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I
TRlfCKEE-DONHES PUBLIC UTILITY DISTRICT
PROPOSAL SHEETS
TRUCXEE-DONNER PUBLIC UTILITY DISTRICT
PR JPOSAL SHEET
Pace 1 of 9 if
I. PROPERTY INSURANCE
$5,.?T<,600.00 BLANKET ALL PROPERTY, Both Real and Personal Situated in
the State of California.
Per Page -2- of the Specifications.
"ALL RISK" not Including Earthquake and Flood, but including Sprinkler Leakage
and Theft.
Quote Annual Premium:
DEDUCTIBLE
90? Average
Clause Applying
Agreed Amount in
1 ieu of Average Clause
£1,000 per Occurrence: £ $
£5,000 per Occurrence: $ $
Ri placement Cost Coverage on both Buildings and Equipment? (Yes or No)
Same site requirement deleted on Replacement Cost Kndt? (Yes or No)
Part of a Package Policy? (Yes or No)
INSURANCE COMPANY
BROKER OR AGENT
BY
ADDRESS
TELEPHONE if
.iC UTILITY U(, i Page 2 of 9 «H
II. LIABILITY
A. COMPREHENSIVE GENERAL LIABILITY - applying to Hodily Injury, Personal
Injury and Property Damage.
Per Pare -3- and -'i- of the Specifications.
Quote annual
COMPANY
Limit of
Liability
Premium for
no deductible
Premium for
$1,000 Deductible
Ycu have read oages 3 and H of the Specifications and the changes to be
made in trie icrmr (Yes or Mo)
Changes to be trade to the form indicated on page 3 and 'J of the Specifications
and numbered as 1 through 13 arc included in your quote? (Yes or No)
If not, list any exceptions to the specifications below:
Part of a Package? (Yes or No)
BROKER OR AGENT_
ADDRESS
BY
TELEPHONE if
rRUCKEE-DOMNER PUBLIC UTILITY DISTRICT
PROPOSAL SHEET
-e 3 o ,ib
II. LIABILITY INSURANCE
B. AUTOMOBILE LIABILITY including Physical Damage per Page -5- of the Specifications!
Coverage Includes: All Owned, Hired and Non-Owned Autos?
$5,000 ea. person Medical Payments?
(Scheduled vehicles only)
$30,000 CSL Uninsured Motorists?
Snowmobile covered as an auto?
(Yes or No)
(Yes or Mo)
(Yes or No)
(Yes or No)
Quote Annual Premium:
Company:
Limit of Liability $
Premium; Liability $
$1,000 Deductible Collision $
$100 Deductible Comprehensive $_
TOTAL: $
(Scheduled Vehicles only)
(Scheduled Vehicles only)
Exceptions to Specifications:
BROKER OR AGENT_
BY
ADDRESS
TELEPHONE $
;! [C UTII [TY DISTRICT Pane b of 9 I*
II. LIABILITY INSURANCE
C. SPECIAL PUBLIC ENTITY DIFFERENCE IN CONDITIONS COMPREHENSIVE LIABILITY
POLICY.
Per Page -6- of the Specifications.
COMPANY
Limit of
Liability
Premium for Indicated Deductibles:
-0- $1,000 $5,000
Is this a Plat Premiian? _
If not, what Ls the rate?
(Yes or' No)
BROKER OR AGENT_
BY
ADDRESS
TFLEPHONE #
; .
XRUCKEE—E' MNER . IBLIC UTILITY DISTRICT Page 5 of 9 f£p
PROPi SAL SHEET
II. LIABILITY INSURANCE
D. EXCESS LIABILITY
FOLLOWING FORM EXC ESS OF UNDERLYING per Page -7- of the Specifications. j
1
Coverage Includes: Comprehensive Genera] Liability? (Yes or Mo) ;;
mprehensive Auto Liability? (Yes or No)
Special Public Entity DIG to
cover Errors and Omissions? (Yes or No)
$100,000 Employers Liability
as an underlying coverage?
$10,000 Deductible on any
uninsured exposure if an
umbrella form?
SHOW LAYERS TO $5,000,000 and $10,000,000
(Yes or Mo)
(Yes or No)
COMPANY
LIMIT OF
LIABILITY RATE PREMIUM
FOLLOWING
FORM?
BROKER OR AGENT
EY
ADDRESS
TELEPHONE #
I*
Pa ■;.: 6 of 9
I
PROPOSAL SHEET
TRUCKEE-DONNER PUBLIC UTILITY DISTRICT
CONTRACTORS EQUIPMENT FLOATER ALL RISKS
1980 John Deere Backhoe, ID #3554451
with Ripper Tooth Assembly
Coverage Amount: $36,000
Policy shall include automatic coverage of all newly acquired etjuipmenc
of this type owned, leased, horrowed or rented subject to 60 days
report with a limit of liability of at least $50,000 any one item.
S100 Deductible 1- Year
PREMIUM: $^
Rate per $100 of value $^
Part of Package
I
Yes
Co-insurance Clause Eliminated
Basis of Recovery:
Valued S, Insured at
No
Yes
Yes
No
No
INSURANCE COMPANY
AGENT OR BROKER
By
Address
Telephone Number
Page 7 of 0 M
\
PROPOSAL SHEET
TRUCKEE-DONNER PUHLIC UTILITY DISTRICT
VALUABLE PAPERS & RECORDS ALL RISK FORM
Li.Tiic of Liability: $50,000
Located: District Office Building, N/S Donncr Pass Rd.
between HWY. 89 & Meadow Rd., Truckec, Ca.
Deductible: NIL
Part of Package
Yes No
PRE-ilUM:
1-Year
I INSURANCE COMPANY
AGEOT OR BROKER
BY
Address
Telephone Number
Pa ;e 8 of 9 \»
PROPOSAL SHEET
TRUCKEE-BONNER PUBLIC UTILITY DISTRICT
\
ACCOUNTS RECEIVABLE ALL RISK FORM
LIMIT OF LIABILITY: ?600,000
Location: District Office Building, N/S Donner Pass Rd.
between UWY 89 S Meadow Rd., Ttuckce, Ca.
Deductible: NIL
Part of Package
Yes No
Non Reporting Form
Yes No
1-Year
I
PREMIUM:
INSURANCE COMPANY
AGENT OR BROKER
BY
Address
Telephone Number
rRUCKEE-DOMNER PUBLIC 'ITTLITY DISTRICT
PROPOSAL SHEET
Page 9 of 9
M
IV. CRIME
I
ROBBERY INSIDE AND OUTSIDE THE PREMISES - Per Page 11 of the Specifications.
$25,000 Robbery Inside the Premises
325,000 Robbery Outside the Premises
CQMPAMY
3-Year
Premium
g P"Tr)H TTV
COMPAQ:
h00,000 Honesty Blanket Position Bond:
•100,000 Faithful Performance Blanket
Position Pond:
I
3-Year
Premium
Annual
Premium
Annual
Premium
BROKER OR AGENT
BY
ADDRESS
TELEPHONE #