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City Of Decatur <br /> Client Authorization to Bind Covera re (Cont.) <br /> .. -. . . .• . . . <br /> Client Initials <br /> Provide Quotations or Additional Information on the Following Coverage Considerations: <br /> Other Coverage Considerations <br /> ❑Yes ONo Pollution Liability <br /> ❑Yes ❑No Workers Compensation Buffer <br /> Note: Selecting the"Reject All or Accept All"option will override any selections that you have made above <br /> ❑Reject All ❑Accept All-Coverages for Consideration <br /> It is understood this proposal provides only a summary of the details; the policies will contain the actual coverages. <br /> We confirm the values, schedules, and other data contained in the proposal are from our records and acknowledge it <br /> is our responsibility to see that they are maintained accurately. <br /> We agree that your liability to us arising from your negligent acts or omissions, whether related to the insurance or <br /> surety placed pursuant to these binding instructions or not, shall not exceed$20 million, in the aggregate. Further, <br /> without limiting the foregoing, we agree that in the event you breach your obligations, you shall only be liable for <br /> actual damages we incur and that you shall not be liable for any indirect, consequential or punitive damages. <br /> By: <br /> Specify Title <br /> Print Name <br /> Date: <br /> Arthur J.Gallagher Risk Management Services,Inc. <br /> 51 <br />