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.� . <br /> , THIS IS AN APPLICATION FOR A CLAIMS MADE POLICY <br /> NATIONAL UNION <br /> FIRE INSURANCE COMPANY <br /> � 7Ecri H OF PITTSBURGH, PA. <br /> A CAPITAL STOCK COMPANY <br /> (Herein called the Company) <br /> 70 PINE STREET, NEW YORK, N.Y. 10270 <br /> APPLICATION FOR <br /> PUBLIC OFFICIALS AND EMPLOYEES LIABILITY INSURANCE <br /> 1. Legal Name of Public Entity City of Decatur, Illinois <br /> Address 1 Civic Center Plaza Decatur IL 62523 <br /> (Number) (Street) (Gty) (Stete) (Zip) <br /> 2. Public Entity was created in 1836 and derives its authority to operate as a <br /> (y68r) <br /> City under the laws of the State of Illinois <br /> (City,County,TOwn,Perk DistnCt,etc) <br /> 3. (a) Present Population 83,636 (1990 census) <br /> (b) If Public Entiry is a County, name and population of largest Ciry: <br /> n/a <br /> 4. (a) Names and Official Title of Governing Board Members <br /> NAME TITLE ELECTED APPOINTED <br /> Gary K. Anderson Mayor X <br /> Erik Brechnitz Councilman X <br /> Steve John Councilman X <br /> Kent N. Mittelberg Councilman X <br /> William Mitchell Councilman �_ ' <br /> Shirley Moore Councilwoman X <br /> William Oliver Councilman X <br /> (Use a separate sheet of paper if additional space is required) <br /> (b) If Board Members are appointed, by whom ? n/a <br /> (c) If the appointing Board indicated in 4(b) presently carries Public Officials Liability or similar insurance, please detail the terms <br /> of such coverage: <br /> nfa <br /> 5. The following official or employee of the Public Entiry is authorized and designated to receive any and all notices from the Company � <br /> or its authorized representative(s) concerning this insurance: , <br /> Gerard J. Bauer Risk Manager , <br /> (NAME) (TITLE) �, <br /> 29297 �� <br /> (6/83) I <br />