HomeMy WebLinkAboutC20-451 Gallagher Core 360 Eagle County, Colorado
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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