3.04 3.4
INSURANCE\Worker's Compensation Insurance Prodder—PERMA Renewal-6-1-15
RESOLUTION AUTHORIZING RENEWAL OF
TOWN OF QUEENSBURY'S WORKERS' COMPENSATION POLICIES
WITH PUBLIC EMPLOYER RISK MANAGEMENT
ASSOCIATION, INC. (PERMA)
RESOLUTION NO.: ,2015
INTRODUCED BY:
WHO MOVED ITS ADOPTION
SECONDED BY:
WHEREAS, by Resolution No.: 167, 2013, the Queensbury Town Board authorized the
naming of Haylor, Freyer & Coon, Inc. as Broker of Record (Broker) relating to the Town of
Queensbury's Workers' Compensation Policies(Policies), and
WHEREAS, by Resolution No.: 218, 2014, the Queensbury Town Board authorized and
awarded the Town of Queensbury's Workers' Compensation Policies to the Public Employer Risk
Management Association, Inc., ("PERMA"), and
WHEREAS, the Town Board wishes to renew such Policies with PERMA as set forth in the
renewal quotation dated May 21, 2015 and presented at this meeting,
NOW, THEREFORE, BE IT
RESOLVED, that the Queensbury Town Board hereby authorizes its renewal of its Town of
Queensbury's Workers' Compensation Policies with the Public Employer Risk Management
Association, Inc., ("PERMA") as set forth in the renewal quotation dated May 21, 2015 and presented
at this meeting, and
BE IT FURTHER,
RESOLVED, that the Town Board further authorizes and directs the Town Supervisor to sign
any needed Agreement and/or any other documentation and the Town Supervisor and/or Budget
Officer to take all actions necessary to effectuate the terms of this Resolution.
Duly adopted this 1St day of June, 2015, by the following vote:
AYES
NOES
ABSENT:
May 21,2015
Town of Queensbury
Attn:Victoria LaMarque
742 Bay Road
Queensbury,NY 12804
Dear Member:
Thank you for your business this past year. Your Workers' Compensation coverage will expire on
07/01/2015 and automatically renews as per the enclosed renewal quotation and optional `PERMA Pay
Plan.' Please review the documents carefully and advise if any changes to the indicated exposures are
necessary. Payment for the enclosed Pay Plan must be received prior to 07/01/2015.
We greatly appreciate your cooperation this past year with providing quarterly payroll updates for the
NYS Workers Compensation Board assessment billing process. The required changes were implemented
in January 2014 and have had cost savings benefits for most members. The 2015 assessment rate was just
released and it has dropped slightly from 13.8%to 13.2%,which is reflected in your renewal quotation.
Again,many thanks for your continued support.
Sincerely,
)8. &It'-- ------
Alfred . Campney
Senior Director of Marketing&Underwriting
888-737-6269 x3017
acampnev n,perma.org
cc: Haylor,Freyer&Coon,Inc- Syracuse
IMPORTANT: If you plan to entertain competitive quotes, it is imperative that you provide written notice to PERMA no
later than 30 days before your renewal to avoid penalties. Please contact Member Services for assistance in complying
with this requirement.
y r%� Public Employer Risk Management Association, Inc.
9 Cornell Road,Latham,NY 12110
Toll Free in US(888)737-6269
wwW.perma.org
PERMA-
Managed by Northeast Association Management, inc.
Quote Date: May 21,2015
Member Number: WC 0001390-01 Broker of Record: 1650-01
Town of Queensbury Naylor,Freyer&Coon, Inc-Syracuse
Attn:Victoria LaMarque PO Box 4743
742 Bay Road 231 Salina Meadows Parkway
Queensbury, NY 12804 Syracuse, NY 13212
First Dollar Pricing Indication
Workers' Compensation and Employers Liability Coverage Period:
Unit: 1-Town of Queensbury From 07/01/2015-07/01/2016
Class`Code Description Estimated Estimated
Exposure Contribution
5506 Street Maintenance-Paving 533,156 156,387
5645 Carpentry:Dwellings 68,432 13,954
7520 Waterworks 900,224 89,331
7542 Meter Readers-Utility Company 226,200 19,079
7590 Transfer Station-Operators 174,720 11,737
8391 Automobile Mechanics 104,000 8,048
8810 Clerical Office 2,488,512 10,665
8820 Attorneys 56,368 221
8831 Animal Control Officers 39,832 1,108
9015 Lifeguards/Beaches 37,024 2,212
9026 Building Operations, Custodial 342,576 23,468
9063 Recreation 196,560 3,413
9101 Schools:All Others 16,120 1,357
9102 Parks Maintenance 340,652 16,139
9220 Cemetary Operations 172,848 20,036
9402 Street Cleaning 570,024 71,961
9410 Municipal Employees 350,896 28,039
9999 V All Volunteers If any 0
• Subtotals( hi 6,618,144 $477,155`
Volunteer Firefighters Benefit Law(VFBL):
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Public Employer Risk Management Association, Inc.
9 Cornell Road, Latham,NY 12110
Toll Free in US(888)737-6269
wwwperma.org
DERMA-
Managed by Northeast Association Management, Inc.
Quote Date: May 21,2015
Member Number: WC 0001390-01 Broker of Record: 1650-01
Town of Queensbury Haylor,Freyer&Coon, Inc-Syracuse
Attn:Victoria LaMarque PO Box 4743 •
742 Bay Road 231 Salina Meadows Parkway
Queensbury, NY 12804 Syracuse, NY 13212
First Dollar Pricing Indication
Workers' Compensation and Employers Liability Coverage Period:
Unit: 1-Town of Queensbury From 07/01/2015-07/01/2016
Class Code Description Total % Estimated
Population Served :: Contribution
7711 Volunteer Firefighters 25,001 100% 185,315
7711 ELN Extension of Employers Liability Coverage- Coverage Elected- Included
Coverage Elected-No Charge No Charge.44 Subtotals ,r >g ,. , f 25,001xia $185,315
Ambulance Workers Benefit Law(VAWBL):
Class Code Description Number of Ambulances.� Estimated
Used Contribution
7370-01 Volunteer 1st Ambulance 1 100% 14,109
7370-02 Volunteer 2nd Ambulance 9 100% 63,489
7370 ELX Extension of Employers Liability Coverage- No Coverage Excluded
No Coverage
Subtotals: „,,10 $ 7,598
Total Contribution $740,068
New York StatelA"ssessment•; , $15,725
Total Estinlated,Contribution&Asse smentf t 1 $755,793
Total Estimated'CPverage Cost clue PERMA',! ` ' $755,793;
Please note that the promulgated Experience Modification Factor for the Town of Queensbury is 1.5.
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PERMA Pay Plan
i FA r`'Y
ti�esc fto
�+ �� � : " ��._s. Y� � .. ,"�M,
Annual Billing
Descnpt orb Due at Inceptiont
Contribution $740,068
New Yorl� ate ,ssessment $15 725
Total e. `4 ` 1r $755 793
Invoice Schedule Amount
Post Date
06/01/2015 Annual Installment $755,793
Total $755,793
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