HomeMy WebLinkAboutLANDMARK AMERICAN INSURANCE FROM 4-19-10-TO 4-19-11 PROPOSALDIRECTORS AND OFFICERS LIABILITY POLICY
DECLARATIONS
Corporate Office
945 E. Paces Ferry Rd.
Suite 1800
COMPANY SYMBOL POLICY PREFIX & NUMBER RENEWAL OF Atlanta, GA 30326
L HP636535 LHP632687
*THIS IS A CLAIMS MADE POLICY. PLEASE READ IT CAREFULLY..
THIS POLICY IS ISSUED BY: LANDMARK AMERICAN INSURANCE COMPANY (hereinafter referred to as the Insurer)
ITEM 1 . INSURED'S NAME AND MAILING ADDRESS PRODUCER'S NAME AND ADDRESS
AUGUSTA, GEORGIA; AUGUSTA REGIONAL AIRPORT
AUTHORITY, SOLID WASTE MANAGEMENT AUTHORITY
530 GREENE STREET
ROOM 217
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 04/19/2010 TO 04/19/2011 12:01 AM Standard Time at the Insured's address as stated herein
ITEM 3. LIMIT OF LIABILITY:
$ 2,000,000 Aggregate Limit of Liability each policy period
ITEM 4. RETENTION:
$ 250,000 Each Wrongful Act Other Than Employment Practices Liability Related Violations
$ 250,000 Each Employment Practices Liability Violation
ITEM 5. PREMIUM:
$ 65,680.00
ITEM 6. POLICY FORM AND ENDORSEMENTS MADE A PART OF THIS POLICY AT THE TIME OF ISSUE:
SEE RSG 200007 0204 - SUPPLEMENTAL DECLARATIONS - SCHEDULE OF ENDORSEMENTS; POLICY FORM - MANUSCRIPT
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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Countersig 0 3/23!2010
DATE AUTHORIZED REPRESENTATIVE
RSG 200006 0204 A member of Xleghany Insurance Holdings L-C
DIRECTORS AND OFFICERS LIABILITY POLICY
SUPPLEMENTAL DECLARATIONS
POLICY NUMBER: LHP636535
SCHEDULE OF ENDORSEMENTS
(� �I
TITLE FORM NUMBER
Disclosure Pursuant to Terrorism Risk Insurance Act
Cancellation Amendatory
Cap on Losses From Certified Acts of Terrorism
Defense Costs In Addition to the Limit
Exclusion- Prior and /or Pending Litigation Backdated
Extended Discovery Endorsement
Minimum Earned Premium Clause
Service of Suit
RSG 204123 0108
RSG 200007 0204
LANDMARK AMERICAN INSURANCE COMPANY
THIS ENDORSEMENT IS ATTACHED TO AND MADE A PART OF THIS POLICY IN RESPONSE TO THE
DISCLOSURE REQUIREMENTS OF THE TERRORISM RISK INSURANCE ACT. THIS ENDORSEMENT DOES
NOT GRANT ANY COVERAGE OR CHANGE THE TERMS AND CONDITIONS OF ANY COVERAGE UNDER
THIS POLICY.
DISCLOSURE PURSUANT TO TERRORISM RISK
INSURANCE ACT
SCHEDULE*
Terrorism Premium (Certified Acts)
$ Waived
Additional information, if any, concerning the terrorism premium:
I nformation required to complete this Schedule, if not shown above, will be shown in the Declarations Page.
A. Disclosure of Premium
In accordance with the federal Terrorism Risk Insurance Act, the Insurer is required to provide the Insured with a notice
disclosing the portion of the Insured's premium, if any, attributable to coverage for terrorist acts certified under the Terrorism
Risk Insurance Act. The portion of the Insured's premium attributable to such coverage is shown in the Schedule of this
endorsement or in the policy Declarations Page.
B. Disclosure of Federal Participation in Payment of Terrorism Losses
The United States Government, Department of the Treasury, will pay a share of terrorism losses insured under the federal
program. The federal share equals eighty -five percent (85 %) of that portion of the amount of such insured losses that
exceeds the applicable Insurer's retention. However, if aggregate insured losses attributable to terrorist acts certified under
the Terrorism Risk Insurance Act exceed $100 billion in a Program Year (January 1 through December 31), the Treasury shall
not make any payment for any portion of the amount of such losses that exceeds $100 billion.
RSG 204123 0108
Policv No.: LHP636535 Effective: 04 /19/2010
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
CANCELLATION AMENDATORY
This endorsement modifies insurance provided under the following:
PUBLIC OFFICIALS AND EMPLOYMENT PRACTICES LIABILITY POLICY
In consideration of the premium charged, it is hereby understood and agreed that wherever used in this
endorsement:
(1) Company means the insurance company which issued this policy;
(2) Insured means the person or entity who is afforded coverage by this policy.
It is further understood and agreed as follows that the Cancellation Provision of this policy is amended to include
the following:
X1 1 14344AcA9[7►
A notice of termination, including a notice of cancellation or nonrenewal, by the Company, a notice of an increase
in premium rates, other than an increase in premium rates due to a change in risks or exposure, which exceeds
15 percent (15 %) of the current policy's premium, or a notice of a change in any policy provision which limits or
restricts coverage, shall be delivered to the Insured or mailed to the Insured by first -class mail, at least forty -five
(45) days prior to the policy termination date.
If the Company fails to comply with the above requirements, the Insured shall be entitled to purchase, under the
same premium rate and policy terms and conditions, an additional thirty (30) day period of insurance coverage
beyond the termination date of such policy; provided, however, that the Insured tenders the prorata premium
amount to the Company on or before the termination date. The insurance coverage is not required to be
extended for more than thirty (30) days from the policy termination date.
It is further understood and agreed that the Insured first named in Item 1 of the Declarations shall be the sole
agent of all Insureds for the purpose of effecting cancellation or nonrenewal or the giving or receiving of notice
thereof.
All other terms and conditions of this policy remain unchanged.
Policy No.: LHP636535 Effective: 04/19 /2010
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
This endorsement modifies insurance provided under the following:
PUBLIC OFFICIALS AND EMPLOYMENT PRACTICES LIABILITY POLICY
If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed
$100 billion in a Program Year (January 1 through December 31) and the Insurer has met our insurer deductible
under the Terrorism Risk Insurance Act, the Insurer shall not be liable for the payment of any portion of the
amount of such losses that exceeds $100 billion, and in such case insured losses up to that amount are subject to
pro rata allocation in accordance with procedures established by the Secretary of the Treasury.
Certified Act of Terrorism means an act that is certified by the Secretary of the Treasury, in concurrence with
the Secretary of State and the Attorney General of the United States, to be an act of terrorism pursuant to the
federal Terrorism Risk Insurance Act. The criteria contained in the Terrorism Risk Insurance Act for a Certified
Act of Terrorism include the following:
1. The act resulted in insured losses in excess of $5 million in the aggregate, attributable to all types of
insurance subject to the Terrorism Risk Insurance Act; and
2. The act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed
by an individual or individuals, as part of an effort to coerce the civilian population of the United States or to
influence the policy or affect the conduct of the United States Government by coercion.
All other terms and conditions of this policy remain unchanged.
Policy No.: LHP636535 Effective: 04 /19/2010
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
DEFENSE CASTS IN ADDITION TO THE LIMIT OF LIABILITY
This endorsement modifies insurance provided under the following:
PUBLIC OFFICIALS AND EMPLOYMENT PRACTICES LIABILITY POLICY
Any Defense Costs covered under this policy shall not reduce the Limit of Liability, stated in Item 3. of the
Declarations Page, available to pay Damages. Defense Costs shall be subject to and applied against any
applicable Retention amount stated in Item 4. of the Declarations Page, however, and the Company will have no
obligation to pay Damages or Defense Costs, or to defend or continue to defend any Claim after the aggregate
Limit of Liability, stated in Item 3. of the Declarations Page, has been exhausted by payment of covered
Damages.
All other terms and conditions of this policy remain unchanged.
Policy No.: LHP636535 Effective: 04/19/2010
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
EXCLUSION - PRIOR AND /OR PENDING LITIGATION
BACKDATED
This endorsement modifies insurance provided under the following:
PUBLIC OFFICIALS AND EMPLOYMENT PRACTICES LIABILITY POLICY
SECTION 5. - EXCLUSIONS, p. is deleted and replaced with the following:
(p) Alleging, arising out of, based upon or attributable to, in whole or in part, any litigation involving any Insured
that was commenced or initiated prior to, or pending as of April 19. 1997 for Augusta. Georgia: April 19. 2003
for Augusta Regional Airport Authority and August 1, 2004 for Solid Waste Management Authority or arising
out of or based upon, in whole or in part, any facts or circumstances underlying or alleged in any such prior or
pending litigation.
All other terms and conditions of this policy remain unchanged.
Policy No.: LHP636535 Effective: 04 /19/2010
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
EXTENDED DISCOVERY ENDORSEMENT
This endorsement modifies insurance provided under the following:
PUBLIC OFFICIALS AND EMPLOYMENT PRACTICES LIABILITY POLICY
In consideration of the premium charged, it is hereby understood and agreed that Clause 9,
Discovery Clause, is deleted in its entirety and replaced by the following:
9. Extended Discovery Period
If the Company or the Insureds shall cancel or non -renew this Policy the Insureds shall have the
right, upon payment of the additional premium of 200% of the total Policy premium hereunder, to an
extension of the coverage granted by this Policy in respect of any claim or claims first made against
the Insureds and reported to the Company during the period of three (3) years after the effective
date of such cancellation or refusal to renew but only in respect of any Wrongful Act committed
before the effective date of such cancellation or refusal to renew and otherwise covered by this
Policy.
This right shall terminate, however, unless written notice of such election together with the
additional premium due is received by the Company not later than (30) days after the effective date
of cancellation or refusal to renew.
This clause and the rights contained herein shall not apply to any cancellation resulting from non-
payment of premium.
All other terms and conditions of this policy remain unchanged
Policy No.: LHP636535 Effective: 04/19/2010
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
MINIMUM EARNED PREMIUM CLAUSE
This endorsement modifies insurance provided under the following:
PUBLIC OFFICIALS AND EMPLOYMENT PRACTICES LIABILITY POLICY
In the event of cancellation of this policy by the Insured, a minimum premium of twenty -five percent (25 %) of the
original policy premium shall become earned.
Failure of the Insured to make timely payment of premium shall be considered a request by the Insured
for the Company to cancel. In the event of such cancellation by the Company for non - payment of
premium, the minimum premium shall be due and payable; provided, however, such non - payment
cancellation shall be rescinded if the Insured remits the full premium due within ten (10) days of receiving
notice of such cancellation by the Company.
All other terms and conditions of this policy remain unchanged.
Policy No.: LHP636535 Effective: 04/19/2010
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
SERVICE OF SUIT
This endorsement modifies insurance provided under the following:
PUBLIC OFFICIALS AND EMPLOYMENT PRACTICES LIABILITY POLICY
In the event of the failure of the Company to pay any amount claimed to be due hereunder, the Company, at the
request of the Insured, will submit to the jurisdiction of any court of competent jurisdiction within the United States
and will comply with all requirements necessary to give such court jurisdiction, and all matters arising hereunder
shall be determined in accordance with the law and practice of such court.
Service of process in such suit may be made upon the highest one in authority bearing the title "Commissioner ",
"Director" or "Superintendent" of Insurance of the state or commonwealth wherein the Public Entity named in
Item 1. of the Declarations Page of this policy is located, and that in any suit instituted against it based upon this
contract the Company will abide by the final decision of such court or any appellate court in the event of an
appeal. The one in authority bearing the title "Commissioner ", "Director" or "Superintendent" of Insurance of the
state or commonwealth wherein the Public Entity named in Item 1. of the Declarations Page of this policy is
located, is hereby authorized and directed to accept service of process on behalf of the Company in any such
suit and/or upon the Insured's request to give a written undertaking to the Insured that they will enter a general
appearance upon the Company's behalf in the event such a suit shall be instituted.
All other terms and conditions of this policy remain unchanged.
Policy No.: LHP636535 Effective: 04/19 /2010
LANDMARK AMERICAN INSURANCE COMPANY
IMPORTANT NOTICE
GEORGIA SURPLUS LINES DISCLOSURE NOTICE
This contract is registered and delivered as a surplus line coverage under the Surplus
Line Insurance Law, O.C.G.A. Chapter 33 -5.
RSG 99025 0106
LANDMARK AMERICAN INSURANCE COMPANY
This Endorsement Changes The Policy. Please Read It Carefully.
PUBLIC OFFICIALS AND EMPLOYMENT
PRACTICES LIABILITY POLICY
In consideration of the premium charged, and in reliance upon the statements in the application attached hereto
and made a part hereof, and subject to the Limit of Liability stated in Item 3 of the Declarations and the terms and
conditions contained herein. The Company and the Insured agree as follows:
1. INSURING AGREEMENTS
To pay on behalf of the Insured all sums which the Insured shall become legally obligated to pay as Damages
resulting from any Claim first made against the Insured during the Policy Period or the Discovery Period (if
applicable) and reported to the Company pursuant to the terms of this policy for any Wrongful Act of the
Insured in the performance of duties for the Public Entity.
2. DEFENSE PROVISIONS
a) The Company shall, in addition to the Limit of Liability, appoint an attorney and defend any Claim against
the Insured alleging a Wrongful Act, even if such Claim is groundless, false or fraudulent; and pay on
behalf of the Insured Defense Costs.
b) The Insured shall not admit liability or settle any Claim or incur any cost or expense without the written
consent of the Company. The Company shall have the right to make such investigation and negotiations
and, with the written consent of the Public Entity, such settlement of any Claim as the Company deems
expedient. If the Public Entity refuses to consent to any settlement recommended by the Company, the
Insured shall thereafter negotiate or defend such Claim independently of the Company and the liability of
the Company shall not exceed the amount for which the Claim could have been settled plus Defense
Costs incurred with the Company's consent up to the date of such refusal.
c) The Company shall not be obligated to pay any Damages or Defense Costs or to undertake or
continue defense of any Claim after the Limit of Liability has been exhausted by payment of
Damages or after deposit of the applicable limit of the Company's liability in a court of competent
jurisdiction, and in such case the Company shall have the right to withdraw from the further defense
thereof by tendering control of said defense to the Insured.
3. DEFINITIONS
a) "Arising Out Of' means originating from, having its origin in, growing out of, flowing from, incident to or
having connection with, whether directly or indirectly.
b) "Claim" means a judicial proceeding alleging a Wrongful Act that is filed against an Insured in a court of law
or equity and which seeks Damages or other relief. Claim shall also mean an administrative proceeding
alleging a Wrongful Act, provided an enforceable award of Damages can be made against an Insured at
the administrative proceeding.
c) "Damages" means a monetary judgment or settlement agreed to with the consent of the Company.
d) "Defense Costs" means reasonable and necessary fees, costs, and expenses incurred by the Company, or
incurred by the Insured with the written consent of the Company, (including premiums for any appeal bond,
attachment bond, or similar bond but without any obligation to apply for or furnish any such bond) resulting
from the investigation, adjustment, defense, and appeal of a Claim against any Insured; provided,
however, that Defense Costs do not include salaries of employees or officers of the Company.
e) "Employment Practice Violation(s)" means any actual or alleged:
(1) wrongful dismissal, discharge or termination (either actual or constructive) of employment,
including breach of an implied contract;
(2) harassment (including sexual harassment whether "quid pro quo ", hostile work environment or
otherwise);
(3) discrimination, (including but not limited to discrimination based upon age, gender, race, color,
national origin, religion, sexual orientation or preference, pregnancy or disability);
(4) retaliation (including lockouts);
(5) employment - related misrepresentation(s) to an employee or applicant for employment with the Public
Entity;
(6) wrongful failure to employ or promote;
(7) wrongful deprivation of career opportunity, wrongful demotion or negligent employee evaluation,
including the giving of negative or defamatory statements in connection with an employee reference;
(8) wrongful discipline;
(9) failure to grant tenure;
(10) failure to provide or enforce adequate or consistent policies and procedure relating to any
Employment Practices Violation;
(11) violation of an individual's civil rights relating to any of the above,
but only if the Employment Practices Violation relates to an employee or applicant for employment with the
Public Entity whether direct, indirect, intentional or unintentional.
(f) "Insured' means the Public Entity and:
(1) all persons who were, now are or shall be lawfully elected or appointed officials or employees while
acting for or on behalf of the Public Entity;
(2) commissions, boards, or other units, and members and employees thereof, operated by and under
the jurisdiction of such Public Entity and within an apportionment of the total operating budget
indicated in the application for this policy;
(3) volunteers acting for or on behalf of, and at the request and under the direction of, the Public Entity;
(4) officials, and employees of the Pubic Entity appointed at the request of the Public Entity to serve with
an outside tax exempt entity.
(g) "Policy Period" means the period from the inception date of this policy shown in Item 2 of the Declarations
to the earlier of the expiration date shown in Item 2 of the Declarations or the effective date of cancellation
of this policy.
(h) "Public Entity' means the municipality, governmental body, department or unit which is named in Item 1 of
the Declarations.
(i) "Retaliation" means a wrongful act of an Insured relating to or alleged to be in response to any of the
following activities: (1) the disclosure or threat of disclosure by an Employee of the Public Entity to a
superior or to any governmental agency of any act by an Insured which act is alleged to be a violation of
any federal, state, local or foreign law, common or statutory, or any rule or regulation promulgated
thereunder: (2) the actual or attempted exercise by an Employee of the Public Entity of any right that such
employee has under law, including rights under workers' compensation laws, the Family and Medical Leave
Act, the Americans with Disabilities Act or any other law relating to Employee rights; (3) the filing of any
claim under the Federal False Claims Act or any other federal, state, local or foreign "whistle- blower' law;
(4) strikes by Employees of the Public Entity or (5) political affiliation.
Q) "Wrongful Act" means any actual or alleged breach or duty, neglect, error, misstatement, misleading
statement, omission or Employment Practices Violation by an Insured solely in the performance of duties for
the Public Entity.
4. EXTENSIONS
Subject otherwise to the terms hereof, the policy shall cover Claims made against the estates, heirs, or legal
representatives of deceased Insureds, and the legal representatives of Insureds in the event of an Insured's in
competency, insolvency or bankruptcy, who were Insureds at the time the Wrongful Acts upon which such
Claims are based were committed.
2
Subject otherwise to the terms hereof, this policy shall cover Claims made against the lawful spouse (whether
such status is derived by reason of statutory law, common law or otherwise of any applicable jurisdiction in the
world) of an Insured for all Claims arising solely out of his or her status as the spouse of an Insured, including
a Claim that seeks damages recoverable from marital community property, property jointly held by the Insured
and the spouse, or property transferred from the Insured to the spouse; provided, however, that this extension
shall not afford coverage for any Claim for any Wrongful Act of the spouse, but shall apply only to Claims
Arising Out Of the Wrongful Acts of an Insured, subject to the policys terms, conditions and exclusions.
5. EXCLUSIONS
This policy does not apply to any Damages or Claim:
(a) alleging fraud, dishonesty or criminal acts or omissions; however, the Insured shall be reimbursed for the
reasonable amount which would have been collectible under this policy if such allegations are not
subsequently proven;
(b) seeking relief or redress in any form other than Damages, or attorney's fees, costs or expenses which the
Insured shall become obligated to pay as a result of an adverse judgment or settlement for a Claim
seeking such relief; however, the Company shall defend such a Claim in accordance with Clause 2,
subject to a Policy Period aggregate limit of $100,000 This limit shall be part of the Limit of Liability stated
in Item 3 of the Declarations;
(c) Arising Out Of (1) false arrest, detention or imprisonment, (2) libel, slander or defamation of character, (3)
assault or battery, (4) malicious prosecution or abuse of process, (5) wrongful entry or eviction, or
invasion of any right of privacy, (6) any allegation relating to the foregoing exclusions 5(c)(1) through
5(c)(5) that an Insured negligently employed, investigated, supervised or retained any person, or based
on an alleged practice, custom or policy and including, without limitation, any allegation that the violation
of a civil right caused or resulted from such Damages or Claim;
(d) Arising Out Of (1)bodily injury to, or sickness, disease, emotional distress or death of any person, (2)
damage to or destruction of any property, including the loss of use thereof, (3) any allegation relating to
the foregoing exclusions 5(d)(1) through 5(d)(2) that an Insured negligently employed, investigated,
supervised or retained a person, or based on an alleged practice, custom or policy and including, without
limitation, any allegation that the violation of a civil right caused or resulted from such Damages or Claim;
(e) Arising Out Of inverse condemnation, temporary or permanent taking, adverse possession or dedication
by adverse use;
(f) Arising Out Of strikes, riots or civil commotions;
(g) Arising Out Of the failure to effect or maintain any insurance or bond, which shall include, but not be
limited to, insurance provided by self- insurance arrangements, pools, self- insurance trusts, captive
insurance companies, retention groups, reciprocal exchanges or any other plan or agreement of risk
transfer or assumption; however, the Company will defend such a Claim but without obligation to pay
Damages;
(h) Arising Out Of the gaining in fact of any profit or advantage to which the Insured is not legally entitled; the
return of taxes, assessments, penalties, fines or fees; any award of salary, wages or earnings;
(i) Alleging, Arising Out Of, based upon, attributable to, or in any way involving, directly or indirectly:
(1) the actual, alleged or threatened discharge, dispersal, release or escape of Pollutants, or
(2) any direction or request to test for, monitor, clean up, remove, contain, treat, detoxify or neutralize
Pollutants.
"Pollutants" include, but are not limited to, any solid, liquid, gaseous or thermal irritant or contaminant,
including smoke, vapor, soot, fumes, acids, alkalis, chemicals, asbestos, lead and Waste. "Waste"
includes, but is not limited to, materials to be recycled, reconditioned or reclaimed;
(j) Arising Out Of the planning, construction, maintenance, operation or use of any nuclear reactor, nuclear
waste storage or disposal site or any other nuclear facility, or the transportation of nuclear material;
(k) Arising Out Of a breach of fiduciary duty, responsibility or obligation in connection with any employee
benefit or pension plan, or to any amount due under any fringe benefit or retirement program; however,
the Company will defend such a Claim but will have no obligation to furnish any benefits due or pay
Damages;
(1) brought by or on behalf of one Insured against another Insured, however, as respects any Claim alleging
an Employment Practices Violation, this exclusion shall only apply to cross - claims or counter - claims
brought by one Insured against another Insured;
(m) Arising Out Of breach of contract, except this exclusion shall not apply to any Claim alleging an
Employment Practices Violations;
(n) Arising Out Of the operation of or activities of any schools, airports, transit authorities, hospitals, clinics,
nursing homes or other health care operations, utilities, housing authorities, jails or detention facilities, law
enforcement agencies or fire fighting authorities unless specifically included by endorsement attached;
(o) for fines, penalties, or punitive, exemplary or the multiplied portion of multiplied Damages; however, only
where permitted by law, this policy shall cover, subject to all the terms, conditions and exclusions
contained herein, up to $500,000 punitive, exemplary or the multiplied portion of multiplied Damages, as
part of and not in addition to the Limit of Liability of the Company otherwise afforded by this policy;
(p) arising from all pending or prior litigation or hearing as well as future Claims Arising Out Of said pending
or prior litigation or hearing. If this policy is a renewal of a policy issued by the Company, this exclusion
shall only apply with respect to a pending or prior litigation or hearing prior to the effective date of the first
policy issued and continuously renewed by the Company;
(q) Arising Out Of, based upon or attributable to the facts alleged, or to the same or related Wrongful Acts
alleged or contained, in any Claim which has been reported, or in any circumstances of which notice has
been given, under any policy of which this policy is a renewal or replacement or which it may succeed in
time;
(r) Arising Out Of any Wrongful Act prior to the inception date of the first policy issued by the Company and
continuously renewed and maintained, if on or before such date any Insured knew or could have
reasonably foreseen that such Wrongful Act could lead to a Claim.
The following exclusions shall also apply to any Claim alleging an Employment Practices Violation(s).
This policy does not apply to any Damages or Claim:
(s) Arising Out Of any obligation pursuant to any worker's compensation, disability benefits, unemployment
compensation, unemployment insurance, retirement benefits, social security benefits or similar law;
provided, however, this exclusion shall not apply to a Claim for Retaliation;
(t) Arising Out Of any violation of the Employee Retirement Income Security Act of 1974, the Fair Labor
Standards Act (except the Equal Pay Act), the National Labor Relations Act, the Worker Adjustment and
Retraining Notification Act, the Consolidated Omnibus Budget Reconciliation Act, the Occupational Safety
and Health Act, any rules or regulations of the foregoing promulgated thereunder and amendments
thereto or any similar provisions of any federal, state, local or foreign statutory law or common law;
provided however, this exclusion shall not apply to a Claim for Retaliation;
(u) Arising Out Of any costs or liability incurred by any Insured to modify any building, property or facility to
make said building, property or facility more accessible or accommodating to any disabled person as
mandated by the Americans With Disabilities Act Of 1992, and as amended, or any similar federal, state
or local law, regulation or ordinance.
6. LIMIT OF LIABILITY
(a) The total liability of the Company for all Damages arising from all Claims made against the Insured during
the Policy Period and during the Discovery Period (if applicable), shall not exceed the Limit of Liability
stated in Item 3 of the Declarations. The inclusion herein of more than one Insured shall not increase the
Limit of Liability of the Company. The Limit of Liability stated in Item 3 of the Declarations shall apply to all
Claims Arising Out Of the same Wrongful Act or related Wrongful Acts.
(b) If additional Claims are subsequently made which Arise Out Of the same Wrongful Act or series of
continuous, repeated or interrelated Wrongful Acts as Claims already made and reported to the
Company, then all such Claims, whenever made, shall be considered first made within the Policy Period
or the Discovery Period (if applicable) in which the earliest Claim Arising Out Of such Wrongful Act or
series of continuous, repeated or interrelated Wrongful Acts was first made and reported to the Company,
and all such Claims shall be subject to one such Limit of Liability.
7. DEDUCTIBLE
Subject to the Limit of Liability, exclusions and other terms of this policy, the Company shall only be liable for
those Damages and Defense Costs which are in excess of the Deductible stated in Item 4 of the Declarations.
This Deductible shall apply to each Wrongful Act or Employment Practice Violation or series of continuous,
repeated or interrelated Wrongful Acts or Employment Practice Violations and shall be borne by the Public
Entity and remain uninsured. The Public Entity shall also be responsible for payment of the Deductible. The
Company may direct the Public Entity to make partial or full payment of the Deductible to others.
8. NOTICE/ CLAIM REPORTING PROVISIONS
Notice hereunder shall be given in writing to RSUI Group, Inc., at the address indicated on the
Declarations Page.
If mailed, the date or mailing shall constitute the date that such notice was given and proof of mailing
shall be sufficient proof of notice. A Claim shall be considered to have been first made against an
Insured when written notice of such Claim is received by any Insured, by the Public Entity on the
behalf of any Insured or by the Company, whichever comes first.
(a) The Public Entity or the Insureds shall, as a condition precedent to the obligations of the Company under
this policy, give written notice to the Company of any Claim made against an Insured as soon as
practicable and either:
(1) anytime during the Policy Period or during the Discovery Period (if applicable),
(2) within 30 days after the end of the Policy Period or the Discovery Period (If applicable), as long as
such Claim is reported no later than 30 days after the date such Claim was first made against an
Insured.
(b) If written notice of a Claim has been given to the Company pursuant to Clause 8(a) above, then any
Claim which is subsequently made against the Insureds and reported to the Company Arising Out Of the
facts alleged in the Claim for which such notice has been given, or alleging any Wrongful Act which is the
same as or related to any Wrongful Act alleged in the claim of which such notice has been given, shall be
considered made at the time such notice was given.
(c) If during the Policy Period or during the Discovery Period (If applicable) the Public Entity or the Insureds
shall become aware of any circumstances which may reasonably be expected to give rise to a Claim
being made against the Insureds and shall give written notice to the Company of the circumstances and
the reasons for anticipating such a Claim, with full particulars as to dates, persons and entities involved,
then any Claim which is subsequently made against the Insureds and reported to the Company Arising
Out Of such circumstances or alleging any Wrongful Act which is the same as or related to any Wrongful
Act alleged or contained in such circumstances, shall be considered made at the time such notice of such
circumstances was given.
9. DISCOVERY CLAUSE
(a) Automatic Discovery Period
If the Company or the Public Entity shall cancel or refuse to renew this policy and the Public Entity does
not obtain replacement coverage as of the effective date of such cancellation or non - renewal, the Public
Entity shall have the right to a period of sixty (60) days following the effective data of such cancellation or
non - renewal in which to give written notice to the Company of any Claim made against the Insured during
said 60 day period for any Wrongful Act before the end of the Policy Period. This Automatic Discovery
Period shall immediately expire upon the purchase of replacement coverage by the Public Entity.
(b) Optional Discovery Period
If the Company or the Public Entity shall cancel or refuse to renew this policy, the Public Entity shall have
the right, upon payment of an additional premium of 50% of the total policy premium, to a period of twelve
(12) months following the effective date of such cancellation or non - renewal in which to give written notice
to the Company of any Claim made against the Insured during said twelve (12) month period for any
Wrongful Act before the end of the Policy Period. This right shall terminate, however, unless written notice
of such election together with the additional premium due is received by the Company within thirty (30)
days after the effective date of cancellation or non - renewal. This clause and the rights contained herein
shall not apply to any cancellation resulting from non - payment of premium.
10. CANCELLATION CLAUSE
This policy may be canceled by the Public Entity by surrender of this policy or by giving written notice to the
Company stating when thereafter such cancellation shall be effective. This policy may also be canceled by
the Company by delivering to the Public Entity or by mailing to the Public Entity by registered, certified, or
other first class mail, at the address shown in Item 1 of the Declarations, written notice stating when, not less
than thirty (30) days thereafter, the cancellation shall be effective. However, if the Company cancels this
policy because the Pubic Entity has failed to pay a premium when due, or has failed to reimburse the
Company such amounts as the Company has paid as Damages or Defense Costs within the amount of the
applicable Deductible, or excess of the Limit of Liability, this policy may be canceled by the Company by
mailing to the Public Entity by registered, classified, or other first class mail, at the address shown in Item 1
of the Declarations, written notice stating when, not less than ten (10) days thereafter, the cancellation shall
be effective. The mailing of such notice as aforesaid shall be sufficient proof of notice and this policy shall
terminate at the date and hour specified in such notice.
If this policy shall be canceled by the Public Entity, the Company shall retain the customary short rate
proportion of the premium hereon. If this policy shall be canceled by the Company, the Company shall retain
the pro rata proportion of the premium hereon. Payment or tender of any unearned premium by the
Company shall not be a condition precedent to the effectiveness of cancellation, but such payment shall be
made as soon as practicable.
11. REIMBURSEMENT OF THE COMPANY
If the Company has paid any Damages in excess of the Limit of Liability or Damages or Defense Costs
within the applicable Deductible, the Insureds, jointly and severally, shall be liable to the Company for any
and all such amounts and, upon demand, shall pay such amounts to the Company.
12. SUBROGATION
In the event of any payment under this policy, the Company shall be subrogated to all the Insured's rights of
recovery against any person or organization, and the Insured shall execute and deliver all instruments and
papers and do whatever else is necessary to secure such rights for the Company. The Insured shall do
nothing to prejudice such rights. Any amount recovered in excess of the total payment by the Company shall
be restored to the Insured, less the cost to the Company of recovery.
13. OTHER INSURANCE
Such Insurance as is provided under this policy shall apply only as excess over any other valid and
collectible insurance, self insurance, or indemnification or any similar agreement, whether such other
insurance or agreement is stated to be primary, pro rata, contributory, excess, contingent or otherwise.
14. COOPERATION CLAUSE
The Insured shall cooperate with the Company and, upon the Company's request, assist in making
settlements and in the conduct of Claims. The Insured shall attend hearings and trials and assist in securing
and giving evidence and obtaining the attendance of witnesses. The Insured shall not, except at the
Insured's own cost, voluntarily make any payment, assume any obligation or incur any expense.
15. NOTICE AND AUTHORITY
By the acceptance of this policy, the Public Entity agrees to act an behalf of all Insureds with respect to the
giving of notice of Claim, the giving or receiving of notice of cancellation or non renewal, the payment of
premiums, the receiving of any premiums that may become due under this policy, consenting to any
settlement and exercising the right to the Discovery Period. All Insureds agree that the Public Entity shall act
on their behalf.
16. ASSIGNMENT
Assignment of interest under this policy shall not bind the Company until its consent is endorsed hereon;
however, subject otherwise to the terms hereof, this policy shall cover the estate heirs, legal representatives
or assigns of the Insured in the event of the death, bankruptcy or insolvency of the Insured or the Insured
being adjudged incompetent.
17. ACTION AGAINST THE COMPANY
No action shall lie against the Company unless, as a condition precedent thereto, the Insured shall have fully
complied with all the terms of this policy, nor until the amount of the obligation of the Insured to pay shall
have been finally determined either by judgment against the Insured after actual trial or by written agreement
of the Insured, the claimant and the Company.
Any Insured or the legal representative thereof who has secured such judgment or written agreement shall
thereafter be entitled to recover under this policy to the extent of the insurance afforded by this policy. No
Insured shall have any right under this policy to join the Company as a party to any action against other
Insureds or the Public Entity to determine the Insureds' liability, nor shall the Company be impleaded by the
Insureds or the Public Entity or their legal representatives. Bankruptcy or insolvency of the Insured or the
estate of the Insured shall not relieve the Company of any obligation hereunder.
18. REPRESENTATIONS AND SEVERABILITY
In granting coverage under this policy, it is agreed that the Company has relied upon the statements and
representations contained in the application for this policy (including materials submitted thereto, and if this is
a renewal application, all such previous policy applications for which this policy is a renewal) as being
accurate and complete. All such statements and representations shall be deemed to be material to the risk
assumed by the Company, are the basis of this policy and are to be considered as incorporated into this
policy.
With respect to such statements, and representations, no knowledge or information possessed by any
Insured shall be imputed to any other Insured. If any person who executed the application knew that such
statement or representation was inaccurate or incomplete, such statement shall not be imputed to any
Insured other than such signature and any other Insureds who knew such statement or representation was
inaccurate or incomplete.
19. POLICY TERRITORY
This policy applies to Wrongful Acts committed anywhere in the world provided Claim is made in The United
States of America, its territories or possessions, or Canada.
20. HEADINGS
The descriptions in the headings of this policy are solely for convenience, and form no part of the terms and
conditions of coverage.
7
DIRECTORS AND OFFICERS LIABILITY -NOT FOR PROFIT
ORGANIZATION RENEWAL APPLICATION
CC S DO
NOTICE: THIS IS A CLAIMS MADE AND REPORTED POLICY THAT APPLIES ONLY TO THOSE CLAIMS FIRST
MADE AGAINST THE INSURED DURING THE POLICY PERIOD AND REPORTED TO THE INSURER
DURING THE POLICY PERIOD, OR THE DISCOVERY PERIOD, IF APPLICABLE, THE LIMIT OF
LIABILITY AVAILABLE TO PAY LOSS SHALL BE REDUCED OR TOTALLY EXHAUSTED 13Y PAYMENT
OF DEFENSE EXPENSES,
I. GENERAL INFORMATION SECTION
1. (aj Name of Organization: u4164a & org;6 , i Au3i�c h kfA € ?;tai My- ,4Lt- her i4V
-lid &) i or,-
(b) Organization Address: n
t Irk
2. Date Organized:
3, Purpose of Organization: 1f3 )(,1 Afotw +y /' _r it ed 0--ve1v 1+
4. (a) Have there been any changes In the Organization operations within the last twelve (12) Yes ❑ No
months or is the Organization currently contemplating any merger or acquisition?
(If "Yes ", please give details)
(b) Has the Organization acquired or created any Subsidiaries within the last twelve (12) Yes ❑ No Q- y
months?
(If "Yes ", please give details)
Ill. EMPLOYMfrNT PRACTICES LIABILITY SECTION
1. (a) Number of Employees: Union Non -U on
Full time: Full time: '
Part time:
rn` Part time:
Total: s-1 Total:
(b) Total number of Volunteers:
2. List total number of Employees in the following states:
CA NJ NY '."�- MA � TX -''-�-
3. How many Employees or Officers have been terminated within the last twelve (12) months?
Number of Employees: _ tom( Number of Officers:
RSG 21W6t 0008
4. Turnover percentage of Employees within the last twelve (12) months?
5. Does the Organization anticipate making any reductions in the work force within the next Yes Q No Y
twelve (12) months?
(if "Yes ", please give details)
6. Did the Organization make any changes to its Employee manual or handbook, or Yes ❑ No [
employment application within the last twelve (12) months?
(1f "Yes ", please give details)
The undersigned authorized Officer of the Organization, on behalf of the Directors and Officers and the Organization,
declares that to the best of his/her knowledge and belief the statements set forth herein are true. The undersigned agrees
that this renewal application is a supplement to the application completed for the issuance of the first policy, and that
application together with this renewal application and information, particulars, documents, representations and written
statements fumished pursuant hereto shall be the basis of the contract should a policy be Issued and such applications
will be attached and become part of the policy, The Insurer is hereby authorized to make any investigation and inquiry it
deems necessary i n connection with this application.
NOTE: This application must be signed by the Chairman of the Board, President or Executive Director and dated
within thirty (30) days of the effective date of coverage.
The undersigned authorized Officer agrees that if the information supplied on this application changes between
the date of this application and the effective date of the insurance, he/she (undersigned) will immediately notify
the Insurer of such changes, and the Insurer may withdraw or modify any outstanding quotations and/or
authorization or agreement to bind the insurance.
Signature Title A,om, A/t SrA ArdlL
(.. Irman of the Board, resldenf or Executive Director)
Date Organization Amac T ova 6y!aLcAL t1 yjrotym 'N7
One copy of each of the following documents is attached and made part of the policy:
(a) COMPLETE COPY OF LATEST ANNUAL REPORT. IF AUDITED FINANCIALS, PLEASE INCLUDE AUDITORS NOTES.
(b) COMPLETE COPY OF BY LAWS
(C) CURRENT L IST OF DIRECTORS AND OFFICERS
(d) EEO -1 REPORT (IF REQUIRED BY FEDERAL LAW)
J SMITH .LANIER OF AUGUSTA
PO BOX 211110
Augusta, GA 30917 -1110
Submitted 13y Date
(Producer)
1//6�/d
RSG 210026 NOW
Augusta, GA - Official 'Website - Augusta Commission
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Tuesday, February 16, 2010
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�riaze.r
�5YSsTf#�6�1',
Address
75 Conifer Cir.
Augusta, GA 30909
Contact
Ph: (706) 738 -3156 (home)
Ph: (706) 821 -1831 (work)
Fx:(706) 821 -1835
FLnrl 1
Matt Aitken
Term 2010 - 2012
Address
609 Telfalr Street
Augusta, GA 30961
Contact
Ph; (706) 724 -4377 (home)
lmlail
Carey Johnson
Term 2008-2010
Address
2222 Woodland Avenue
Augusta, Georgia 30904
Contact
Ph: (706) 736 -4435 (home)
Fx:(706) 821 -1838
Ph; (706) 993 -D224 (cell)
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Toe Bowles
Term 2010 - 2012
Address
D14 Milledge Rd.
4ugusta, GA 30904
: ontact
Ih: (706) 825.6894 (cell)
'h: (706) 210 -1880 (work)
°x: (706) 210 -1871
District 4 District 9
Alvin Mason Mayor Pro Tem
Term 2008 - 2010
.Joe Jackson
Term 2008 - 2010
Address
2328 Neal St.
Augusta, GA 30906
Contact
Ph; (706) 533 -7839 (home)
Fx :(706) 821 -1838
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Jerry Brigham
Term 2010 -2012
Address
2904 Pleasant Cove Ct.
Augusta, GA 30907
Contact
Ph: (706) 863 -1698 (home)
oh: (706) 650 -1700 (work) '
x: (706) 650 -1141
:.mail
Jimmy Smith
Term 2008 -2010
Address
1332 Brown Rd.
Hephzibah, GA 30815
Contact
Ph: (706) 798 -3890 (home)
Fx :(706) 821 -1838
zmall
J. R. Hatney
Term 2010 - 2012
http:// www .augustaga.gov /index.aspx' ?ni.d =652 2/16 /2010
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Commissioners
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Address
4504 Frank Warren Drive
Hephzibah GA 30815
Contact
Ph: (706) 955 -6130 (cell)
Fx:(706) 821 -1838
Emai
817[ Lockett
Term 2010 - 2012
Address
3030 Longfeaf Court
Augusta, GA 30906
Contact
"h: (706) 798 -7175 (home)
=x: (706) 821 -1838
rri"
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Address
119 E. Walker St
Augusta, GA 30901
Contact
Ph: (706) 722 -5035 (home)
Fx:(706) 821 -1838
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Dort A. Grantham
Term 2008 -2010
Address
808 Quail Ct.
Augusta, GA 30909
Contact
Ph: (706) 738 -2331 (home)
Ph: (706) 738 -7786 (work)
Fx: (706) 733 -4741
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