HomeMy WebLinkAboutC20-451 Gallagher Core 360 Eagle County, Colorado 27 Client Authorization to Bind Coverage After careful consideration of Gallagher's proposal dated 12/16/2020, we accept the following coverage(s). Please check the desired coverage(s) and note any coverage amendments below: COVERAGE/CARRIER ☐Accept ☐ Reject Property - $259,874 + 6,000 = 265,874 Zurich American Insurance Company ☐Accept ☐ Reject TRIA - $4,500 ☐Accept ☐ Reject Public Entity Liability and Excess - $324,135 Travelers Indemnity ☐Accept ☐ Reject TRIA - Included ☐Accept ☐ Reject Crime - $6,380 Travelers Casualty and Surety Co of America ☐Accept ☐ Reject Cyber Liability $2,000,000 w/$50k retention - $37,735 ACE American Insurance Company ☐Accept ☐ Reject Cyber Liability $2,000,000 w/$100k retention - $35,334 ACE American Insurance Company ☐Accept ☐ Reject Cyber Liability $5,000,000 w/$100k retention - $67,049 ACE American Insurance Company ☐Accept ☐ Reject Work Comp - $0 Deductible - $480,888 Pinnacol Assurance ☐Accept ☐ Reject Work Comp - $17,500 Deductible – $396,194 Pinnacol Assurance ☐Accept ☐ Reject Work Comp - $18,000 Deductible - $394,780 Pinnacol Assurance The above coverage may not necessarily represent the entirety of available insurance products. If you are interested in pursuing additional coverages other than those addressed in the coverage considerations included in this proposal, please list below: _____________________________________________________________________________________________ DocuSign Envelope ID: E3D4975B-BFAA-41DF-BE50-B70CDAC46D88 C20-451 Eagle County, Colorado 28 Producer/ Insured Coverage Amendments and Notes: Exposures and Values We confirm the payroll, values, schedules, and other data contained in the proposal, and submitted to the underwriters, are compiled from information provided by you and we acknowledge it is our responsibility to see that such information is updated and maintained accurately. For renewal policies, if no updates were provided to Gallagher, the values, exposures and operations used were based on the expiring policies. Provide Quotations or Additional Information on the Following Coverage Considerations: Gallagher recommends that you purchase the following additional coverages for which you have exposure. By rejecting a quotation for this valuable coverage, you understand that there will be no coverage and agree to hold Gallagher harmless in the event of a loss. Other Services to Consider ☐Yes ☐ No - CORE360™ Loss Control Portal ☐Yes ☐ No - eRiskHub Gallagher's liability to Client arising from any acts or omissions of Gallagher shall not exceed $20 million in the aggregate. Gallagher shall only be liable for actual damages incurred by Client, and shall not be liable for any indirect, consequential or punitive damages or attorneys' fees. No claim or cause of action, regardless of form (tort, contract, statutory, or otherwise), arising out of, relating to or in any way connected with this Agreement or any Services provided hereunder may be brought by either party any later than two (2) years after the accrual of such claim or cause of action. Gallagher has established security controls to protect Client confidential information from unauthorized use or disclosure. For additional information, please review Gallagher’s Privacy Policy located at https://www.ajg.com/privacy-policy/. I have read, understand and agree that the above information is correct and has been disclosed to us prior to authorizing Gallagher to bind coverage and/or provide services to us. By: _______________________________________________________________________ Print Name (Specify Title) _______________________________________________________________________ Company _______________________________________________________________________ Signature Date: _______________________________________________________________________ DocuSign Envelope ID: E3D4975B-BFAA-41DF-BE50-B70CDAC46D88 12/22/2020 Chair Eagle County Kathy Chandler-Henry