HomeMy WebLinkAboutPOL/EPL BROKER SERVICE TO INCLUDE PREMIUM QUOTE FOR 2018- 2019 POL/EPL COVERAGE TO J. SMITH LANIER & CO. LLC, CURRENT BROKER, THROUGH INSURANCE CARRIER RSUI .--( di
RSUI Indenmity Company
Corporate Office
945 East Paces Ferry Rd.
Atlanta, GA 30326-1160
NON-PROFIT ORGANIZATION
MANAGEMENT LIABILITY POLICY
NOTICE: THIS IS A CLAIMS MADE AND REPORTED POLICY THAT APPLIES ONLY TO
THOSE CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICY
PERIOD THAT ARE REPORTED TO THE INSURER DURING THE POLICY
PERIOD, OR EXTENDED REPORTING PERIOD (IF APPLICABLE) AND
REPORTED IN ACCORDANCE WITH THIS POLICY'S REPORTING
PROVISIONS. THE LIMIT OF LIABILITY AVAILABLE TO PAY LOSS SHALL
BE REDUCED OR TOTALLY EXHAUSTED BY PAYMENT OF DEFENSE
EXPENSES,
PLEASE READ YOUR POLICY CAREFULLY
CLAIM NOTICE
Mail notices to: RSU1 Group, Inc.
945 East Paces Ferry Rd.
Suite 1800
Atlanta, GA 30326-1160
Fax notices to: (404)231-3755
Attn: Claims Department
1 E-mail notices to: reportclaims(d rsui.com
RSUI's Panel Counsel Finder: Panel Counsel Link
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RSG 211008 0118
NON-PROFIT ORGANIZATION COMMON POLICY DECLARATIONS rj
Corporate Office
945 E.Paces Ferry Rd.
Sate 1800
COMPANY SYMBOL I POLICY PREFIX&NUMBER I RENEWAL OF Atlanta,GA 30328
N HP676117 NHP671840
*THIS IS A CLAIMS MADE AND REPORTED POLICY, PLEASE READ IT CAREFULLY.*
THIS POLICY IS ISSUED BY: RSUI Indemnity Company(hereinafter referred to as the Insurer)
ITEM 1. INSURED ORGANIZATION'S NAME AND MAILING ADDRESS
AUGUSTA,GEORGIA;AUGUSTA REGIONAL AIRPORT
AUTHORITY;SOLID WASTE MANAGEMENT AUTHORITY
535 TELFAIR STREET
SUITE 920
AUGUSTA, GA 30901
IN CONSIDERATION OF THE PAYMENT OF THE PREMIUM, IN RELIANCE UPON THE STATEMENTS HEREIN OR
ATTACHED HERETO, AND SUBJECT TO ALL THE TERMS OF THIS POLICY, THE INSURER AGREES TO PROVIDE THE
INSURANCE AS STATED IN THIS POLICY.
ITEM 2. POLICY PERIOD:
FROM 4/1912018 TO 4/19/2019 12:01 AM Standard Time at the Insured's address as stated herein
ITEM 3.COVERAGE SECTIONS APPLICABLE TO POLICY:
Purchased Shared Limit Separate Limit
A. Directors and Officers Liability Insurance ®Yes 0 No ® 0
B. Employment Practices Liability Insurance ®Yes 0 No ® ❑
1) Third Party Liability Coverage ®Yes ❑No
C. Fiduciary Liability Insurance 0 Yes ►.0 No ❑ ❑
ITEM 4.LIMIT OF LIABILITY:
$ 2,000,000 Aggregate Limit of Liability for All Coverage Sections
ITEM 6.PREMIUM:
$ 58,700.00 Total Policy Premium for All Coverage Sections
ITEM 6.POLICY FORM AND ENDORSEMENTS MADE A PART OF THIS POLICY AT THE TIME OF ISSUE:
SEE SCHEDULE OF ENDORSEMENTS—RSG 210077 0118
•
THESE DECLARATIONS TOGETHER WITH THE COMPLETED,SIGNED AND DATED APPLICATION, POLICY FORMS AND
ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY.
Countersigned: April 11,2018
DATE AUTHORIZED REPRESENTATIVE
RSG 210073 0118 AmemberAllegpanybmnaceHolengs(LC Page 1 of 1
NON-PROFIT ORGANIZATION DIRECTORS AND OFFICERS i h
LIABILITY DECLARATIONS tt
Corporate Office
945 E.Pates Ferry Rd.
State 1600
COMPANY SYMBOL POLICY PREFIX&NUMBER
GA30326
N HP676117
+THIS IS A CLAIMS MADE AND REPORTED POLICY. PLEASE READ IT CAREFULLY..
THIS POLICY IS ISSUED BY: RSUI Indemnity Company(hereinafter referred to as the Insurer)
ITEM 1. NVSURED ORGANIZATION'S NAME
AUGUSTA,GEORGIA;AUGUSTA REGIONAL AIRPORT
AUTHORITY;SOLID WASTE MANAGEMENT AUTHORITY
ITEM 2.LIMIT OF LIABILITY:
A. Directors and Officers Limit of Liability $ 2,000,000
B. Additional Side-A Limit of Liability $ 1,000,000
ITEM 3.RETENTION:
A. Directors and Officers Liability Retentions
1) Insuring Agreement A $ 0
2) Insuring Agreement B $ 250,000
3) Insuring Agreement C $ 250,000
ITEM 4.PRIOR AND/OR PENDING LITIGATION DATE:
Directors and Officers Prior and/or Pending Litigation Date: 04/19/1997
THESE DECLARATIONS TOGETHER WITH THE COMPLETED,SIGNED AND DATED APPLICATION, POLICY FORMS AND
ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY.
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Countersigned: April 11,2018
DATE AUTHORIZED REPRESENTATIVE
RSG 210078 0118 Am: MvQA1kpttanyfasaxteMddfg!tLC Page 1 of 1
NON-PROFIT ORGANIZATION EMPLOYMENT PRACTICES
LIABILITY DECLARATIONS
Cope-ate Office
946 E.Paces Ferry Rd.
Suite 1800
303
COMPANY SYMBOL POLICY PREFIX&NUMBERn� � 28
N HP676117
.THIS IS A CLAIMS MADE AND REPORTED POLICY. PLEASE READ IT CAREFULLY..
THIS POLICY IS ISSUED BY: RSUI Indemnity Company(hereinafter referred to as the Insurer)
ITEM 1. INSURED ORGANIZATION'S NAME
AUGUSTA,GEORGIA;AUGUSTA REGIONAL AIRPORT
AUTHORITY;SOLID WASTE MANAGEMENT AUTHORITY
ITEM 2.UMIT OF LIABILITY:
A. Employment Practices Limit of Liability $ 2,000,000
(Including Third Party Liability, if purchased)
B. Workplace Violence Expenses Sublimit $ 250,000
ITEM 3.RETENTION:
A. Employment Practices Liability Retentions
1) Employment Practices Liability $ 250,000
2) Third Party Liability Coverage $ 250,000
ITEM 4.PRIOR AND/OR PENDING LITIGATION DATE:
Employment Practices Prior and/or Pending Litigation Date: 04/19/1997
THESE DECLARATIONS TOGETHER WITH THE COMPLETED, SIGNED AND DATED APPLICATION, POLICY FORMS AND
ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF,COMPLETE THE ABOVE NUMBERED POLICY.
Countersigned: April 11, 2018
DATE AUTHORIZED REPRESENTATIVE
RSG 210079 0118 Amember otalegnxlyMsx eemrgsLW Page 1 of 1