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f <br /> l ���. . � ��.4��a�a� � I <br /> � <br /> �..� �� ��j, �= <br /> ; ___ __ ____ __ _ _ <br /> � <br /> ! Clien# Authorization to Bind Coverage <br /> After careful consideration of Gallagher's proposal dated August 2015,City of Decatur accepts the following <br /> covera.ge(s). <br /> Please check the desired coverage(s). <br /> -.,_:- _-_��._.,=...,..:•:,::.=:-,.:-.: .::.: :.;;_: -,. ,-�:-.:_:-:�;-:;;�,-:I;iiie:'of Covera e::- '... :__--': . .:_:::::.: ..:.:: . :,-. �..,:.:;Ca"rrier:-;` „__ ---- <br /> �Acce t Re'ect Public Enri Packa e—O tion I Munich Re � <br /> ❑Acc t Re'ect Public Enti Packa e—O tion II AIX � <br /> Acce t Re'ect Public Enti Packa e— tion III .4� <br /> ❑Acc t Re'ect Public Enti Packa e—O tion IV AIX � <br /> ❑Acce t ❑Re'ect Excess Liabili Munich Re � <br /> I <br /> Acc t ❑Re'ect Excess Pro e Travelers � <br /> ❑Acc t ❑Re'ect Crime—O tion I AIG ' <br /> € <br /> ❑Ace t ❑Re'ect Crime—O tion II Zurich i <br /> Acc t ❑Re'ect Boiler&Machine Chubb <br /> ❑Acce t ❑Re'ect Excess Workers Com ensation—O rion I$500,000 SIR Lib Mutual � <br /> Acce t ❑Re'ect Excess Workers Com ensation—O tion II$750,000 SIR Libe Mutual � <br /> ❑Accept __ ❑Reject G�ber Liability _____ _____ ACE __ � <br /> TRIA/Terrorism Coyerage _ j, Line_of CoY_erage ._._.___,.____ _ __. ._ Carrier __ � <br /> ' �Accept � ❑Reject Bind TRIA Terrorism Coverage Act as quoted � <br /> Pr.ovide uotations or°Addihonal Infor•maiion on"the Followin Covera e Consider.ations <br /> ❑Yes ❑No Line of Coverage <br /> Descri tion <br /> The above coverage may not necessarily represent the entirety of available insurance products.If you are interested in <br /> pursuing additional coverages other than those addressed in the coverage considerations included in this proposal, ! <br /> please list below: � <br /> � <br /> f <br /> It is understood this proposal provides only a suminary of the details;the policies will contain the actual coverages. � <br /> City of Decatur confums the values,schedules,and other data contained in the proposal are from our records and <br /> acknowledge it is our responsibility to see that they are maintained accurately. <br /> We agree that your liability to us arising from your negligent acts or omissions,whether related to the insurance or <br /> surety placed pursuant to these binding instrucrions or not,shall not exceed$20 million,in the aggregate.Further, <br /> without limiting the foregoing,we agree that in the event you breach your obligations,you shall only be liable for <br /> actual damages we incur and that you shall not be liable for any indirect,consequential or punirive damages. <br /> Client Signature <br /> _ _ I <br /> Dated I <br /> � <br /> � <br /> ,._.,__......,_...... ............�_..._,_..�.._--.�,.�.__..:..._�_�:.�,..--- <br /> Arthnr J.Gallagher Risk Managemeat Seryices,Inc. <br /> DCN DMS Pks/XS WC/XSPro(DECATUA-02)51 <br /> �1 <br /> I <br />