HomeMy WebLinkAbout2023 PL Renewal Documents - Horse Mountain Ranch Metropolitan District (1) (1)Renewal Documents and Invoice
1/1/2023 to EOD 12/31/2023
Acceptance of this coverage is evidenced only by payment of the enclosed invoice by January 1, 2023.
The following renewal documents are attached where applicable:
1. Invoice: Payment is due upon receipt. Please return a copy of the invoice with your payment to
ensure that it is applied correctly. We have attached a Coverage Contribution instructions
sheet which provides details about your payment.
2. Comparison of Annual Contributions.
3. Deductible Options:
Provides the difference in cost by coverage line if you were to increase or decrease the
deductible for that specific coverage.
4. Quote for Excess Liability limits for your consideration:
Limits of up to $8 million, in excess of the primary $2 million Liability limit, are available.
Although the primary $2 million Liability limit is sufficient to cover the CGIA tort cap, we do
recommend you consider purchasing higher limits primarily due to special districts’
unlimited liability to federal civil rights, discrimination, harassment, whistle blowing, and
other employment-related practices claims.
5. Coverage Declaration Pages: Informational page summarizing the key points about the coverage
provided including limits and deductible descriptions for all coverage provided. Full coverage
forms will be available at csdpool.org/documents by January 1, 2023.
6. Schedules: Lists of exposures and values.
7. Certificates of coverage: Originals are mailed directly to the Certificate Holders.
8. Automobile identification cards: Hard copies will be mailed.
Payment evidences “acceptance” of this coverage. The terms of the Intergovernmental Agreement (IGA) require timely payment
to prevent automatic cancellation of coverage. Please return this invoice and reference the coverage number on your check to help
us apply your payment correctly. Only prior notice to the board of directors of the Colorado Special Districts Property and Liability
Pool and subsequent approval may extend cancellation provision.
Remit checks to: Colorado Special Districts Property and Liability Pool We accept online payments at E-Bill Express
c/o McGriff Insurance Services, Inc. Refer to Payment Instructions page for additional options
PO Box 1539 billing@csdpool.org
Portland, OR 97207-1539 800-318-8870 ext. 3
Property and Liability Coverage
Invoice
Named Member:Broker of Record:
Horse Mountain Ranch Metropolitan District
c/o Marchetti & Weaver LLC
28 Second Street, Suite 213
Edwards, CO 81632
NO BROKER
Coverage No.Entity ID Effective Date Expiration Date Invoice Date
23PL-60780-1735 60780 1/1/2023 EOD 12/31/2023 10/31/2023
Coverage Contribution
General Liability $ 546.00
Crime $ 135.00
Non-Owned Auto Liability $ 132.00
Hired Auto Physical Damage $ 65.00
No-Fault Water Intrusion & Sewer Backup $ 35.00
Public Officials Liability $1,163.00
Pollution $ 0.00
Total Contribution $2,076
Please note: where included above, Hired Auto Physical Damage, Non-Owned Auto Liability, and No-Fault Water Intrusion &
Sewer Backup are mandatory coverages and may not be removed.
The following discounts are applied (Not applicable to minimum contributions):
13.78% Continuity Credit Discount
10% Direct Discount
8% Multi Program Discount for WC Program Participation
Payment Due Upon Receipt
Payment Instructions
The annual contribution for coverage with the Pool is due upon receipt of this invoice.
We accept the following payment methods:
1. Online using E-Bill Express (www.e-billexpress.com/ebpp/CSDPool). For detailed instructions,
please click here or go to csdpool.org/documents. You can also find an FAQ here or go to the E-
Bill Express logon screen.
2. Mail your check to:
Colorado Special Districts Property and Liability Pool
c/o McGriff Insurance Services, Inc.
PO Box 1539
Portland, OR 97207
For express or overnight mail services, please use the address below:
Colorado Special Districts Property and Liability Pool
c/o McGriff Insurance Services, Inc.
1800 SW 1st Ave, Suite 400
Portland, OR 97201
To ensure that your payment is accurately applied, please always include a copy of the invoice.
3. Wire or ACH transfer from your own bank account. Please let us know if you wish to use this
method and we will be happy to provide you with these instructions.
Please be advised that in accordance with the Intergovernmental Agreement (IGA), automatic expulsion
will occur on the 60th day should your account not be current. If you wish to reinstate your district’s
coverage after cancellation has occurred, a $100 reinstatement fee will apply.
If your district requires a payment extension, please submit a written request within ten (10) business
days from the date of the invoice, for consideration by the CSD Pool Board of Directors.
Finally, all members of the Pool must be members in good standing with the Special District Association
of Colorado (SDA). Please visit the SDA website at sdaco.org for member information.
Please contact us at billing@csdpool.org or 800-318-8870 ext. 3 for billing questions.
Annual Comparison of 2023 and 2022 contributions.
Loss Ratios based on participation years from 2016 to 2023
Horse Mountain Ranch Metropolitan District
General Liability Contribution TOE
Yr. 2023 $546.00 $154,096.00
Yr. 2022 $520.00 $154,096.00
Difference $26.00 NaN
% Difference 5.00%0.00%
Loss Ratio 0.00%
Equipment Breakdown Contribution
Yr. 2023 $0.00
Yr. 2022 $0.00
Difference $0.00
% Difference 0.00%
Loss Ratio 0.00%
Auto Liability Contribution Auto Count
Yr. 2023 $132.00 0
Yr. 2022 $132.00 0
Difference 0
% Difference NaN 0.00%
Loss Ratio 0.00%
Crime Contribution
Yr. 2023 $135.00
Yr. 2022 $135.00
Difference $0.00
% Difference 0.00%
Loss Ratio 0.00%
Auto Physical Damage Contribution TIV
Yr. 2023 $65.00 $0.00
Yr. 2022 $65.00 $0.00
Difference $0.00
% Difference NaN 0.00%
Loss Ratio 0.00%
Property/Inland Marine Contribution TIV
Yr. 2023 $0.00 $0.00
Yr. 2022 $0.00 $0.00
Difference $0.00 $0.00
% Difference 0.00%0.00%
Loss Ratio 0.00%
Public Officials Liability Contribution EE Count
Yr. 2023 $1,163.00 0
Yr. 2022 $1,163.00 0
Difference $0.00 0
% Difference 0.00%0.00%
Loss Ratio 0.00%
Excess Liability Contribution
Yr. 2023 $0.00
Yr. 2022 $0.00
Difference $0.00
% Difference 0.00%
Loss Ratio 0.00%
Earthquake Contribution
Yr. 2023 $0.00
Yr. 2022 $0.00
Difference $0.00
% Difference 0.00%
Loss Ratio 0.00%
Flood Contribution
Yr. 2023 $0.00
Yr. 2022 $0.00
Difference $0.00
% Difference 0.00%
Loss Ratio 0.00%
No Fault Contribution
Yr. 2023 $35.00
Yr. 2022 $34.00
Difference $1.00
% Difference 2.94%
Loss Ratio 0.00%
Year Contribution
2023 $2,076.00
2022 $2,049.00
Difference $27.00
% Difference 1.32%
2023 Excess Liability Options Proposal
This Proposal Does Not Bind Coverage
This report demonstrates what it would cost your district to increase coverage from your current limit of
liability to a higher limit.
Named Member: Horse Mountain Ranch Metropolitan District
Certificate Number: 23PL-60780-1735
Excess Limit Annual Excess Contribution Change in Contribution
$1,000,000 $330 $330
$2,000,000 $570 $570
$3,000,000 $810 $810
$4,000,000 $1,020 $1,020
$5,000,000 $1,250 $1,250
$6,000,000 $1,500 $1,500
$7,000,000 $1,750 $1,750
$8,000,000 $2,000 $2,000
.
Note: This is not your Coverage Document. It was created solely for informational purposes.
10/31/2023
Public Entity Liability and Auto Physical Damage Certificate Holder Declaration
Master Coverage Document Number: CSD Pool CTC 01 01 22 and CSD Pool PEL 01 01 23
Certificate Number: 23PL-60780-1735 Coverage Period: 1/1/2023 to EOD 12/31/2023
Named Member:Broker of Record:
Horse Mountain Ranch Metropolitan District
c/o Marchetti & Weaver LLC
28 Second Street, Suite 213
Edwards, CO 81632
NO BROKER
Coverage is provided only for those coverages indicated below for which a contribution is shown.
Coverage Per Occurrence Limit Annual Aggregate Limit Deductible Contribution
Public Entity Liability Coverage including:$2,000,000 None
General Liability Included None None $546
Medical Payments - Premises $10,000 None None Included
Employee Benefits Liability Included None None Included
Public Officials Liability Included None $1,000 $1,163
Employment Practices Liability Included None *$100,000 Included
Pre Loss Legal Assistance $3,500 $7,000 None Included
No-Fault Water Intrusion & Sewer Backup
$200,000 limited to
$10,000 Any One
Premises
***$1,000,000 $500 $35
Cyber $200,000 **$200,000 $1,000 Included
Fiduciary Liability $200,000 **$200,000 $1,000 Included
Excess Liability - Coverage agreements
A,B,C,D
No Coverage No Coverage N/A No
CoverageAuto Liability No Coverage No Coverage N/A No
CoverageMedical Payments – Auto No Coverage No Coverage N/A No
CoverageNon-Owned and Hired Auto Liability Included None None $132
Uninsured/Underinsured Motorists Liability No Coverage No Coverage N/A No
CoverageAuto Physical Damage No Coverage No Coverage N/A No
CoverageHired Auto Physical Damage $50,000 N/A $500/$500 $65
Auto Physical Damage -
Employee Deductible
Reimbursement
$2,500 N/A None Included
Total Contribution $1,941
*Employment Practices Liability Deductible: 50% of loss including Indemnity and Legal Expenses subject to a maximum deductible of $100,000
each occurrence.
**A $5,000,000 All Member Annual Aggregate Limit shall apply to Cyber.
**A $1,000,000 All Member Annual Aggregate Limit shall apply to Fiduciary Liability.
***No-Fault Water Intrusion & Sewer Backup has $1,000,000 All Member Annual Aggregate Limit.
Additional Endorsements applicable to Member:
This Certificate Holder Declaration is made and is mutually accepted by the CSD Pool and the Named Member subject to all terms
which are made a part of the Public Entity Liability Coverage Document. This Certificate represents only a brief summary of
coverages. Please refer to the Master Coverage Document for actual coverage, terms, conditions, and exclusions.
Countersigned by:
Authorized Representative
Crime Certificate Holder Declaration
Master Coverage Document Number: J05931794 Insurer: Federal Insurance Company (Chubb)
Certificate Number: 23PL-60780-1735 Coverage Period: 1/1/2023 to EOD 12/31/2023
Named Member:Broker of Record:
Horse Mountain Ranch Metropolitan District NO BROKER
c/o Marchetti & Weaver LLC
28 Second Street, Suite 213
Edwards, CO 81632
Covered Designated Agent(s):
Coverages and Limits:
Employee Theft:$5,000
· Limit is maximum for each loss
· Employee includes executives, full-time, part-time, seasonal, leased and
temporary employee(s), interns or non-compensated volunteer.
· Includes funds from a sponsored benefit plan.
Public Official Faithful Performance of Duty:$5,000
Client Theft:$5,000
Forgery or Alteration:$5,000
On Premises:$5,000
In Transit:$5,000
Computer System Fraud:$5,000
Funds Transfer Fraud:$5,000
Debit, Credit or Charge Card Fraud:$5,000
Money Orders and Counterfeit Paper Currency Fraud:$5,000
Social Engineering Fraud:$5,000
Deductible(s):
All Crime except Social Engineer Fraud:$100
Social Engineering Fraud: 20% of Social Engineering Fraud Limit
Contribution: $135
Policy Forms:
PF-52815 (04/20) The Chubb Primary℠ Commercial Crime Insurance
PF-52853 (04/20) Governmental Entity (Colorado Special Districts Pool) Endorsement
PF-53127 (04/20) Colorado Amendatory Endorsement
PF-52851 (04/20) Add Corporate Credit Card Coverage
This Certificate Holder Declaration is made and is mutually accepted by the CSD Pool and the Named Member subject to all
terms which are made a part of the Master Crime Policy. This Certificate represents only a brief summary of coverages. Please
refer to the Master Policy Documents for actual coverage, terms, conditions, and exclusions.
Countersigned by:
Authorized Representative
Identity Recovery Certificate Holder Declaration
Master Coverage Policy Number:
CSD 2009 CP IDR Form 01 01 21
Insurer:
The Hartford Steam Boiler Inspection
and Insurance Company
Certificate Number:23PL-60780-1735 Coverage Period:1/1/2023 to EOD 12/31/2023
Named Member: Broker of Record:
Horse Mountain Ranch Metropolitan District
c/o Marchetti & Weaver LLC
28 Second Street, Suite 213
Edwards, CO 81632
NO BROKER
Member:
All permanent employees and District Board members participating in the Colorado Special Districts Property and
Liability Pool; Special District Association of Colorado staff and Board of Directors.
Coverage:
Reimbursement coverage for expenses arising from a defined “Identity Theft” event. Including: legal fees for
answer of civil judgements and defense of criminal charges; phone, postage, shipping fees; notary and filing fees;
credit bureau reports; lost wages; child/elder care and mental health counseling.
This coverage does not reimburse the member for monies stolen or fraudulently charged to the member, and
excludes loss arising from the member’s fraudulent, dishonest or criminal act.
Annual Aggregate Limit per Member: $35,000
Case Management Service Expenses - does not reduce the limit available
Legal Costs - reduces the limit available
Sub Limits:
$5,000 Lost Wages and Child/Elder Care
$1,000 Mental Health Counseling
$1,000 Miscellaneous Expenses
Coverage Trigger:Coverage is provided on a discovery basis with a 60-day reporting requirement
Claims:For Recovery Assistance and Counseling, please call 1-800-945-4617
This Certificate Holder Declaration is made and is mutually accepted by the CSD Pool and the Named Member
subject to all terms which are made a part of the Identity Recovery Coverage Policy. This Certificate represents
only a brief summary of coverages. Please refer to the Master Coverage document for actual coverage, terms,
conditions, and exclusions.
Countersigned by:
Authorized Representative
Page 1 of 2
Environmental Legal Liability Certificate Holder Declaration
Master Policy Number: ER00A9V23 Insurer: Aspen Specialty Insurance Company
Certificate Number: 23PL-60780-1735 Coverage Period: 1/1/2023 to EOD 12/31/2023
Named Member: Broker of Record:
Horse Mountain Ranch Metropolitan District
c/o Marchetti & Weaver LLC
28 Second Street, Suite 213
Edwards, CO 81632
NO BROKER
Claims-Made Coverage:
1.First Party Protection: For coverages 1.a – 1.d, the pollution incident must be first
discovered by the responsible insured and reported to the insurer during the policy
period.
a.Clean up: Covers clean-up costs resulting from a pollution incident on, at,
under, or migrating from or through an insured location.
b.Emergency Response: Covers emergency response cost resulting from a
c.Pollution Incident: (i) on, at, under or migrating from or through an insured
location; (ii) caused by transportation; or (iii) caused by covered operations.
d.Environmental Crisis: Covers crisis cost resulting from a crisis event.
e.Business Interruption: Covers business interruption cost and extra expense
incurred by the insured and solely and directly by a pollution incident on, at or
under an insured location, provided the pollution incident results in clean-up
cost covered by this policy.
2.Legal Liability Protection: For coverages 2.a – 2.d, the claim for damages because of
such bodily injury or property damage, or a claim for such clean-up cost, is first made
against an insured and reported to the insurer during the policy period.
a.Insured Location: Covers sums the insured becomes legally obligated to pay:
(1) as damages because of bodily injury or property damage; or (ii) for clean-
up costs, resulting from a pollution incident on, at under, or migrating from or
through an insured location.
b.Non-owned Site: Covers sums the insured becomes legally obligated to pay (1)
as damages because of bodily injury or property damage; or (ii) for clean- up
costs, resulting from a pollution incident on, at under, or migrating from or
through any non-owned site.
c.Transportation: Covers sums the insured becomes legally obligated to pay (1)
as damages because of bodily injury or property damage; or (ii) for clean- up
costs, resulting from a pollution incident caused by transportation.
d.Covered Operations: Covers sums the insured becomes legally obligated to
pay (1) as damages because of bodily injury or property damage; or (ii) for
clean-up costs, resulting from a pollution incident caused by covered
operations or completed operations.
Limits of Liability: $1,000,000 Each Pollution Incident
$5,000,000 Total Policy and Program Aggregate – Shared All Members
Sublimits: $500,000 Environmental Crisis Aggregate
$250,000 Business Interruption Aggregate
$100,000 Perfluorinated Compounds Aggregate
Member Deductible: $1,000 Each Pollution Incident
Page 2 of 2
Retroactive Date: January 1, 2009 (unless otherwise specified)
Defense Costs:Legal defense expenses and settlement shall erode the Limits of Liability
Partial List of Exclusions:
Asbestos, Contractual Liability, Criminal Fines and Criminal Penalties, Cross Liability (Insured vs. Insured), Damage
to Insured’s Product/Work, Divested Property, Employers Liability, Fraud or Misrepresentation, Intentional Non-
Compliance, Internal Expenses, Known Conditions, Lead-Based Paint, Material Change in Risk, Non-Owned Disposal
Sites, Underground Storage Tanks and Above Ground Storage Tanks excluded unless scheduled, Vehicle Damage,
War or Terrorism, Workers Compensation, Lead at all gun or shooting ranges, Maintenance, Upgrades,
Improvements or Installations where required by law, Microbial Matter with carveback for sudden and accidental
water intrusion; 10-day discovery period/30 day reporting period, Prior Claims, Communicable Disease
Policy Forms:
ASPENV110 06 17 Environmental Legal Liability Policy
ASPENV098 11 17 Cap on Losses from Certified Acts of Terrorism
ASPENV340 05 17 Insured Location(s) Schedule Endorsement
ASPENV310 05 17 Known Conditions Exclusion Endorsement
ASPENV316 05 17 Legal Expense Aggregate Limit of Liability Endorsement
ASPENV117 11 17 Self-Insured Retention Aggregate (Erosion by Underlying Policies)
ASPENV117 11 17 Sewage Back-up Deductible Amendatory Endorsement
ASPENV117 11 17 Perfluorinated Compounds, Sublimit and Retroactive Date Amendatory Endorsement
ASPENV117 11 17 Cancellation Amendatory Endorsement
ASPENV117 11 17 Microbial Matter Exclusion Endorsement
ASPENV117 11 17 Maintenance, Upgrade, Improvements or Installations Exclusion Endorsement
ASPENV117 11 17 Retroactive Date All Coverage Endorsement
ASPENV117 11 17 Microbial Matter Sudden and Accidental Coverage Limitation Amendatory Endorsement
ASPENV117 11 17 Insured Location/Acquired Property Endorsement
ASPENV117 11 17 Public Entity Amendatory Endorsement
ASPENV322 05 17 Minimum Earned Premium Endorsement
ASPENV341 05 17 Named Insured Schedule Endorsement
ASPENV118 11 17 Nuclear, Biological, Chemical, or Radiological Terrorism Exclusion
ASPENV003 05 17 Other Insurance Condition Amendatory Endorsement
ASPER334 01 14 Prior Claim Exclusion Endorsement
ASPENV338 04 19 Schedule of Crisis Management Firms Endorsement
ASPENV431 11 17 Aspen Environmental Emergency Response Hotline
SNCO 0314 Colorado Surplus Lines Notice
ASPENV117 11 17 Communicable Disease Exclusion
Additional Endorsements Applicable to Named Member:
This Certificate Holder Declaration is made and is mutually accepted by the CSD Pool and the Named Member
subject to all coverage terms under the Pollution Liability Policy #EV00A9V23 issued by Aspen Specialty
Insurance Company. This Certificate represents a brief summary of coverages. Please refer to the Master
Coverage Document for all coverage terms, conditions and exclusions.
Countersigned by:
Authorized Representative
Page 1 of 4
General Liability Schedule
Metropolitan District
Policy Number:23PL-60780-1735 Coverage Period:1/1/2023 – EOD 12/31/2023
Named Member:Horse Mountain Ranch Metropolitan
District
Broker:NO BROKER
Code
Description Unit Amount Effective Date Expiration Date
1 1-Number of Skate Board Parks Total 0.00 1/1/2023 12/31/2023
2 2-Number of Diving Boards Total 0.00 1/1/2023 12/31/2023
3 3-Number of Water Slides Total 0.00 1/1/2023 12/31/2023
4 4-Maximum Bond Issued Dollars 0.00 1/1/2023 12/31/2023
5 5-Number of Bonds Issued Total 0.00 1/1/2023 12/31/2023
20 20-Day Care Operations - Total Annual Payroll Dollars 0.00 1/1/2023 12/31/2023
30 30-Number of EMT Personnel Total 0.00 1/1/2023 12/31/2023
32 32-Paid Firefighters - Non-EMT Total 0.00 1/1/2023 12/31/2023
37 37-Pipe Line - Under Drain Miles 0.00 1/1/2023 12/31/2023
39 39-Pipe Line Miles 0.00 1/1/2023 12/31/2023
43 43-Pipe Line - Sewer / Storm Drainage Combined Miles 0.00 1/1/2023 12/31/2023
50 50-Number of Teachers Total 0.00 1/1/2023 12/31/2023
70 70-Number of Golf Courses Total 0.00 1/1/2023 12/31/2023
80 80-Number of Go Cart Tracks Total 0.00 1/1/2023 12/31/2023
98 98-Additional First Named Members Total 0.00 1/1/2023 12/31/2023
105 105-Total Operating Expenses - Any other Dollars 154,096.00 1/1/2023 12/31/2023
130 130-Total Operating Expenses - Park & Recreation Dollars 0.00 1/1/2023 12/31/2023
131 131-Total Operating Expenses - Cemetery Dollars 0.00 1/1/2023 12/31/2023
132 132-Total Operating Expenses - Soil & Water Conservation Dollars 0.00 1/1/2023 12/31/2023
Page 2 of 4
133 133-Total Operating Expenses - Pest Control Dollars 0.00 1/1/2023 12/31/2023
134 134-Total Operating Expenses - Hospital / Health Dollars 0.00 1/1/2023 12/31/2023
135 135-Total Operating Expenses - Drainage Dollars 0.00 1/1/2023 12/31/2023
136 136-Total Operating Expenses - Library Dollars 0.00 1/1/2023 12/31/2023
137 137-Total Operating Expenses - Water Control Dollars 0.00 1/1/2023 12/31/2023
138 138-Total Operating Expenses - Fire / Ambulance Dollars 0.00 1/1/2023 12/31/2023
139 139-Total Operating Expenses - Water Dollars 0.00 1/1/2023 12/31/2023
140 140-Total Operating Expenses - Irrigation Dollars 0.00 1/1/2023 12/31/2023
141 141-Total Operating Expenses - Sanitation Dollars 0.00 1/1/2023 12/31/2023
142 142-Total Operating Expenses - Transit Dollars 0.00 1/1/2023 12/31/2023
143 143-Total Operating Expenses - Improvement Dollars 0.00 1/1/2023 12/31/2023
151 151-Total Operating Expenses - Sanitation MW Discounted Dollars 0.00 1/1/2023 12/31/2023
215 215-Buildings & Premises Occupied by District Sq. Ft.0.00 1/1/2023 12/31/2023
250 250-Number of Homes – Covenant Enforcement/Design Review Services
under District Authority
Total 0.00 1/1/2023 12/31/2023
270 270-Number of Aboveground Storage Tanks (excluding water tanks)Total 0.00 1/1/2023 12/31/2023
331 331-Number of Paid Firefighters - Full-Time Total 0.00 1/1/2023 12/31/2023
332 332-Number of Paid Firefighters - Part-Time Total 0.00 1/1/2023 12/31/2023
333 333-Number of Volunteer Firefighters Total 0.00 1/1/2023 12/31/2023
334 334-Number of Paid EMT - Full-Time Total 0.00 1/1/2023 12/31/2023
335 335-Number of Paid EMT - Part-Time Total 0.00 1/1/2023 12/31/2023
341 341-Time Spent by Club/Recreation/Camp Volunteers Hours 0.00 1/1/2023 12/31/2023
342 342-Time Spent by Day Care Volunteers Hours 0.00 1/1/2023 12/31/2023
344 344-Time Spent by Event Organizer Volunteers Hours 0.00 1/1/2023 12/31/2023
345 345-Time Spent by General Volunteers Hours 0.00 1/1/2023 12/31/2023
Page 3 of 4
348 348-Number of Board Members Total 5.00 1/1/2023 12/31/2023
350 350-Number of Permanent Employees - Full-Time Total 0.00 1/1/2023 12/31/2023
351 351-Number of Permanent Employees - Part-Time Total 0.00 1/1/2023 12/31/2023
366 366-Total Payroll Dollars 0.00 1/1/2023 12/31/2023
400 400-Number of Boats - Under 26'Total 0.00 1/1/2023 12/31/2023
411 411-Total Water Delivered Annually - Millions of Gallons (MGAL)MGAL 0.00 1/1/2023 12/31/2023
414 414-Playground/parks (Area)Acres 0.00 1/1/2023 12/31/2023
415 415-Number of Grandstands/Stadiums Total 0.00 1/1/2023 12/31/2023
420 420-Vacant Land Acres 0.00 1/1/2023 12/31/2023
450 450-Miles of Road Maintained Miles 16.00 1/1/2023 12/31/2023
522 522-Number of Ponds, Lakes & Reservoirs Total 0.00 1/1/2023 12/31/2023
550 550-Fire Department Area Served Sq Miles 0.00 1/1/2023 12/31/2023
671 671-Number of Parks Total 0.00 1/1/2023 12/31/2023
710 710-Dams - Class 1 - Low Hazard - Total Acre-Feet Acre Ft.0.00 1/1/2023 12/31/2023
712 712-Dams - Class 1 - Low Hazard - Number of Dams Count 0.00 1/1/2023 12/31/2023
720 720-Dams - Class 2 - Med Hazard - Total Acre-Feet Acre Ft.0.00 1/1/2023 12/31/2023
722 722-Dams - Class 2 - Med Hazard - Number of Dams Count 0.00 1/1/2023 12/31/2023
730 730-Dams - Class 3 - High Hazard - Total Acre-Feet Acre Ft.0.00 1/1/2023 12/31/2023
732 732-Dams - Class 3 - High Hazard - Number of Dams Count 0.00 1/1/2023 12/31/2023
811 811-Number of Spillways Total 0.00 1/1/2023 12/31/2023
900 900-Services Contracted out to Others Dollars 145,070.00 1/1/2023 12/31/2023
924 924-Revenue from use of Swimming Pools Dollars 0.00 1/1/2023 12/31/2023
925 925-Number of Swimming Pools Total 0.00 1/1/2023 12/31/2023
945 945-Number of Sewage Taps Total 0.00 1/1/2023 12/31/2023
Page 4 of 4
946 946-Number of Water Mains or Connections Total 0.00 1/1/2023 12/31/2023
947 947-Sewer and/or Sanitation Line Maintenance (budget)Dollars 0.00 1/1/2023 12/31/2023
948 948-Water Line Maintenance (budget)Dollars 0.00 1/1/2023 12/31/2023
997 997-Number of district sponsored Events/Fundraisers - No Alcohol Served Total 0.00 1/1/2023 12/31/2023
998 998-Number of District sponsored Events/Fundraisers – With Alcohol Served Total 0.00 1/1/2023 12/31/2023
999 999-Prior Acts Coverage Under a Previous “Claims Made” Policy Premium 1/1/2023 12/31/2023
If your district has exposures not listed on the General Liability schedule above, such as airplanes, security staff, bridges, drones,
etc., please furnish details. Certain activities may be excluded or restricted.