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Home My WebLink AboutC24-501 Gallagher CORE 360 Eagle County, Colorado 59 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: Coverage/Carrier ☐ Accept ☐ Reject Package Travelers Indemnity Company TRIA - Package ☐ Accept ☐ Reject ☐ Accept ☐ Reject Automobile The Travelers Indemnity Company of CT ☐ Accept ☐ Reject Excess Liability - $7M Travelers Property Casualty Co of America TRIA - Excess Liability ☐ Accept ☐ Reject ☐ Accept ☐ Reject Standalone Law Enforcement – Lead $3M xs $500K SIR Lexington Insurance Company TRIA – Standalone Law ☐ Accept ☐ Reject ☐ Accept ☐ Reject Standalone Law Enforcement - $5M xs $3M Kinsale Insurance Company TRIA – Standalone Law ☐ Accept ☐ Reject ☐ Accept ☐ Reject Excess Liability - $2M xs $8M Arch Specialty Insurance Company TRIA – Excess Liability ☐ Accept ☐ Reject ☐ Accept ☐ Reject Cyber Liability ☐ Option #1 ☐ Option #2 Palomar Excess and Surplus Insurance Company Houston Casualty Company TRIA - Cyber Liability Included* ☐ Accept ☐ Reject Airport General Liability National Union Fire Insurance Company of Pittsburgh PA TRIA - Airport General Liability ☐ Accept ☐ Reject WAR – Airport General Liability ☐ Accept ☐ Reject ☐ Accept ☐ Reject Accidental Death and Dismemberment Arch Insurance Company TRIA - Accidental Death and Dismemberment Included* Docusign Envelope ID: 898A09DC-8F7C-494C-BD88-BA7F95FFC8AC Eagle County, Colorado 60 Coverage/Carrier ☐ Accept ☐ Reject Crime Travelers Casualty and Surety Co of America TRIA – Crime Included* ☐ Accept ☐ Reject ☐ Option #1 ☐ Option #2 ☐ Option #3 ☐ Option #4 Pollution Liability Indian Harbor Insurance Company Ascot Specialty Insurance Company - $2M Limit Ascot Specialty Insurance Company - $3M Limit Ascot Specialty Insurance Company - $5M Limit TRIA – Pollution ☐ Accept ☐ Reject ☐ Accept ☐ Reject Property ☐ Option # 1 ☐ Option # 2 Zurich / Quota Share - $150M Limit Affiliated FM Insurance Company - $150M Limit TRIA - Property ☐ Accept ☐ Reject ☐ Accept ☐ Reject Workers' Compensation Pinnacol Assurance Company TRIA - Workers' Compensation Included* ☐ Accept ☐ Reject Workers' Compensation - CT, OK, MI Zurich American Insurance Company TRIA - Workers' Compensation - CT, OK, MI Included* *For this coverage, TRIA cannot be rejected 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 ☐ Crisis Protect 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 Docusign Envelope ID: 898A09DC-8F7C-494C-BD88-BA7F95FFC8AC Eagle County, Colorado 61 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 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: 898A09DC-8F7C-494C-BD88-BA7F95FFC8AC Eagle County, Colorado Matt Scherr 12/23/2024