R94-24 AUTHORIZING APPLICATION - PUBLIC OFFICIALS' LIABILITY INSURANCE

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" S.a.Total amount of outstanding bonds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 61,960,730 � b.Late$t Bond Rating(Mood�s or Standard 8�Poo�'s) . . . . . . . . . . . . . . . . . . . . . . . . . . $� � � c. Previous Bond Rating(If changed within last three years).. . . . . . . . . . . . . . . . . . . . . $ A d.Has any bond proposal been defeated within the last three years? . . . . . . . . . . . . . . YES x NO e.If yes,has the proposal been resubmitted or is it expected to be resumitted? . . . . . . _YES NO f. Has the Public Entity been in default on principal or interest of any bond? . . . . . . . . . YES g NO (If yes,on any of the above,please detail on last page.) 9.Have any of the following situations occured within the last thee years? a.Strike,stowdown or other disruption by the employees. . . . . . . . : . . . . . . . . . . . . . . . YES Y NO b.Layoff of employees or reduction in services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g YES NO c.Any person,former employee or job appticant made claim alleging unfair or improper treatment regarding employee hiring,remuneration,advancement,or g termination of employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO d.Disputes invotving intergration,segregation,discrim�nation,or violation of civil rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g YES NO (If yes to any of the above,please detail on last page including the date,the nature of the situation and its present status.) 10.a.Has any claim been made or is now pending against the Public Entity or any person in his/her capacity as an official or employee of the Public Entiry? . . . . . . . . . . . . . . . YES g NO b.Does any official or employee have any knowledge of any act,error or ommission, which might give rise to a claim against them or aganist the Public Entity? . . . . . . . . YES g NO (If yes to any oi the above,please detail on last page,the nature of the situation and its present status.) c.No fact,circumstance or situation indicating the probability ot a claim or action is now known to any Public Official or Employee;and it is agreed by afI concerned that if there be knowledge of any such fact,circumstance,or situation, any claim or action subsequently emanating therefrom shall be excluded from coverage under the insurance here being applied for. 11.The official designated to receive any and alI notices from the Insurers of their authorized representative concerning this insurance is Gerard J. Sauer Risk Mana�er Mams Tme 12.The undersigend being authoriied by, and acting on behalf of, the applicant and all persons or concerns seeking insurance,has read and understands the Application or Proposal,and declares all statements set forth herein are true, complete and accurate.The undersigned further declares and represents that any occurrence or event taking place prior to the issuance of the policy applied for,which may render inaccurate,untrue or incomplete any statement made herein will immediately be reported in writing to the insurer.The undersigned acknowledges and agrees that the submission and the insure�s receipt of such written report,prior to the inception of the policy applied for,is a condition precedent to coverage. The signing of the Application or Proposal does not bind the undersigned to purchase the insurance,nor does review of the Application or Proposal bind the insurance company to issue a policy. It is agreed that this Application or Proposal shall be the basis of the contract should a policy be issued. IMPORTANT:ATTACH COPY OF LATEST FINANCIAL STATEMENTS,BID SPECIFICATIONS(IF APPLICABLE), AND LIST OF BOARD/COUNCIL MEMBERS. � /,' ' -C.cJ Agent SIGNE �'/ �^'' , '� PrKidinp Otf�cial , POSITION/TITLE Mayor �� —�e_,/t..j DATE 2/22/94 Su lus in r rp L es License Numbe Expiration Date Crum&Forster A ent YES NO 9