptionisusedthecoinsurancerequirementisremovedand theinsureragreestocoverlossesforitsagreedvalue.Asan example,theinsured hasproperty insured for $100,000 andtheagreedvalueisalso$100,000,if aloss occurs,anylossupto$100,000iscovered100%.Whenthisoptionisusedthe insuredandtheinsurancecompanyagreeonthevalueofthepropertybeforethe policyisissued.Thisoptionisusuallyassignedto one-of-a-kind property. Propertycanbevaluedinseveraldifferentways.Insurancecompaniescommonly usetwo approaches to determine value,which also determines how alosswillbe paid:the replacement cost method andtheactual cash value method.Insurers consider replacement costofapropertyitemtobethecosttoreplaceitwithnew property of likekind.Actualcashvalueis replacement cost,minusthe accumulated depreciation forageand condition. Aninsuredcaninsureabuildingforitsfullvalueatthebeginningofthepolicy year,but attheend of theyear,itmightnotbe covered foritsfullvalue.This problem canbe corrected by adding inflation guard coverage.With inflation guard,the policy limit increases gradually duringthe policy termsothatthetotal increase amountstothedesiredpercentage increase attheend of thepolicyterm. InadditiontothelimitsstatedintheBuildingandPersonalPropertycoverage form,thepolicyhasacoverageextensionssectionandanadditionalcoverages section.Thecoverageextensionssectionprovides limited coveragefornewly acquiredor constructed property,propertyofothers,certainoutdoorproperty, andthecost of research and reconstruct information on destroyed records.When coverage is placed ontheall risk form,two additional extensions are added for property in transit andcoverageforcertain repair costsrelatedtodamagecaused bywater.Thetwoadditionalextensionsarecoveredbycertainperilsonly.The additional coverage section provides coverage for indirect losses that result froma direct loss.The coverage appliestoremoval of debris,preservation ofproperty, fire department service charges and pollutant cleanup and removal.The coverage extensions andthe additional coverages have limitations andare subject tocertain conditions. Fire,lightning,explosion,windstorm orhail,smoke that causes sudden and accidental lossor damage,aircraft or vehicles,riot or civil commotion,vandalism, sprinkler leakage,sinkhole collapse and volcanic action. Fire,lightning,explosion,windstorm orhail,smoke that causes sudden and accidental lossor damage,aircraft or vehicles,riot or civil commotion,vandalism, sprinkler leakage,sinkholecollapse,volcanicaction,glassbreakage,falling objects,weightofsnow,ice,orsleet,andwaterdamage(accidentaldischargeor leakage). SpecialForm |Excludingfloodand earthquake. 38 EQUIPMENT BREAKDOWN DEFINITIONS Definition of Equipment Breakdown Coverage (Boiler & Machinery) Boiler&Machineryinsurancecoversdirectdamageto covered property when caused bya covered cause of loss. Coveredpropertyisanypropertythatisownedbythenamed insuredorisinthenamed insured's care,custody orcontrol andforwhichthenamed insured is legally liable.Acovered cause of loss is a sudden and accidental breakdown of the insured'sboiler&machineryequipmentoranypartofthe equipment described in the policy. Expediting Expense Whichpaysthereasonableextracostincurredtoexpedite progress after a loss Automatic Coverage Coversaccidentstoobjectsatnewlyacquiredlocationsforup to ninety days after the named insured acquires the property. 39 GENERAL LIABILITY DEFINITIONS Premises/Operations Products/Completed Operations Personal Injury Advertising Injury Medical Payments Fire Damage Coverage is provided for damages arising outof ownership or occupancy of the insured premises when maintained ina reasonable manner.Thisalsocovers damages arisingoutof operations performed by the insured business. Products coverage is provided for damages arisingoutof productsmanufactured,sold,handledordistributedbythe insured.Completed Operations covers damages occurring afteroperationshavebeencompletedorabandoned,orafter an item is installed or built and released for it's intended purpose. PersonalInjurymeansinjuryotherthanbodilyinjury. Coverageisprovidedforinjuryresultingfromoffensessuch asfalsearrest,maliciousprosecution,detentionor imprisonment,the wrongful entryinto,wrongfuleviction fromandotheractsofinvasion,orrightsofprivate occupancy of a room.Coverage for libel and slander isalso provided in the policy, Thiscoveragepaysfordamagesdoneinthecourseoforalor writtenadvertisementthatdisparages,libelsorslandersa person's or organization's goods,productsorservices. Coveragefortheseoffensesisprovidedunderadvertising injurycoverageonlyiftheyoccurduringthecourseof advertisingthenamed insured's owngoods,productsor services. MedicalPaymentscoveragepaysmedicalexpensesresulting frombodilyinjurycausedbyanaccidentonpremisesowned orrentedbytheinsured,orlocationsnexttosuch property,or whencausedbythe insured's operations.Thesepaymentsare made without regard tothe liability ofthe insured. Thefiredamagelimitprovidescoverageforfiredamage causedbynegligenceonthepartoftheinsuredtopremises rented to the named insured.If a fire occurs because of negligenceoftheinsuredandcausesdamagetopropertynot rentedtotheinsured,coveragewouldbe provided underthe occurrence limit. 40 GENERAL LIABILITY DEFINITIONS Continued... Contractual Liability Host Liquor Liability Broad Form Property Damage Coverage Incidental Medical Malpractice Non-Owned Watercraft Liability Coverage Limited Worldwide Coverage Extended Bodily Injury Coverage Newly Acquired Organizations Additional Persons Insured Claims Made Form Only Extendsyourcoverageto liability assumedundercontract,applies tobothoraland written agreements relating to named insured's business. Coversyourexposureforservingliquortoclientsoremployeesat companyparties.Appliesonlytofirmsnotengagedinbusinessof sellingorserving alcoholic beverages. Intendedforfirms,whichperformworkorservices,rather thansell or produce products.Usually intended for construction contractors,repairers of automobiles,installers of property. Extendsterm"bodilyinjury"tomeaninjuryarisingoutof renderingoforfailuretorender,duringthepolicyperiod;medical, surgical,dental,x-ray,ornursing services,or furnishing offoodor beverages in connection therewith orthe dispensing or furnishing drugsormedical,dentalor surgical supplies (Under26feetinlength)Providescoverageforliability,which arisesfromany watercraft aslongaswatercraftisnotownedby insurednorbeingusedtocarrypersonsorpropertyforafee, Intendedtoextendthescopeof"policy territories"toanywherein theworld.Limitedtotheactivitiesofanyinsuredwhois domiciledintheUnitedStatesandtheoriginalsuitfordamageis broughtwithintheUnitedStates,its territories,possessions,orin Canada. Amends definition of occurrence to;includesanyintentionalactby oratthe direction oftheinsured,whichresultsinbodilyinjury,but only if such bodily injuryresultsfromtheuse of "reasonable" forceforpurposesof protecting personsorproperty. Automatic protection fornewlyacquired organizations untilthe new organizations is specifically addedtothepolicyor90 days, whichever occurs first. Includes as insureds;(1)Any spouse ofapartner concerning business activities ofthepartnershipand(2)anyemployeeofthe namedinsuredwhileactingwithinthescopeofhisorherduties. Doesnotapplytobodilyinjuryorpersonalinjurysustainedbya fellowemployeewhichoccursduringthecourseofemployment. Thiscoverageisprovidedautomaticallywithoutanadditional premiumchargeifcoverageiscanceled,notrenewed,orthe insurer renewal with a later retroactive date.The basic extended reportingperiodstartsattheendofthepolicyperiodandlastfor fiveyearsforclaimsmadeagainsttheinsuredwithinthefiveyear periodandreportedtotheinsurerwithin60daysaftertheendof thepolicyperiod. 41 UNDERSTANDING THE CLAIMS-MADE POLICY The claims-made insurance policy provides financial protection for all claims presented during the current policy year,providing the claim occurred after theprior acts date. Tounderstandthe claims-made policy,wewilldefine: Current Policy Year: The policy year begins on the effective date shown onthe policy and expires onthe expiration dateallshownonthe policy.Thepolicy's effective and expiration dates change with yearly renewal ofthe policy.Theprioractsor retroactive date remains the same,soyouare protected forincidentsthatoccurredprioryearsbythecurrentpolicy. Prior Acts or Retroactive Date: Thisisthedate (shown onyour policy)that dictates ifaclaimis eligible tobe covered.Any claim occurring afterthisdate,presented duringthecurrentpolicy year,areeligiblefor coverage by your current policy. Supplemental Extended Reporting Period (Tail Coverage): Shouldthepolicybecanceledor non-renewed,youareentitledto purchase insurance protection foranyclaimswhichmaybeafterthe cancellation date.Thepremiumchargedforthisinsurance isbaseduponthenumberofyearsyouhavebeeninsured(prioractsyears)andthelimits purchased. 42 Liability Coverage Owned Automobiles Personal Injury Protections Medical Payments Coverage Uninsured/Underinsur ed Motorists Hired Automobiles Non-Owned Automobiles Comprehensive Collision Rental Reimbursement AUTOMOBILE DEFINITIONS Theliability coverage ofthe commercial autopolicy provides protection against legalliability arising outofthe ownership, maintenance,oruseofanyinsured automobile.The insuring agreementagreestopaydamagesforbodilyinjuryorpropertydamage forwhichtheinsuredislegallyresponsiblebecauseofanautomobile accidentresultingfromthe ownership,maintenance,oruseofa coveredauto.Theinsuringagreementalsostatesthatinadditiontothe paymentof damages forwhichtheinsuredislegallyliable,theinsurer alsoagreestodefendtheinsuredforalllegaldefensecost.The defensecostisinadditiontothepolicylimits. Coverstheliabilityarisingoutofthe ownership,maintenance oruseof automobiles. Coverage is included for vehicle passengers under No-Fault Law provisions. The insuring agreement states thattheinsurerwillpayall reasonable and necessary medical and funeral expenses incurred byan insured becauseofbodilyinjurycausedbyanaccident.Theinsuredisthe named insured,the insured's employees and guests,andanyother personoccupyingacoveredauto.Thesepaymentsaremadewithout regardto fault. Protects insureds who arenot contributorily negligent against bodily injurycausedbynegligentunderinsuredoruninsureddriversandhit- and-run motorists. Coverstheliabilityfortheuseofhired automobiles inyour business. Covers the liability forthe use of non-owned automobiles in your business.An example wouldbean employee usinghisowncaronan errand for you. Pays forlossofor damage to automobiles from perils otherthan collision. Paysforlossofordamagetoautomobilesfromcollisionwithanother object or upset, Thebusinessautopolicyprovidesacoverageextensionifanautois insured for comprehensive or specified cause ofloss coverage,which insures against loss ofuseofa covered auto only ifthe auto isa private passengertypeautoandisstolen.Thecoverageextensionpaysuptoa daily limitof$10 and a maximum limit of $300.Payments begin forty-eight hoursafterthetheftandendswhenthe insured autois returnedorwhentheinsurerhaspaidtheinsuredfortheauto.For broader coverage,theinsuredcanpayanadditionalpremiumforrental reimbursement coverage.Rental reimbursement paysthecostof rentingasubstituteautoforreplacementofanycoveredautothathas sufferedacoveredloss.Thedailyandmaximumlimitforthis coveragevariesamonginsurers. 43 COVERED AUTO DESIGNATION SYMBOLS 1 Any "Auto"6 Owned"autos"subjecttoacompulsory uninsured motoristslaw.Onlythose "autos"you own that because of the law inthestate where theyare licensed or principally garagedarerequiredtohave and cannot reject Uninsured Motorists coverage.This includes those "autos" you acquire ownership of afterthe policy begins provided theyare subject to the same state uninsured motorists requirement. 2 Owned "autos"only.Onlythose autos you own (and for liability coverage any trailers you don't own while attached to power unitsyou own.)This includes those "autos" youacquire ownership of afterthe policy begins. 7 Specifically Described "autos".Only those autos described in ITEM THREE of the Declarations for which a premium charge is shown (and for liability coverage any "trailers"you don't ownwhile attached toany power unit described in ITEM THREE.) 3 Owned Private Passenger "Autos" Only.Only the private passenger "autos"you own.This includes those private passenger "autos"you acquire ownership of afterthepolicy begins. 8 Hired "Autos"Only.Only those autos you lease,hire,rent or borrow.This doesnot include any "auto"youlease, hire,rentor borrow fromany of your employees or partners or members of their households. 4 Owned "Autos"other thanprivate passenger "autos"only.Only those autos you own that are not of the private passenger type(andfor liability coverage any "trailers"you don't own while attached to power units you own.)This includes those autosnot of the private passenger type you acquire ownership ofafter the policy begins. 9 Non-Owned "Autos"Only.Only those "autos"you do not own,lease,hire,rent or borrow that are used in connection with your business.This includes "autos"ownedbyyour employees or partners or members of their households but only while used in your business or your personal affairs. 5 Owned "Autos'subject toNo-Fault. Only those "autos"youownthatare required to have No-Fault benefits in the state where they are licensed or principally garaged.This includes those "autos"you acquire ownership of after the policy begins provided theyare required to have No-Fault benefitsinthestatewheretheyare licensed or principally garaged. 44 CRIME DEFINITIONS Employee Dishonesty Forgery or Alteration Theft,Disappearance & Destruction Employee dishonesty is considered tobea criminal act committedbyanemployeeactingaloneorincollusion withothers.Theremustbeintentbytheemployeetocause the employer alossandto obtain a financial benefit forthe employeeorsomeoneelse.Coverageisprovidedfor dishonestactsofemployeesofthenamedinsuredonly. Coverageinsuresagainstlossofmoney,securities,and property otherthan money and securities.The blanket form provides coverage fordishonestactsofall employees. Thelimitforblanketcoverageappliesperloss,regardless ofhowmanyemployeesareinvolved.Thescheduledform provides coverageonlyforthe dishonest actsof employees specificallylistedinthepolicy.Onthe scheduled form,a separatelimitappliestoeach employee listedonthe schedule. Forgeryisgeneratingadocumentorsignaturethatisnot genuine. Alterationischanginga document ina manner thatis neither authorized nor intended. Thisforminsuresagainstlosscausedbytheforgeryor alterationofacovereditemdrawnagainsttheinsured's accounts.A covered item might beacheck,draft, promissorynote,bill of exchange or similar instrument. Theftmeansanyactofstealing. Disappearance isunknowncausesofloss.Disappearance lackstheelementsofknowing if thecrimewasatheft, burglary or robbery. Destruction isthelossofcertain property,itisusuallythe result of another cause of loss. Section(1)oftheformcoversmoneyandsecurities againstlossbytheft,disappearance,ordestructioninside thepremises.Section(2)coversmoneyandsecurities outsidethepremisesincareandcustodyofamanager. 45 PREFERRED GOVERNMENTAL INSURANCE TRUST "Preferred" NOTICE AND ACKNOWLEDGEMENT OF FINANCIAL CONDITION Brown&Brown of Florida,Inc.-MiamiDivision,anditsparentcompany,Brown&Brown,Inc.(collectively "Brown &Brown")donotcertify,warrantorguaranteethefinancialsoundnessorstability of anyinsurancecarrier oralternativerisktransferorpoolingentity.Weendeavoredtoplaceyourcoveragewithaninsurancecarrierwith anA.M.Best Company financial rating of "A-"orbetter.*WhileBrown &Brown cannot certify,warrant or guaranteethefinancialsoundnessorstability of anyinsurancecarrieroralternativerisktransferorpoolingentityor otherwisepredict whether thefinancialcondition of anysuchentitymightimproveordeteriorate,weare hereby providingyouwithnoticeanddisclosure of financialconditionsothatyoucanmakeaninformeddecisionregarding theplacement of coverage.Accordingly,withreceipt of thisnoticeyouacknowledgethefollowingwithregardto the placement andany subsequent renewal of thecoverageindicatedbelow: •Brown&Brown attempted topresent otheroptionsforyourinsuranceplacement,includingquotations with insurance carriersholdingan "A-"orbetterratingfromA.M.BestCompany,but wewereunableto secure such aquote. •Coverageisbeingplacedthrough Preferred Governmental Insurance Trust ("Preferred"),whichisasa Floridalocalgovernmentself-insurancefundestablishedpursuanttoSection624.4622,FloridaStatutes,as such Preferred isnotratedbythe A.M.BestCompany. •Preferred isnotsubjecttotheprotectionsaffordedbyanystateguarantyfundorassociation. «Thefinancialcondition of insurancecompaniesandothercoverageprovidersincludinglocalgovernment self-insurancefundslike Preferred maychangerapidlyandthatsuchchangesarebeyondthecontrolof Brown &Brown. •Youshouldreviewthefinancialandmembershipinformationfrom Preferred andagreetoabidebythe conditions of membership establishedby Preferred. Youshould consjdemhe information provided,includingthe Preferred coverage quoteand coverage placemeji^rnareview itwithyouraccountants,legalcounselandadvisors. i^i^JriBtTF AUTHORIZED REPRESENTATIVE OF INSURED] Named Insured:City of South Miami Policy Number:PKFL101320211405 Policy Period:10/01/14 TO 10/01/15 Date of Notice:09/15/2014 *A.M.Best Rating Guide:Rating for Stability:A++toD =Highest to lowest rating Rating for Assets/Surplus:15to1-Largest to smallest raring 46 Insured: Correction: City of South Miami Insurance Coverage Review Policy Eff Date: Addl Named Insured: JO/01/2014 Please advise if quotations for increased limits of liability or for any coverage listed below are requested: E =Exposure;C =Coverage throughBrown&Brown;Q=Quotefor Uncovered Exposure E C Q PROPERTY Y/N Y/N Y/N Buildings Business Personal Property Personal Property of Others Tenants Betterments &Improvements Business Income Extra Expense Leaseholders Interests Boiler&Machinery(EquipmentBreakdown) Building Ordinance or Law A.LosstoUndamagedPortionofBldg B.Demolition Cost C.Increased Cost of Construction Earthquake Rental Income Difference in Condition Flood (Primary) Flood (Excess) Wind Off Premises Power Interruption Overhead Transmission Lines Glass « Spoilage AUTOMOBILE Auto Liability Auto Physical Damage Drive Other Car Liability Drive Other Car Physical Damage Hired/Non Owned Liability Hired Car Physical Damage PEP:Ext Additional,Broad Rental Reimbursement (PPT) Rental Reimbursement (Com.Vehicle) Uninsured Motorist (Primary) Uninsured Motorist (Excess) Garage Liability Garage keepers Liability Garage Dealers Physical Damage Truckers Liability Un-laden Liability Truckers Physical Damage Trailer Interchange CRIME Employee Dishonesty (1st Party) Employee Dishonesty (3rd Party) ERISA Bond Forgery or Alteration Fiduciary Liability Money &Securities BONDS Bonds (describe) E C Q 1 LIABILITY Y/N Y/N Y/N General Liability Directors*&Officers'Liability ECommerce/E-BusinessLiability Employee Benefits Liability Liquor Liability Employment Related Practices Liability Third Party Discrimination Errors or Omissions Liability Owners/ContractorsProtLiability PollutionLiability (1stParty) Pollution Liability (3rd Party) Products Liability Product Recall Professional Liability Warehouse Legal Liability Watercraft Liability Umbrella/Excess Liability INLAND MARINE Accounts Receivable Valuable Papers Bailee Coverage Computer/EDP Contractors Equipment Signs Installation Floater Mobile Equipment Rented/Leased Equipment Motor Truck Cargo Transit/Transportation Builders Risk/COC Ocean Cargo WORKERS'COMPENSATION Workers Compensation . Other States USL&H Jones Act Stop Gap Liability Excess Employers Liability AIRCRAFT Aviation -Owned Aviation -Non-Owned MISCELLANEOUS International/Foreign Exposures Kidnap &Ransom Travel Accident Credit Insurance Mold/Fungi EIFS Terrorism Subsidence •This listof insurance coverage isfor information purposes only andisnot meant tobea complete listfor all yourinsurance needs.Theabove analysis is basedsolelyon information providedbytheclient. Insured Representative Brown&BrownRepresentative Signature Date -Place Completed with Insured Comments:(may be continued on reverse) Prepared byBrown&Brown Insurance-Rev 01.01.11 _42_ k Underwriters 8455 FL 32795-8455 !-832-1450 -832-1489 Public EntityApplication 08/28/14 4:19 PM Renewal Application Muni fPK FL1 0132021 14-05J Portal Reference #209786 CoverageTerm10/01/2014-10/01/2015Page1 Name:South Miami,( Mailing:6130 Sunset Dr. City/State/ap:South Miami,FL 33143 Physical:6130 Sunset Dr. City/State/Zip:South Miami,FL 33143 Phone #:305-663-6338 Contact LaTasha Nickle Title:H.R.Director Phone #:305-663-6338 Fax#: Email: Agency:Brown &Brown -Miami Address:14900 NW 79th Court Suite 200 City/State/Zip:Miami Lakes,FL 33016 Phone #:305-714-4400 Fax#:305-714-4401 Member Type:Municipality Contact:Nancye Batista Phone #:305-364-7816 Fax#: Email:nbatista@bbmla.com m CERTIFICATION The undersigned being authorized by,andacting on behalf oftheapplicant and al persons/concerns seeking insurance,has read and understands this Application,including any appendices and/br supplements,and declares that all statements setforth herein are true,complete and accurate.The undersigned acknowledges and agrees that thesubmission and theTrust's receipt ofsuchwritten report,prior tothe inception ofthe coverage agreement applied for,isa condition precedent to coverage. The signing ofthisApplication doesnot bind the undersigned to purchase the coverage,nordoesthe review ofsame bind The Trust toissuea coverage agreement Thisapplicationshall be the basis of ffie contract should one be issued. This Application must besignedbythe "Ranking Elected/Appointed( Manager/equivalent Officer)ortheRiskManager(orrankingc SIGNATURE: TITLE: DATE: it"of the Entitymakingtheapplication (e-g.Mayor/ id tWs function. C,Vft{—t^ggqgg^ NOTICE TO APPLICANT Foryourprotection,thefollowing Fraud Warning Is requiredtoappearon this application: FLORIDA FRAUD STATEMENT Any person who knowingly and with intent to Injure,defraud ordeceive anyinsurer,files a statement of claim oran application containing any false,incomplete or misleading information is guilty ofa felony ofthe third degree. I herebyauthorizetherelease of claimsinformationfromanyPriorInsurer/CarrierrTrust to PRU &/orPGIT." Renewal Application Muni [PK FL1 0132021 14-05] Coverage Term:10/01/2014-10/01/2015 MemberName:South Miami,Cityof Agency:Brown&Brown-Miami Current Coverages Selected AutoLiability Boiler&Machinery Rood inland Marine Property Coverage/Exposure Summary Line of Business Exposure/Coverage General Question General Question General Question General Question Auto Liability AutoPhysicalDamage Crime General Liability General Liability General Liability General Liability General Liability General Liability General Liability General Liability Generai Liability General Liability General Liability General Liability General Liability General Liability General Liability General Lability General Liability General Liability General Liability General Liability General Liability General Liability Professional Liability Professional Liability Professional Liability Property Auto Physical Damage Crime General Liability Professional Liability Application General Information Excess WC (Standard Limits are $1M/$1M/$1M) SIR-TPA Information Stop Loss Coverage Coverage Coverage Coverage Operations:Athletic Fields &Activities Operations:Beaches/Lakes/Retention Ponds Operations:Bleachers/Auditoriums/Stadiums Operations:DaycareOperations Operations:ElderCare/RespiteCare Operations:Electric Utility Operations:EMTs/Paramedics Operations:Exhibition/Convention Centers Operations:Gas Utility /Local Distribution Operations:Golf Courses Operations:Marinas Operations:Restaurants Operations:Skate Parks Operations:SpecialEvents,FairsorCarnivals Operations:Swimming Pools/WaterParks Operations:Transportation &Community Services Operations:Wastewater Treatment Operations:Water Utility Operations:Watercraft Operations:Wharves/Piers/Docks Supervision Abuse Prevention (Required) EmployeeBenefits Liability Law Enforcement POUELL/EPLI Coverage Page 2 Portal Reference #209786 Applicable/Not Applicable Applicable Not Applicable Not Applicable Not Applicable Applicable Applicable Applicable Applicable Applicable Applicable Applicable NotApplicable NotApplicable Not Applicable Not Applicable Not Applicable Not Applicable NotApplicable NotApplicable NotApplicable Applicable Applicable Applicable Applicable NotApplicable Not Applicable Not Applicable Not Applicable Applicable Applicable Applicable Applicable Applicable RenewalApplicationMuni[PK FL1 013202114-05] Coverage Term:10/01/2014-10/01/2015 MemberName:South Miami,Cityof Agency:Brown&Brown -Miami Page 3 Portal Reference #209786 COVERAGE INFORMATION General Questions New Response Account CSR:Nancye Batista Agent Name:Robert Hoflander Primary Member Contact LaTasha Nickle NewPrimaryContact,ifnotlistedindropdown above (includename,phoneandemail address) Requested Effective Date:10701/2014 Requested Termination Date:10/01/2015 BidDate(IfApplicable}: Need ByDate:09/05/2014 If WC,completesubmissionmustincludePayroll Classification Schedule and Employee Concentration Schedule.Shedules attached to portal app? Ifnew business,completeand attach the"Expiring Information"form.Template can be found withPool Forms under the Documents section ofthe application. (Submissionisnotcompletewithoutthis information) If withPGITlessthan5years,complete and attach the "Loss Summary"formora "No Known Losses"letter.Form can be found with Pool Forms under the Documents section of theapplication.(Submission isnot complete without this information) Year was the entity was organized,chartered or incorporated Members FEIN:123456789 NCCIRisklD#:094009340 Population:11,000 Largest city within25 miles Miami Seasonal change inpopulationofmorethan25%duringthe year (Yes/No) No Enter the Total General Fund Revenue from the most recent audited financial statement 21,364,698 Have you attached the most recent audited financtate/budget(Yes/No) Yes Enter date of the most recent audited financial statement 10701/2013 1927 Full /DetailedDescriptionof Operations: Installment Schedule:{Only available forpremium>$100K, payplanis agency billed) Doyouhavearisk manager?(Yes/No) If yes,please provide name and phone number. Full Time? If parttime,howmanyhours does therisk manager work per week? Doyou have a Human Resources or Personnel Department (Yes/No)?If No,please describehandlingofthisfunctionon a separate piece of paper. Entertotalnumberofemployeesbudgetedfortheupcoming fiscal year Full time Police Full time Fire MUNICIPALITY:POLICE CODE ENFORCEMENT,PUBLIC WORKS,PARKS &RECREATION PKG -50%Down,25%due at 75 days and25%due at 166days No No Yes 170 50 Renewal Application Muni [PK FL1 013202114-05] Coverage Term:10/01/2014-10701/2015 MemberName:South Miami,Cityof Agency:Brown&Brown-Miami COVERAGE INFORMATION Page 4 Portal Reference #209786 uenerai wussaons New Response Fulltimeall other personnel 85 Full time seasonal (40hoursper week)0 Part time Police 0 Part time Fire 0 Parttimealt other personnel 36 Volunteers Police 2 Volunteers Fire 0 Volunteers all others 8 Enter totalpayroll amount 7,578,902 PoSce -Estimated Payroll 3,520,856 Fire-Estimated Payroll 0 M other-Estimated Payroll 4,056,046 -XNtrrtu Ml-jV&ZS Initial Date t/¥r RenewalApplication Muni [PK FL1 0132021144)5] Coverage Term:10/01/2014-10/01/2015 MemberName:South Miami,Cityof Agency:Brown &Brown -Miami Page 5 Portal Reference #209786 COVERAGE INFORMATION -PROFESSIONAL LIABILITY -PUBLIC OFRCIALS &EMPLOYMENT PRACTICES THISISANAPPLICATIONFOR "CLAIMS MADEANDREPORTED"COVERAGE ruucLutru New Response What is the requested POLLimit?$1,000,000 2 What Is the requested POL Deductible?$50,000 3 What is the requested EPLI Limit?$1,000,000 4 What isthe requested EPLIDeductible $50,000 5 Total Number of Board Members 50 6 Are Board Members Elected?Y/N No 7 If BoardMembersareappointed,bywhom?MAYOR 8Howmany employees holdprofessionaldesignationsi.e. Attorneys,architects,engineers,accountants etc. 3 9Hasany band issue been defeatedwithinthepastthree years? No 10 If yes,hasthe proposal been resubmitted,orisitexpected to be resubmitted? 11 Hasyour pubfic entitybeenindefaultonthe principal or interest on any bond? No 12 If yestoanyofthesequestions,pleasegive details: 13 Prior Carrier Information -Answerthe following forNew Business Quotesonly.If renewalskiptonextsection. Ace 14New Business -Who isyourcurrent POL/EPLI carrier?Ace 15New Business -What Is your current POL/EPLI Limit?1,000,000 16New Business -WhatIsyourcurrent POL/EPLI Deductible? 17New Business-Does yourcurrent POUEPU coverage have a Retroactive Date?If so,what isit? 10/01/2013 18Hasyour POL/EPLI coverage ever been canceled or non-renewed? Yes 19Ifso,please explain 20Doyou have azoning commission?No 21Doesyourlegal counselattendallmeetingsofthe planning and zoning board? 22Do officials receive training withrespectto "open meetings" and hearing regulations? Yes 23 Doyou have awritten master planfor economic development? No 24Ifso,date last updated? 25Doyou have formally approved land use ordinances?Yes 26 Doyou have aformal procedure tofilefora variance to land use statutes? Yes 27Doyouhavea formal processfor application and approval of permits and licenses? Yes 28Doyouhavea formal writtenpolicy prohibiting elected officialsand/or boardmembersfromsittingondecisionsin which they may have aconflictof interest? Yes 29 In thepast5yearshaveyouhadany disputes orclaims involvingawrongful"taking",zoningvarianceorland use right?If yes.provkJe details. 0 Initial Date f/tyr RenewalApplicationMuni[PKFL1013202114-05] CoverageTerm:10/01/2014-10/01/2015 MemberName:SouthMiami,Cityof Agency:Brown&Brown-Miami COVERAGEINFORMATION-PROFESSIONALUABILITY-PUBLICOFFICIALS&EMPLOYMENTPRACTICES THISISANAPPLICATIONFOR"CLAIMSMADEANDREPORTED"COVERAGE POL/ELUEPLI 30Inthepast5yearshaveyouhaveanydisputesorclaims involvingtheapprovalofbuildingpermits,design,orcode enforcement?Ifyes,provtdedetailswithinlosssummary. 31Inthepast5yearshaveyouhadanydisputes,claimsor complaintsinvolvingopenorcJosedlandfills?Ifyes.provide detailswithinlosssummary. 32indicatetotalemploymentturnoverduringthelast3years for#Full-timeemployeesterminated(vol/invol) 33ForhowmanyIndividuals{noFEIN)doesapplicantreport earningsonIRSForm10997 34Hastherebeenalayoffofemployeesorreductioninservice Inthelastthreeyears? 35Indicatetotalemploymentturnoverduringthelast3years for#Full-timeemployeeshired 36Indicatetotalemploymentturnoverduringthelast3years for#Part-timeemployeeshired 37Indicatetotalemploymentturnoverduringthelast3years far#Part-timeemployeesterminated(vol/invol) 38Indicatecurrentnumberofemployeesemployedmorethan 10years: 39Indicatecurrentnumberofemployeesemployedbetween2 -10years 40Indicatecurrentnumberofemployeesemployedlessthan2 years: 41Overthelast5yearshasanypersonmadeaclaimalleging unfairorimpropertreatmentregardingemployeehiring, remuneration,advancement,treatmentorterminationof employment?(Ifyes,providedetailsunderseparatecover): 42Providenames&positionsofpersonswithwhomany Insuredhaswrittenemploymentagreements) 43Inthepast5years,hasanyclaimbeenmadeorisnow pendingagainsttheEntityoranypersoninhis/hercapacity asanofficialoremployeeoftheentity?Ifyes.provide details. 44Withinthepast5years,has/doesanyofficialoremployee haveanyknowledgeofanyfact,circumstanceorsituation whichmightreasonablybeexpectedtogiverisetoaclaim againstthemoragainsttheentity?Ifso,pleaseprovide details. 45Dosupervisorsreceivetrainingintheproperimplementation ofyourpoliciesandprocedures? 46Doyouhaveawrittenemploymentmanualincludingail personnelpoliciesandprocedures? 47Enterdateemploymentmanualwrittenorlastupdated (MMYYor'None") 48Isthismanualreviewedbycounselexperiencedand qualifiedInemploymenttew? 49Dopoliciesandprocedurescomplywithstateandfederal guidelines? Page6 PortalReference#209786 NewResponse No No No 62 84 96 40 SeeBetow StevenAlexander-Manager Yes-PerClaimrecords No Yes Yes 10701/2013 Yes Yes 50Isthismanualdistributedtoallemployeesuponhiring? 51Ifno,pleaseexplainwhynot Initial^Date*/^rV Renewal Application Muni PK FL1 013202114-05] Coverage Term:10/01/2014-10/01/2015 Member Name:South Miami,City of Agency:Brawn &Brown-Miami COVERAGE INFORMATION -Auto Liability Coverage 1 AL Limit 2AL Deductible? 3ALTerritory? 4Hiredand Non-Owned Liability? 5ALMedical Payment limit? 6 Uninsured/Underinsured motorist limft {max $100,000)? 7 Ifsymbol10forAL Is required,provide definition. 8Doyou have awritten safety manual for Fleet Management? 9 Is thesafety manual forfleetmanagementupdated annually? 10 Are safety inspection records maintained? 11Howoftendoyouinspectvehiclesforsafetyhazards? 12DoyouhaveaDriverTrainingProgram? 13 Is the Driver Training program updated annually? 14 Doyouhaveawrittencriteria/policyonhowtoanalyze MVR's? 15Doyouhavea formal written accidentreporting procedure? 16Doyouhavea written Employee Disciplinary program In place for Driver Safety Violations? 17 Arevehiclesassignedtospecificdrivers with backup drivers? 18Doyouown any 15 Passenger VanswithModelYear2006 orolder?(Ifyes,provide Member's policy/procedurewith regards to how many passengers are transported in each van,seatbelts,other safety procedures,etc.) Initial ^&-Date Page 8 Portal Reference #209786 New Response $1,000,000 $0 Tri County Yes $0 $0 No No Yes Quarterly Yes Yes Yes Yes Yes Yes Yes RenewalApplicationMuni[PKFL1013202114-05] Coverage Term:10/01/2014-10/01/2015 Member Name:South Miami,City of Agency:Brown &Brown-Miami COVERAGE INFORMATION -Auto Physical Damage Page 9 Portal Reference #209786 Coverage New Response Comprehensive Auto Symbol 7,8 2Collision Auto Symbol 7,8 3 If symbol 10 required,providedefinition: 4HiredPhysical Damage (Y/N)Yes 5 Hired Physical Damage Limit (35K/50K/75K100K):$75,000 6HiredPhysicalDamageDeductible 500 Initial Date 9/Mv |\fi 1 Renewal Application Muni [PK FL1 0132021 14-05] rfftfVfPn Coverage Term:10/01/2014-10/01/2015 ItWW IWf Member Name:South Miami,City of Hi WJMM Agency:Brown &Brown -Miami COVERAGE INFORMATION -Crime Page 10 Portal Reference #209786 Coverage New Response EmployeeDishonestyBlanketLimit(faithfulperformance Included) $100,000 2EmployeeDishonestyBlanketDeductible $1,000 3 Forgery orAlteration Umit $100,000 4Forgeryor Alteration Deductible $1,000 5 Then,Disappearance or Destruction Limit $0 6 Theft,Disappearance or Destruction Deductible X$0 7 Computer Fraud Umft $100,000 8 Computer Fraud Deductible $1,000 9Doestheapplicantcheckforpast criminal records(theftof money and securities,robbery,etc)on prospective rateable employees? Yes 10Howfrequentlyareauditsperformed?Annual 11 Who performs the audit?CPA 12 Is countersignature of checks required?Yes 13 Areyour bank accounts reconciled by someone not authorized to deposit or withdraw? Yes 14Number of employees handling money (accountants, bookkeepers,cashiers,checksigners,etc.)? 3 15 Number of messengers?0 16 Number of guards accompanying messenger?0 17 Is bankingdonebyyourinternalstafforbyotheroutside professionals? Internal Staff Initial Date r/tyr RenewalApplicationMuni[PKFL1013202114-05] CoverageTerm:10/01/2014-10/01/2015 MemberName:SouthMiami,Cityof Agency:Brown&Brown-Miami COVERAGEINFORMATION-GeneralLiability Coverage GLOccurrenceUmit 2GLDeductible 3EmployeeBenefitsOccurrenceUmit 4WhatistherequestedGLHerbicide&PesticideUmit(Inclin GLOccurrenceLimit)? 5No-FaultSewerBackupCoverage($1KperClaim/$5K AnnualAggregate)? 6MedicalExpenseUmit(Max$2,500) 7GLTerritory 8WhatistheGLnetoperatingexpensesamount? 9PleaseprovidethetotalnumberofHousingAuthorityunits. 10IfHousingAuthority,pleasegivethenumberofsection8 units,(includingUSDAUnits) 11Numberofhotelunitsowned/operatedbytheentity. 12Doyourequireailcontractors&vendorswithwhomyoudo businesstoprovideacontractualholdharmlessand certificateofInsurance. 13Doyourequireailcontractors&vendorswithwhomyoudo businesstomakeyouanAdditionalInsuredontheirpolicy 14Doyourequiregroupsusingyourfacilitiestoprovidea contractualholdharmlessandCertificateofInsurance? 15Doyourequiregroupsusingyourfacilitiestomakeyouan additionalInsuredontheirinsurancepolicy? 16Doyouown/operate,andarerequestingcoverage forAiiports/Aircraft(PremisesLiabilityOnly) 17Doyouown/operate,andarerequestingcoverage forrHospttals,NursingHomes,MedicalFacilities(Coverage limitedtoPremisesUabilltyOnly,MedicalMalpractice excluded.) 18Doyouown/operate,andarerequestingcoveragefonLaw Enforcement(SeeProfessionalLiabilitysectionforcoverage questions) 19Doyouown/operateandarerequestingcoveragefor DetentionFacilities(SeeLawEnforcementsectionfor coveragequestions) Operations:AthleticFields&Activities Doyouown/operate,andarerequestingcoverage forAthlefcFields&Activities 2Describetypeofoutdoorathleticactivities: Operations:Beaches/Lakes/RetentlonPonds 1Doyouown/operate,andarerequestingcoverage fonBeaches/Lakes 2AreSafetySignsinplace? Initial°>-^vDatet/b/iv Page11 PortalReference#209786 NewResponse $1,000,000 $1,000,000 $1,000,000 No $0 Tri-County $19,375,053 Yes Yes Yes Yes N/A N/A Own/Operate N/A NewResponse RequestingCoverage PLAYGROUNDS,SOCCER, BASEBALL,TENNIS, RACQUETBALL NewResponse 7\f f Renewal Application Muni [PK FL1 0132021 14-05] rfpfjfltPn Coverage Term:10701/2014-10/01/2015 11WWI Wf Member Name:South Miami,City of•faun y VSm mmm Agency:Brown &Brown-Miami COVERAGE INFORMATION -GeneralLiability Operations:Bteachars/Audttorlumsretadiums Doyouown/operate,andarerequestingcoverage for Bieachers/Auditoriums/Stadlums 2#of Bieachers/Auditoriums/Stadlums withSeatingCapacity less than 2,500 3 #of Bleachers/Auditoriums/Stadiums withSeatingCapacity over 2,500 Operations:Skate Parks Doyouown/operate,andarerequestingcoverage focSkate Parks 2Hasa disclaimer sign been posted? Page 12 Portal Reference #209766 New Response Own/Operate New Response COVERAGE INFORMATION -General Liability Operations:Special Events,Fairs or Carnivals New Response 1Doyouown/operate,andarerequestingcoverage fonSpeclal Events,FairsorCarnivals Own/Operate 2 Description of Events:INDEPENDENCE DAY,ETC 3Doyoucontractoutsecurityatthe events?No 4Doyou have fireworksdisplays?Yes 5ifyou have fireworks displays,how many ayeardoyou have? 1 6Doyoucontractoutthe fireworks displaytoalicensed Pyrotechniclan? Yes Operations:Swimming Pools /Water Parks New Response 1Doyouown/operate,andarerequesting coverage for: Swimming Pools/Water Parks Own/Operate 2 Total number of pools/water parks 1. Operations:Transportation &Community Services New Response Doyou own/operate,andarerequesting coverage fon Transportation &Community Services 2Are Dept ofTransportationphysicalsrequiredfordrivers over age 65 ? 3 Are MVR's reviewed for all volunteer drivers ? 4 What is the minimum liabilitylimits volunteer drivers are requiredtomaintainontheir personal automobile coverage?' Supervision Abuse Prevention (Required)New Response Who intheEntity has been designated tohandleclaims (includename,address,telephonenumberandemail)? Latasha Nickle 2With respect toClaimsIncidents,etc.,doyou have awritten procedure forobtaininginformation? Yes 3 Enter Y/N forall operations Y 4Doyouoperate camps (residential)?Mo f/-*///Initial Date Renewal ApplicationMuni[PKFL1 013202114-05] Coverage Term:10/01/2014-10/01/2015 MemberName:South Miami,Cityof Agency:Brown&Brown-Miami Page 13 Portal Reference #209766 COVERAGE INFORMATION -General Liability Supervision Abuse Prevention (Required)New Response 5Doyouoperate camps with overnightstays?No 6Doyou operate daycare centers/nursery schools -children or adult care? Yes 7Doyou operate juvenile detention centers?No 8Doyou operate medical services and professionals - doctors,psychiatrists,visitingnurse services? No g Doyou operate mental institutions?No 10 Doyouoperateorphansorfoster homes,Including social service agencies responsible for the foster home evaluation and/or placement? No 11Doyouoperate reflglous/ctergy/chutch organizations?No 12 Doyouoperateschools -publicor private elementary,Junior highorhigh school? No 13Doyou operate social service counselors -socialworkers, psychologists? No 14Doyou operate special needs educational facilities?No 15Doyouoperatesubstanceabuse facilities withovernight stays? No 16Doyou operate substanceabuse facilities without overnight stays? No 17Doyouoperateyouthorganizations(sports,scouts, YMCA/YWCA,BigBrothers/Sisters,etc)? No 18 Whatotheractivitiesdoyouoperate?Sports Programs 19 IsthereaSexualAbuse Prevention Program ineffect?Yes 20Hasa written policy beenestablishedclearlyexpressing management's commitment tosexual abuse prevention? Yes 21Havewrittenprocedures encompassing rules,acodeof conduct anddisciplinary measures been established forall staff and/orvolunteers,whichclearlydefinethe policy and consequences of non-adherence? Yes 22Hasa mechanism been developed to ensure thatsexual abusepreventionpoliciesandproceduresareimplemented andenforcedthroughoutthe organization? Yes 23 Is thereaSexualAbuse Prevention Coordinator that reports toa member of management? Yes 24Aremanagement/stafftrained in policies and procedures relating totheSexualAbuse Prevention Program? Yes 25Dopolicies and procedures include an incident reporting and follow-up mechanism? Yes 26Arestandardapplicationsusedfor alt prospective employees or volunteers? Yes 27 Is thereaminimum of twobackground checks for prospective employees with documentation maintained in file? Yes 28 Do background checks Include checks with "Sex Offender Hot-fines",State Police,State DepartmentofSocial Services,or similar public agencles?(where applicable) Yes 29 In thepastfiveyearshaveany employees orofficersbeen terminatedfor cause relatedto sexuatfy abusive behavior? No Initial AM UEl Agency:Brown &Brown -Miami Renewal ApplicationMuni[PKFL1013202114-05] Coverage Term:10/01/2014-10/01/2015 Member Name:South Miami,Cityof 14 Portal Reference #209786 COVERAGE INFORMATION -General Liability Supervision Abuse Prevention (Required)New Response 30Are records maintained documenting adherence toall applicablepoliciesandprocedures,e.g.,hiring and screening,codeof conduct,training,incidentand follow-up procedures? Yes 31Areyouawareofanycircumstancethatmayresultina sexual abuse claim?If Yes.explain ona separate sheet. No 32 Have any members of the staff been transferred because of allegations of sexual abuse? No 33 Is training documented intheir personnel file?Yes Initial Jl Date Renewal Application Muni[PKFL1 013202114-051 Coverage Term:10/01/2014-10/01/2015 Member Name:South Miami,Cityof Agency:Brown &Brown -Miami COVERAGE INFORMATION -Professional Liability Employee Benefits Liability DoyoucurrentlyhaveanEmployeeBenefitprogram? 2 Enter Limitamount for each employee 3EnterDeductible amount for each employee Page 15 Portal Reference #209786 New Response Yes $1,000,000 $1,000 COVERAGE INFORMATION -Professional Liability law Enforcement New Response 1WhatIsthe requested Law Liability Limit?$1,000,000 2WhatistherequestedLaw Liability Deductible?$0 3 Please providethe title ofpersonresponsibleforLaw Enforcement Operations CHIEF 4 Contact Person Rene Lania 5 Phone:3056636345 6 Email address INFO@SOUTHMIAMiFL.GOV 7Areyouapartytoanymutualaidagreements?(Pleaselist or answer "None".)SURROUNDING COMMUNITIES 8Doyouprovidecontractedservicesforanyotherentities? (Please Hstor enter "No".) NO 9 PLEASE COMPLETE THE FOLLOWING BY ENTERING NUMBEROFEMPLOYEES,ACCOUNTINGFOREACH EMPLOYEE ONLY ONCE IN THEIR PRIMARY CLASSIFICATION: 10 ClassA-ChleflSheriff 1 11Class A-Deputy Chief/ChiefDeputy 0 12ClassA-OtherRankingOfficers(Captains,Lieutenants, Sergeants) 14 13ClassA-FuB-time Armed Officers with arrrest authority (non-ranking) 35 14 Class A-Jail Wardens and Assistant Wardens 0 15 ClassA-District AttorneyInvestigators 0 16 ClassA-DA orProsecutingattorneys 0 17 ClassB-ArmedPart-time,Auxiliary,orReserveOfficers 2 18ClassB-WhatIs theaveragenumberofhoursper officer / per week? 40 19 ClassB-Armed ProbationOfficers,bothadultand juvenile?0 20 Class B -Jailers -Full-time and Part-time 0 21ClassB-Canines (provide certification of training forboth dog and handler) 1 22 Class B-Civil Process Officers 0 23 Class B-Court Security Officers 0 24ClassC-UnarmedPart-time,Auxiliary,orReserveofficers.0 25ClassC-Whatistheaveragenumberofhoursper officer /per/week? 0 26 Class C -Unarmed Probation Officers,both adult and juvenile. 0 27 Class C-School Crossing Guards.0 28 Class C-Dispatchers/Communications^.^8 ^E ipwinitialDate Renewal Application Muni[PKFL1 013202114-05] Coverage Term:10/01/2014-10/01/2015 MemberName:South Miami,Cityof Agency:Brown &Brown -Miami COVERAGE INFORMATION -Professional Liability Lew Enforcement Page 16 Portal Reference #209786 New Response 29 Class C-Animal Control Officers.j0 30 Class C-Building inspectors.7 31Whatis the currentannualoperating budget forthelaw enforcement agency? 7289896 32How many attack canines are rn Law Enforcement operations? 1 33 WHICH OF THE FOLLOWING ARE INCLUDED IN YOUR SELECTION PROCESS PRIOR TO EMPLOYMENT: 34 Written Exam?No 35 Psychological Exam?Yes 36Backgroundand employment investigation?Yes 37Doaillaw enforcement officers meet your state's minimum standards fortraining and receive certification? Yes 38 If yes,how many hours of training?Otherwise,please explain. 480 39Doyoufollowwrittenpoliciesregarding In-service trainingor continuing education for all officers? Yes 40If yes,how many hours per year?480 41 Is all employee training,both past and present,documented and kept on file? Yes 42Doesyour agency have aFieldTrainingProgramfor new employees? Yes 43 If yes,how many weeks?12 44 What Is the Average Salary of your current full-timesworn officers? 50,000 45 What Is the Average #of Years of Service ofyourcurrent full-time sworn officers? 12 46 ARE OFFICERS REQUIRED TO COMPLETE TRAINING IN THE USE OF: 47 Baton/PR-24/ASP?Yes 48 Chemical Irritants?No 49ElectronicControlDevice(StungunorTaser)?Yes 50 Carotid control hold?No 51 Other,please describe. 52Areallofficersrequiredto complete a Defensive Driving Program? Yes 53Doall officers receive training In simulated or actual high speed pursuit? Yes . 54Doallofficers receive traininginFirstAid?Yes 55Doall officers receive training In CPR?Yes 56Doall officers receive training ki the use of Defibrillators?No 57 WHAT TRAINING IS REQUIRED OF RESERVE AND AUXILIARY OFFICERS: 12 WEEKS 58 Same as Full-time Officers?Yes 59 Less thanFull-time Officers?If less,please explain.NO 60Do you maintain aformal Policies and Procedures Manual Yes Initial ^ff d"'f'Atf'? Renewal Application Muni[PKFL1 013202114-05] Coverage Term:10/01/2014-10/01/2015 Member Name:South Miami,City of Agency:Brown&Brown -Miami COVERAGE INFORMATION -Professional Liability Page 17 Portal Reference #209786 Law Enforcement New Response 61Doall employees receive their own copy?Yes 62 Is every employee held accountable for knowing the contents of the manual Yes 63 When was your manual originally assembled?01/01/1990 64 When was your manual last updated?01/01/2013 65 Is your manual regularly reviewed by competent legal counsel? Yes 66 Reviewed by whom?LEGAL 67 DO YOU HAVE FORMAL WRITTEN POUCIES AND PROCEDURES PERTAINING TO THE FOLLOWING SUBJECTS: 68 Use of deadly force?Yes 69 Use of non-deadly force?Yes 70 Vehicle high-speed pursuit?Yes 71 Domestic Violence?Yes 72 Search and seizure?Yes 73 Intoxicated arrestees?Yes 74 Communicable diseases?Yes 75 Employee moonlighting?Yes 76Doyou handle yourown dispatching?Yes 77Doyou dispatch forany other entities?No 78DoyourLaw Enforcement dispatchers alsodispatchfor emergency medical and firefighting services? No 79 Are all incoming calls recorded?Yes 80Howlongare the tapes maintained?90 DAYS 81How many hours of trainingdo dispatchers receive?10 82Doyou participate inanyinternshipor ride-along programs?If so,please attach explanation. Yes 83Doyouown,operateormaintainanyfixedorrotarywing aircraft?If Yes,please explain. NO 84 Doyouown,operate ormaintain any watercraft?If yes, please explain. NO 85WithrespecttoyourLawEnforcement Liability coverage,If withPGIT less than5 years,complete andattachthe "Loss Summary"formora "No Known Losses"letter.Form template can be found with Pool Forms under the Documents section of the application. 86Hasanyclaim been made orsuitfiledagainsttheentityor anypersonintheircapacity as anofficialor employee ofthe entityin the lastfive years?if yes,please attachanarrative summary with details and status. Yes 87 Does anyofficialor employee have any knowledge ofany fact,circumstance orsituationwhichmight reasonably be expected togiverisetoaclaim?If yes,please attacha narrative summary with details. No 88 New Business -Who is your current carrier?N/A 89NewBusiness -Whatisyourcurrent Limit ofjjabilily? ^yyInitialDate Renewal ApplicationMuni[PKFL1 0132021 14-05] Coverage Term:10/01/2014-10/01/2015 Member Name:South Miami,Cityof Agency:Brown &Brown -Miami COVERAGE INFORMATION -Professional Liability Page 16 Portal Reference #209786 Law Enforcement New Response 90New Business -What isyour current Deductible? 91New Business -What type ofLaw Enforcement Liability coverage doyou currently have?Occurrence?Or Claims-Made?(Preferred form Occurence noprior acts available.) 92Has the Law Enforcement coverage been cancelled or non-renewed within the last five years? No 93If so,please explain: 94 If youdoNOT have a detention facilityofanykind,please check this box and skip to the next section No Detention facflfty No 95 Which of thefollowing best describes yourfacility?HOLDING CELL 96 Temporary holdingfacility (under 8 hours -no overnight)Yes 97 Temporary holdingcell(from8to 24 hours)No 98 Jail -for persons serving time,awaiting trialor transfer.No 99 When was yourfacilitybuilt?01/01/1993 100 When was yourfacilitylast renovated?1993 101 What is the state certified capacity?5-6 102 What is the average daily inmate population?0 103 Does your facility house... 104 Adult prisoners only?No 105 Males and females?Yes 106 violent and non-violent prisoners?Yes 107 Is your facility equipped with surveillance systems to monitor activity in the following areas?If so,please check Yes 108 Individual detention cells?Yes 109 Secured common areas?Yes 110 Booking area?Yes 111 Sallyport?Yes 112 When was yourfacility last inspected by the following:FIRE-2012 113 State Corrections Officials?0 114 Fire Inspectors?1 115 Department of Health?0 116 Do you have standard fire protection systems Including smoke detectors and fire alarms? Yes 117 How many hours of trainingare required priorto employment as aguardorjailer? 0 116 Do dispatchers serve as jailers?No 119 If so,do they receive the same training?No 120Do you employ or contract with Doctors)?No 121Doyou employ or contract with Nurse(s)?No 122 Do you employ or contract with Dentists)?No 123Doyou employ or contract with Psycholoajst(s)?No Initial >r t/*/r T\fi 1 Renewal Application Muni [PK FL1 0132021 14-05] imPfml CoveraSeTerm:10/01/2014-10/01/2015 I IWW IW Member Name:South Miami,City of BB KStftEIfl Agency:Brown &Brown -Miami COVERAGE INFORMATION -Professional Liability Page 19 Pc i al Reference #209786 Law Enforcement New Response 124 Do each of the above maintain their own professional errors and omissions liability coverage? 125 Has anyone ever successfully committed suicide inyour fadllty?If yes,please attach explanation. Yes 126 How many attempted suicides have there been inyour facilityin the last three years? 0 127 DO YOU HAVE FORMAL WRITTEN POLICIES AND PROCEDURES FOR: 128 Intake screening and classification?Yes 129Medical screening?Yes 130 Suicide detection and prevention?Yes 131Periodic walk-through of the facility?Yes 132 Administration and control of medication?Yes 133 Use of force?Yes 134 Emergency evacuation?Yes 135 Communicable diseases?Yes 136 When was yourmanuallast updated (date)?01/01/2013 137 Is your manual reviewed by legal counsel?Yes 138 Hasyourfacility ever been subject toacourtorderor Consent Decree? No 139What Is theaverage occupancy percentageofyour facility?1 Initial j^h m %fo/' Renewal ApplicationMuni[PKFL1 013202114-05] Coverage Term:10/01/2014-10/01/2015 Member Name:South Miami,Cityof Agency:Brown&Brown -Miami COVERAGE INFORMATION -Property Page 20 Portal Reference #209786 Coverage New Response FJoodlimit(primaryfor zones other thanA&V)-Maximum Umit $5,000,000 $1,000,000 2 What is the requested AOP Property Deductible?$2,500 3 What Is the requested Earthquake Limit?$0 4 What is the default protection class?4 5If any of the buildings have unrepaired damage froma previous loss,please describe the extent of the damage and location. NONE 6 Date of last property valuation:06/03/2013 7 Does the member own any structures not listedon the PropertyApplication Schedule of Locations?If yes,provide description and/or schedule under separate cover. No 8 Are these structures insured with another carrier?No sir Renewal Application Muni [PK FL1 0132021 14-05]Page7 CoverageTerm:10/01/2014-10/01/2015 Portal Reference #2097B6 MemberName:South Miami,Cityof Agency:Brown&Brown-Miami COVERAGE INFORMATION -PROFESSIONALLIABILITY-PtlBUCOFFICIALS&EMPLOYMENTPRACTICES THIS IS AN APPLICATION FOR 'CLAIMS MADEAND REPORTED"COVERAGE ruuELUcru New Response 52Doyouhavea written policywithrespecttobothsexualand non-sexual harrassment? Yes 53Doyou follow a formal written procedure for employee disputes/complaints? Yes 54Areallactionstodismissordemoteemployees reviewed in advance by legal counsel? Yes 55Doyourequirethatdue process be served and documented forall proceedings Involving dismissal,demotionor suspension? Yes 56Areallprobationaryordisciplinary actions recordedIn writing andsignedbythe employee? Yes 57AreyouanEqualOpportunityEmployer?Yes 58Havejob descriptions beendraftedfor regular full-time positions? Yes PROFESSIONAL LIABILITy IT IS AGREEDTHAT IF ANY SUCHFACT,CIRCUMSTANCE OR STATION NOT USTED/DISCLOSED HEREIN,THEN ANY CLAIM BASED UPON,ARISINGOUTOF,OR ATTRIBUTABLETHERETO,IS EXCLUDED FROM THECOVERAGEBEINGAPPLIEDFOR. The undersigned being authorized by.and acting on behalf ofthe applicant and ail persons or concerns seeking coverage,hasreadandunderstandsthis Application,anddeclaresallstatementsset forth herein are true,complete and accurate.The undersigned further declares and represents that any occurrence orevent taking place prior tothe inception ofthe coverage agreement applied for,which may render inaccurate,untrue orincomplete any statement made herein will immediately be reported in writing tothe Trust.The undersigned acknowledges andagrees thatthe submission andthe Trust's receipt ofsuchwritten report,prior tothe inception ofthe coverage agreement applied for,isa condition precedent to coverage. The signing ofthis Application doesnotbindthe undersigned to purchase coverage,nordoes the review ofthis Application bind Preferred toissuea coverage agreement Thfs Application shall,however,bethebasisofthe contract,shouldacoverageagreementbeissued. Signed Title Date This Application must be signed bythe "Ranking Elected /Appointed OfflciaTof the Entity making the application (e.g. Mayor/Manager/equivalent Officer)ortheRite*Manager (or ranking official}assigned this function. SIGNATORY ABOVE IS ALSO TOINITIALEACHANDEVERYPAGEOFTHISAPPLICATION. IMPORTANT NOTICE:SHOULD THESIGNED APPLICATION DIFFER INANYWAY FROM THE APPLICATION SUBMITTED FORUNDERWRITING/RATING PURPOSES,THETERMS,CONDITIONS AND PREMIUM AS REFLECTED ON QUOTE/BINDER/COVERAGE AGREEMENTMAYBESUBJECTTO CHANGE. Initial Date GOVERNMENTAL INSURANCE TRUST Covered Party:City of South Miami Agreement Number:PK FL1 013202114-05 Coverage Period:From:10/01)2014 to 10/01/2015 I hearby confirm that limits/coverages as shownhereunder,corresponding with theCoverageAgreement,are correct: Property TIV Inland Marine $22,673,917 Buildings&ContentsCombined NotIncludedCommunication Equipment NotIncluded Contractor's /Mobile Equipment NotIncludedElectronicData Processing Equipment NotIncluded Emergency Services Portable Equipment Not Included Fine Arts $417,896 Other Inland Marine Not Included Rented,Borrowed,Leased Equipment Not Included Valuable Papers Not Included Watercraft I reject property TRIA (TerrorismRisk Insurance Act)coverage Automobile 144#of Units-Auto Liability 99#ofUnits-Comprehensive 99 #of Units-Collision I herebyconfirmthat I havereceivedacopyof Preferrecfs CurrentInterlocalAgreement (which was last amended October 1,2004)and amendment A(which was effective October 1,2013). I confirmhaving read and agreed tothe terms aslaidout \r\the attached PGITParticipation Agreement (which also requires asignature) Please remember that a signedcopyofthe following arealsorequired: •First Page ofPGJT application •UninsuredMotoristRejection/Electionform,ifapplicable •Professional Liability (POL/EPLIorELL/EPLI)application,ifapplicable. f>H\|Uflnaggr* Name Please note:Failureto return thissignature page couldresultincancellationof coverage. Date/* TtebrtefdescrfptiOTCf coverage oartiak^Formore <»nMdc middetailed Ir^bnrattoiretatJngtD^Specimen farms ateavailable upon request. Page 14 Preferred NSURANCETRUST COVERED PARTY:City of South Miami AGREEMENTNO.:PKFL1 0132021 14415 AGREEMENT PERIOD:10/01/2014 to 10/01/2015 YOUARE ELECTING NOTTOPURCHASE CERTAIN VALUABLECOVERAGE WHICH PROTECTS YOUANDYOURFAMILYORYOU ARE PURCHASINGUNINSURED MOTORISTS LIMITS LESS THAN YOUR BODILY INJURY LIABILITY LIMITS WHEN YOU SIGN THIS FORM.PLEASE READ CAREFULLY. Uninsured Motorist coverage provides for payment ofcertain benefits for damages caused by owners or operators of uninsured motor vehicles because ofbodily injury ordeath resulting there from.Such benefits may include payments for certain medical expenses,lost wages,and pain and suffering,subject tolimitations and conditions contained In the Coverage Agreement For the purpose ofthis coverage,an uninsured motor vehicle may Include a motor vehicle asto which the bodily injury limits arelessthanyourdamages. Honda law requires that automobile liability coverage agreements include Uninsured Motorist coverage at limits equal tothe Bodily Injury Omits In your coverage agreement unless you select a lower limit offered bytheTrust,or reject Uninsured Motorist entirely.Please indicate whether you desire to entirely reject Uninsured Motorist coverage,or,whether you desire this coverage at Omits lower thanthe Bodily Injury Liability limits of your Coverage Agreement a.herebyrejectUninsured Motorist coverage. b.hereby selectthefollowing Uninsured Motorist limits which are lower than my Bodily Injury Liability Limits: eachperson(enterlimitif applicable): each accident 0; •; •;c.I hereby select Uninsured Motorist coverage limits equal tomy Bodily Injury Liability limits.(Ifyou select this option disregardtheboldfacestatementabove.) ELECTION OF NOK-STACKED COVERAGE (Donotcompleteifyouhaverejected Uninsured Motorist) You have the option to purchase,ata reduced rate,non-stacked (limited)type of Uninsured Motorists coverage.Under this form ifInjury occurs ina vehicle owned orleasedbyyou oranyfamily member who resides with you,this Coverage Agreement will appfy only tothe extent ofcoverage (if any)which applies tothat vehicle In this Coverage Agreement.Ifan injury occurs while occupying someone else'svehicle,or you are struck asa pedestrian,you are entitled toselectthe highest fimits of Uninsured Motorist coverage avaiiable onanyonevehicle for which you area Named Covered Party,covered family member,or covered resident ofthe Named Covered Part/s household.This Coverage Agreement will notapply Ifyou select the coverage available underanyother Coverage Agreement Issued to you orthe Coverage Agreement ofanyotherfamily member who resides withyou. Ifyoudonotelecttopurchasethe non-stacked form,yourCoverage Agreement Rmit(s)foreachmotorvehicle areadded together (stacked)forall covered Injuries.Thus,your Coverage Agreement limits would automatically change during the Coverage Agreement termif you increaseordecreasethe number ofautos covered underthe Coverage Agreement. D i Ihereby elect the non-stacked form of Uninsured Motorist coverage. I understand andagreethat selecjttorj^afiy oftheaboveoptions applies tomyliability Coverage Agreement and future renewals or replacemerrte^UQwCoverage Agreementwt*|ch are issued atthesame Bodily Injury Liability limits.IfIdecide toselect another optio^sTsome future time,I mujtlefmeTrustor my agent know in writing. Signed <z&S&A*f< Signed PGIT398(0705) vered Party) (Covered Party) Date:*/*/" otihjMb and detailed Hbnratto Specimen tonre are avallBbte upon request Page 13 AGENCY BROWN &BROWN OF FLORIDA INC 14900 NW 79th Court Sulte#200 Miami Lakes,FL 33016-5869 Robert Hollander CONTACT mm Robert Hollander BEL—30W64-7800 FAX ADDRESS; CODE: 305-714-4401 AGENCY CUSTOMER P:OTYO09 SUBCODE: CSR.-C7 DATE(MM/DD/tYYY) 9/16/2014APPLICANTINFORMATIONSECTION CARRIER *ACE American Insurance Co/ UNDERWRITER; POLICIESORPROGRAM REQUESTED INDICATE SECTIONS ATTACHED BOILER &MACHINERY BUSINESS AUTO COMMERCIAL GENERAL LIABILITY CRIME/MISCELLANEOUS CRIME DEALERS DRIVER INFO SCHEDULE NAICCODE 22667 UNDERWRITER OFFICE: ELECTROM--HATAPROC EQUIPMENT FLOATER GARAGE AND DEALERS GLASS AND SIGN INSTALLATION/BUILDERS RISK OPEN CARGO PROPERTY TRANSPORTATION/ MOTOR TWUTMRARffn POLICY NUMBER EONM0Q6Q9079001 TRUCKERS/MOTOR CARRIER UMBRELLA VEHICLE SCHEDULE WORKERSCOMPENSATION YACHT STATUS OF TRANSACTION ||ISSUE POLICYQUOTE BOUND(Gtar Dateand/lor AttachCopy): CHANGE ^^ CANCEL TxJ RENEW PACKAGE POLICY INFORMATION ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLY TO SEVERAL LINES.OR FOR MONOUNE POLICIES TIME PROPOSED EFF DATE PROPOSED EXP DATE BILLING PLAN PAYMENT PLAN APPLICANT INFORMATION NAME (FfretNaimd fraurad &Other Named(nsurecft) City of South Miami TsramswgfcT (ofF ifdlnaqrotfte gg^aaiea.InicMeSsouthmiamifLgov INDIVIDUAL PARTNERSHIP CORPORATION JOINT VENTURE inspection contact:Latasha Nickfe PHONE 13^^305-868-3878Kwcw^Btfi; SUBCHAPTER"?* CORPORATION HSffi*ORG 10/01/14 10/01/15 DIRECT BILL AGENCY BILL £ACKAQE POLICY PREMIUM:& LLC NO.OFMEMB^S AND MANAGERS _ MAIUNG ADDRESS KCLZIP+4 (of First NamMl fcMuAd) La Tasha Nickle,HR Dlr. 6130 Sunset Drive South Miami,FL 33143 WEBSITE CR BUREAU NAME; ID NUMBER: rA/CN«.E«tt«305-668-3878 E-MAIL In!ck!^64ttHm!flfinTr$5V- ACCOUNTING RECORDS CONTACT: PHONE JflSJfrgrtF, "HEaT— ADDRESS.- AUDIT DATE BUS STARTED rrccmtares IN r*uwM I iun i i acord 023 attached tor additioiialipremises* LOC#BUS*STREET,CITY.COUNTY,STATE,ZIP+4 CITY LIMITS INTEREST YR BUB.T # EMPLOYEES ANNUAL REVENUES % OCCUPIED INSIDE OUTSIDE OWNER TENANT INSIDE OUTSIDE OWNER TENANT INSIDE OUTSIDE OWNER TENANT INSIDE OUTSIDE OWNER TENANT NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS BY PREMISE(S) ACORD 125 (2007/10)Page1of3 <S>1993-2007 ACORD CORPORATION.All rights reserved. The ACORD name andlogoare registered marks of ACORD GENERAL INFORMATION AGENCY CUSTOMER ID:CITYOOS CSR:C7 EXPLAIN ALL-YES"RESPONSES 1a.IS THE APPLICANTA SUBSIDIARY OF ANOTHER ENTITY? 1b.DOES THE APPLICANT HAVE ANY SUBSIWAfUES? Z ISA FORMAL SAFETY PROGRAM IN OPERATION? 3.ANY EXPOSURE TOFLAMMABLES,EXPLOSIVES.CHEMICALS? 4.ANY CATASTROPHE EXPOSURE? 5.ANY OTHER INSURANCE WITHTHIS COMPANY ORBEINGSUBMITTED? 6.ANYPOLICY ORCOVERAGE DECLINED.CANCELLED ORNON-RENEWED DURING THE PRIOR THREE (3)YEARS?(No*applicable inMO) EPL/Public Officials -PGIT 7.ANYPASTLOSSESORCLAWS RELATING TO SEXUAL ABUSEOR MOLESTATION ALLEGATIONS.DISCRIMINATION OR NEGLIGENT HIRING? DURING THE LASTFIVE YEARS (TEN IN Ri),HASANYAPPLICANT BEEN INDICTED FOR ORCONVICTED OFANYDEGREE OFTHE CRIME OFFRAUD.BRIBERY,ARSON ORANY OTHERARSON-RELATED CRIMEINCONNECTION WITHTHISORANYOTHERPROPERTY? (In Rl frfequwDon must ba wwwred byanyapplicantforpropertyinsurance.FafuretodtedoseteeidiaarraGfanensonconvtctta year oriftpnsoniiieflCj. a ANY UNCORRECTED FIRECODE VIOLATIONS? 10.ANYBANKRUPTCIES,TAXOR CREDIT UENSAGAINST THE APPLICANT IN THE PAST FIVE (6)YEARS? 11 HAS BUSINESS BEEN PLACED INA TRUST? IF"YES",NAME Of TRUST: 12.ANY FOREIGN OPERATIONS,FOREIGN PRODUCTS DISTRIBUTED INUSA,ORUS PRODUCTS SOLD/DISTRIBUTED INFOREIGN COUNTRIES? (If"YES",attachACORD 815 farUabflity Expoaurp and/orACORD816 farProperty Exposure) REMARKS/PROCESSING INSTRUCTIONS (AttachwMMoMl sheets \fmon apaceIs lequfred) LH a m LH LU LH m LyJ a a LTD LU H |COPY OF THE NOTICE OF INFORMATION PRACTICES (PRIVACY)HAS BEEN GIVEN TO THE APPLICANT.(Not appflcsWe In at)gtetet,consult your agent or broker for your state's requirements.) NOTICE OF INSURANCE INFORMATION PRACTICES -PERSONAL INFORMATION ABOUT YOU.INCLUDING INFORMATION FROM A CREDIT REPORT.MAYBECOLLECTED FROM PERSONSOTHERTHANYOU IN CONNECTION WTTH THIS APPLICATION FOR INSURANCE ANDSUBSEQUENT POLICY RENEWALS.SUCH INFORMATION AS WELL AS OTHERPERSONALAND PRIVILEGED INFORMATION COLLECTED BYUSOROURAGENTSMAY IN CERTAIN CIRCUMSTANCES BE DISCLOSED TOTHIRD PARTIESWITHOUT YOUR AUTHORIZATION.YOUHAVETHE RIGHT TOREVIEWYOURPERSONAL INFORMATION IN OUR FILES ANDCANREQUESTCORRECTION OF ANY INACCURACIES.A MORE DETAILED DESCRIPTION OFYOUR RIGHTS ANDOUR PRACTICES REGARDING SUCH INFORMATION IS AVAILABLE UPON REQUEST. CONTACTYOUR AGENT ORBROKERFOR INSTRUCTIONS ONHOWTOSUBMITAREQUESTTOUS. ANYPERSONWHO KNOWINGLY ANDWITHINTENTTO DEFRAUD ANY INSURANCE COMPANY ORANOTHERPERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENTOF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION,ORCONCEALSFORTHEPURPOSEOF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO,COMMITS A FRAUDULENT INSURANCE ACT.WHICH IS A CRIME AND SUBJECTS THE PERSON TO CRIMINAL AND [NY:SUBSTANTIAL]CML PENALTIES.(Not applicable fn CO.FL,HI.MA,NE,OH.OK.OR.orVT;In DC.LA,ME.TN.VAandWA.insurance benefitsmay also be denied) IN FLORIDA.ANYPERSONWHOKNOWINGLYANDWITH INTENT TO INJURE.DEFRAUD,OR DECEIVE ANYINSURER FOES ASTATEMENTOF CLAIM ORAN APPLICATIONCONTAININGANY FALSE.INCOMPLETE.OR MISLEADING INFORMATION ISGUILTYOFAFELONYOFTHETHIRDDEGREE. THE UNDERSIGNED IS AN Al THE ANSWERS TO QUE! HIS/HER KNOWLEDGJ ACORD 125 (2007/10) REPRESENTATIVE OFTHE APPLICANT AND REPRESENTS THAT REASONABLE ENQUIRY HASBEENMADETOOBTAIN THI&APPLICATION.HE/SHE REPRESENTS THATTHE ANSWERS ARE TRUE,CORRECT ANDCOMPLETETOTHE BEST OF PRODUCER'S NAME (Please Print) Robert Hollander Page2of3 STATE PRODUCER LICENSE NO (Required InFlorida) A121581 'NATIONAL PRODUCERNUMBERDATE^1 ^YW ACE Municipal Advantage31* Public Entity Liability Renewal Application NOTICE ThePolicyfor which youare applying is written ona claims-made and reported basis.Only Claims first made against the Insuredand reported to the InsurerduringthePolicyPeriodare covered subject to the Policy provisions. The Limits of Liability stated in the Policyare reduced,and may be exhausted,by Claims Expenses.Claims Expenses are also applied against your Retention,ifany.If you have any questions about coverage,please discuss them with your insurance agent. INSTRUCTIONS Pleasetypeorprintall answers clearly.Answerallquestionscompletely,leavingnoblanks.Ifthereis insufficient spacetocompleteananswer,please continueona separate sheet indicating thequestionnumber.Ifanyquestions,or anypartthereof,donotapply,print N/A inthe space.InsertchecksinYesorNo answer boxes,ifany.Thisapplication mustbecompleted,signed,and dated byan authorized officerofyour firm.Underwriters will relyon all statements made inthis application. The information requested inthisapplicationisforunderwriting purposes onlyand does not constitute noticetothe InsurerunderanyPolicyofaclaimorpotentialclaim.All such notices must be submitted tothe Insurer pursuant tothe terms of the Policy,if and when issued. Please attach copies of the following: •AuditedFinancial Statement orBudgetforthemostrecentavailablefiscalyear,ifthe applicant has morethan $500,000,000 inAnnual Budget •Minimum of last 3 years of liability claim loss runs (5 years desired) 1.Nameof Public Entity:Cityof South Miami 2.Principal Address:6130 Sunset Drive City:South Miami Public Entity's Website www.southmiamifl.gov 3.Doyouhavea Full TimeRiskManager?QYes E3 No NameofRisk Manager: GENERAL INFORMATION: 4.Population Trends:Please provide Population information: Year Established:1927 State:FL Zip:33143 Phone Number: Current Year Prior Year 2™Prior Year I Population ofMunicipality 13,778 13,567 i 12,363 | Seasonal increase in population?DYes QNo PF-23705a (01/13)©20131 Pagel of6 Budgetand Employment information forthePublic Entity. a.Please provide theannualbudgetandemployeecountofthePublic Entity. Please donot include that portion ofthe Annual Budget thatis allocated toanyofthe following entities: schools,hospitals,clinics,nursing homes or other health care operations,jails or detention facilities,law enforcement agencies orfirefighting authorities. Public Entity Cityof South Miami Current Annual Revenue/Budget $16.7million Number of Employees Full Time Part Time 132 46 If coverage isdesiredforanyofthe operations listed below,please provide the Budget and Employment information as requested. Pleasenote:Coverageforanyoftheseoperationsis subject tothereviewand acceptance by the underwriter and will be provided by endorsement only Public Entity Current Annual Revenue/Budget Number of Employees Full Time Part Time Schools $N/A Health Care Operations (hospitals, clinics,nursing homes,etc.)$N/A Jails or detention facilities $N/A Law enforcement agencies $6.032million 59 0 Firefighting authorities.$N/A Doesthe Public Entity employanyofthe following professional staff: Lawyers •Yes 0 NoTotalNumber Accountants G3 Yes•NoTotalNumber Architects/Engineers [x]Yes•No Total Number 2 FINANCIAL INFORMATION: Pleaseprovidethe following information.If "Yes"toany question below,orifthe applicant hasbudget deficits inthepast three years,please explainona separate attachment 7.a.Indicate fiscal year end date:9/30 ^ b.Piease provide a budget figure for the current and priortwofiscal years- Current Year Prior Year 2nd Prior Year Revenues 16.8 163 16.5 Expenditures 16.7 16.2 15.2 Outstanding Bond Issues 13.2 13.8 14.3 Budget Surplus (Deficit)127,170 140,548 1.3 c. d. e. Hasany State or Federal funding(aid)been eliminatedin the past year? Does the PublicEntity anticipate any special projects whichwill result ina substantial budget increase or decrease in the next 3 years? HasthePublicEntity been in default onprincipalor interest on any bond? DYes QNo DYes ENo QYes GO No 8.Have therebeenanychanges in the PublicEntity's bond rating(s)overthepastyear?D Yes Q No PF-23705a (01/13)©20131 Page 2of6 PUBLIC ENTITY OPERATIONS Iftheansweris "YES"toany question below,please attach details onaseparatepieceofpaper 9.Overthepastyearhavetherebeenany changes tothePublic Entity's: a.Public Officials election or appointment process?•Yes GO No b.Zoning provisions,policiesand processes?\x\Yes•No c.Vendor contract bidding processandcontract review process?•Yes GO No d.Disaster planning document In placefor both natural disastersand terrorist acts?•Yes 0 No 10.Overthepastyearhasthe PublicEntity begun to operate,license and/orregulateany child oreldercare facilities,family child careor foster care homes,child adoption services,QYes CO No child welfareservices,or public housing? EMPLOYMENT PRACTICES Ifthe answer is "YES"to any question below,please attach details on a separate pieceofpaper 11 Over thepastyear have there beenany changes tothe Public Entity's: a.Human Resources or Personnel Department?•Yes Q No b.Employee orientation program?QYes QNo c.Sensitivity training or discrimination/harassment prevention education?•Yes GO No d.Employee Performance evaluations procedures/process?•Yes Q No e.Out-placement program for laid off or disassociated Employees?QYes (3 No f.Employee termination review process?•Yes Q No g.Employment handbook?DYes [3 No 12.Regarding Third Party Liability exposure,over the past year has there been any changes tothe Public Entity's policiesorprocedures: a.Regarding Employee conduct when interacting with customers,clients,the general publicorotherthirdparties, b.Dealing with complaints from customers,clients or third parties for issues involving rn yes R No harassment or discrimination;or lmJ c.Regarding Diversity or cultural sensitivity training for employees who interact with customers,clientsorthe general public? If "Yes",please attach details ona separate piece of paper CURRENT INSURANCE INFORMATION 13.Over the past year have there been any changes to the Public Entity's General Liability r-i v ra coverage or insurer?U Yes lj No 14.Over the past year have there been any changes to the Public Entity's Law Enforcement ,-,v ,-,Kl Liability coverageorinsurer?L-l Yes Uy No PF-23705a (01/13)©201313 Page 3 of 6 FOR FLORIDA APPLICANTS ONLY: AgentName: Agent License Identification Number: FOR WYOMING APPLICANTS ONLY: PLEASE ACKNOWLEDGE AND SIGN THE FOLLOWING DISCLOSURE TO YOUR APPLICATION FOR INSURANCE: THE APPLICANT UNDERSTANDS AND ACKNOWLEDGES THAT THE POLICY FOR WHICH IT IS APPLYING CONTAINS A DEFENSE WITHIN LIMITS PROVISION WHICH MEANS THAT CLAIMS EXPENSES WILL REDUCE THE POLICY'S LIMITS OF LIABILITY AND MAY EXHAUST THEM COMPLETELY.SHOULD THAT OCCUR,THE APPLICANTSHALLBELIABLEFORANYFURTHERCLAIMSEXPENSESANDDAMAGES. Applicant's Signature: PF-237G5a (01/13) Mv^Jp&%\{irieci by an Officer of the Applicant) StevenAlexander,CityManager Print Name and Title 08/06 /2014 Date (Mo./Day/Yr.) ©20131 Page 6of6 AGENCY BROWN &BROWN OF FLORIDA INC 14900 NW 79th Court Sulte#200 Miami Lakes,FL 33016-6869 Robert Hollander CONTACT NAME:Robert Hollander fflHL»»305^64-7800 FAX ADDRESS; 305-71*4401 SUBCODE: I AGENCY CUSTOMER P:CITYO09 STATUS OF TRANSACTION APPLICANT INFORMATION SECTION CARRIER *ACE American Insurance Co.* CSR:C7 DATE(MM/DD/YYYY) 9/16/2014 NA1CCODE 22667 UNDERWRITER; POLICIES OR PROGRAM REQUESTED f UNDERWRITER OFFICE.- WDICATE SECTIONS ATTACHED •COUNTS*VALaABLE"PAPERSAfiLE/ BOILER &MACHINERY BUSINESS AUTO COMMERCIAL GENERAL LIABILITY CRIME/MISCELLANEOUS CRIME DEALERS DRIVER INFO SCHEDULE ELECTRON-HATAPROC EQUIPMENT FLOATER GARAGE AND DEALERS GLASS AND SIGN INSTALLATION/BUILDERS RISK OPEN CARGO PROPERTY TRANSPORTATION/ MOTOR TRUCK RAPOH POLICY NUMBER EONM00609079001 TRUCKERS/MOTOR CARRIER UMBRELLA VEHICLE SCHEDULE WORKERS COMPENSATION YACHT QUOTE BOUND (Givo DateandforAttachCopy): CHANGE 0ATE I ™E CANCEL • ISSUE POLICY |X|RENEW PACKAGE POLICY INFORMATION ENTER THIS INFORMATION WHEN COMMON DATES AND TERMS APPLYTQ SEVERAL LINES,ORFOR MONOLINE POLICIES. APPLICANT INFORMATION NAME<Ffret NwiMtf Insured&Other Named Insuratft) City of South Miami FEWORSOtiSEC* («*nrrtH«m»dlp«Mre<n: PROPOSED EFF DATE 10/01714 I{ggftk^305-668^3878 PROPOSED EXP DATE BILLING PLAN PAYMENT PLAN 10/01/15 DIRECT BILL AGENCY BILL EACKAQE POLICY PREMIUM;S MAIUNG ADDRESS MCL ZIP+4(of RrmtNamwJfcnundl La Tasha Nickle,HRDir. 6130 Sunset Drive South Miami,FL 33143 ADDUCES):|nickl^SQUthmigmiftg°V INDIVIDUAL PARTNERSHIP CORPORATION JOINT VENTURE SUBCHAPTER "S" CORPORATION PRORTORG LLC NO.OF MEMBERS AND MANAGERS _ WEBSITE ADDRESSIES1: CR BUREAU NAME; inspection contact:Latasha NickVe BEI-eSQ—MWB I E-MAIL Jnlckl^5s6iHhitilamirJ.g6vIaddress:^^ ID NUMBER: ACCOUNTING RECORDS CONTACT; PHONE llflAt AUDIT DATE BUS STARTED rrecwfliaca in rum*i iun ii aluku 023 attached for additioiialipremise*I LOC#BLD#STREET,QTY.COUNTY,STATE.ZIP+4 CITY LIMITS INTEREST YR BLRLT * EMPLOYEES ANNUAL REVENUES % OCCUPIED INSIDE OUTSIDE OWNER TENANT INSIDE OUTSIDE OWNER TENANT INSIDE OUTSIDE OWNER TENANT INSIDE OUTSIDE OWNER TENANT NATURE OF BUSINESS/DESCRIPTION OFOPERATIONSBY PREMISEfSl ACORD125 (2007/10)Page1of3 <§>1993-2007 ACORD CORPORATION.All rights reserved. The ACORD name and logoare registered marks of ACORD GENERAL INFORMATION AGENCY CUSTOMER ID:CITYO09 CSR:C7 EXPLAM ALL -YES"RESPONSES la.IS THE APPLICANT A SUBSIDIARY OF ANOTHER ENTITY ? lb.DOES THE APPLICANT HAVE ANY SUBSIDIARES7 2.ISA FORMAL SAFETY PROGRAM IN OPERATION? 3.ANY EXPOSURE TO FLAMMABLES.EXPLOSIVES,CHEMICALS? 4.ANY CATASTROPHE EXPOSURE? 5.ANY OTHER INSURANCE WITH THIS COMPANY OR BEING SUBMITTED? 6.ANYPOLICY OR COVERAGE DECLINED,CANCELLED OR NON-RENEWED DURING THEPRIOR THREE (3)YEARS?(Notapplicable InMO) EPL/Public Officials -PGIT 7.ANYPASTLOSSESORCLAMS RELATING TOSEXUALABUSEOR MOLESTATION ALLEGATIONS,DISCRIMINATION OR NEGLIGENT HIRING? B.DURING THE LASTFIVE YEARS(TEN INRIX HASANY APPLICANT BEEN INDICTED FOR ORCONVICTED OFANY DEGREE OFTHECRWE OF FRAUD.BRIBERY,ARSONORANY OTHERARSON-RELATEDCRIME IN CONNECTIONWITHTHISORANYOTHERPROPERTY? {In Rl,thisqusstion mustbe answered by anyapplicant torproperty insurance:Foflure to disclose lhoexistence ofanarson conviction Isa misdenraajiar punishable bya sentenca ofuptoone yeaf of imprisonment). a ANY UNCORRECTED FIRECODE VIOLATIONS? 10.ANYBANKRUPTCIES,TAXORCRE0IT (JENSAGAINST THE APPLICANT IN THE PASTFIVE (5)YEARS? 11.HAS BUSINESS BEEN PLACED INA TRUST? IF -YES",NAME Of TRUST: 12.ANY FOREIGN OPERATIONS,FOREIGN PRODUCTS DISTRIBUTED INUSA,ORUS PRODUCTS SOLD/DISTRIBUTED INFOREIGN COUNTRIES? (If"YES",attachACORD 815 forUabflity Exposureand/orACORD816 for Property Exposure) REMARKS/PROCESSING INSTRUCTIONS (Afech additions!sheets ttmon spaceIs required) m m m m B m m H H E m (U |COPY OF THE NOTICE OF INFORMATION PRACTICES (PRIVACY)HAS BEEN GIVEN TO THE APPLICANT.(Not applicable In aO slates,consult your agent or broker for your state's requirements.) NOTICE OFINSURANCE INFORMATION PRACTICES -PERSONAL INFORMATION ARfHlT YOU,INCLUDING INFORMATION FROM A CREDIT REPORT MAY BECOLLECTED FROM PERSONS OTHER THAN YOU IN CONNECTION WITH THIS APPUCATION FOR INSURANCE AND SUBSEQUENT POLICY RENEWALS.SUCH INFORMATION AS WELL AS OTHER PERSONAL AND PRIVILEGED INFORMATION COLLECTED BYUSOR OUR AGENTS MAY IN CERTAIN CIRCUMSTANCES BE DISCLOSED TO THIRD PARTIES WITHOUT YOUR AUTHORIZATION,YOU HAVE THE RIGHT TO REVIEW YOUR PERSONAL INFORMATION IN OUR RLESAND CAN REQUEST CORRECTION OF ANY INACCURACIES.A MORE DETAILED DESCRIPTION OF YOUR RIGHTS AND OUR PRACTICES REGARDING SUCH INFORMATION IS AVAILABLE UPON REQUEST CONTACTYOURAGENTORBROKERFORINSTRUCTIONSON HOWTO SUBMIT AREQUESTTOUS. ANY PERSON WHO KNOWINGLY AND WTTH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ANOTHER PERSON FILES AN APPLICATION FOR INSURANCE OR STATEMENT OF CLAIM CONTAINING ANY MATERIALLY FALSE INFORMATION,OR CONCEALS FOR THE PURPOSE OF MISLEADING INFORMATION CONCERNING ANY FACT MATERIAL THERETO,COMMITS A FRAUDULENT INSURANCE ACT,WHICH ISA CRIME AND SUBJECTS THE PERSON TOCRIMINAL AND [NY:SUBSTANTTAL1 CIVIL PENALTIES.(Not applicable bi CO,FL,HI.MA,NE,OH.OK,OR,orVT;inDC,LA.ME,TN.VA and WA.insurance benefits may also bedenied) ^r^?J^.f^J^^2T,.25?1?KNOWTNGLY AND WITH INTENT TO INJURE,DEFRAUD,OR DECEIVE ANY INSURER RLES A STATEMENT OF CLAIM OR ANAPPLICATIONCONTAININGANYFALSE,INCOMPLETE.OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE. THE UNDERSIGNED IS AN AL THE ANSWERS TO QUE* HIS/HER KNOWLEDGE ACORD125(2007/10) )REPRESENTATIVE OFTHEAPPLICANT ANDREPRESENTS THAT REASONABLE ENQUIRY HAS BEEN MADE TO OBTAIN I THI&APPLICATION.HE/SHE REPRESENTS THAT THEANSWERSARETRUE.CORRECT ANDCOMPLETE TOTHEBESTOF PRODUCER'SNAME(PleasePrint) Robert Hollander Page 2 of 3 DATE STATEPRODUCERLICENSENO (Required InFlorida) A1215S1 NATIONAL PRODUCER NUMBER