HomeMy WebLinkAboutDocumentation_Regular_Tab 09B_10/10/2002 .� �- �
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To: JoAnne Forsythe
From: Daniel J. Gallagher�
Date: 10/1 /2002
Re: Renewal Coverage for all insurance except Workers' Compensation
Attached for your information is a copy of the Proposal from Acordia. The total cost of the insurance is
within the budget figure of $174,000.00, provided for in the budget approved by Council.
I recognize that any contract over $15,000.00 must be brought before Council therefore, Mary Wolcott
should receive this information for inclusion on the agenda.
1
P_R_EF'ER_F2ED
GOVERNMENTAL
I NSURANGE TRU
VILLAGE OF TEQUESTA
PACKAGE POLICY QUOTE
Quote prepared for: Brian Cottrell, CIC, CRM
Acordia - West Palm Beach
Quote prepared by: Mike Scholl
PMSI - Ft. Lauderdale
(954) 915-9221
THIS QUOTE IS VALID THROUGH: October 1, 2002
1
Preferred Governmental Insurance Trust
Excess Insurance
P�.��
�.R � F.��2$�D
G QV E_R IV M.E N T��,
INSURANCE TRUST
To protect members of the fund from large losses and to protect the financial security of the fund, the PGIT board of trustees has elected to purchase an
extremely conservative excess of loss insurance structure. We stress PGIT excess of loss structure as opposed to our competitors' reinsurance structure
because an excess structure provides PGIT members several levels of protection that reinsurance does not.
First, excess of loss policies list every individual member as additional insured, this gives every member direct access to the insurance company for payment of
claims. Reinsurers are only responsible to the trust, therefore, if a trust became financially troubled, there is no guarantee from an insurance company that any
individual claim will be paid or even that a reimbursement will go towards the originating claim. Secondly, the Florida Department of Insurance has ruled that
excess of loss workers' compensation policies have the protection of the Florida Workers' compensation Guarantee Association, while reinsurance policies do
not.
The Trust has elected to not retain risk on the lines of coverage, which are considered to have catastrophic exposures; Property, Inland Marine, Boiler and
Machinery, Automobile Physical Damage, Public Officials Liabifity and Law Enforcement Liability. For these coverages the Trust transfers all risk to A rated
insurance companies. For the lines of coverage that do not have significant catastrophe exposures, the trust elected for very small retentions. For Generai
�iability and Automobile Liability, the Trust has elected to retain the Florida Statutory cap of 100,000 per person and 200,000 per occurrence. For Workers
Compensation the trust retains 50,000 per occurrence.
9/17/02
2
PACKAGE POLICY QUOTE
PROPERTY
Nam�d In� i�Pd• VILLAGE OF TEQUESTA ���
�' � F �R� � C2
� OV_� R N,M �N'[[}{„
Term: 10/01102 ta 10/01/03 I,NSURANCE TRUST
Companv: Preferred Governmental Insurance Trust (PGIT)
(Not Rated by A. M. Best)
Limit of iabiliM
(Per schedules provided) $8.757 million Blanket for Buildings and Contents
Accounts Receivable
Electronic Data Processing $ 151,274
Fine Arts $ _
Contractor's / Mobile Equipment $ 179,303
Valuable Papers $ _
Rented, Borrowed, Leased Equipment $ _
Watercraft $ 45,000
Misc. Equipment $ � 279,000
$ -
Flood Sublimit Not Covered Optionai Flood coverage available for addl premium of $2102.
Sublimit of $1,000,000 applies.
Deductibies: $ 5,000 Per Occurrence-Buildings and Contents.
$ 2,500 Per Occurrence-Inland Marine
3.0% TIV Per Occurrence/Per Location for "Named" windstorm
subject to minimum of $10,000 Per Occurrence
Flood Deductibla: Zones A or V- Excess of maximum limits (building & contents) available from NFIP, whether
purchased or not.
$ 5,000 Other than Zones A or V
Coveraae.
1. Special form (formerly "All Risk"), subjed to policy exclusions.
2. Replacement Cost applicable to Buildings, Contents and EDP. All others paid per policy form.
3. No Coinsurance Cfause
4. ACV applies to Piers, Oocks and Wharves.
5. Certain wverages subject to sublimits stated in policy.
Govered Pro�y1 Sublimits
Buildings or structures newiy acquired, occupied or constructed: $1,000,000 subject to 90 day reporting period
Personal property newly acquired: $250,000 subject to 90 day reporting period
Personal property temporarily away from premises: $100,000
Personal property of others: $50,000
(limited to $1,000 per volunteer, $2,500 per empioyee)
EXTENSIONS OF COVERAGE
The limits below are in addition to the blanket limit of insurance but subject to the 6lanket limit deductibie shown in the property section of this proposal:
COVERAGE
LIMIT
1. Preservation of property $ 100,000
2. Fire Department service charge $ 25,000
3. Repair of theft damage to non-owned buildings $ 50,000
4. Debris remova the greater of 25% of loss or $ 500,000
5. Increased cost of construction: greater of 15% of value of damaged bldg. or $ 500,000
6. Fire protection devices $ 10,000
7. Pollutant clean up and removal: $ 50,000
8. Arson and crime reward $ 10,000
9. Utility interruption (excluding Transmission & Oistribution) $ 100,000
10. Sewer back up during flooding $ 25,000
3
SPECIAL PROPERTY COVERAGES
OV C .F
LINMII
1. Business Interruption $ 250,000
2. Extra Expense $ 250,000
3. Valuabie papers $ 100,000
4. Accounts receivabie $ 700,000
5. Computer equipment and electronic media $ 100,000
6. Fine arts (maximum per item $5,000) $ 100,000
7. Mobile, portable, or contractor's equipment $ 50,000
8. Miscellaneous property (if included in property schedule) $ 25,000
9. Trees, shrubs, and landscape planting (maximum per tree $1,000) $ 25,000
10. Golf course greens and tees (maximum any one green or tee $5,000) $ 50,000
11. Food spoilage $ 10,000
12. Animais (maximum per animal $1,000) $ 25,000
13. Paved surfaces $ 100,000
14. Commandeered property or impounded property $ 100,000
15. Emergency service portable equipment $ 250,000
16. Communications equipment $ 50,000
17. Vacant buildings Per Form
Please refer to policy on how above coverage applies. Subject to deductibles and certain restrictions. A6ove coverage is provided to you
as part of the b/anket limit of insurence. hlgher /imits are required, they wii� be stated in the propeRy or inland marine sections of
this proposal6ut will remain a part of the b/ankef Ilmit of insurance.
MAJOR EXCLUSIONS
Propgtty Not Govered:
1. Accounts, bills, currency, or other moneys, deeds, food stamps, or other evidences of debt, scrip, notes or securities except
under conditions described in "Special Property Coverages" section of the policy.
2. Automobiles
3. Dams, levees, reservoirs, tunnels, bridges, roadways, walks, patios, or other paved surfaces except under
conditions described in "Special Property Coverages" section of the policy,"
4. Contraband, or property in the course of iilegal transportation or trade.
5. Cost of excavations, grading, backfiliing, or filling `•
6. Land, water, and growing crops.
7. Bulkheads, pilings, piers, wharves, or docks uniess scheduled.
$. Property covered under another coverage form of this or any other policy in which it is more specifically described.
9. Retaining walls that are not part of buildings you own"
10. Underground tanks, pipes, flues, sewers, or drains you own that are not located on "premises" insured under this policy.
11. Electrical or communication lines, towers, and poles you own that are not located on a"premises" insured under this policy.
12. Buildings that are "vacant" except under conditions described in "Special Property Coverages" section of the policy.
13. Watercraft not included in the Iniand Marine Schedule provided to us.
14. Aircreft.
15. Personal property while airborne or waterborne.
Fxcl�ded a� e of Lo
1. Building ordinance enforcement
2. Coilapse
3. Water, except as provided under "Extensions of Coverage"
4. Utility failure, except as provided under "Special Property Coverages"
5. Government action
6. War, military action and terrorism
`7. Mold
8, Nuclear reaction
9. Pollution, except as provided under "Extensions of Coverage"
10. Asbestos
„i.11. Flood and Earthquake
PROPERTY
Notec_ of Importance:
1. A signed schedule(s) of property for all property to be insured is required within 30 days of binding. The following
information should be included:
- Street address or plat description
- 100 % replacement cost value of all property to be insured
- Brief description of the construction of all buildings or structures at each location
2. Functional replacement cost applies to property over 65 years old or with historicaUlandmark status.
Please refer !o policy %rm on how above coverage applies. Subject to deductibles and resVictions as stipulated in policy.
PGIT's liability for /oss or damage will 6e limited only to the loss or damage due a covered cause of /oss.
4
EQUIPMENT BREAKDOWN (BOILER & MACHINERY)
ov r d ��ioment� Covered Property buiit to operate under vacuum or pressure, other than weight of contents,
or used for the generation, transmission or utilization of energy.
.ov ra° c•
Equipment Breakdown Limit $8,756,871
Property Damage $8,756,871
Business Income $250,000
Extra Expense $250,000
Service Interruption Combined with Business Income and Extra Expense
Perishable Goods $100,000
Demoiition and ICC $100,000
Expediting Expenses $100,000
CFC Refrigerants $100,000
�P�� Same as Pro e
p rty - Building and Contents
5
PACKAGE POLICY
CRIME/EMPLOYEE DISHONESTY
Name_ d In rPd• VILLAGE OF TEQUESTA
Term: 10l01/02 to 10/01/03
omoanv. Preferred Govemmental Insurance Trust
(Not Rated by A. M. Best)
COVERAGE INSURED OUTSIDE OF PGIT PROGRAM
L imits of Liabilitv ^nd ov r^ag;;
Employee Dishonesty (Coverage O- Per Loss Basis)
Honesty Blanket Bond $ _
Deductible g _
Theft, Disappearance, and Destruction Limit $ - inside
$ - outside
Deductibles $ - inside/ outside
Forgery or Alteration Limit g _
Deductible g _
Computer Fraud Limit $ .
Deductible g _
Notes of Imoort_ancp.
1 Employee dishonesty coverage is extended to cover those employees required by Florida Statute to be separately bonded.
Coverage applies in excess of the statutory bond amount.
2 Electronic Transfers are automatically covered under Computer Fraud.
3 Excludes Faithful Performance.
6
PACKAGE POLICY
GENERAL LIABILITY
Nam .d In �r d• V{LLAGE OF TEQUESTA
Term: 10/01/02 to 10l01l03
Com°anv Preferred Governmental Insurance Trust
(Not Rated by A. M. Best)
Form. Occurrence
Limits of Liability,�
Primary Bodily Injury and Property 2,000,000 Per Occurrence
Damage Liability- Combined
General Aggregate: 4,000,000 Annual
General Liability Ded�ctible� $ 0 Per Occurrence
ov raa .•
1. EMT/Paramedic Professional liability 8. Watercraft liability (under 52 feet)
2. Premises Operations 9. Limited Woridwide coverage
3. Products and Completed Operations 10. Additional Persons insured
4. Fire Legal Liability -$50,000 11. Employee Benefits Liability
5. "Insured" contracts (Claims-made basis)-Retro Date 10N/02. Separate Limits Apply
6. Host Liquor Law liability 12. Failure to Suppiy Water
7. Broad Form PropeRy damage 13. Principle of Eminent Domain including Inverse Condemnation
- $100,000 Per Occurrence / Annual Aggregate
Maior Fx I� ion in i�d b�t ^r not limited to th followino�
- Facpected or intended injury - Damage to owned ptopeRy
- Workers' Compensation and similar laws - Medical Payments
- Employment-Related Practices Liability • Nuclear
- Employer's Liabiliry - Health care facilities
- Pollution, Asbestos - Hospital ! Clinic Medical Malpractice
- Automobiles - War
- Aircraft and airports - Law Enforcement Professional Liability
Notes of Importance•
1. Premium is �ot auditabte.
2. Defense Costs are paid in addition to policy limits.
For additional exclusions and more details on how fhey apply, please refer to coverage form.
7
PACKAGE POLICY
LAW ENFORCEMENT LIABILITY
Nam d In �r d• VILLAGE OF TEQUESTA
Term: 10/01/02 to 10/01/03
Com°anv: Preferred Govemmental Insurance Trust
(Not Rated by A. M. Best)
Form: Occurrence
Coveraae" Pays damages the insured becomes legally obligated to pay because of a"wrongful act" resulting
in "personal injury" or "property damage" in the performance of law enforcement activities.
l imits of Liabilitv�
Each Person Limits 2,000,000
Occurrence Limits: 2,0OO,OQa
Aggregate Limits 2,000,000
Deductible- per Occurrence $ 7,500
Coverage Extensions
- Definitions of Personal Injury includes Bodily Injury, Death, Sickness, Disease, Humiliation, Mental Mguish, Mental Distress
and Violations of Property Rights.
- Liability assumed in any mutual aid or reciprocal law enforcement contracts.
- Definition of "Employee" includes auxilliary law enforcement officers, reserve officers and volunteers.
- Broadened definition of "Who is an Insured"
M�jor Exclusion� incl �d n t ar not limit d to th follo��in��
- Contractual Liability (except mutual aid or reciprocal law enforcement contracts).
- Workers Compensation, Employer's Liability and similar laws
- Pollution
- Asbestos, Silica, Dust
- Lead
- War, Terrorism
- Personal Property in Insured's care, custody or control (except for properry on persons at time of arrest)
- Criminal Acts
- Aircraft, Auto or Watercraft
- Employment Injury
- Non-Monetary Damages
Notes of Imoortance:
1. Defense Costs are paid in-addition-to policy limits.
2. Premium is not auditable.
3. Deductible applied to money damages and claims expenses (inciuding investigation, adjustment, and defense costs).
8
PACKAGE POLICY
AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE
Nam d In �r d• VILLAGE OF TEQUESTA
Term: 10/Ot/02 to 10/01/03
om°anv Preferred Governmental Insurance Trust
(Not Rated by A. M. Best)
�imits of Liabilitv (Based on 0 Vehiclegl;
Primary Bodily Injury and Property 2,000,000 Per Occurrence
Damage Liability- Combined (Symbol 1- Any Auto)
Personal Injury Protedion $10,000 (Statutory)
Uninsured Motorist Rejected
t iability Dedi�ctibig $0 Each Accident
Hired 8 Non-owned Liability $1,000,000
Increased PIP offered? NO
Medical Payments Limit None
�ysical Damaag;
Actual Cash Value: Comprehensive-42 vehicles
Collision-42 vehicles
Physical Damaa D d� tibl •
Comprehensive $ 1,000
Collision $ 1,000
ov r pe and Notas of Imnortroce•
1. Hired and non-owned liability is included.
2. Need signed UM rejection form.
3. Need schedule of vehicles with "ACV" amounts.
4. Premium is not auditable.
9
PACKAGE POLICY
PUBLIC OFFICIALS LIABILITY
Named Insured� VILLAGE OF TEQUESTA
Term: 10/01/02 to 10/1/03
°m°anv. Preferted Governmental Insurance Trusi
(Not Rated by A. M. Best)
Form: Claims Made - Duty to Defend
ov raa • Pays damages the insured becomes legally obligated to pay due to "wrongful acts" arising
out of the discharge of duties.
imit of iabili�� $1,000,000 Each WrongfulAct
$1,000,000 AnnualAggregate
� d'�hb� $ 5,000 Per Wrongful Act
o r^q� xt ncion �
1. Defense costs are included in the policy limit. The company appoints counsel.
2. Deductible applies towards damages, "claim expenses" and supplemental payments.
3. Full Prior Acts coverage provided.
4. Broadened definition of "Who is an Insured"
�or Exclusion in I d h t ar not limit d to th folio�+ina•
- Fiduciary Liability
- Workers Compensation, Employer's Liability and similar laws
- Poliution
- Asbestos, Silica, Dust, Lead, Fungi a�d Bacteria
- Bodily Injury, Personal Injury, Property Damage or Advertising fnjury
- War, Strikes or Terrorism
- Law Enforcement Activities
- Criminal Acts
- Failure to effect and maintain insurance
- Non-monetary damages, fines or penalties
- Insured vs. Insured
- Employment Practices
- Bonds, Taxes or Construction contracts
- Collective Bargaining Agreements
- Strike and Lockouts
- Prior or Pending claims
- Damages arising out of Eminent Domain, Condemnation, Inverse Condemnation or Adverse Possession (except defense costs
for these items, which are covered up to $10,000 annually).
- Workers' Adjustment and Retraining Notification Act
- Health Care Professional or Health Care Facilities
- Contractual Liability
- Capitai improvement to make property more accessibie or accomodating to disabled persons
- R. I. C. O.
Notes of Importance�
1. This quotation is subject to receipt and approval of completed and signed application prior to binding.
2. Exciudes coverege for Employment Practices Liability. (See EPL Coverage Section)
10
EMPLOYMENT PRACTICES LIABILITY
Nam d Inc �r d• VILLAGE OF TEQUESTA
Term: 10/01/02 to 10/1I03
Comoanv. Preferred Governmental Insurance Trust
(Not Rated by A. M. Best)
Form: Claims Made - Duty to Defend
ov rao . Pays damages the insured becomes legaliy obligated to pay due to "wrongful
employment practices" arising out of the discharge of duties.
I_imits of Liability $1,000,000 Each Wrongful Employment Practice
$1,000,000 Annual Aggregate
D de i� $ 5,000 Per Wrongful Employment Practice
ov raqe xt .n ionr
1. Defense costs are included in the policy limit. The company appoints counsel.
2. Deductble appiies towards damages, "claims expenses" and supplemental payments.
3. Full Prior Acts included.
4. Broadened definition of "Who Is An Insured"
5. Defense costs (attorney) provided for claims or suits seeking relief or redress in any
form other than monetary damages including EEOC hearings.
Notes of_ Im�ortaneg
This quotation is subject to receipt and approval of completed and signed application prior to binding.
Coverage includes for sexual harassment (inciuding physical contact).
Definition of "Wrongful Employment Practice" extended to include discrimination misrepresentation, invasion of privacy, defamation, and retaliation,
infliction of emotional distress, wrongful discipline, negligent evaivation, negligent hiring or supervision.
M�'or Ex 1� ion in I�d b�t ar not limit d to th foilowino,�
- Criminal Acts.
- Fiduciary Liability.
- Pollution.
- Asbestos, Silica Dust, Lead, Fung: and Bacteria.
- Bodily, Personal Injury, PropeRy Damage or Advertising Injury.
- Self-Dealing or Illegal Profil.
- Law Enforcement Activities.
- War, Strikes or Terrorism.
- Failure to Effed and Maintai� Insurance.
- Bonds, Taxes or Construction Contracts.
- Prior or Pending Claims.
- Non-Monetary Damages, Fines or Penalties.
- Insured vs. Insured.
- Workers Compensation or similar laws.
- Collective Bargaining Agreements.
- Strike and Lockouts.
- Worker's Adjustment and Retraining Notification Act.
- Health Care Professional or Health Care Facilities.
- Contractual Liability.
- RICO
11
CLAIMS ADMINISTRATION
Preferred Governmental Ctaims Solutio�s (PGCS) administers and closely controls all claims from start to finish. Mr. Kevin Cothron is the Claims Coordinator for property and
liability and pertorms the initial review of all loss notices. PGCS is dedicated to exclusively serving Florida governmentai agencies. This team of fult-time, licensed adjusters
understands federal laws and state statutes goveming actions against public entities. A toll-free telephone number is provided.
You will find our approach to be aggressive a�d protective of your entitys interests. We take Puii advantage of rights afforded under the law. Setting a precedent of always settling
claims does not characterize the Program's position.
In case of a disaster, a 24-hour claim hotline is available.
12
UMBRELLA/EXCESS
None Requested
13
PREMIUM RECAPITULATION
VILLAGE OF TEQUESTA
Annual Premium
Property/Inland Marine/Equip. Breakdown g 28,so3
Crime/Employee Dishonesty $ _
General Liability / Law Enforcement $ �� 419
Automobile Liability g 38,662
Automobile Physical Damage g �,00s
Public Officials/Employment Practices Liability g 12,848
Umbrella / Excess Premium
Total Premium: $ 158,538
Optional Property/Inland Marine/Equip. Breakdown with Flood Included $2,102 Addl.
Notes of Im�ortan e•
1. PGIT is not protected by the Florida Guarantee Association in the event it becomes unable to meet
its cfaims payment obligations.
2. Quote subject to review and acceptance by PGIT Board of Trusfees.
3. Premiums are subject to change if ALL lines of coverage quoted are not bound.
4. PLEASE NOTE THAT NOT ALL CO VERAGES REQUESTED MAY NOT BE PROVIDED /N TH/S QUOTAT/ON.
9. Florida Surcharges not included above.
s. Total Premium due within 30 days of inception.
7. Quote is not bound until written orders to bind are received from the insured, and the Trust su6sequently
accepts fhe risk.
14
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 1
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
Group Accident 10/O1/03 HARTFORD ETB102089 $4,648.00
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LOCATIONS
1 357 TEQUESTA DRIVE, TEQUESTA, FL
Group Accident
GROUP ACCIDENT POLICY
POLICE DEPT.EMPLOYEES
SEE MANUSCRIPT FOR COVER.AGES & LIMITS
PER %COINS VALUATION
ACC DEATH & DISMEM
PERILS: LOSS OF LIFE ACCIDENT INDEMNITY
FORMS/CONDITIONS/ENDORSEMENTS: ELIGIBLE PERSONS: CLASS l: ALL FULL-TIME SWORN LAW
ENFORCEMENT OFFICERS, ALL OTHER POLICE DEPT. PERSONNEL,
ALL FULL-TIME FIREFIGHTERS, AND ALL OTHER FIRE DEPT.
PERSONNEL OF THE POLICYHOLDER.
GROUP ACCIDENT POLICY
CLASS 1- HAZARD: C-62 - BENEFIT ADD - AMOUNT:$50,0OO THE LINE OF DUTY.
CLASS 1- HAZAR.D: C-64 - BENEFIT: AD - AMOUNT:$50,000. FRESH PURSUIT.
CLASS 1- HAZARD: c-31 VL118 BENEFIT: AD- AMOUNT:$150,000 UNLAWFUL & INTEN-
TIONAL DEATH. AGGREGATE LIMITATION: NOT APPLICABLE.
DESCRIPTION OF FORMS:
HAZARD C-62 -24 HOUR COVER.AGE WHILE ON THE BUSINESS OF THE POLICYHOLDER.
HAZARD C-64 - FRESH PURSUIT COVERAGE FOR POLICE OFFICERS AND FIREFIGHTERS
WHILE ON THE BUSINESS OF THE POLICYHOLDER.
THIS HAZARD COVERS INJURY WHICH:
A)FOR POLICE OFFICERS, RESULTS IN ACCIDENTAL DEATH DUE TO A RESPONSE TO A
FRESH PURSUIT OR TO THE OFFICER'S RESPONSE TO WHAT IS REASONABLY BELIEVED
TO BE AN EMERGENCY; OR
B} FOR FIREFIGHTERS, RESULTS IN ACCIDENTAL DEATH DUE TO A RESPONSE TO WHAT
IS REASONABLY BELIEVED TO BE AN EMERGENCY.
. SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN {561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 2
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PAEMIUM DED.AMT
FRESH PURSUIT MEANS THE PURSUITE OF A PERSON WHO HAS CONIMITTED OR IS
REASONABLY SUSPECTED OF HAVING COMMITTED A FELONY, MISDEMEANOR, TR.AFFIC
INFRACTION OR VIOLATION OF A COUNTY OR MUNICIPAL ORDINANCE. FRESH
PURSUIT SHALL NOT NECESSARILY IMPLY INSTANT PURSUIT, BUT PURSUIT
WITHOUT REASONABLE DELAY.
REFER TO POLICY MODIFICATIONS, DEFINITIONS AND EXCLUSIONS SECTION FOR
MODIFICATIONS, LIMITATIONS AND EXCLUSIONS AFFECTING THIS COVERAGE.
HEART, CIRCULATORY, TUBERCULOSIS COVERAGE IS PROVIDED ON FORM 7679 B5(HL)
SCHEDULE (MODIFICATIONS).
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SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLA,GLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 25 Sep 2002 PAGE 3
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
Fidelity Bond 10/O1/03 TR.AVELERS 103505325 $3,201.00
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LOCATIONS
1 357 TEQUESTA DRIVE, TEQUESTA, FL
FIDUCIARY
FIDUCIARY
$2,000,000 LIMIT
$2,000,000 AGGREGATE
$1,000 RETENTION
VILLAGE OF TEQUESTA GENERAL EMPLOYEES' TRUST FUND
VILLAGE OF TEQUESTA PUBLIC SAFETY OFFICERS' PENSION TRUST FUND
ELIMINATION OF RECOURSE
GOVERNMENT PLAN
DEFENSE WITHIN LIMIT
POLLUTION EXCLUSION
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SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 4
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
Bonds 10/O1 03 ZURICH NO 08538214 $210.00
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SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 5
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
Pollution Liability 10 O1 03 FPLIPA BINDER56565 $698.00
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LOCATIONS
1 901 OLD DIXIE HIGHWAY, TEQUESTA, FL
2 357 TEQUESTA DRIVE, TEQUESTA, FL
Pollution Liability
POLLUTION LIABILITY POLICY
COMMERCE & INDUSTRY
RETRO ACTIVE DATE 1/1/97
CLAIMS MADE AND REPORTED POLICY
$1,000,000 EACH INCIDENT, PER LOCATION
$2,000,000 AGGREGATE
DEDUCTIBLE: $5,000.
THIRD PARTY BODILY INJURY AND PROPERTY DAMAGE
EXPENSES FOR DEFENSE
CORRECTIVE ACTION FOR UNDERGROUND STORAGE TANK RELEASES
CLEAN UP FOR ABOVEGROUND STOR.AGE TANK RELEASES
POLLUTION LIABILITY
LIMITS $1,000,000/$2,000,000, DEDUCTIBLE $5,000
LOCATIONS: 901 N OLD DIXIE HWY TEQUESTA, FL.
357 TEQUESTA DRIVE TEQUESTA, FL.
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SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDTA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. $#600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 6
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
Comm. Package Policy 10 O1/03 PMSI BINDER56570 $160,642.00
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COMMERCIAL PROPERTY
LOCATIONS
1 357 TEQUESTA DR., TEQUESTA, FIL
2 2280 COUNTY LINE ROAD, TEQUESTA, FL
3 416 CYPRESS DRIVE, TEQUESTA, FL
4 901 N. OLD DIXIE HWY., TEQUESTA, FL
5 NEW R/O PLANT: 90, TEQUESTA, FL
6 TEQUESTA PARK, TEQUESTA, FL
7 861 NORTH OLD DIXIE HWY, TEQUESTA, FL
8 399 SEABROOK RD., TEQUESTA, FL
9 136 BRIDGE RD., TEQUESTA, FL
10 250 TEQUESTA DRIVE, TEQUESTA, FL
11 190-210 TEQUESTA DRIVE, TEQUESTA, FL
12 WEST END OF ROBERT ST., TEQUESTA, FL
13 NORTH END OF HOMEWOOD RD., TEQUESTA, FL
14 CORNER OF COUNTRY CLUB DR, TEQUESTA, FL
15 ALONG COUNTRY CLUB DRIVE, TEQUESTA, FL
16 TURTLE CREEK DEVELOPMENT, TEQUESTA, FL
17 566 U.S. HIGHWAY ONE NORTH, TEQUESTA, FL
18 596 U.S. HIGHWAY ONE NORTH, TEQUESTA, FL
BI,ANKETS �CO-INS VALUATION PERILS
BLKT# Bl
BLDGS/CNTS/SPEC PROP $11,260,293 NONE RC/AA SPECIAL FORM $5,000
LOC# 1 °sC0-INS VALUATION PERILS
BUILDING 2
FIRE DEPT.SLEEPING QTRS $33,433 (BLANKET B1)
FIRE GARAGE $113,436 (BLANKET B1)
CONTENTS $17,911 (BLANKET B1)
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 7
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLfCY NUMBER PREMIUM DED.AMT
BUILDING 1
CONTENTS $35,822 (BLANKET B1)
LOC# 2
BUILDING 1
CHEMI CAL STOR.AGE $17 , 911 ( BLAI�TKET B 1)
CONTENTS $2,389 (BLANKET:B1)
BUILDING 4
EQUIP. STGE. $17,911 (BLANKET Bl)
CONTENTS $8,956 (BLANKET B1)
BUILDING 2
RECREATION BLDG. $62,688 (BLANKET B1)
CONTENTS $1,194 (BLANKET B1)
Y
BUILDING 3
RESTROOMS $71,644 (BL�NKET B1)
LOC# 3
BUILDING 1
PUMP BLDG. $4,179 (BLANKET B1)
CONTENTS $35,822 (BLANKET B1)
LOC# 4
BUILDING 1
CHLORINATOR EQUIP. $54,926 (BLANKET B1)
BUILDING 2
GROUND STGE TANK $310,553 (BLANKET B1)
BUILDING 3
BLDG.(TENANT OCC) $17,911 (BLANKET_B1)
BUILDING 4
GROUND STGE.TANK $616,189 (BLANKET B1)
BUILDING 5
WATER PLANT FILTERS $583,735 (BLANKET Bl)
BUILDING 6
SURGE TANK $7,164 (BLANKET B1)
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 8
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
BUILDING 7
PUMPS/MOTORS $14,329 (BLANKET Bl)
BUILDING 8
DIESEL GENERATOR $71,644 (BLANKET.B1)
BUILDING 9
WELL FIELD #4 BLDG. $62,688 (BLANKET B1)
CONTENTS $135,824 (BLANKET.B1)
LOC# 5
BUILDING 1
WATER TREATMENT FACILITY $4,698,726 (BLANKET B1)
INCLUDES SULFURIC ACID TANK, CAUSTIC SODA TANK, HYDROGEN PEROXIDE TANK,
DEGASIFER, CLEARWELL PUMP, SCAVENGER TANK, WELL R1 AND RD, EMERGENCY
GENER.ATOR, AND GENERATOR FUEL TANK WITHIN LIMIT.
LOC# 6
BUILDING 1
WELL FIELD #5/PUMPS $65,674 (BLANKET.B1)
LOC# 7
BUILDING 1
WAREHOUSE $23,882 (BLANKET B1)
CONTENTS $59,702 (BLANKET B1)
LOC# 8
BUILDING 1
RECREATION CTR BLDG $416,110 (BLANKET B1)
CONTENTS $29,852 (BLANKET B1)
LOC# 9
BUILDING 2
CONTROL BLDG/WATER $11,940 (BLANKET B1)
CONTENTS $16,883 (BLANKET B1)
BUILDING 1
MAINT. GARAGE $483,750 (BLANKET B1}
MAINT.GAR.AGE CONTS $57,964 (BLANKET Bl)
MAINTENANCE BUILDING
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 25 Sep 2002 PAGE 9
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POI.ICY NUMBER PREMIUM DED.AMT
BUILDING 3
STORAGE BLDG $22,510 (BLANKET B1)
CONTENTS $2,814 (BLANKET Bl)
USED FOR STORAGE OF MOSQUITO SPRAY CHEMICALS.
BUILDING 4
STORAGE TANK-ABOVE GROUND $262,364 (BLANKET B1)
SERVICE PUMPS $39,393 (BLA.NKET B1)
500,000 GAL CAPACITY
LOC# 10
BUILDING 1
OFFICE CONTENTS $84,413 (BLANKET Bl)
LEASED OFFICE SPACE FOR VILLAGE OFFICES
LOC# 12
BUILDING 1
PUMP AND EQUIP $5,628 (BLANKET B1)
LOC# 13
BUILDING 1
PUMP AND EQUIP $5,628 (BLANKET B1)
LOC# 14
BUILDING 1
PUMP AND EQUIP $5,628 (BLANKET B1)
LOC# 15
BUILDING 1
PUMP AND EQUIP $5,628 (BLANKET.Bl)
LOC# 16
BUILDING 1
PUMP AND EQUIP $5,628 (BLANKET B1)
LOC# 17
BUILDING 1
POLICE STATION/CHAMBERS $77,250 (BLANKET B1)
POLICE STATION/CHAMBERS
LOC# 18
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 10
COVERAGE AMOUNT/IIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
BUILDING 1
FIRE ADMIN/CONII�! SRVCS $77,250 (BLANKET Bl)
FIRE-RESCUE DEPT ADM OFFICES
SCHEDULED ENDORSEMENTS
Edition
Form No. Date Description
BUSINESS INCOME, ALS
$250,000 $5,000
Loc ( s ) : ALL
EXTR.A EXPENSE, ALS
$250,000 $5,000
LoC(s) : ALL
VALUABLE PAPERS, RC
$100,000 $5,000
Loc ( s ) : ALL
ACCOUNTS RECEIVABLE, RC
$100,000 $5,000
Loc ( s ) : ALL
COMPUTER EQUIPMENT & MEDIA, RC
$151,274 $2,500
Loc ( s ) : ALL
FINE AR.TS, APPRAISED VALUE
$100,000 $5,000
LoC ( s ) : ALL
MOBILE OR CONTRACTORS EQUIPMENT, ACV
$179,303 $2,500
Loc(s) : ALL
MISC PROPERTY, ACV
$324,000 $5,000
Loc ( s ) : ALL
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT �NSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 25 Sep 2002 PAGE 11
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
SCHEDULED ENDORSEMENTS
Edition
Form No. Date Description
TREES, SHRUBS, LANDSCAPING, SPECIFIED COST
Loc (s) : ALL $25, 000 $5, 000
GOLF CbURSE GREENS & TEES, RC
LoC(s) : ALL $50,000 $5,000
FOOD SPOILAGE, SPECIFIED COST
LoC(s) : ALL $10,000 $5,000
ANIMALS, SPECIFIED COST
$25,000 $5,000
LoC ( s ) : ALL
PAVED SURFACES, RC
Loc(s) : ALL $100,000 $5,000
COMMANDERED OR INPOUNDED, RC
$100,000 $5,000
Loc ( s ) : ALL
EMERGENCY SERVICE EQUIPMENT, RC
$250,000 $5,000
Loc ( s ) : ALL
COMMUNICATIONS EQUIPMENT, RC
Loc (s) ; AI,L $50, 000 $5, 000
MONEY & SECURITIES, SPECIFIED COST
$5,000 $5,000
LoC(s) : ALL
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 Sep 2 0 02 PAGE 12
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
SCHEDULED ENDORSEMENTS
Edition
Form No. Date Description
B&M, PG, D&ICC, EE, CPC REGRIGERANTS
$100,000 $5,000
Loc ( s ) : ALL
CMPDP.1002 10/97 MISC.PROT.INCL.AQUATOR COMPUTER SYSTEM FOR WATER PLANT
COMMERCIAL GENER.AL LIABILITY
LIABILITY: GENER.AL AGGREGATE $4,000,000
PROD/COMPLTD OPS AGGR $4,000,000
PERS/ADVERTISING INJURY $2,000,000
EACH OCCURRENCE $2,000,000
FIRE DAMAGE (ANY 1 FIRE) $50,000
MED EXP (ANY 1 PERSON) $5,000
COVERAGES: OCCURRENCE
OWNERS/CONTRACTORS PROTECTIVE
LAW ENFORCEMENT
OTHER COVERAGES/RESTRICTIONS, AND/OR ENDORSEMENTS :
LAW ENFORCEMENT LIABILITY $2,000,000, DEDUCTIBLE $7500
PUBLIC OFFICIALS LIABILITY $1,000,000, DEDUCTIBLE $5000
EMPLOYMENT PRACTICES $1,000,000, DEDUCTIBLE $5000
SCHEDULED ENDORSEMENTS
Edition
Form No. Date Description
CXPDL1000 10-97 EMPLOYEE BENEFITS LIABILITY, 10-1-96 RETRO
$2,000,000/ $0
$4,000,000
Loc ( s ) : ALL
CMCEL10901 8-98 INVERSE CONDEMNATION SUBLIMIT
$1,000,000/
$1, 000, 000
Loc ( s ) : ALL
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 Sep 2 0 02 PAGE 13
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
SCHEDULED ENDORSEMENTS
Edition
Form No. Date Description
CMCSL1000 8-98 FLORIDA LEGISLATIVE CLAIM BILL
LoC ( s ) : ALL
CXPEL1010 10-97 SEWER BACKUP
$5,000/
$25,000
Loc ( s ) : ALL
CMCSL1001 8-98 MEDICAL DIRECTOR AS INSURED
Loc ( s ) : ALL
CXPEL1000 10/97 AUTOMATIC ADDITIONAL INSUREDS
BUSINESS AUTO
LIABILITY
COMBINED SINGLE LIMIT $2,000,000
PERSONAL INJURY PROT $10,000
COMPREHENSIVE SEE VEHICLE SCHEDULE
COLLISION SEE VEHICLE SCHEDULE
HIRED/BORROWED AUTO LIABILITY STATES: FLORIDA
EMP. NON-OWNERSHIP AUTO LIABILITY STATES: FLORIDA
HIRED PHYSICAL DAMAGE - PRIMARY COVER.AGE COMP DED: $1,000
STATES: FL . • • •
# DAYS: . . . . SPEC DED:
$# VEHS• . • : : COLL DED: $1,000
ENDORSEMENTS: HIRED PHYSICAL DAMAGE $35,000
DRIVERS DOB STATE LIC NO
1 DAVID ADAMS A352-161-72-030-0
2 GREGG DIXON D250-297-65-338-0
3 SCOTT DONALDSON D543-799-67-415-0
4 PAUL MAGNANO M255-685-64-471-0
5 STEPHEN MEDFORD M316-781-68-464-0
6 CHRIS MURPHY M610-103-70-095-0
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. $#600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 25 Sep 2002 PAGE 14
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
7 PETER ALLEN A450-670-57-449-0
8 JARED DEPASQUALE D124-420-75-297-6
9 DAN PR.AJER P626-176-62-095-0
10 TIMOTHYCAMPBELL C514-818-66-364-0
11 MARCUS DINGERS D526-559-76-063-0
12 PAUL AGUSO A262-680-71-422-0
13 SEAN HART
14 MATT FREEMAN F655-54-63-289-0
15 ANTHONY TORINO T650-000-76-100-0
16 CHA.RLES BRUNSED B652-141-55-241-0
17 WILLIAM DAVIS D120-921-48-223
18 ALEX NATHANSON N352-017-62-099-0
19 JAMES TRUBE T610-422-68-334-0
20 JOHN FLINT F453-478-63-443-0
21 WILLIAM GARRIGAN G625-938-64-017-0
22 CRAIG HALLADAY H430-104-64-404-0
23 ROY OLLIFF 0410-173-60-137-0
24 ROBERT PIERIS P620-768-68-471-0
25 ROBERT SMITH 5530-762-6Z-374-0
26 RICKMAN TAYLOR T460-724-69-371-0
27 SHAWN THURMAN T655-793-70-470-0
28 DANIEL TILLES T420-176-63-311-0
29 ERNEST J. MCGEE M200-210-62-085-0
30 RAYMOND SMALL 5540-720-58-022-0
31 ARCHIE GARRETT G630-012-57-269-0
32 BUTCH RONALD SMITH S530-076-52-332 P05
VEHICLES VIN OTHER COMP/SPEC DED COLL DED
1 1988 FORD/F100/PICKUP 1FTDF15Y5JNA70036 ACV COMP $1,000 $1,000
INSD# R19
2 1989 GMC/PICKUP/1/2 TON 1GTDC14Z6KZ531483 ACV COMP $1,000 $1,000
INSD# PW14
3 1989 GMC/PICKUP/1/2 TON 1GTDC14Z3KZ531747 ACV COMP $1,000 $1,000
INSD# W5
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561} 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 Sep 2 0 02 PAGE 15
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
4 1990 FORD/F250/PICKUP 1FTEF26N2LLB03085 ACV COMP $1,000 $1,000
INSD# W6
5 1992 CHEVROLET/SIERRA/FLEETSI 1GCEC14H1NE232636 ACV COMP $1,000 $1,000
INSD# PW18
6 1993 FORD/RANGER/PICKUP 1FTCR10A4TPA59927 ACV COMP $1,000 $1,000
INSD# W8
7 1997 FORD/E-450/TYPE III AMBU 1FDLE40F9VHA15577 ACV COMP $1,000 $1,000
INSD# FIRE
8 1993 CHEVR.OLET/LUMINA/4 DR. S 2G1WL54T6P1154335 ACV COMP $1,000 $1,000
INSD# FIRE
9 1991 SUTPHEN/PUMPER 1000 /125 1HTSDPBR6MH374818 ACV COMP $1,000 $1,000
INSD# FIRE
10 1994 FORD/R.ANGER/PICKUP 1FTCR10AXRVC71607 ACV COMP $1,000 $1,000
INSD# W4
11 1993 FORD/CROWN VICTORIA/4 DR 2FALP72N2RX190682 ACV COMP $1,000 $1,000
INSD# PD
12 1994 CHEVR.OLET/BLAZER K-5/2 D 1GNEK18KXRJ415854 ACV COMP $1,000 $1,000
INSD# FIRE
13 1994 CHEVROLET/K-5 BLA.ZER/2DR 1GNEK18K5RJ418905 ACV COMP $1,000 $1,000
INSD# PD21
14 1994 SUTPHEN/100' AERIAL PLAT IS9A4KFE8R1003005 ACV COMP $1,000 $1,000
INSD# FIRE
15 1995 PACE AMERICAN/2450/CARGO 4FPAB1420SG009169 ACV COMP $1,000 $1,000
INSD# FIRE
16 1995 JEEP/CHEROKEE 1J4FT2752SL642641 ACV COMP $1,000 $1,000
INSD# W9
17 1996 FORD/CROWN VICTORIA/SEDA 2FALP71W4TX160978 ACV COMP $1,000 $1,000
INSD# PD
18 1996 FORD/CROWN VICTORIA/SEDA 2FALP71W6TX160979 ACV COMP $1,000 $1,000
INSD# PD
19 1996 CHEVROLET/5-10/PICKUP 1GCCS1446T8220159 ACV COMP $1,000 $1,000
INSD# PW7
SCHEDULE OF YOUR CURRENT INSURANCE -.
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 16
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
20 1997 FORD/E-450/TYPE III AMBU 1FDLE40F9VHA15576 ACV COMP $1,000 $1,00�
INSD# FIRE
21 1997 CHEVROLET/CS10603/1/2 TO 1GCC514XOVK219542 ACV COMP $1,000 $1,OOi
INSD# W2
22 1998 FORD/CROWN VICTORIA/4 DR:IFAFP7IWOWX131401 ACV COMP $1,000 $1,OOi
INSD# PD
23 1998 FORD/CROWN VICTORIA/4 DR 2FAFP71W2WX131402 ACV COMP $1,000 $1,OOI
INSD# PD
24 1996 DODGE/RAM/1500 PICKUP 1B7HC16YOTJ192757 ACV COMP $1,000 $1,00f
INSD# PW15
25 1999 FORD/CROWN VICTORIA/4 DR 2FAFP71W9XX165578 ACV COMP $1,000 $1,00(
INSD# PD
26 1999 FORD/CROWN VICTORIA/4 DR 2FAFP7IWOXX165579 ACV COMP $1,000 $1,00(
INSD# PD
27 1999 FORD/TAURUS SE/4 DR. SED 1FAFP53S3XA208867 ACV COMP $1,000 $1,00(
INSD# PD
28 1999 GMC/TC7H042/DUMP TRUCK 1GDJ7H1B5XJ525221 ACV COMP $1,000 $1,00(
29 2000 CHEVROLET/5-10/PICKUP 1GCCS14W3Y8223853 ACV COMP $1,000 $1,00C
INSD# PW
30 2000 FORD/CROWN VICTORIA/SEDA 2FAFP71W1YX173398 ACV COMP $1,000 $1,00C
INSD# PD
31 2000 FORD/CROWN VICTORIA/SEDA 2FAFP7IWXYX173397 ACV COMP $1,000 $1,OOC
INSD# PD
32 2000 CHEVROLET/CK30943/4X4 CR 1GCHK33F06F502871 ACV COMP $1,000 $1,OOC
INSD# FIRE
33 2001 DODGE/RAM/PICKUP 1B7HC16X915687988 ACV COMP $1,000 $1,OOC
INSD# REC
34 OPEN TR.AILER 1ZJUU1217SM038062 ACV COMP $1,000 $1,000
35 2000 HARLEY DAVIDSON 1HD1FHW19YY620861 ACV COMP $1,000 $1,000
36 2001 FORD 2FAFP71W11X153089 ACV COMP $1,000 $1,000
37 2001 FORD 1FAFP58571A200659 ACV COMP $1,000 $1,000
38 2002 FORD/F-150/XCAB 1FTRX17242KB78226 ACV COMP $1,000 $1,000
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 Sep 2 0 02 PAGE 17
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
39 2002 FORD/F-150/XCAB 1FTRX17W22KB78227 ACV COMP $1,000 $1,000
40 2002 FORD/F-150/XCAB 1FTRX17W42KB78228 ACV COMP $1,000 $1,000
41 2002 FORD/F-150/CREW CAB 1FTRW08682KB90586 ACV COMP $1,000 $1,000
42 2002 DODGE/DURANGO/SPORT UTIL 1B4HS48N62F163057 ACV COMP $1,000 $1,000
INSD# FIRE
EDP
SCHEDULED ITEMS �COINS
1-1 NCR MODEL 55 COMPUTER SYSTE $78,000 NONE $500
1-2 SUPERVIEW 280 SER.#40025967 $2,535 NONE $500
1-3 COMPUTER PowerMate, NEC Ser $2,547 NONE $500
1-4 COMPUTER COLORBOOK, 486 DX2 $3,163 NONE $500
1-5 MultiSync Computer 3FGX-NEC NONE $500
1-6 GATEWAY 2000 CRYSTAL SCAN S $2,746 NONE $500
1-7 COPY 2000 READER/PRINTER SE $5,210 NONE $500
1-8 GATEWAY 2000 CRYSTAL SCAN S $3,542 NONE $500
1-9 NOTEBOOK COMPUTER DX 4, SER $3,660 NONE $500
1-10 GATEWAY 2000 DX2-66 486 COM $2,719 NONE $500
1-11 SLC SYSTEM BOARD SER.#20903 $595 NONE $500
1-12 PC386 SX W/Dual Drive Ser.# $2,683 NONE $500
1-13 SONATA PERSONAL COMPUTER SE $3,144 NONE $500
1-14 PC VERSA TAP LAP, NEC SER.# $3,678 NONE $500
1-15 PC8 NCR SER.#18569153 $3,087 NONE $500
1-16 ZEOS COMPUTER MONITOR SER.# $2,554 NONE $500
1-17 NEC MultiSync Powermate 425 $2,535 NONE $500
1-18 PC COMPUAD WITH MONITOR SER $2,296 NONE $500
1-19 TATUNG MONITOR COMPUTER (RK $1,083 NONE $500
1-20 AUSTIN 486 SX COMPUTER SER. $1,749 NONE $500
1-21 GVC COMPUTER MONITOR (UPGR.A $1,008 NONE $100
1-22 EDS20SN AUSTIN DX 266 COMPU $4,234 NONE $500
1-23 CTX COMPUTER, MODEL 1562GM $1,350 NONE $500
1-24 PC SONATA W/MONITOR (DISPAT $1,998 NONE $500
1-25 VGA MINITOR 386 COMPUER SER $8,123 NONE $500
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 2 5 S ep 2 0 0 2 PAGE 18
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
1-26 486 SX COMPUTER W/COLOR MON $1,434 NONE $500
1-27 486 COMPUTER, CLONE, (LW) S $1,365 NONE $500
1-28 INTEL 486 DX 33 COMPUTER SE $1,500 NONE $500
1-29 COMPUTER NEC, VERSA LAP TAP $2,746 NONE $500
Comm. Property Policy
SCHEDULED ITEMS �COINS
1-1 LECO ULV FOG MACHINE MDL.55 $4,000 NONE
1-2 WELL PUMP MOTORS (TOTAL 7) $10,000 NONE
1-3 FAIRBANKS MORSE ELECTRIC PL $1,000 NONE
1-4 FORD TR.ACTOR MDLCU212B,#C55 $14,198 NONE
1-5 1986 FORD 2810 TRACTOR (DIE $10,504 NONE
1-6 CASE 1835B SKID -STEER LOAD $18,296 NONE
1-7 BLANKET POLICE EMERGENCY EQ $15,000 NONE
1-8 1988 FORD 555BK-TLB TRACTOR $22,000 NONE
1-9 BOBCAT TRAILER, RTT1050 $2,485 NONE
1-10 WELLS CAR.GO TRL,MOD.TC-8 IN $6,370 NONE
1-11 WINCO PORTABLE GENER.ATOR, M $33,400 NONE
1-12 WINCO PORTABLE GENER.ATOR, M $683 NONE
1-I3 AQUALTROL COMPUTER (OPER.ATE $279,000 NONE
1-14 1986 HARDEE 5'HEAVY DUTY RO $1,170 NONE
1-15 86 FORD TRACTOR SER.#BB2131 $11,000 NONE
1-16 WINCO PORTABLE GENERATOR, M $1,099 NONE
1-17 1995-773 BOBCAT SKID STEER $19,837 NONE
1-18 1995 709 BACKHOE ATTACHMENT $5,991 NONE
1-19 1995 LT 204 TRENCHER, S# 42 $2,272 NONE
1-20 1994 TIGER SHARK JET SKI WA $6,000 NONE
1-21 2001 22' EDGEWATER OUTBOARD $39,000 NONE
------------------------------------=---------------------------------------------------------------------
SCHEDULE OF YOUR CURRENT INSURANCE
1179871 CT INSURED: VILLAGE OF TEQUESTA ACORDIA-WPB DIVISION
P.O. BOX 3273 501 S. FLAGLER DR. #600
TEQUESTA, FL 33469-0273 (561) 575-6209 WEST PALM BEACH, FL 33401
PHN (561) 655-5500
DATE: 25 Sep 2002 PAGE 19
COVERAGE AMOUNT/LIMIT EXP.DATE COMPANY POLICY NUMBER PREMIUM DED.AMT
Worker's Compensation 10/O1/03 PMSI BINDER56575 $199,120.00
---------------------------------------------------------------------------------------------------------
LOCATIONS
1 357 TEQUESTA DR., TEQUESTA, FL
WORKERS COMPENSATION
PAR.T 1 - STATES: FLORIDA
PART 2 - EMPLOYERS LIABILITY $1,000,000
DISEASE - POLICY LIMIT $1,000,000
DISEASE - EACH EMPLOYEE $1,000,000
----------------------------------------------------------=----------------------------------------------
THIS SCHEDULE SERVES ONLY AS A REFERENCE FOR YOUR CONVENIENCE.
THE ACTUAL TERMS AND CONDITIONS OF YOUR POLICIES WILL PREVAIL IN THE EVENT OF ANY DISCREPANCIES.
A Wells Fargo Company
September 27, 2002
Dan Gallagher�9-�
Village Of Tequ�ta
P.O. Box 3273 �
Tequesta, FL 33469-0273
RE: Crime Renewal
POLICY: BINDER56677
CARRIER: Zurich North Amer.
Dear Dan:
Enclosed please find the invoice for the renewal
of your Crime coverage effective 10/1/02. Please forward
the payment to our office in the envelope provided at your
earliest possible convenience.
As always it is a pleasure to service your insurance
needs. If you have any questions feel free to contact our
office.
Si ce ely,
�
ryl a or
Accou Mana r
CT:CT
Acordia
501 South Flagler Drive
Suite 600
West Palm Beach, FL 33401
Voice: 561.655.5500
Fax: 561.655.5509
www.acordia.com
AMem6erofthe �global iJetwork.
INVOICE
, Acordia
501 South Flagler Drive
Suite 600
West Palm Beach, FL 33401
Tel: (561) 655-5500 �/
Fax:(561)655-5509 PRODUCER CUSTOMER INVOICE '
NO. NO. DATE NO.
106 117987I Sep 27 2c�+r5Fag�g�84ga�T
VILLAGE OF TEQUESTA
P.O. BOX 3273
TEQUESTA FL 33469-0273
$
PAYMENTENCLOSED
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PAGE 1
INSURANCE BINDER ;;;: 09 26 02
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AME AND ADDRESS OF AGENCY INSURANCE COMPANV
CORDIA-WPB DIVISION ZURICH NORTH AMER. '
Ol S. FLAGLER DR. #600 P O BOX 331045
EST PALM BEACH FL 33401 TAMPA FL 33631-0000
HN (561) 655-5500 AC3ENCYCODE
AX (561) 655-5509 50512821
AME AND MAILINf3 ADDRESSOF INSURED POLICY NUMBER POLICYTYPE
ILLAGE OF TEQUESTA BINDER56677 Fidelity Bond
. O. BOX 3 2 7 3 cr ioo � c � � �
EQUESTA FL 33469-0273 10/O1/02 To 10/O1/03
BOUND 10/Ol/02 TO 11 30 02 12:0
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O C A T I O N I N F O R M A T I O N
OC# LOCATION OF PROPERTY
357 TEQUESTA DRIVE
TEQUESTA, FL 33469
ATURE UTH�iil2 EPRES�NTATfVE
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DATE pAGE 2
IN
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AME AND ADDAESS OF ApE1YCY tNSUiiANCE COMPANY
CORDIA-WPB DIVISION ZURICH NORTH AMER.
O1 S. FLAGLER DR. #600 P O BOX 331045
ST PALM BEACH FL 33401 TAMPA FL 33631-0000
HN (561) 655-5500 ACiENCYCODE
AX (561) 655-5509 50512821
AME AND MAI�INCi ADDRESSOF INSURED POLICY NUMBER POLICYTYPE
ILLAGE OF TEQUESTA BINDER56677 Fidelity Bond
. O. BOX 3 2 7 3 o p (E RA 10
EQUESTA FL 33469-0273 10/O1/02 To 10/O1/03
Bo�n�n io/oi/oa To ii/3o/oa i2:oi �
R I M E S E C T I O N
LAN 1
ORM FORM TITLE LIMIT DEDUCTIBLE
TR.
A EMPLOYEE DISHONESTY
BI '��T . 100, OOQ . 2, 500
OVER.AGE AMENDMENTS
ORM O - PUBLIC EMPLOYEE
SI(3 ATURE OF HO D ESENTATIVE
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PAGE 3
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INSURANCE BINDER
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09 26 02
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AMEANDADORESSQFACiENCY " '"' " ''
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INSUR/INCE COMPANY
CORDIA-WPB DIVISION ZURICH NORTH AMER.
Ol S. FLAGLER DR. #600 P O BOX 331045
EST PALM BEACH FL 33401 TAMPA FL 33631-0000
HN (561) 655-5500 AGENCYCODE
AX (561) 655-5509 50512821
AME AND MAILINO ADDRE380F INSURED POLICY NUMBER POLICYTYPE
ILLAGE OF TEQUESTA BINDER56677 Fidelity Bond
. O. BOX 3 2 7 3 0 � io � ia
EQUESTA FL 33469-0273 10/Ol/02 To 10/O1/03
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BOUND 10/O1/02 TO 11 30 •
/ /02 12.O1 AM
CONDITIONS
HIS COMP.ANY BINDS THE KIND(S) OF INSUR.ANCE STIPULATED ABOVE. THIS INSUR-
CE IS SUBJECT TO THE TERMS, CONDITIONS AND LIMTTATIONS OF THE POLICY(IES)
N CURRENT USE BY THE COMPANY.
HIS BINDER MAY BE CANCELLED BY THE INSURED BY SURRENDER OF THIS BINDER OR
Y WRITTEN NOTICE TO THE COMPANY STATIATG WHEPT CANCELLATION WILL BE EFFECTIVE.
HIS BINDER MAY BE CANCELLED BY THE COMPANY BY NOTICE TO THE INSURED IN AC-
ORDANCE WITH THE POLICY CONDITIONS. THIS BINDER IS CANCELLED WHEN REPLACED
Y A POLICY. IF THIS BINDER IS NOT REPLACED BY A POLICY, THE COMPANY IS EN-
ITLED TO CHARGE A PREMIUM FOR THE BINDER ACCORDTNG TO THE RULES AND RATES
N USE BY THE COMPANY.
. APPLICABLE IN NEVADA
PERSON WHO REFUSES TO ACCEPT A BINDER WHICH PROVIDES COVER.AGE OF LESS
HAN $1,000,000.00 WHEN PROOF IS REQUIRED: (A) SHALL BE FINED NOT MORE THAN
500.00, AND (B) IS LIABLE TO THE P,ARTY PRESENTING THE BINDER AS PROOF OF
NSURANCE FOR ACTUAL DAMAGES SUSTAINED THEREFROM. _
ONATUR HO D REPRESENTATIVE
INVOICE
tl�orciia
501 Snnth [�la�ier Drive
SiiitF 600
\U�st Palm Reacl�, FL :33�01
'1'cl: (S(�1) 6:i:i-:�500
H�t� �-�� ����'�-�������� PRODUCER CUSTOMER INVOICE �� � � �
NO. NO. DATE NO.
106 1179871 Sep 27 2(�IIsFa�,pa�84gar�T
VILLAGE OF TEQUESTA
P.O. BOX 3273
TEQUESTA FL 33469-�0273
$
PAYMENTENCLOSED
EFFECTIVE DATE POLICY NO DESCRIPTiON AMOUNT E�IRATION
10 O1 02 BINDER56677 ZURICH NORTH AMER.
RENEW POL-Fidelity Bond 545.00 10 O1 0
CRIME POLICY RENEWAL
10/1/02
539809 CT 545.00
TOTA�AMOUNTDUE