R2019-144 Resolution Authorizing Property and Liability Insurance Coverage for the City of Decatur, Illinois for the Policy Period October 1, 2019 to October 1, 2020

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C ity Of Decatu r �¢# Gallagher :.�coRE�6o� Coverage: Excess Workers Compensation Carrier: Liberty Mutual Insurance Company Policy Period: 10/1/2019 to 10/1/2020 Form Number: Form Type: � �- -s � � • � �- � � ', Excess Workers Compensation Occurrence , Not Applicable Not Applicable Coverage: R • � Insurer's Limit of Indemnity for each accident or each employee for disease ' ', Workers Compensation , $50,000,000 Employers Liability , $1,000,000 _... ........ _ - ............. . - -. .. _ _ _ .. Self Insured Retention � • ', Insured's Retention for each accident or each employee for disease ', $500,000 � _ . _.. ... _ . .. .. ..._. _......_ ... .. _ .. . .. . Endorsements include,but are not limited to: . . �, Excess Insurance Policy for Self Insurer of Workers Compensation and Employers Liability Amendatory Endorsement Amendatory Endorsement-Notice of Accident-GPO 4328 Amendatory Endorsement(Change in TPA)-GPO 4330 Amendatory Endorsement(Paragraph D in Part Seven)-GPO 4323 Employers Liability Insurance Endorsement-GPO 4321 ' Knowledge Of Occurrence-GPO 4351 Notice Of Occurrence-GPO 4350 Terrorism Risk Insurance Act Endorsement -GPO 4807 ' Unintentional Failure to Disclose-GPO 4349 Who is Insured-GPO 4333 _ _. .. . . _ .. .. _. _ _ . .... _ _.. Exclusions include,but are not limited to: � � FELA Exclusion Endorsement-GPO 4354 Maritime Exclusion Endorsement-GPO 4313 _ _ ._._.... _ . . .. _._...... .. . _._ .. _ .. . _ _ _ . .__ _ �:�:� ::�:_;;��`�: r;�.'` -�:< � :�, :� ~ �. �,�` '�. 29 :�.,: �: � ;�a�. ,��. ,�... _.e....�., . � �< . �