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Home My WebLink AboutC22-407 Arthur J. Gallagher Risk Management Services Eagle County, Colorado 60 Client Authorization to Bind Coverage After careful consideration of Gallagher's proposal dated 12/5/2022, we accept the following coverage(s). Please check the desired coverage(s) and note any coverage amendments below: COVERAGE/CARRIER ☐ Accept ☐ Reject Public Entity Liability Program Travelers Indemnity Company ☐ Accept ☐ Reject TRIA ☐ Accept ☐ Reject Automobile Charter Oak Fire Insurance Company ☐ Accept ☐ Reject Excess Liability Travelers Property Casualty Co of America ☐ Accept ☐ Reject TRIA ☐ Accept ☐ Reject Property Zurich American Insurance Company ☐ Accept ☐ Reject TRIA ☐ Accept ☐ Reject Network Security and Privacy Liability Palomar Excess and Surplus Insurance Company TRIA Cannot Be Rejected ☐ Accept ☐ Reject Accidental Death and Dismemberment Arch Insurance Company TRIA Cannot Be Rejected ☐ Accept ☐ Reject Airport Liability National Union Fire Insurance Company of Pittsburgh PA ☐ Accept ☐ Reject TRIA ☐ Accept ☐ Reject WAR ☐ Accept ☐ Reject Workers Compensation Pinnacol Assurance Company - $0 Deductible TRIA Cannot Be Rejected ☐ Accept ☐ Reject Workers' Compensation - CT, OK Pinnacol Assurance Company TRIA Cannot Be Rejected x x x x x x x x x x x x x x DocuSign Envelope ID: 77862F60-44A8-4A73-AA04-6EAC6DC1EC74 Eagle County, Colorado 62 Additional Recommended Coverages Gallagher recommends that you purchase the following additional coverages for which you have exposure. By checking the box(es) below, you are requesting that Gallagher provide you with a Proposal for this coverage. By not requesting a Proposal for this coverage, you assume the risk of any uncovered loss. Other Coverages to Consider ☐ Fiduciary ☐ Drones Liability The above coverage(s) does not necessarily represent the entirety of available insurance products. If you are interested in pursuing additional coverages other than those listed in the Additional Recommended Coverages, please list below: Coverage Amendments and Notes: Exposures and Values You confirm the payroll, values, schedules, and any other information pertaining to your operations, and submitted to the underwriters, were compiled from information provided by you. If no updates were provided to Gallagher, the values, exposures and operations used were based on the expiring policies. You acknowledge it is your responsibility to notify Gallagher of any material change in your operations or exposures. Additional Terms and Disclosures Gallagher is not an expert in all aspects of your business. Gallagher’s Proposals for insurance are based upon the information concerning your business that was provided to Gallagher by you. Gallagher expects the information you provide is true, correct and complete in all material respects. Gallagher assumes no responsibility to independently investigate the risks that may be facing your business, but rather have relied upon the information you provide to Gallagher in making our insurance Proposals. 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/. You have read, understand and agree that the information contained in the Proposal and all documents attached to and incorporated into the Proposal, is correct and has been disclosed to you prior to authorizing Gallagher to bind coverage and/or DocuSign Envelope ID: 77862F60-44A8-4A73-AA04-6EAC6DC1EC74 Eagle County, Colorado 63 provide services to you. By signing below, or authorizing Gallagher to bind your insurance coverage through email when allowed, you acknowledge you have reviewed and agree with terms, conditions and disclosures contained in the Proposal. By: _______________________________________________________________________ Print Name (Specify Title) _______________________________________________________________________ Company _______________________________________________________________________ Signature Date: _______________________________________________________________________ DocuSign Envelope ID: 77862F60-44A8-4A73-AA04-6EAC6DC1EC74 Eagle County Government Jeanne McQueeney, Chair of BOCC 12/20/2022