No preview available
HomeMy WebLinkAboutC24-482 GallagherEagle County, Colorado •••Gallagher•••CORE36o· Client Authorization to Bind Coverage After careful consideration of Gallagher's proposal dated 1/1/2025, we accept the following coverage(s). Please check the desired coverage(s) and note any coverage amendments below: llll!•l'i!.fc# • •JJ..-:1111 • .,, -□Accept □ Reject Cyber Liability □Option# 1 Palomar Excess and Surplus Insurance Company □Option# 2 Houston Casualty Company *Included TRIA Cannot Be Rejected □Accept □ Reject Airport General Liability National Union Fire Insurance Company of Pittsb urgh PA D Accept D Reject TRIA -Airport General Liability □Accept □ Reject WAR -Airport General Liability D Accept D Reject Accidental Death and Dismemberment Arch Insurance Company N/A TRIA -Accidental Death and Dismemberment □Accept □ Reject Property □Option# 1 Zurich American Insurance Company, RSUI, Bermuda, Chubb, RSUI □Option #2 Affiliated FM Insurance Company □Accept □ Reject TRIA -Property D Accept D Reject Workers' Compensation Pinnacol Assurance Company Included* TRIA Cannot Be Rejected D Accept D Reject Workers' Compensation -Out of State Zurich American Insurance Company Included* TRIA Cannot Be Rejected □Accept □ Reject Crime Travelers Casualty and Surety Co of America Included* TRIA Cannot Be Rejected D Accept D Reject Pollutio n Liability □Option# 1 Indian Harbor Insurance Company □Option# 2 Ascot Specialty Insurance Company -$2M Limit □Option #3 Ascot Specialty Insurance Company -$3M Limit 63 Docusign Envelope ID: A8114719-7D69-40ED-B404-96E5791B1F03 Eagle County, Colorado 1..-, ,· .. :..s..-# • • �1••1:..Jr -□Option #4 Ascot Specialty Insurance Company -$5M Limit D Accept D Reject TRIA -Pollution Liability *For this coverage, TRIA cannot be rejected Additional Recommended Coverages •••Gallagher•••CORE36o· 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 □Crisis Protect□Flood 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: 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's liability to you arising from any of Gallagher's acts or omissions will not exceed $20 million in the aggregate. The parties each will only be liable for actual damages incurred by the other party, and will not be liable for any indirect, special, exemplary, consequential, reliance or punitive damages. 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 the Proposal, any of Gallagher's services or your relationship with Gallagher may be brought by either party any later than two (2) years after the accrual of the 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/. 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 64 Docusign Envelope ID: A8114719-7D69-40ED-B404-96E5791B1F03 Docusign Envelope ID: A8114719-7D69-40ED-B404-96E5791B1F03 12/17/2024 Eagle County Government Matt Scherr