HomeMy WebLinkAbout20 CYBERCYBER
LIMIT DETAIL:
Shared Additional Defense Limit of Liability:
CyberRisk Policy Aggregate Limit:
EXTENDED REPORTING PERIOD AND RUN-OFF:
Extended Reporting Period for Cyber Coverage:
Additional Premium Percentage:
Additional Months:
Run -Off Extended Reporting Period for Cyber Coverage:
Additional Premium Percentage:
Additional Months:
N/A
$1,000,000
N/A
N/A
ENDORSEMENTS (Not all inclusive):
ACF-7006-0511 Removal of Short -Rate Cancellation Endorsement
AFE-19008-0115 Federal Terrorism Risk Insurance Act Disclosure
CYB-10028-0813 Replace Section V.C. Settlement Endorsement
CYB-19001-0817 Final Non -Appealable Adjudication in the Underlying Action Exclusion Endorsement
CYB-19004-0313 Fines and Penalties and Consumer Redress Funds Endorsement
CYB-19015-0614 Replace Representation Section Endorsement
CYB-19017-0315 Global Coverage Compliance Endorsement
CYB-19019-0217 Privacy Policy Endorsement
CYB-19022-0817 Contingent Business Interruption — IT Provider Endorsement
CYB-19024-0715 Amend Definition of Covered Material to Include Non -Electronic Material
CYB-19025-0815 Amend Acquisition or Creation of Subsidiaries Condition Endorsement
CYB-19039-0217 180 Day Business Interruption Period Of Disruption Endorsement
CYB-19042-0217 Designated Officer Endorsement
CYB-19043-0217 Amend Claim Defense Condition Endt— Severability Of Cooperation Requirement
CYB-19047-0217 Indemnified Independent Contractors Endorsement
CYB-19048-0217 Expand E-Commerce Extortion To Include Acts By Employees Endorsement
CYB-19051-0817 Social Engineering Fraud Insuring Agreement Endorsement
CYB-19052-0817 Telecommunications Fraud Insuring Agreement Endorsement
CYB-19053-0817 Reputational Harm Insuring Agreement Endorsement
CYB-19055-0817 Payment on Behalf of the Insured Endorsement
CYB-19056-0817 Amend Definition of Claim to Include Civil Investigative Demands and Requests for
Information Endorsement
CYB-19057-0817 Remove Specific Target Requirement for Computer System Disruption Endorsement
CYB-19058-0817 Virtual Currency Coverage Endorsement
CYB49060-0817 Business Interruption Wage and Overhead Coverage Endorsement
CYB-19063-0817 Suspend Notice Reqrmnt for Info Subject to Law Enforcement or Court Order Endt
CYB-19064-0817 State Inconsistency Endorsement
CYB-19065-0817 Expand Definition of Communications and Media Wrongful Act Endorsement
Let our experience guide you.
13
CRIME
Carrier:
Policy Period:
AM Best Rating
Federal Insurance Company
06/01/18to 06/01/19
A++
Organization: Truckee Donner Public Utility District and its Subsidiaries
Crime Coverage Limit
(A)Employee Theft Coverage $2,0001000
(B) Premises Coverage $2,0001000
(C) In Transit Coverage $2,000,000
(D) Forgery Coverage $2,000,000
(E)Computer Fraud Coverage $2,000,000
(F) Funds Transfer Fraud Coverage $2,000,000
(G) Money Order & Counterfeit Fraud Coverage $2,000,000
(H) Credit Card Fraud Coverage $2,000,000
(1) Client Coverage $2,000,000
(J) Expense Coverage $25,000
Retention: $5,000
14-02-13658 0314 Pension Protection Act Enhancement Endorsement
14-02-15348 0909 Amend Premises Coverage Insuring Clause Endorsement
14-02-16840 0410 Amend Exclusion 12(M) Endorsement
14-02-19671 0414 Privacy And Data Breach Exclusions Endorsement
14-02-7402 1002 Amend Definition of Employee Endorsement
14-02-21135 0616 Social Engineering Fraud Sub Limit $250,000 Retention $10,000
14-02-89310408 Amend Definition of Employee Endorsement
14-02-8932 1103 Amend Definition of Securities Endorsement
14-02-8933 1103 Amend Money Order and Counterfeit Currency Fraud Endorsement
Let our experience guide you.
14
GENERAL LIABILITY
Carrier: Travelers Property & Casualty Co of America
Policy Period: 06/01/18 to 06/01/19
AM Best Rating: A++
COVERAGES
General Liability Aggregate Limit
Products/Completed Operations Aggregate Limit
Coverage A Bodily Injury and Property Damage — Each Occurrence
Coverage B Personal and Advertising Injury
Damage to Rented Premises
Medical Expense (Any one Person)
Failure to Supply — Each Occurrence
Employee Benefits Liability — Each Employee
Employee Benefits Liability - Aggregate — Retro Date 05/01/02
DEDUCTIBLES
TYPE
Combined Bodily Injury/Property Damage Deductible
Products/Completed Operations and Premises Ops
Employment Benefits — Each Employee
LIMITS
$2,000,000
$2,000,000
$1,000,000
$1,000,000
$1,000,000
$10,000
$1, 000,000
$1,000,000
$3,000,000
AMOUNT
$251000
Hazards
Description Exposure Rate
Electric Light or Power Companies Sales $3,165,300 $3.488
Water Company Sales $1,893,326 $8.952
Not auditable
Let our experience guide you.
15
GENERAL LIABILITY ENDORSEMENTS
CG 00 01 Commercial General Liability Cov Form
CG DO 76 Exclusion -Lead
CG D1 42 Exclusion -Discrimination
CG D2 03 Amend -Non Cumulation Of Each Occ
CG D2 42 Exclusion - War
CG D2 43 Fungi Or Bacteria Exclusion
CG D2 55 Amendment Of Coverage - Pollution
CG D2 88 Employment -Related Practices Exclusion
CG D3 05 Deductible Liability Insurance
CG D3 26 Exclusion - Unsolicited Communication
CG D4 09 Amendment Of Bodily Injury Definition
CG D4 13 Amendment Of Coverage -Pollution- Cooling
CG D4 19 Amend Of Property Damage Definition
CG D4 20 Amend Other Ins Cond Mean Other Ins/Insr
CG D4 21 Amend Contract Liab Excl-Exc To Named Ins
CG D4 22 Amend Suppl Pay Tax Costs & Appeal Bonds
CG D4 25 Other Ins-Addl Ins -Primary & Noncontrib
CG D4 70 Excl-Employees & Volunteer Work As Insds
CG D4 71 Amend Coverage B - Pers & Adv Injury
CG D4 72 Excl - Law Enforcement Activities Or Ops
CG D4 74 Mobile Equip Redefined - Public Entities
CG D4 75 Excl - Health Care Serv-Public Entities
CG D4 76 Excl -Public Use Of Private Property
CG D4 86 Failure To Supply - Limited Coverage
CG D6 18 Excl-Violation Of Consumer Fin Prot Laws
CG D7 46 Excl-Access Or Discl Of Conf/Pers Info
CG T4 78 Exclusion -Asbestos
GN 0182 Coverage &Medical Payments Exclusion
IL 00 21 Nuclear Energy Liability Exclusion
IL T3 18 Common Policy Conditions -Deluxe
IL T4 12 Amndt Common Policy Cond-Prohibited Covg
IL T4 14 Cap On Losses Certified Act Of Terrorism
Let our experience guide you.
16
PUBLIC ENTITIES XTEND ENDORSEMENT
PUBLIC ENTITIES XTEND ENDORSEMENT CG D4 80
A. Reasonable Force Property Damage — Exception To Expected Or Intended
Injury Exclusion
Be Non -Owned Watercraft 50 Feet Long Or Less
C. Owned Watercraft Less Than 25 Feet
D. Aircraft Chartered With Pilot
E. Damage To Premises Rented To You
F. Increased Supplementary Payments
G. Who Is An Insured — Public Entities, Elected Or Appointed Officials, And
Members Of Your Boards
H. Who Is An Insured — Employees And Volunteer Workers
I. Who Is An Insured — Newly Acquired Or Formed Organizations
1. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises
K. Blanket Additional Insured — Lessors Of Leased Equipment
L. Blanket Additional Insured — Persons Or Organizations For Your Ongoing
Operations As Required By Written Contract Or Agreement
M. Who Is An Insured — Liability For Conduct Of Unnamed Partnerships, Joint
Ventures Or Limited Liability Companies
N. Good Samaritan Services Coverage —Amendment of Occurrence Definition a
Each Occurrence Limit
0. Contractual Liability —Railroads
P. Knowledge And Notice Of Occurrence Or Offense
Q. Unintentional Omission
R. Blanket Waiver of Subrogation
Let our experience guide you.
SI
PUBLIC ENTITY MANAGEMENT
Carrier:
Policy Period:
AM Best Rating:
Travelers Property & Casualty Co of America
06/01/18 to 06/01/19
Claims -Made Coverage
COVERAGES
Public Entity Management Liability — Each Wrongful Act
Public Entity Management Liability — Aggregate — Retro Date 05/01/02
DEDUCTIBLES
TYPE
Public Entity Management Liability — Each Wrongful Act
(Damages and Defense Expenses)
Coverage Features
LIMITS
$1, 000, 000
$1,000,000
AMOUNT
$151000
This coverage is designed to cover damages (other than bodily injury, personal injury,
advertising injury or property damage) any insured is legally required to pay for a covered loss
that results from the conduct of duties by or for a public entity or its boards and is caused by a
wrongful act. Wrongful act is defined as any act, error or omission. However, employment
related practices are not
Who is an Insured:
• Public Entity •Elected and Appointed Officials
• Executive Officers and Directors • Boards and Board Members
• Volunteer Workers • Legal Representatives
• Employees (including employees of the entity's board)
Endorsements
PR TO 03 Public Entity Management Liability Coverage Part Declarations (Claims -Made)
PR T10 Public Entity Management Liability Coverage Form (Claims -Made) 6
PR T4 27 Amendment Of Network And Information Security Wrongful Act Definition
PR T3 54 Amendment Of Coverage — Designated Boards, Commissions, Or
Governmental Units Or Departments
IL T4 14 Cap On Losses From Certified Acts Of Terrorism
Let our experience guide you.
F�3
PUBLIC ENTITY EMPLOYMENT RELATED
PRACTICES LIAWLTY
Carrier: Travelers Property &Casualty Co of America
Policy Period: 06/01/18 to 06/01/19
AM Best Rating: A++
Claims -Made Coverage
COVERAGES LIMITS
Employment — Related Practices — Each Wrongful Act Practice Offense $1,000,000
Employment — Related Practices — Aggregate — Retro Date 05/01/02 $1,0000000
DEDUCTIBLES
TYPE AMOUNT
Each Wrongful Employment Practice Offense Deductible Retention $15,000
(Damages and Defense Expenses)
Coverage Features
This coverage is designed to cover damages (other than bodily injury or property damage) any
insured is legally required to pay for covered employment loss that results from a wrongful
employment practice offense. Wrongful employment practice offense is defined to include
discrimination, wrongful termination, harassment, retaliatory action, wrongful discipline,
wrongful hiring, supervision, demotion, or failure to promote, and employment related
misrepresentation, defamation, libel, slander, disparagement, and invasion of privacy.
Who is an Insured:
• Public Entity
• Elected and Appointed Officials
• Executive Officers and Directors
• Boards and Board Members
• Employees (including employees of the entity's board)
• Legal Representatives
• Volunteer Workers
Public Entity Employment Practice Liability Coverage Forms
PR TO 05 Public Entity Employment -Related Practices Liab Cov Part Dec (Claims -Made)
PR T1 08 Public Entity Employment -Related Practices Liability Cov Form (Claims -Made)
PR T3 72 Amendment Of Coverage — Designated Boards, Commissions, Or
Governmental Units Or Departments
Let our experience guide you.
19
COMMERCIAL AUTO
Carrier:
Policy Period:
AM Best Rating:
COVERAGE
Travelers Property &Casualty Co of America
06/01/18to 06/01/19
A++
Combined Single Limit - $25,000 Deductible
Medical Payments
Uninsured Motorist
Comprehensive Deductible
Collision Deductible
Hired Automobile Liability
Non -owned Automobile Liability
Hired Physical Damage Limit
Comprehensive Deductible
Collision Deductible
Auditable
Coverage Symbols:
(1) Any Auto
(2) All Owned Autos
(3) Owned Private
Passenger Autos
Let our experience guide you.
SYMBOLS)
LIMITS
OF LIABILITY
0
1 $1,000,00
2 $5,000
2 $1,000,000
2 (See Schedule of Vehicles)
2 (See Schedule of Vehicles)
Included
Included
$1,000,000
$25,000
$25,000
(4) Owned Autos Other Than Private
Passenger
(5) All Owned Autos Requiring No -Fault
Coverage
(6) Owned Autos Subject To
Compulsory U.M. Law
(7) Autos Specified On
Schedule
(8) Hired Autos
(9) Non -Owned Autos
20
COMMERCIAL AUTO
LIABILITY, MEDICAL PAYMENTS AND UNINSURED MOTORIST COVERAGE:
When liability, medical payments and/or insured motorist coverage is applicable, a
"✓" will appear in the appropriate column.
COMPREHENSIVE AND COLLISION DEDUCTIBLES:
The applicable comprehensive and collision deductible is noted for each vehicle to
which that coverage applies. Please note that comprehensive and collision deductibles apply
separately to each vehicle.
Vehicle Schedule:
Comprehensive Collision
Veh # State Veh Year Make/Model Deductible Deductible
1 CA 2007 CHEVR TRAIL $25,000 $25,000
2 CA 2013 FORD ESCAP $25,000 $25,000
3 CA 2014 JEEP CHERO $25,000 $25,000
4 CA 2015 JEEP CHERO $25,000 $25,000
5 CA 2015 JEEP CHERO $25,000 $25,000
6 CA 2015 JEEP CHERO $25,000 $25,000
7 CA 2015 JEEP CHERO $25,000 $25,000
8 CA 2014 CHEVR EXPRE $25,000 $25,000
9 CA 2007 CHEVR COLOR $25,000 $25,000
10 CA 2008 GMC CANYO $25,000 $25,000
11 CA 2006 CHEVR SILVE $25,000 $25,000
12 CA 2008 GMC SIERR $25,000 $25,000
13 CA 2006 CHEVR SILVE $25,000 $25,000
14 CA 2006 CHEVR SILVE $25,000 $25,000
15 CA 2006 CHEVR SILVE $25,000 $25,000
16 CA 2010 CHEVR SILVE $25,000 $25,000
17 CA 2013 GMC SIERR $25,000 $25,000
18 CA 2018 CHEVR SILVE $25,000 $25,000
19 CA 2012 INTER 7000 $25,000 $25,000
20 CA 2000 INTER 4000 $25,000 $25,000
21 CA 2007 INTER 7000 $25,000 $25,000
22 CA 2016 FORD F550 $25,000 $25,000
23 CA 2014 INTER 7000 $25,000 $25,000
24 CA 2017 INTER 7000 $25,000 $25,000
25 CA 2008 GMC SIERR $25,000 $25,000
26 CA 2018 CHEVR SILVE $25,000 $25,000
27 CA 2018 CHEVR SILVE $25,000 $25,000
28 CA 2015 LOAD TRAIL $25,000 $25,000
29 CA 1993 FLEMM 3 REE $25,000 $25,000
30 CA 1972 HDDAV SPOOL $25,000 $25,000
31 CA 1987 SHERM WIRE $25,000 $25,000
32 CA 2004 OTHER MODEL $25,000 $25,000
33 CA 2004 OTHER MODEL $25,000 $25,000
34 CA 2005 OTHER MODEL $25,000 $25,000
35 CA 2005 WESTE TRAIL $25,000 $25,000
Let our experience guide you.
21
COMMERCIAL AUTO
Comprehensive
Collision
Veh #
State
Veh Year
Make/Model
Deductible
Deductible
36 CA 2006 BUTLE POLE $25,,
000 $25000
37 CA 2008 TRAIL TRAIL $25,000 $25,000
38 CA 2006 CHEVR SILVE $25,000 $25,000
39 CA 2007 CHEVR SILVE $25,000 $25,000
40 CA 2007 CHEVR SILVE $25,000 $25,000
41 CA 2007 CHEVR SILVE $25,000 $25,000
42 CA 2013 GMC SIERR $25,000 $25,000
43 CA 2013 GMC SIERR $25,000 $25,000
44 CA 2018 CHEVR SILVE $25,000 $25,000
45 CA 2018 CHEVR SILVE $25,000 $25,000
46 CA 2018 CHEVR SILVE $25,000 $25,000
47 CA 2011 INTER 7000 $25,000 $25,000
48 CA 2011 FORD F550 $25,000 $25,000
49 CA 2011 FORD F550 $25,000 $25,000
50 CA 2011 FORD F550 $25,000 $25,000
51 CA 2016 FORD F550 $25,000 $25,000
52 CA 2014 INTER 7000 $25,000 $25,000
53 CA 2008 CHEVR SILVE $25,000 $25,000
54 CA 2011 CHEVR SILVE $25,000 $25,000
55 CA 2002 GMC NEW S $25,000 $25,000
56 CA 2005 FREIG M2 $25,000 $25,000
57 CA 1998 WESTE TRAIL $25,000 $25,000
58 CA 1989 TRAIL TK24 $25,000 $25,000
59 CA 2006 OTHER MODEL $25,000 $25,000
60 CA 2009 WANCO TRAIL $25,000 $25,000
61 CA 2016 HALLM TRAIL $25,000 $25,000
62 CA 2007 CHEVR SILVE $25,000 $25,000
63 CA 2006 CHEVR SILVE $25,000 $25,000
64 CA 1997 GMC SIERR $25,000 $25,000
65 CA 2001 OTHER MODEL $25,000 $25,000
66 CA 2014 BROOK TRAIL $25,000 $25,000
67 CA 2005 SHERM TRAIL $25,000 $25,000
68 CA 2013 HAUL TRAIL $25,000 $25,000
69 CA 2013 EH WA TRAIL $25,000 $25,000
Let our experience guide you.
22
DRIVERS
DRIVER NAME STATE
001 Edward Atkins NV
002 Kristen Baumbach CA
003 Daniel Baumbach CA
004 Craig Beede CA
005 Lana Bell CA
006 David Bourque NV
007 Tige Burk CA
008 Susan Camara CA
009 Megan Campe CA
010 Casey Chavez NV
011 Shane Christian NV
012 CA
013 Robert Clarke CA
014 Regina Cooley CA
015 Thomas Dwyer CA
016 David Emery CA
017 Ralph Ercolin CA
018 Kenneth Eyler CA
019 Charles Fillman NV
020 Ian Fitzgerald NV
022 Charles Gazso NV
023 Trey Griffin NV
024 Kimberly Harris CA
025 Michael Hatch NV
026 Forrest Heston NV
027 Stephen Hollabaugh CA
028 Michael Holley CA
029 Joseph Horvath CA
030 Shannon Hoyt CA
031 Jack Johnson CA
032 Neil Kaufman CA
033 Jesse Kindle NV
034 Melissa Kleffman CA
035 Shanna Kuhlemier CA
036 Cody LaPlaca NV
Let our experience guide you.
23
DRIVERS
DRIVER NAME
STATE
037 James Leonard CA
038 Joshua Loubet CA
039 Jennifer Mason CA
040 Becky Mazzer CA
041 Dennis Mazzini CA
042 Kristin Mcafee CA
043 Tamara Mccollum CA
044 Mark Mehler CA
045 Elliot Mezger CA
046 Julie Nelson CA
047 Kathleen Neus CA
048 Sara Owens CA
049 Ronald Palmer CA
050 Linda Pendleton CA
051 Tricia Phillips CA
052 Steven Poncelet CA
053 CA
054 Ryan Pursel NV
055 Steven Roden NV
056 Patricia Ruby CA
058 Anabel Sanchez NV
059 Lauren Schaake- CA
060 Sanna Schlosser CA
061 Earl Smith CA
062 NV
063 Lisa Swartz CA
064 Steve Trevino CA
065 Roe Vernon CA
066 Clayton Walker CA
068 James Wilson CA
069 Regina Wise CA
070 Clayton Wise CA
071 Brian Wright CA
072 Stefan Youngren CA
Note: All drivers must be reported. Any unreported driver may cause your policy to be
cancelled by the insurance company.
Let our experience guide you.
24
PRIMARY EARTHQUAKE
Carrier: Landmark American Ins Company
Policy Period: 06/01/18 to 06/01/19
AM Best Rating: A+
EARTHQUAKE COVERAGE LIMITS
Property —Per Occurrence and Annual Aggregate $10,000,000
Business Income w/Extra Expense other than "Rental Value" $2,500,000
Valuation: Replacement Cost, Business Income — Actual Loss
Total Insured Value $76,466,932 per Statement of Values on file w/Company 04/02/2018
Coverages:
• Building (District office building including property described in the submission
which includes tanks, wells, equipment, generators & substations)
• Personal Property
• Electronic Data Processing (Included as Personal Property)
• Business Income with Extra Expense other than "Rental Value"
• Radio & Television
• Special Floater
• Mobile Equipment
Perils: Earthquake
• Including Earthquake Sprinkler Leakage
Form: ISO Forms — Current to 2012 versions & RSUI Forms
Deductible:
Earthquake -168 Hour Definition of Occurrence - 5.00% *subject to a
minimum of $25,000 per occurrence(Prove, y Damage &Time Element)
Including Earthquake Sprinkler Leakage
* If the Deductible is expressed as a percentage (unless otherwise stated), the Deductible is calculated separately
for and applies separately to each building that sustains loss or damage, the personal property at each building at
which there is loss or damage to personal property. Personal property in the open. Business Income and Extra
Expense. If there is damage to both a building and personal property in that building, separate deductibles apply to
the building and to the personal property.
Policy Attachments
Exclusion of Pathogenic or Poisonous Biological or Chemical Material RSG 96014 0504
Let our experience guide you.
25
EXCESS/UMBRELLA
Carrier: Travelers Property &Casualty Co of America
Policy Period: 06/01/18 to 06/01/19
W Best Rating: A++
COVERAGE
Aggregate Limits of Liability General Aggregate(Other
than Products/Completed
Operations)
Coverage A -Bodily Injury
and Property Damage
Liability
Coverage B -Personal and
Advertising Injury Liability
Retained Limit
Products/
Completed
Operations
Aggregate
Specialty Coverage Aggregate
(Public Entity & EPLI)
Any one occurrence subject to
the Products/Completed
Operations and the General
Aggregate Limits
Any one person or
organization subject to the
General Aggregate Limit of
Liability
Any one occurrence or offense
No Coverage for Failure to Supply
REMARKS:
Subject to it's own coverage's and exclusions
15,000,000
$15,000,000
$15,000,000
$15,000,000
$15,000,000
$10,000
Let our experience guide you.
26
EXCESS/UMBRELLA ENDORSEMENTS
U
M
00
01
I L
T3 68
UM
06
03
U
M
06
09
U
M
06
50
UM
06
88
Commercial Excess Liability (Umbrella) Insurance
Federal Terrorism Risk Insurance Disclosure
Crisis Management Expense
Exclusion — Consumer Financial Protection Laws
Exclusion — Access Or Disclosure Of Confidential Or Personal Information
Amendment Of Conditions And Coverage For Financial Interest In Foreign Insured
Organizations - Umbrella
Exclusion — Discrimination
UM 03 37 Reasonable Force —Bodily Injury Or Property Damage
UM 00 76 Nuclear Energy Liability Exclusion Endorsement (Broad Form)
UM 05 11 Amendment Of Coverage B - Personal Injury And Advertising Injury Liability
UM 0196 Exclusion — Asbestos
UM 0191 War Exclusion
UM 02 12 Exclusion — Aircraft Products And Grounding
UM 04 66 Amendment Of Bodily Injury
UM 04 75 Definition Amendment Of Defense Of Claims Or Suits - Reasonable Expenses Incurred
By The Insured At Our Request
UM 04 76 Amendment Of Who Is An Insured - Insureds Added When Qualifying Under
Scheduled Underlying Insurance Without Written Contract And
Limitations Added For Limited Liability Companies & For Your Employees
UM 04 78 Amendment Of Property Damage Definition
UM 04 79 Amendment — Other Ins Condition And Meaning Of Other Insurance And Other Insurer
UM 04 80 Amendment Of Defense Of Claims Or Suits — Taxed Costs
UM 04 81 Amendment — Meaning Of You And Your And Meaning Of Employee
UM 04 82 Amendment Of Contractual Liability Exclusion
UM 04 83 Amendment Of Pollution Excl — Pollution Not Related To Autos — Limited Following form
UM 04 84 Amendment Of Watercraft Or Aircraft Exclusion
UM 04 85 Amendment Of Damage To Property Exclusion
UM 04 86 Amendment Of Damage To Your Work Exclusion
UM 04 87 Amendment Of Maintenance Of Underlying Insurance Condition
UM 04 88 Waiver Of Our Right To Recover From Others
UM 04 90 Auto Liability Exclusion — Limited Following Form
UM 04 92 Pollution Exclusion — Pollution Related To Autos
UM 05 08 Amendment Of Who Is An Insured - Your Executive Officers, Employees, Directors Or
Stockholders Are Insureds Only When Qualifying Under Scheduled Underlying Insurance
UM 05 09 Amendment Of Duties In The Event Of Occurrence Or Offense, Claim Or Suit And
Representation Conditions - Public Entities Or Indian Tribes
UM 05 12 Law Enforcement Activities Or Operations Exclusion
UM 05 14 Public Use Of Private Property Exclusion
UM 04 15 Exclusion — Unsolicited Communications
UM 05 15 Professional Health Care Services Exclusion — Limited Following Form — Public Entities
UM 01 52 Employee Benefits Liability Endorsement
UM 01 04 Abuse Or Molestation Exclusion
UM 03 64 Fungi Or Bacteria Exclusion (Not Applicable In La)
UM 03 78 Total Exclusion — Failure To Supply
UM 03 04 Exclusion — Lead
Let our experience guide you.
27
SECONDARY EXCESS/UMBRELLA
Carrier: Endurance Risk Solutions Assurance Co
Policy Period: 06/01/18 to 06/01/19
AM Best Rating: A+
LIMITS OFTHIS INSURANCE:
$10,000,000 Each Occurrence Limit
$10,000,000 Aggregate Limit
LIMITS OF UNDERLYING EXCESS INSURANCE:
$14,000,000
$14,000, 000
$14,000,000
FOLLOWED POLICY:
General Liability -Each
Occurrence Limit
General Liability - Aggregate Limit
Auto — Per Occurrence
Company: Travelers
Coverage: Excess of Primary (Defense outside the limits)
Policy Period: From: June 1,2018 To: June 1,2019
Forms (notall inclusive):
EXL60010813 Absolute Asbestos Exclusion
EXL0509 0110 Exclusion for Mold &Other Naturally —Occurring Contaminants
EXL0577 0110 Eminent Domain / Inverse Condemnation Exclusion
EXL0516 0610 Exclusion —Violation of Information Statues
EXL0524 0110 Crisis Response & Crisis Communication Mngmt Insurance Exclusion
EXL0530 0110 Failure to Supply Exclusion
EXL0513 0110 Lead Exclusion
EXL0573 0110 Cyber Liability Exclusion
EXL6066 0813 Nuclear Energy Liability Exclusion
EXL6074 0813 Pollution Exclusion with Hostile Fire Exception
EXL6088 0813 Silica, Silica -Related or Mixed Dust Exclusion
EXL1323 0610 Sub Limited Coverage Exclusion
EX10537 0110 Uninsured/Underinsured Motorist Exclusion
EXL0562 0110 War Liability Exclusion
EXL0907 0813 California Changes — Cancellation Non Renewal
IL1201 0115 Exclusion of Certified Acts of Terrorism &Exclusion of other Acts
EXL0203 0813 Excess Liability Coverage Follow Form (Short Form)
Policy will not be broader than any underlying or excess layer
Let our experience guide you.
m
POLLUTION
Carrier: Arch Specialty Insurance
Policy Period: 06/01/17 to 06101120
AM Best Rating: A+
LImItS Of Llablllty $1,000,000 Per Claim
$1,000,000 Policy Aggregate
Defense Costs are included within the Limits of Liability
COVERAGE
Coverage A - Cleanup Costs, Bodily Injury &Property Damage
resulting from Pre-existing Pollution events
Coverage B - Cleanup Costs, Bodily Injury & Property Damage
resulting from New Pollution events
Coverage C N/A
Coverage D — Clean Costs, BI, & PD at Non Owned Locations
Green Standards Aggregate Limit
Insured Compensation Expense Limit
Deductible $15,000 Each Pollution Event
Retro Date 05/01/04 and 06/01/17
Endorsements:
Non Owned Locations Schedule (blanket for all TSD Facilities)
Third Party Transportation Coverage
First Party Transportation Coverage
Mold &Fungus Exclusion
Min Earned Premium Endt (100% at inception)
Divested Property Schedule (applies to the following loc: 15670 Donner Pass Rd, Truckee, CA)
TRIA Terrorism Coverage (Optional; available for an additional 1%)
OFAC Advisory Notice
Regulatory compliance/ notice endorsements as necessary
Let our experience guide you.
29
PREMIUM COMPARISON
Insured: Truckee Donner P.U.D.
COVERAGE EXPIRING PREMIUM
General Liability
Property (Intl Mandatory Terrorism)
Inland Marine
Business Auto
Public Entity & EPLI
Cyber
Crime
Pollution (3 year $22,237.79)
Earthquake Primary
Earthquake Secondary
Primary Excess
Secondary Excess
$40,259
$591043
$1,585
$261086
$3,532
$131974
$4,776
$71412060
$51,600 (Intl $1600 T&F)
$25,800 (Intl $800 T&F)
$20,440
$24,500 (Intl $500 T&F)
RENEWAL PREMIUM
$33,717
$471482
$4,482
$301349
$131990
$131203
$4,776
$7,412460
$59,856 ($58k w/$1856 T&F)
Non
e
$32,579
$24,500 (Intl $500 T&F)
Estimated Total $279,007.60 $272,347
Binding Subject to Signed forms:
Accepting or reject Terrorism Forms (Policies do not include Terrorism Coverage)
A/P for Terrorism on Excess w/Endurance $240
A/P for Terrorism on Earthquake w/Landmark $58,000
Signed D1 Forms
Signed UMBI/UMPD form
Completed Business Income worksheet
Completed Employment Benefits Application
T&F =Taxes and Fees.
Let our experience guide you.
COMPENSATION DISCLOSURE STATEMENT
InterWest Insurance Services, LLC, does business with multiple competing insurance companies,
enabling us to offer a variety of coverage choices and customize a plan to satisfy your
specialized needs. This proposal is an outline of the coverages offered by our insurers based
on the information provided by your company. It does not include all terms, coverages,
exclusions, limitations or conditions of the actual contract language. To fully understand the
details of the coverages, terms and conditions, you need to review the policy contracts. At your
request, the policy forms will be made available.
The information contained in this proposal is based on the historical loss experience and
exposures provided by you to InterWest and is not an actuarial study.
For the services we provide to our clients, InterWest receives usual and customary commissions
or fees, and occasionally fees in addition to commissions, from the insurance carriers providing
the coverages. This commission percentage is set by the insuring company, not by us, and is
included as part of the insurance premium you pay. We charge you nothing for the placement
of your policies, as we are compensated for this service in the commission previously described.
However, we may charge fees for other professional services that you ask us to perform.
In addition to such fees and commissions, InterWest may also receive investment income on
fiduciary funds temporarily held in our accounts, such as premiums or return premiums.
In placing, renewing, consulting on or servicing retail insurance policies, InterWest may
participate in contingent commission agreements with select insurers that provide for
additional compensation if underwriting, profitability, volume or retention goals are achieved
over multiple years. It is usually impossible to know at the time of placement whether that
policy will contribute to, or detract from, our potential eligibility for future additional
compensation from the insurer.
If you have questions regarding the compensation received by InterWest or our affiliates in
relation to insurance placement, please contact your InterWest representative.
CA DOI #OB01094
Let our experience guide you.
31
CLIENT ACKNOWLEDGEMENT
Coverages Proposed for huckeeDonnei.
• Property
• Cyber
• Boiler & Machinery
• Crime
• Flood
• General Liability
• Equipment/Inland Marine
• Business Auto
• Umbrella/Excess Liability
• Earthquake
• D&O/Professional/EPLI
• Pollution
I have reviewed your proposal dated May 1, 2018. Please bind coverage on my (our) behalf.
Please initial your choice below:
As Proposed OR With the Following changes:
Other Suggested Coverages
Coverage
Quote
Requested
Not
Interested
Increased Building Limits
Increased Liability Limits
Drone Coverage
Authorized Signature:
Let our experience guide you.
Date:
32
Carrier
Description
Quote
SDMRA (Same carrier as Workers' Comp)
Package
$281,901
Liberty Mutual
Package
No response -
declination
Declined due to type
McKee Insurance
Package
of operations
Sompo International- Endurance
Excess
Quoted- FTS exclusion
No Lead, no Public
Allied World Assurance Company
Package and
Entity w/o $25M
Excess
attachment
$100,000 Min
Hallmark
Excess
Premium for CA P.Ent.
Wildfire exclusion,
Berkely
Higher Excess
dam inspection
Layers only
reports
Excludes FTS &Wildfire
Colony, Swiss RE
Excess layers
Declined; Catlin
stopped writing Public
XL Catlin
Lead Excess
Entity biz after XL
merger
Would need to
Markel
Excess
exclude FTS and
Wildfire
AXIS, RSUI, Great AM Custom, Trident,
Excess Layers
Pending
Scottsdale
Let our experience guide you.
33
SOMPO
INTERNATIONAL
Name of Applicant: Truckee Donner Public Utility District
Date of Notice: May 03, 2018
Insurance Company: Endurance Risk Solutions Assurance Co.
POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM INSURANCE COVERAGE
You are hereby notified that under the Terrorism Risk Insurance Act, as reauthorized and amended, that you have a
right to purchase insurance coverage for losses resulting from acts of terrorism, as defined in Section 102(l) of the
Act: The term "act of terrorism" means any act that is certified by the Secretary of the Treasury, in accordance
with the provisions of the federal Terrorism Risk Insurance Act, to be an act of terrorism; to be a violent act or an
act that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States,
or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission;
and to have been committed by an individual or individuals as part of an effort to coerce the civilian population of
the United States or to influence the policy or affect the conduct of the United States Government by coercion.
YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES
RESULTING FROM CERTIFIED ACTS OF TERRORISM SUCH LOSSES MAY BE PARTIALLY
REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY
FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT
AFFECT YOUR COVERAGE, SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS, UNDER THIS
FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 85% IN 2015 AND
DECREASES ITS REIMBURSEMENT PERCENTAGE 1% EACH CALENDAR YEAR TO A TOTAL OF
80% IN 2020 OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED
DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE, THE PREMIUM
CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES
FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT.
YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS REAUTHORIZED
AND AMENDED, CONTAINS A $100 BILLION CAP THAT LIlVIITS U.S. GOVERNMENT
REIMBURSEMENT AS WELL AS INSURERS' LIABILITY FOR LOSSES RESULTING FROM
CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE
CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL
INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED.
Acceptance or Rejection of Terrorism Insurance Coverage
[ ] I hereby elect to purchase Terrorism coverage for certified acts of terrorism for a prospective premium
of $ 240
[ ] I hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will
have no coverage for losses resulting from certified acts of terrorism.
Policyholder Signature
Let our experience guide you.
Date
TRIA TRIN 0115
34
NOTICE;
I. THE INSURANCE POLICY THAT YOU ARE APPLYING TO
PURCHASE I S BEING ISSUED BY AN INSURER THAT IS NOT
LICENSED BY THE STATE OF CALIFORNIA. THESE
COMPANIES ARE CALLED "NONADMITTED" OR
"SURPLUS LINE" INSURERS.
II. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA
LICENSED INSURERS,
III.THE INSURER DOES NOT PARTICIPATE IN ANY OF THE
INSURANCE GUARANTEE FUNDS CREATED BY
CALIFORNIA LAW, THEREFORE, THESE FUNDS WILL NOT PAY
YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE
INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE
PAYMENTS AS PROMISED.
IV.THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN
INSURER IN ANOTHER STATE IN THE UNITED STATES OR
AS A NON -UNITED STATES (ALIEN) INSURER. YOU
SHOULD ASK QUESTIONS OF YOUR INSURANCE
AGENT, BROKER, OR "SURPLUS LINE" BROKER OR
CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE
AT THE FOLLOWING TOLL -FREE TELEPHONE NUMBER: 1-800-
9274357 OR INTERNET WEB SITE
WWW.INSURANCE.CA.GOV. ASK WHETHER OR NOT
THE INSURER IS LICENSED AS A FOREIGN OR NON -
UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL
INFORMATION ABOUT THE INSURER. YOU MAY ALSO
CONTACT THE NAIC'S INTERNET WEB SITE AT WWWNAIC.ORG.
V. FOREIGN I N S U R E R S SHOULD B E LICENSED B Y A STATE IN THE
UNITED STATES AND YOU MAY CONTACT THAT
STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE
INFORMATION ABOUT THAT INSURER.
VLFOR NON -UNITED STATES (ALIEN) INSURERS, THE INSURER
SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF
THE UNITED STATES AND SHOULD BE ON THE NAIC'S
INTERNATIONAL INSURERS DEPARTMENT (IiD)
LISTING OF APPROVED NONADMITTED NON -UNITED STATES INSURERS.
ASK YOUR AGENT, BROKER, OR "SURPLUS LINE"
BROKER TO OBTAIN MORE INFORMATION ABOUT T H A T
Let our experience guide you.
35
INSURER.
VIICALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE
INSURERS. ASK YOUR AGENT OR BROKER IF THE
INSURER IS ON THAT LIST, OR VIEW THAT LIST AT
THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT
OF INSURANCE: WWW.INS URANCE.CA.GOV.
VIIIF YOU, AS THE APPLICANT, REQUIRED THAT THE
INSURANCE POLICY YOU HAVE PURCHASED BE BOUND
IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE
WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR
BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE
WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE
THIS DISCLOSURE FORM AND A REQUEST FOR YOUR
SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE,
YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN
FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU
CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED
AND ANY BROKER'S FEE CHARGED FOR T H I S I N S U R A N C E
WILL BE RETURNED TO YOU.
Date:
Insured:
D-1(Effective January 1, 2017
Let our experience guide you.
36
Terrorism for Earthquake
OFFER OF TERRORISM COVERAGE
In accordance with the Terrorism Risk Insurance Act, we are required to offer the insured coverage for losses
resulting from an act of terrorism, not otherwise excluded by this policy and as covered by the Terrorism Risk
Insurance Act. All other policy provisions will apply to coverage for such act of terrorism. The insured must
choose whether or not to pay the premium described below under DISCLOSURE OF PREMIUM for coverage for
acts of terrorism that are certified by the Secretary of the Treasury as covered acts under the Terrorism Risk
Insurance Act, or not to pay the premium, and reject this offer of coverage at the time of binding.
In any case, if the insured rejects terrorism coverage in any scheduled underlying policy, this policy is
written to exclude terrorism.
If the premium shown in the DISCLOSURE OF PREMIUM is not collected and the insured does not reject
coverage for terrorism this policy will be issued excluding acts of terrorism.
DISCLOSURE OF PREMIUM
If you accept this offer, the portion of your premium for the policy term attributable to coverage for all acts of
terrorism covered under toincluding terrorist acts certified under the Act is
$ 58,000.00 .
DISCLOSURE OF FEDERAL PARTICIPATION IN PAYMENT OF TERRORISM LOSSES
The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under
the federal program. Under the formula, the United States Government generally reimburses 85% through 2015;
84% beginning on January 1, 2016; 83% beginning on January 1, 2017; 82% beginning on January 1, 2018; 81 %
beginning on January 1, 2019 and 80% beginning on January 1, 2020, of covered terrorism losses that exceed
the applicable insurer retention. However, if aggregate insured losses attributable to terrorist acts certified under
the Terrorism Risk Insurance Act exceed $100 billion in a calendar year, the Treasury shall not make any
payment for any portion of the amount of such losses that exceeds $100 billion.
CAP INSURER PARTICIPATION IN PAYMENT OF TERRORISM LOSSES
If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed
$100 billion in a calendar year and the Insurer has met our Insurer deductible under the Terrorism Risk Insurance
Act, the Insurer will not be liable for the payment of any portion of the amount of such losses that exceeds $100
billion, and in such case insured losses up to that amount are subject to pro rata allocation in accordance with
procedures established by the Secretary of Treasury.
Let our experience guide you.
37