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City Of Decatur <br /> Program Details (Cc�nt.) <br /> Endorsements include, but are not limited to: <br /> . - - � <br /> Common Declarations Page <br /> Signatures <br /> - ---- -_ ---- ------------ <br /> Protected Self-Insurance Package Policy <br /> - ----------- ------ ------ <br /> Statutory Requirement Endorsement <br /> Service of Process—IL Endorsement <br /> __ __ � <br /> Endorsement—Contingent Tax Interruption Coverage <br /> If you choose to purchase Cap on Losses from Certified Acts of Terrorism <br /> Exclusions include,but are not limited to: <br /> . - - • <br /> Earth Movement Exclusion <br /> Flood Exclusion <br /> _ --_.. ___ _ --..__ __ ____... ____- _._..__. <br /> Government Action Exclusion <br /> War Exclusion <br /> --- -- <br /> Nuclear Hazard, Power Failure <br /> ----------------------- _......_ _____ <br /> ______-------- <br /> Date Related Losses ' <br /> Binding Requirements: <br /> � - - • <br /> Subject to Receipt of A signed and dated Terrorism Disclosure notice must accompany all binding requests <br /> designating an acceptance or rejection of quoted Terrorism coverage. <br /> Subject to Receipt of A signed and dated Application must be submitted to PSI Program Managers, a division of <br /> Risk Placement Services, Inc.within 30 days of binding <br /> Other Significant Terms and Conditions/Restrictions: <br /> . - • • <br /> Total Package TRIA premium includes Surplus Lines Tax Rate of$65.00 and Surplus Lines Stamping Fee Rate of <br /> $4.00 <br /> Note: Quotation is subject to receipt of signed and dated complete application prior to binding. Premium is subject to <br /> change if exposures have increased.This indication is based on Total Insured Value at$207,242,501 (expiring with <br /> 2.5%increase due to inflation), 534 employees, 247 autos, 74,701 population and 163 full-time police. <br /> PSI Program Managers(10.0%Program Management&Underwriting + 1.5%Claims Management) <br /> Insured's Loss Fund: $350,386 In the Aggregate Annually <br /> The Maximum Limit Of Insurance We Will Pay In Excess Of The Insured's Self Insured Retention For Part I B. - <br /> Clash Coverage Will Be: $750,000 <br /> Premium is minimum&deposit. Loss Fund is fully earned at Inception. Premium is payable in two equal ' <br /> installments due 10/1/2016 and 4/1/2017. i, <br /> Arthur J.Gallagher Risk Management Services,Inc. <br /> 1G <br />