R90-23 AUTHORIZING APPLICATION - PUBLIC OFFICIALS' LIABILITY INSURANCE

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11. ThE•foliowing Boards,Commissions or units may be considered for coverage by endorsement to the policy upon request. Does�the - authority of the Governing Board here listed cover the operation and allocated budget of: -� • • (a) an airport Yes No X Current Budget$ n/a (b) hospital, clinic, nursing home or other health care operation Yes No � Current Budget $ n/a (c) utilities Yes X No Current Budget � 6,499,972 (d) school Yes No X CuRent Budget$ n/a (e) transit authority Yes x No Current Budget$ 2�387,393 (� housing authoriry Ye� No X Current Budget $ n/a 12. (a) Does the Public Entiry carry primary General Liability•Insurance: Yes No X Limit of General Liability n/a Does coverage incfude discrimination? n/a Does coverage include Personal Injury? n/a (b) If the Public Entity does not carry Primary General Liability lnsurance, state the self-insured retantion and limit of liability of ths excess insurance for the Entiry's self-insurance program. If 2here is no self-insurance program, so state: SIR = $150.000 AGGREGATE Excess CoveragQ = $5�0}(L, F.xcecc nf �i,nnn 13. Does the Public Entity presently carry Public Officials Liability or similar insurance? �Pq Name of Company National Union Fire Insurance Co. Expiration date 5/5/90 �imit $1,000,000 Deductible $10,000 I 20 389 annuall I Premium (optional) � ' y indicate annual or three year 14. No similar insurance on behalf of the Public Entity has been declined, cancelled or renewal thereof refused, except as follows: (If answer is none, so state) none • Page 3