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. ' , , � -9- <br /> SCHEDULE V <br /> SERVICES AND FEES <br /> Client: City of Decatur, Illinois <br /> Service Period: From 10/1/03 to 10/1/04 GB Client#: 000322 <br /> SERVICES PROVIDED: �j SERVICES PROVIDED: � <br /> A. Claims Administration C. Loss Funding <br /> Auto Liability-Bodily Injury(AB) X SIMMS X <br /> Auto Liability-Property Damage(AD) X Voucher <br /> Auto Physical Damage(APD) X Client Owned Banking <br /> General Liability-Bodily Injury(GB) X D. Supplemental <br /> General Liability-Property Damage(GD) X Loss Notice Program Rpt.Level*See Below X <br /> Products Liability Topical Capt.Rpts.Rpt.Level'"See Below X <br /> Professional Liability X Meetings X <br /> Property X Settlement Authority$10,000 X <br /> Workers'Compensation(WC) Index Bureau X <br /> Medical Only X Coordination X <br /> Indemnity X Audits X <br /> Other Incident Processing X <br /> Assumption Manual Report by Branch X <br /> B. Information Services Copying Correspondence X <br /> RISX-FACSO Risk Inspections <br /> Standard Package X GB/GCR Mgd.Care(Paid Off File) X <br /> Non-Standard Reports E. Risk Control Consulting <br /> risxfacs.com X Loss Control -48 Hours X <br /> Terminals&Printers Risx-Control Consulting- Hours <br /> Data Transfer X <br /> Other TOTAL $ 105,189 <br /> ADDITIONAL SERVICE TERMS AND CONDITIONS: <br /> Client will be billed $424 per claim for each Auto/General Liability,Auto Physical Damage, Professional Liability or Property claim <br /> reported against the initial deposit of$50,880 and$375 per claim for each Workers'Compensation claim reported against the initial <br /> deposit of$33,750. <br /> This is the fourth year of a five-year agreement. The per claim rates will not increase by more than 4%from year four to year five. <br /> All parties to this agreement fully agree that should the client terminate this program for convenience or through default prior to <br /> 10/1/05,the client shall pay GB an early termination surcharge based on an additional 2%of the annualized service fees for the then <br /> current period of the overall program. Such surcharge to be due and payable by the client immediately upon receipt of invoice from <br /> G B. <br /> BILLING AND PAYMENT TERMS: <br /> Fee is payable in 12 monthly installments beginning 10/1/03. Fees are payable upon receipt of invoice. GB reserves the right <br /> to charge 1% per month, or the maximum legal rate, on balances unpaid after 30 days. <br /> ' Liability& Property @ $10,000/Indemnity @ $25,000 <br /> ""`Liability& Property @ $25,000/Indemnity @$50,000 <br /> 06\cql�Decatur,IL,Cityof-000322.doc <br />