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3.08 3.8 INSURANCE\hisurance Agent for 2015-16–ReneNval for Marshall&Sterling-Trident-Argonaut—6-15-15 RESOLUTION AUTHORIZING MARSHALL & STERLING UPSTATE, INC. TO RENEW TOWN OF QUEENSBURY INSURANCE COVERAGE FROM TRIDENT/ARGONAUT RESOLUTION NO.: ,2015 INTRODUCED BY: WHO MOVED FOR ITS ADOPTION SECONDED BY: WHEREAS, by Resolution No.: 212,2014, the Queensbury Town Board authorized Marshall & Sterling Upstate, Inc., to obtain insurance coverage for the Town of Queensbury from Trident/Argonaut effective July 1St, 2014—June 30t1i 2015, and WHEREAS, the Town Board wishes to authorize the renewal of insurance coverage with Trident/Argonaut effective July 1St, 2015 — June 30t1i 2016, in accordance with Marshall and Sterling Upstate, Inc.'s June 8t1i 2015 proposal presented at this meeting, NOW, THEREFORE, BE IT RESOLVED, that the Queensbury Town Board hereby authorizes and directs the Town Budget Officer and Marshall & Sterling Upstate, Inc., to renew insurance coverage for the Town of Queensbury from Trident/Argonaut effective July 1St, 2015 — June 30t1i 2016 in accordance with Marshall and Sterling Upstate, Inc.'s June 8t1i 2015 proposal presented at this meeting, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Town Supervisor to execute any agreements and any other documentation, and the Town Supervisor, Town Counsel and/or Town Budget Officer to take any actions necessary to effectuate the terms of this Resolution. Duly adopted this 15th day of June, 2015, by the following vote: AYES NOES ABSENT: Queensbury Town 2015 renewal proposal Town of Queensbury Attn: John Strough, Town Supervisor Barbara Tierney, Budget Officer Joanne Watkins, Accountant 742 Bay Road Queensbury, NY 12804 Re: Town of Queensbury insurance proposal June 2015 Enclosed is the Town of Queensbury insurance and risk management proposal for the July 1, 2015 to 2016 policy period. Overall, the current Trident program has provided the town exceptional value through a stable and highly competitive market. Since the time Marshall & Sterling was favored with your business in 2008, premiums have significantly decreased with continued broadening of coverage. Examples include increasing umbrella limits from $5 million to $10 million and an increase in blanket property values from $32,515,617 to $49,615,367. Overall, premium versus exposure is almost half of the town's insurance costs in 2006, prior to Marshall & Sterling. A summary of historical insurance premiums and services is included below: • Trident premium: $161,877.99 plus taxes; expiring premium: $155,058.90. • Trident reduced rates for the Town for the 2014-15 policy while increasing property limits by 3%. For 2015-16, Trident's renewal rate increased by less than 3%. Auto liability increased with one ratable unit. Auto physical damage limits increased from $4,852,689 to $5,400,012. Total property insurance values increased from $47,533,403 to $49,615,367. Inland Marine limits increased from $3,086,287 to $3,197,337. For perspective, the overall public entity market experienced rate increases of approximately 7-11% in 2013 and 5-7% for 2014 for accounts with profitable loss experience. For 2015, market rates are stabile. • Safeonline cyber liability/data breach renewal remained unchanged: $12,287.55; expiring premium versus expiring premium of$12,289.92. • Umbrella/excess coverage was increased in 2010 from $5 million to $10 million for an additional premium of$2,500 ($500 per million of coverage). • Public Officials' coverage form includes first dollar defense coverage, typically not offered by most insurers. • Pollution liability-preparing an alternative quote, as application recently received. First proposal received annual premium of$11,546, details to follow. This analysis was conducted in 2010-11 and 2008 with quotes in the $17,000 + range. • Cyber liability alternatives with significantly broader coverage terms were presented and accepted by the town in 2013. • Marshall & Sterling annually reviews your policy for competitiveness and identifies new market entrants and/or carriers that have changed market position for your benefit. As of this writing, NYMIR's financial rating from AM Best changed from an A Excellent to an A- Excellent with a negative outlook. When the town's insurance program was marketed in 2013, NYMIR was the second most competitive to Trident with a premium/capitalization of$183,235.54, excluding Cyber liability. For 2014, we contacted Traveler's Public Entity which improved their competitive position in the marketplace. Travelers advised they could not compete with Trident's renewal terms. Selective had also improved their competitive position, however, were unable to compete. • Marshall & Sterling has access to the leading municipal insurers, as one of the top 30 privately owned insurance agencies in the US. We continue to evaluate markets, review coverage requirements and provide alternative quotes annually to ensure the Town of Queensbury is receiving the best value. Risk Management and Safety awareness activities: • Provided winter activity books for pet safety awareness, crayons and playing cards for the Queensbury Children's Holiday party (2014). • Lorraine Emerick of Marshall & Sterling worked with Animal Control Officer Fitzgerald and Maya to develop a dog bite prevention campaign (2013-14). Marshall & Sterling provided a powerpoint presentation suitable for elementary age children, coloring books, stuffed animals and Maya decals. • Availability of Marshall & Sterling loss control services and the risk management portal (Mywave). Katy Pagano at Marshall & Sterling is also available to conduct mock OSHA inspections. • Marshall & Sterling conducted an extensive property valuation survey in 2008 at the inception of our business relationship, identifying duplicate exposures, in addition to new exposures for insurance purposes. • October 2009-Selective loss control performs infrared survey of various buildings and participates with Town safety committee. • Defensive Driving online training in 2014; continuously available through Marshall & Sterling at cost$23/per person. • Coordinating in person defensive driver training for Town of Queensbury employees by Marshall and Sterling loss control department for 15-40 personnel. Only charge is cost of books-$17/per employee. Class conducted 2014. • Trident online class (20-30 minutes) to reinforce positive driving behavior. • Reviewed loss control services and Marshall & Sterling risk management portal (Mywave provides OSHA automated logging; Safety training power points; • Provide ongoing consultation and certificate of insurance advice and templates for third party projects to protect the town's assets. • Introduction of the LENS program in 2008 Premium History: 2015-16 Trident: $161,877.99 (includes taxes and NYS fees); $174,166 (includes cyber) 14-15 w/Trident: $155,058.90; $167,348.82 (includes cyber); 13-14 w/Trident: $156,461.77; $168191.17 (Lloyds cyber policy replaces Chubb) 12-13 w/Trident: $156,133 includes Chubb internet liability 11-12 w/Trident: $149,320 includes Chubb intemet liability 10-11 w/Selective: $184,301 includes Chubb internet liability 09-10 w/Selective: $189,008 includes Chubb internet liability 08-09 w/Selective: $183,157 includes Chubb intemet liability 07-08 w/NIF: $226,000(prior to M&S 06-07 w/Trident: $298,000 (prior to M&S) Thank you for your confidence in Marshall & Sterling as your broker and risk management advisor. We look forward to meeting to review your upcoming program and discuss service and risk management initiatives for the new policy term. Sincerely, Ken Grey Cc: Patty Benway, Commercial Lines Supervisor Lorraine Emerick, VP of Client Service and Operations Excellence in Insurance Protection !,t,-,,,,,--g-7,, -44,,,,,v;,9-3r,--,,y7/!,,ps. -im.;;; ---,, ---„,,.: ---,, ,.. i _ 0 y ____ 2,,,::::A5:::,,,,"'44'44,11i;. e,J, ~ f ! '1� 3 d F ' ?�k..j Cll l ilALl. i Town of Queensbury Barbara Tierney Ts v 742 Bay Road mg Queensbury, NY 12804 INSURANCE Our People Are Your Best Insurance PRESENTED BY: MARSHALL & STERLING UPSTATE KENNETH W GREY 125 HIGH ROCK AVENUE SUITE 206 KGREY@MARSHALLSTERLING.COM SARATOGA SPRINGS, NY 12866 PROPOSAL DATE:JUNE 8, 2015 PHONE:518-587-1342 PROPOSAL EXPIRES ON JULY 1, 2015 FAX:518-587-1348 www.marshallsterling.com/leeds The abbreviated outline of insurance coverage contained in this proposal is not intended to express any legal opinion as to the nature of coverage. The abbreviated summary of insurance coverage set forth in this proposal is subject to all of the terms,conditions,exclusions and limitations of the policy(ies)in current use by the insurance contpany(ies)listed for the summarized coverage. In order loftily understand the terms,conditions,exclusions and limitations of the insurance policy(ies)referred to in this proposal,you should request and review a specimen copy of the policy(ies). PREMIUM SUMMARY Town of Queensbury Barbara Tierney Proposed Coverage Date July 1, 2015 Policy Type Expiring Carrier A.M.Best Admitted Expiring Proposed A.M. Admitted Proposed i Name Rating In NY Premium Carrier Best In NY Premium Name Rating Trident\ Trident\Property Argonaut A Yes $41,625.90 Argonaut A Yes $44,481.99 Inland marine Trident\ A Yes $5,341 Trident\ A Yes $4020 Argonaut Argonaut Trident\ Trident\ Commercial Auto Argonaut A Yes $60,940 Argonaut A Yes $63,665 Trident\ Trident\ General Liability Argonaut A Yes $24,337 Argonaut A Yes $25,461 OCP Trident\ A Yes $200 Trident\ A Yes $200 Argonaut Argonaut Public Officials Trident\ A Yes $6,807 Trident\ A Yes $7,616 Argonaut Argonaut Trident\ Trident\ Umbrella Argonaut A Yes $15,808 Argonaut A Yes $16,434 Subtotal $155,058.90 $161,877.99 Cyber Lloyds No $12,289.92 Lloyds No $12,287.55 Total Premium $167,348.82 $174,165.54 Subject To: Signed Statement of Values,Signed TR1A Form,Signed SUM form,Signed Cyber Application,Signed Total Cost Form,Signed Payment Option Form Proposal accepted as presented: Authorized Signature Date Proposal accepted as amended per changes noted on pages: . Authorized Signature Date INSURED LOCATIONS LOCATION# BUILDING# ADDRESS DESCRIPTION 001 001 742 Bay Road, Queensbury,NY 12801 Office 001 002 742 Bay Road, Queensbury,NY 12801 DPW 001 003 742 Bay Road, Queensbury,NY 12801 Activity Center 001 004 742 Bay Road, Queensbury,NY 12801 Salt storage 001 005 742 Bay Road, Queensbury,NY 12801 Equipment Storage building 001 006 742 Bay Road, Queensbury,NY 12801 Equipment Storage building 001 007 742 Bay Road, Queensbury,NY 12801 Storage Shed 001 008 742 Bay Road,Queensbury,NY 12801 2 Bay Wooden Shed j 002 001 110 Gurney Road, Queensbury,NY 12801 Restrooms 002 002 110 Gurney Road, Queensbury,NY 12801 Filter Building 002 003 110 Gurney Road,Queensbury,NY 12801 Pavilion 002 004 110 Gurney Road, Queensbury,NY 12801 Bathhouse 002 005 110 Gurney Road, Queensbury,NY 12801 Swimming Pool 003 001 21 QuakerRoad, Queensbury,NY 12801 Office 003 002 21 Quaker Road, Queensbury,NY 12801 Garage 003 003 21 Quaker Road, Queensbtuy,NY 12801 Garage 003 004 21 Quaker Road,Queensbury,NY 12801 Vault 003 005 21 Quaker Road,Queensbury,NY 12801 Garage 004 001 1396 Ridge Road, Queensbury,NY 12801 Transfer Station Office 004 002 1396 Ridge Road, Queensbury,NY 12801 Garage 004 003 1396 Ridge Road, Queensbury,NY 12801 Compactor Building 004 004 1396 Ridge Road, Queensbury,NY 12801 Guard House 005 001 64 Luzerne Road, Queensbury,NY 12801 Storage Building 005 002 64 Luzerne Road, Queensbury,NY 12801 Compactor Equipment 005 003 64 Luzerne Road, Queensbury,NY 12801 Guard House 005 004 249 Assembly Point, Queensbury,NY 12801 Compactor Equipment 006 001 Clark Street, Queensbury, NY 12801 Pump Station 007 001 249 Assembly Point, Queensbury,NY 12801 Filter Building 007 002 249 Assembly Point, Queensbury,NY 12801 Filter Building 008 001 823 Corinth Road, Queensbury,NY 12801 Water Treatment& Intake 008 002 823 Corinth Road, Queensbury,NY 12801 Garage 008 003 823 Corinth Road, Queensbury,NY 12801 Generator Building 008 004 823 Corinth Road, Queensbury,NY 12801 Storage building 008 005 823 Cornith Road, Queensbury,NY 12801 Office Building 008 006 823 Cornith Road, Queensbury,NY 12801 Storage Building 009 001 117 Luzerne Road, Queensbury,NY 12801 Playground 009 002 117 Luzerne Road, Queensbury,NY 12801 Pavilion. 010 001 96 Gurney Lane, Queensbury,NY 12801 Water Tank 010 002 96 Gurney Lane, Queensbury,NY 12801 Water Tank 011 001 768 Luzerne Road, Queensbury,NY 12801 Water Tank 012 001 153 Jenkinsville Avenue,Queensbury,NY Restrooms 12801 012 002 153 Jenkinsville Ave, Queensbury,NY 12801 Maintenance Building 012 003 153 Jenkinsville Ave, Queensbury,NY 12801 Equipment Building 012 004 153 Jenkinsville Ave, Queensbury, NY 12801 Field House 012 005 153 Jenkinsville Ave, Queensbury,NY 12801 Pavilion 013 001 101 Meadowbrook Road, Queensbury,NY Pump Station 12801 013 002 101 Meadowbrook Road, Queensbury,NY Machinery 12801 014 001 398 Aviation Road, Queensbury,NY 12801 Police Station 015 001 81 Glenwood Avenue, Queensbury,NY 12801 Town Justice 016 001 71 Glenwood Ave, Queensbury, NY 12801 Playground 017 001 Hudson Point Blvd, Queensbury, NY 12801 Nature Building 018 001 N/S Aviation Road, Queensbury, NY 12801 Welcome Sign 020 001 363 Big Bay Road, Queensbury, NY 12801 Salt Shed 021 001 W/S Big Boom Road, Queensbury,NY 12801 Pavilion 021 002 W/S Big Boom Road, Queensbury,NY 12801 Hexagon Pavilion 022 001 West Mountain Road, Queensbury, NY 12801 Water Tank 023 001 195 Sunnyside Road, Queensbury, NY 12801 Storage Building 024 001 284 Queensbury Road, Queensbury,NY 12801 Water Tank 025 001 21 Lafayette Street, Queensbury,NY 12801 Storage Building 026 001 51 Quaker Road,Queensbury, NY 12801 Crematorium 027 001 Queensbury Ave at the Airport,Queensbury,NY Pump Station 12801 028 001 Weeks Road,Queensbury,NY 12801 Pump Station 029 001 Route 9 at Great Escape, Queensbury,NY Pump Station 12804 032 001 Stone Quarry Road, Queensbury, NY 12804 Wastewater Pump Station 033 001 Main St &Media Drive, Queensbury,NY Kiosk 12804 034 001 Media Drive, Queensbury,NY 12804 Park&Ride Shelter COVERAGE SUMMARY POLICIES AND COVERAGE LIMIT PER AGGREGATE DEDUCTIBLE OCCURRENCE LIMIT PROPERTY Building&Contents(TN) $49,615,367 $2,500 Coinsurance Percentage Agreed Amount Valuation Replacement Cost Cause Of Loss Special Extra Expense and Business Income $1,000,000 $1,000 Earthquake $5,000,000 $50,000 Flood $5,000,000 $50,000 Valuable Papers $100,000 Accounts Receivable $100,000 Computer Equipment $275,000 $500 Communications Equipment $50,000 Fine Arts(Includes$45,000 Eagle Statue) , $95,000 $1,,000 BOILER&MACHINERY Equipment Breakdown $49,615,367 $2,500 Extra Expense and Business Income $1,000,000 Expediting Expense $100,000 Hazardous Substance $100,000 CFC Refrigerants Included Data Restoration $100,000 Boiler Inspection Included Computer Equipment $100,000 GENERAL LIABILITY Bodily Injury/Property Damage , $1,000,000 $3,000,000 $0 Products Completed Operations $1,000,000 $3,000,000 Personal Injury&Advertising Injury $1,000,000 Fire Damage Legal Liability $100,000 Medical Expense—Per Person Excluded Employee Benefits Liability $1,000,000 $1,000,000 $1,000 Limited Pollution Liability for Water Utility Included Limited— Failure to Supply for Water Utility Included Professional Engineering Services-Chris Harington& Alex Benway Included Cemetery Professional Liability Included COMMERCIAL AUTOMOBILE Combined Bodily Injury/Property Damage Liability $1,000,000 Personal Injury Protection $50,000 Additional Personal Injury Protection $100,000 OBEL $25,000 Supplementary Uninsured Motorists $1,000,000 Hired &Non-Owned Automobile Liability $1,000,000 Mutual Aid $1,000,000 Comprehensive Coverage Per Schedule Collision Coverage Per Schedule PUBLIC OFFICIALS LIABILITY PER WRONGFUL ACT $1,000,000 $3,000,000 $10,000 Employment Related Practices $1,000,000 $3,000,000 Included Back Wages $50,000 $10,000 Retroactive Date: 10/01/1994 INLAND MARINE Hired, Leased, Borrowed Equipment $235,000 $500 Scheduled Equipment $2,862,337 $500 Unscheduled Equipment $100,000 $1,000 OWNER&CONTRACTORS PROTECTIVE $1,000,000 $2,000,000 EXCESS CATASTROPHE LIABILITY POLICY $10,000,000 $10,000,000 General Liability Included Commercial Automobile Liability Included Public Officials Included DELUXE PROPERTY COVERAGE FORM DESCRIPTION LIMIT Accounts Receivable at Premises $100,000 Loss of Undamaged Portion of Building Building Limit Demolition Cost Coverage $100,000 Increased Cost of Construction $100,000 Changes in Temperature or Humidity $50,000 Commandeered Property $100,000 Common Deductible Provision Included Communications Equipment $50,000 Computer Equipment ($500 Deductible) $275,000 Detached Signs $5,000 Electrical Damage $50,000 Extra Exp & Bus Income($1,000 Deductible) $1,000,000 Fairs, Exhibitions, Expositions or Trade $50,000 Shows Fine Arts ($1,000 Deductible) -Including $95,000 Eagle Statue Fire Department Service Charge $5,000 Flagpoles $5,000 Foundations Included Glass Included Glass Display or Trophy Cases $5,000 Grounds Maintenance Equipment $50,000 Lock Replacement $500 Money&Securities Inside ($1,000 Deductible) $10,000 Outside($1,000 Deductible) $10,000 Newly Acquired or Constructed Property Building $1,000,000 Personal Property $500,000 Off Premises Utility Failure $50,000 Outdoor Property Any One Tree, Shrub or Plant $1,000 Total Limit $50,000 Personal Property of Others Any One Employee or Volunteer $1,500 Any One Occurrence $50,000 Replacement Cost Valuation Included Pollutant Clean Up and Removal $25,000 Premises Boundary Increased Limit 1,000 Feet Property in Transit $50,000 Property Off Premises $50,000 Sewer Back-Up Included Spoilage $10,000 Valuable Papers $100,000 PROPERTY SCHEDULE LOC4 BLDG# ADDRESS DESCR I PTION BUILDING CONTENTS VALUE VALUE 1 1 1 742 Bay Road Office $3,304,902 $200,000 1 2 742 Bay Road DPW $2,865,960 $43,021 1 3 742 Bay Road Activity Center $1,248,529 $119,573 1 4 742 Bay Road Salt Storage $235,841 $0 1 5 742 Bay Road Equipment Storage Building $74,088 $0 1 6 742 Bay Road Equipment Storage Building $5,377 , $0 ' 1 7 742 Bay Road Storage Shed $5,694 $0 1 8 742 Bay Road 2 Bay Wooden Shed $14,662 $0 2 1 110 Gurney Road Restrooms $50024 $0 2 2 110 Gurney Road Filter Building $48,155 $1,645 2 3 110 Gurney Road Pavilion $68,931 $1,266 2 4 110 Gurney Road Bathhouse $295,562 $8,224 2 5 110 Gurney Road Swimming Pool $408,698 $0 3 1 21 Quaker Road Office $285,940 $4,428 3 2 21 Quaker Road Garage $9,133 $1,644 3 3 21 Quaker Road Garage $9,133 $1,644 3 4 21 Quaker Road Vault $220,688 $16,449 3 5 21 Quaker Road Garage $51,374 $0 1 4 1 1396 Ridge Road Transfer Station Office $28,469 $3,796 . 4 2 1396 Ridge Road Garage $68,192 $3,796 4 3 1396 Ridge Road Compactor Building $44,286 $0 4 4 1396 Ridge Road Guard House $7,593 $0 5 1 64 Luzerne Road Storage Building $54,761 $1,645 5 2 64 Luzerne Road Compactor Building $50,614 $0 5 3 64 Luzerne Road Guard House $11,387 $0 5 4 64 Luzerne Road Compactor Equipment $14,551 $0 6 1 Clark Street Pump Station $43,021 $0 7 1 249 Assembly Point Filter Building $25,948 $0 7 2 249 Assembly Point Filter Building $41,712 $0 8 1 823 Corinth Road -Water Treatment& Intake $24,926,786 $86,041 8 2 823 Corinth Road Garage $784,499 $159,430 8 3 823 Corinth Road Generator Building $425,779 $8,223 8 4 823 Corinth Road Storage Building $110,485 $8,223 8 5 823 Corinth Road Office Building $1,886,947 $100,000 8 6 823 Corinth Road Storage Building $102,491 $0 9 1 117 Luzeme Road Playground $83,511 $1,644 9 2 117 Luzerne Road . Pavilion $8,181 $0 10 1 96 Gurney Lane Water Tank $632,659 $0 10 2 96 Gurney Lane Water Tank $999,603 $0 11 1 768 Luzerne Road Water Tank $1,493,077 $0 12 1 153 Jenkinsville Avenue Restrooms $112,085 $0 12 . 2 153 Jenkinsville Avenue Maintenance Building $259,450 $16,449 12 3 I 153 Jenkinsville Avenue Equipment Building $59,469 $1,644 ..._... PROPERTY SCHEDULE Loc# BLDG# ADDRESS DESCRIPTION BUILDING CONTENTS VALUE VALUE 12 4 153 Jenkinsville Avenue Field House $253,064 $12,654 12 5 153 Jenkinsville Avenue Pavilion $8,181 $0 13 1 101 Meadowbrook Road Pump Station $266,984 $1,266 13 2 101 Meadowbrook Road Machinery $64,043 $0 14 1 398 Aviation Road Police Station $1,034,269 $0 15 1 81 Glenwood Avenue Town Justice $897,751 $16,827 16 1 71 Glenwood Avenue Playground $288,493 $1,643 17 1 Hudson Point Boulevard. Nature Building $2,531 $0 18 1 N/S Aviation Road Welcome Sign $18,980 $0 19 1 363 Big Bay Road Salt Shed $235,778 $21,144 20 .1 W/S Big.Boom Road Pavilion $41,756 $0 20 2 W/S Big Boom Road Hexagon Pavilion $6,893 $0 2] 1 West Mountain Road Water Tank $632,659 $0 22 1 195 Sunnyside Road Storage Building $588,363 $39,857 23 1 284 Queensbury Road Water Tank $999,603 $0 24 1 21 Lafayette Street Storage Building $5,000 $0 24 2 21 Lafayette Street Gazebo $20,000 $0 25 1 51 Quaker Road Crematorium $254,961 $8,224 Queensbury Avenue at the 26 1 Airport Pump Station $264,801 $0 27 1 Weeks Road Pump Station $248,004 $0 28 1 Route 9 at Great Escape Pump Station $524,320 $0 29 1 Stone Quarry Road Wastewater Pump Station $554,326 $0 30 1 Main St&Media Dr Kiosk $10,000 $0 31 1 Media Drive Park&Ride Shelter $25,000 $0 TOTAL: $48,723,967 $891,400 EQUIPMENT PHYSICAL DAMAGE COVERAGE Type of Coverage Amount Co-Insurance Valuation Deductible Scheduled Equipment $2,862,337 90% ACV $500 Unscheduled Equipment $100,000 90% ACV $1,000 Hired/Leased/Borrowed $235,000 $500 SOME NOTABLE EXCLUSIONS&LIMITATIONS Equipment Leased or Rented To Others Leased/Rented From Others Flood& Earthquake Rental Expense Business Income Policy Auditable? Computer Virus Blanket Equipment Newly Acquired Equipment Care Custody& Control VALUATION KEY ACV=Actual Cash Value ST=Stated Amount RC=Replacement Cost AA=Agreed Value • 1 a ,____e c_.�.:.::i, _ r.. .we: s z.. _ -� -:J EQUIPMENT SCHEDULE MODEL AMOUNT OF ITEM# YEAR DESCRIPTION SERIAL# INSURANCE 001 1982 Fiat-Allis Loader 80U00124 $35,000 002 1999 Bobcat Loader 514440985 $27,000 003 1983 Caterpillar Grader 87V06795 $30,000 004 1990 Bobcat Skidder/Loader 501962471 $5,000 005 1987 Caterpillar Wheel Loader 950B 22Z2555 $30,000 006 1993 Ford Tractor BD61414 $7,000 007 1993 Rawson Screeb Plant 22493 $23,000 008 1995 Case Akerman Wheel E xcavator/Backhoe EW230V1507 $100,000 009 1995 Caterpillar D4C Tractor w/Bulldozer 064L100908 $32,000 010 1996 Elgin Street Sweeper P1938D $45,000 012 2000 Fermec Backhoe SMFB44TCOX7CM0505 $36,774 013 2003 New Holland Tractor 1292335 $21,632 014 Rawson Radial Stacking Conv-RC4024 121997 $8,000 015 Bobcat Cold Planer $9,000 016 2000 Bobcat Loader 519014870 $21,632 017 2001 Hyundai Wheel Loader L901FG10033 $54,080 018 2001 Elgin Broom Sweeper P3502S $75,712 ' 019 Mauldin Vibratory Roller 00836AA14CGSI $7,000 020 1998 Dynapac Tandem Roller 62510622 $40,000 021 Versalift Aerial Lift A1020117 $12,500 022 1998 Hood Hydraulic Loader 75745 $6,000 023 Vermeet Brush Chipper 1VRN15176Y10032 $10,000 024 2005 John Deere Loader DW624JZ599468 $97,344 025 1987 Mitsubishi Tractor 13619 $5,000 026 2000 Hustler Lawn Mower/T ractor 82001 $9,734 027 Skidsteer Uniloader w/Backhoe 600466 $31,200 029 Hustler Mower 03052356 $9,500 030 Hustler Mower 03062225 $11,900 031 1987 John Deere 490 D Excavator CK490DS014310 $25,000 032 1994 John Deere 510D Wheel Loader T0510DG797999 $82,200 033 2003 John Deere Loader DW544HX587259 $91,612 034 2004 John Deere Backhoe T0410GX938857 $78,957 035 John Deere Hydraulic Breaker 4001H239 $18,900 036 1988 Mitsubishi Tractor/M ower 283997 $6,300 037 1990 Bobcat Loader 501966536 $18,200 038 1989 Case Tractor w/Front End Loader 22181 $16,300 039 1990 John Deere Tractor M0075D025460 $10,300 040 Turfcat Rotary Mower 94671400270 $11,900 041 2005 Jacobsen Mower 94671302014 $14,061 042 Aries Inspection System w/Camera 03112601 $33,500 043 1988 Powerray Asphalt Reclaimer 630 $10,000 044 Ingersoll Rand Air Compressor 292315.-UGI-221 $13,600 045 1993 Alamo Mower AB127-03238 $18,500 047 Alamo Broom Mower 06254 $28,000 048 Highlander Sander-1 0' AO 1AK6041 A04 $6,000 049 Highlander Sander-1 3' A01AN6042A04 $6,900 050 10'Plow $5,600 051 989 MB Tow Behind Sweeper 13-1078 $7,100 052 2008 Wheel Loader w/Plow& Bucket L70FV62347 $130,746 053 Records Filing System $37,333 054 2008 Gas Storage Tank-Above Ground 102158 $41,750 055 2009 2009 Ryan TraicaireA erator $5,320 056 2008 Jacob Hydraulic Rota ry Mower JMC69116691160775 $42,542 057 2008 New A Compactor 15831 $40,555 058 2001 Ehwac Vacuum Excavator TLV0187.1 $21,316 059 1990 Bandi.Brush Chipper 484 $15,372 060 2008 Bulle Intelligent Training System Packag $16,554 061 1999 Pow R Mole Pipe Pusher 1450 $14,454 062 1969 Muell CC25 Tapping machine $10,000 063 2003 Linco 84-015 Pool Cover&Reel(Solar) $10,522 065 2006 Hustl Mower 6041045 $9,569. 066 2006 Hustl 927277 Mower 4061245 $9,566 067 1996 Inger IR 175 Air Compressor 219025 $8,500 068 1994 Joy Dl 85Q5 Sullivan Air Compressor 10781 $8,500 069 1991 John Deere 932 Front Mount Mower M0F932X100113 $6,824 070 2007 Scarifier $7,030 071 2000 Power Stinger For Pow R Mole 1030 $6,360 072 2003 Tidd 012062-02 Trail Groomer $2,949 073 Emergency Generators $39,840 074 2009 Snow Loader $118,885 075 2009 Stationary Compactor 16335 $46,495 077 1975 Generator 674815527 $12,003 078 Generator 6NA01658 $79,450 079 2008 Asphalt Roller 88242269 $16,254 080 2009 Wheeled Paver CATAP600VTFZ00240 $273,216 079 1992 Power Retort for 11 Ton Crematory IE 43 424319 $50,568 080 2009 Benco Snow Blower Attach w/Loader#8878 40-BSN-50-00 $17,000 081 2012 Salsco Chipper 818 4S9PC2228EC171011 $40,804 082 2012 Hustl Mower Super Z 9330875 12032705 $12,828 083 2012 Bobcat Tractor CT122 ABF512224 $13,407 084 2013 Generac Stand by Gen erator GEN881 S SG0070GSH 1 $27,906 085 2013 Caterpiller Mini-Excavator 304E CR TTN01636 $46,606 086 2014 Ring-O-Ma tic Vacuum Trailer VL-275 1R9G21623EP303002 $32,456 087 2009 Emergency Generator Stone Qrry Pump Stn $39,840 088 2009 Chemical Feed System-Stn Qrry Rd Pump St $37,987 089 2014 Caterpillar Loader 9 38K CATA0938KCSWL0281 $125,022 090 2015 John Deere Skid Steer Loader w/hydr snow 1T00315EHDG247590 $37,070 089 2015 Gorman-Rupp 8"Centrifugal Pump 1579285N $45,000 Total Amount of Scheduled Items $2,862,337 COMMERCIAL LIABILITY COVERAGES LIMITS OF LIABILITY General Liability Coverage Type Occurrence Each Occurrence $1,000,000 Personal Injury&Advertising Injury $1,000,000 General Aggregate $3,000,000 Products/Completed Operations Aggregate $3,000,000 Fire Damage Legal Liability $100,000 Medical Expense-Per Person Excluded Employee Benefit Liability Retro Date: Employee Benefit Included Employee Benefit Aggregate Limit $1,000,000 Employee Benefit Deductible $1,000 BUSINESS AUTO COVERAGE AUTOS COVERED LIMITS OF LIABILITY Liability Insurance Any Auto $1,000,000 Combined Single Limit Medical Payments Uninsured Motorists Owned Autos Subject to $1,000,000 Combined Single Limit Compulsory U.M. Laws Underinsured Motorist Owned Autos Subject to $1,000,000 Combined Single Limit Compulsory U.M. Law Personal Injury All Owned Autos Requiring No- Protection Total Limit Fault Insurance $150,000 No Deductible Optional Basic Economic Loss Autos Specified on Schedule $25,000 No Deductible PHYSICAL DAMAGE AUTOS COVERED VALUATION Comprehensive Autos Specified on Schedule Actual Cash Value Less Deductible Collision Autos Specified on Schedule Actual Cash Value Less Deductible SOME NOTABLE EXCLUSIONS AND LIMITATIONS Leased Value GAP Coverage MCS90 Customized/Modified Vehicles Pollution Cargo Garage Liability Foreign Exposures PPT Full Glass PPT Rental Coverage Drive Other Car Broadened PIP Spousal Liability Supplemental Uninsured Motorists Mobile Equipment VEHICLE SCHEDULE COMPREHENSIVE COLLISION VEH# YEAR MAKE VEHICLE IDENTIFICATION# VALUATION DEDUCTIBLE DEDUCTIBLE 001 1988 Ford 1FDYK82A4JVA459571 ACV $ 500 $500 002 1988 Ford IFDYK82A1JVA59575 ACV $ 500 $500 003 1980 Ford K8OUVHA8624 ACV $ 500 $500 1 004 2000 Ford 1FDXF46S9YED96436 ACV $ 500 $500 005 1992 Lntern'I 1HTGGBGT1NH408007 ACV $ 500 $ 500 006 1992 Intend 1HTGGBGT3NH408008 ACV $500 $500 007 2004 Ford 1FTNX21L94ED01333 ACV $ 500 $500 008 1990 Ford 1FDYK82AOLVA37716 ACV $ 500 $ 500 009 2005 Ford 1FDWF37Y15EA65936 ACV $ 500 $500 010 1995 Ford 1FDZU90U7SVA34568 ACV $ 500 $500 011 1995 Ford 1 FDZU9OUOSVA38735 ACV $ 500 $500 012 1996 Ford 1FDLF47G3TEA87479 ACV $500 $500 013 1998 Intern'l IHTGLAET8WG498864 ACV $ 500 $500 014 1999 Intern'! 1HTGLAET2XH6462989 ACV $ 500 $500 015 2000 Sterling 2FZNES"l'B3YAB53082 ACV $ 500 $ 500 016 1999 Ford 1FTZZE1726XNC07038 ACV $ 500 $500 017 1999 Dodge 3B7KF26Z6XMS70800 ACV $ 500 $500 018 2001 Intern'l 1HTSCABN7111341609 ACV $ 500 $500 019 2001 Dodge 31371(F26Z8.1M276904 ACV $ 500 $500 020 2001 Ford IFTNF21L11EC19322 ACV $ 500 $500 021 2001 Sterling 2FZHAZAV71AH49372 ACV $ 500 $ 500 022 2003 Intern'! 1HTGGAXT53H4560444 ACV $ 500 $500 023 2001 Intern'l 1 HTGLAHT11H355484 ACV $ 500 $ 500 024 2002 Intern'l IHTSCAAR32H502317 ACV $ 500 $ 500 025 2001 Ford 1 FDAF56S61 EC67247 ACV $ 500 $ 500 026 1976 Mack CF685F1930 ACV $ 500 $ 500 027 2003 Sterling 2FZHANAKO3AK35930 ACV $ 500 $ 500 028 2002 Ford 1FDWW37S72EC61600 ACV $ 500 $ 500 029 2002 Ford IFDSF35LX2EC49791 ACV $ 500 $ 500 030 2001 Ford 1FDSF47S61ED79212 ACV $ 500 $ 500 031 2002 Ford 1FDSF35L12EC49792 ACV $ 500 $ 500 032 2003 Ford 1FDXF46S23EC74512 ACV $ 500 $500 033 2003 Ford 1FDWW37S13EC72030 ACV $ 500 $ 500 034 2004 Intern'l 11-ITWXAXT14J084621 ACV $ 500 $500 035 2002 Ford 1FDAF57S12EA52021 ACV $ 500 $ 500 036 2004 Ford 3FRXF75S44V661787 ACV $ 500 $ 500 037 2004 Table 40FS0472710235540 ACV $ 500 $ 500 039 2005 Intern'l 1 HTWXSBT35J033202 RC $ 500 $ 500 040 2004 Ford 1FDAF57S24EC74165 ACV $ 500 $ 500 041 1992 Mack IM2K1910CNM003857 ACV $ 500 $ 500 042 2005 Chevy 1GCEK19V25E216995 ACV $ 500 $ 500 044 2006 Intern'! 1 HTWXSBT96J201488 RC $ 500 $ 500 046 2006 Ford 1FTSX21586ED17692 ACV $ 500 $ 500 047 2007 Chevy 1GBJK34087E131062 ACV $ 500 $ 500 048 2007 Chevy 2GCEC19C471704135 ACV $ 500 $ 500 049 2007 Bri-Mar 43YDC23227C059168 ACV $ 500 $ 500 050 2007 Intern'! 1HTWXSBT67J446766 RC $ 500 $ 500 1 051 1993 Ford BD61414 052 2008 Intern'] IHTWXSBT38J636011 RC $ 500 $500 053 2008 Chevy 2CNDL13F286057734 ACV $ 500 $ 500 054 2008 Ford 1FDWF37538EE10152 ACV $ 500 $500 055 2008 Chevrolet 1GNDT13S782240696 ACV $ 500 $500 056 1991 GMC 4V 1 JDBME4MN8l 0008 ACV $ 500 $ 500 057 2008 Ford l FTWF31508EE04998 ACV $500 $ 500 058 2008 Ford 1FTYR15E98PA76709 ACV $ 500 $ 500 059 2006 Eager l 12H8V3246L070830 ACV $500 $ 500 060 2008 Ford 1FAIIP35NX8W223178 ACV $ 500 $ 500 061 2001 Proli 5 SPCH I 8201W000007 ACV $ 500 $ 500 062 2002 Midat 5ANNC18292R009818 ACV $ 500 $ 500 063 1995 GMC I GDJ7H 1 PXSJ501951 ACV $ 500 $500 064 1989 Inter 1HTLDTVNOKH669724 ACV $500 $500 065 2009 Ford 1 FTYR 15E59PA07663 ACV $ 500 $500 066 2009 Ford 1FTYR15E79PA23931 ACV $500 $ 500 067 2009 Intern'] 1HTWXSBT89J104237 RC $500 $ 500 068 2009 Ford 1FTWF31Y79EA14069 ACV $500 $ 500 069 2009 Ford 1FTRX14W89FA66555 ACV $ 500 $ 500 070 2009 GAC 1G91A16279S203069 ACV $500 $ 500 071 2011 Internat'l 1HTWLAZR9BJ330803 RC $ 500 $ 500 072 2009 Cony 5RMBR16259D015201 ACV $ 500 $500 073 2011 Ford 1FTBF2B61BEC25733 ACV $500 $ 500 074 2004 Intern'] 1HTWDAAR54J090556 ACV $ 500 $ 500 075 201 1 Ford IFTBF2B64BED08167 ACV $ 500 $ 500 076 1983 Chevrolet 1GCHP32M4D3309992 ACV $ 500 $ 500 077 2004 Chevrolet 1 G 1 ZT54874F 190533 ACV $ 500 $500 078 2011 Ford 1FTNE2EWOBDB34583 ACV $ 500 $ 500 080 2012 Ford 1FMCU9DGOKB33729 ACV $500 $ 500 081 2012 Ford 1FTF3B69CEA98641 ACV $ 500 $ 500 082 2012 Dodge 3C6LD5AT8CG214572 ACV $500 $ 500 083 2001 GMC 3GDKC34GX1M1.15689 ACV $ 500 $ 500 084 2001 GMC 3GDKC34GX1M115189 ACV $ 500 $ 500 085 1990 Intern'l 1HTGBZ3R8LH244981 ACV $500 $ 500 086 2013 Ford 1FTSE3EL6DDA43805 ACV $500 $ 500 087 2014 Inter 111TGRSJT3EH491412 RC $500 $ 500 088 2014 Jeep 1C 4NJDBB9ED727839 ACV $500 $ 500 089 2014 Ford 1 FT7X2861 EEB27356 ACV $500 $ 500 090 2014 Ford 1FTBF2B69EEA98119 ACV $ 500 $ 500 091 2014 Ford 1FDRF3H65EEB42690 ACV $500 $ 500 092 2007 Chevrolet 1GBJK34U87E131062 ACV $ 500 $ 500 093 2013 Ford 1FMCU9GX9DUB56606 ACV $ 500 $ 500 094 2013 Ford 1FMCU9G93DUD03410 ACV $500 $ 500 095 2013 Ford 1FT7X2B64DEB19931 ACV $500 $ 500 096 2013 Ford 1FTFX1EF9DKE83927 ACV $500 $ 500 097 2013 Ford IFDUF5HYXDEA99390 ACV $500 $ 500 098 2014 Ford 1 FDUFSITY6EEB37585 ACV $ 500 $ 500 099 2014 Chevrolet 1 GNKVFED9EJ335310 ACV $ 500 $ 500 100 2015 Ford 1FT7X2B67FEA53152 ACV $500 $500 101 1997 Dodge 2B6HB21X3VK561713 ACV $ 500 $ 500 102 2015 Ford 1FTBF2B66FEC03636 ACV $ 500 $500 2015 Ford 1FDRF3H65FEC15428 ACV $500 $500 104 2015 Jeep 1 C4NJDBB7FD258476 ACV $500 $500 2015 WesternStar 5KKHAVDV2FLGK0389 RC $ 500 $ 500 105 2015 Haulmark 575CB1010FP287376 ACV $500 $ 500 VALUATION KEY ACV=Actual Cash Value ST=Stated Amount AA=Agreed Amount EXCESS LIABILITY COVERAGES LIMITS OF LIABILITY COVERAGE TYPE Occurrence RETRO DATE N/A Each Occurrence $10,000,000 Annual Aggregate $10,000,000 REQUIRED UNDERLYING INSURANCE TYPE OF INSURANCE EFFECTIVE DATE EXPIRATION DATE LIMIT OF LIABILITY Automobile Liability 07/01/15 07/01/16 $1,000,000 Combined Single Limit General Liability 07/01/15 07/01/16 $1,000,000 Each Occurrence $3,000,000 General Aggregate Public Officials 07/01/15 07/01/16 $1,000,000 Each Wrongful Act Liability $3,000,000 Annual Aggregate PAYMENT OPTIONS TOTAL ANNUAL PREMIUM $161,877.99-Argonaut Insurance Company AGENCY BILL OPTION Full Pay Authorized Signature Dated TOTAL ANNUAL PREMIUM $12.287.55- Lloyds of London AGENCY BILL OPTION Full Pay Authorized Signature Dated AS C ENT=.., U N D E R W R I T I N G INDICATION OF TERMS—QUOTE OPEN UNTIL EXPIRY DATE Quote Date: June 1,2015 INSURED Town of Queensbury COUNTRY/STATE USA/NY BROKER Safeonline LLP CONTACT Sarah Kennerley BROKERAGE 15% FORM Ascent CyberPro US v2.2 PERIOD OF INSURANCE 12 months at 12.01 a.m.LST from a date to be agreed USD LIMITS—ANY ONE CLAIM AND IN THE AGGREGATE INCLUDING CLAIMS EXPENSES INSURING MODULES OPTION 1 OPTION 2 OPTION 3 OPTION 4 Aggregate Policy Limit 2,000,000 N/A N/A N/A Security and Privacy Liability 2,000,000 Multimedia and Intellectual Property Liability 2,000,000 Technology Services N/A Miscellaneous Professional Services N/A Network Interruption and Recovery 1,000,000 Event Support Expenses 250,000 _ Privacy Regulatory Defense and Penalties 500,000 Network Extortion 1,000,000 Electronic Theft,Computer&Telecoms Fraud 25,000 Reputational Damage 2,000,000 DEDUCTIBLE-EACH AND EVERY CLAIM INCLUDING CLAIMS EXPENSES INSURING MODULES OPTION 1 OPTION 2 OPTION 3 OPTION 4 Security and Privacy Liability 10,000 Multimedia and Intellectual Property Liability 10,000 Technology Services N/A Miscellaneous Professional Services N/A Network Interruption and Recovery 10,000 12 hours Event Support Expenses 10,000 Privacy Regulatory.Defense and Penalties 10,000 Network Extortion 10,000 Electronic Theft,Computer&Telecoms Fraud 10,000 Reputational Damage 10,000 PREMIUMS INSURING MODULES OPTION 1 OPTION 2 OPTION 3 OPTION 4 2 Total Premium 11,380.00 Ascent Policy Fee* 460.00 -- Total Payable 11,840.00 Ascent Underwriting Participation 100% *Policy fee is payable in full to Ascent,Underwriting in addition to the Total Premium and is deemed fully earned on inception Ascent Underwriting,London Underwriting Centre T+44(0)203 642 8250 3 Minster Court, Mincing Lane,London EC3R 7DD www.ascentunderwriting.com Ascent Underwriting LLP is authorised and regulated by the Financial Conduct Authority.Registered in England 0C380469. Registered Office:Suite 2/5,London Underwriting.Centre,3 Minster Court,Mincing Lane,London,EC3R 7DD ASCENT,' U N D E R W R I T I N G JURISDICTION Worldwide . CHOICE OF LAW New York SERVICE OF SUIT Sedgwick,Detert,Moran&Arnold,3 Park Plaza, 17` Floor,Irvine,CA 92614-8540 CLAIMS NOTICE R.Kissel.Kissel Hirsh&Wilmer LLP,580 White Plains Rd.5` Floor,Tarrytown NY 10591 Tel:914-750-5933 and in respect of Privacy Breach and/or Cyber Extortion Events: IDT911,Breach Hotline:1-800-493-0943,breach@IDT911.com/Mr Eduard Goodman TERMS ARE SUBJECT TO THE FOLLOWING CONDITIONS •NMA 1256 Nuclear Incident Exclusion(USA) • NMA 1477 Radioactive Contamination Clause(USA) •LSW1001 Several Liability Notice(Insurance) •LSW585 Premium Payment Warranty 45 Days •Retroactive Date—July 1,2013 NATURE OF MISCELLANEOUS PROFESSIONAL SERVICES COVERED Not Applicable IDT 911 RISK MANAGEMENT SERVICES This policy offers Insureds free access to a designated IDT911 password protected risk management portal,offering a range of services including pro-active privacy educational resources,24/7 breach management services and a response hotline. SUBJECTIVITIES TO BE SETTLED AND AGREED PRIOR TO BINDING(UNLESS OTHERWISE AGREED) UNDERWRITERS RESERVE THE RIGHT TO AMEND,ALTER OR WITHDRAW TERMS SHOULD THE RESPONSES TO SUBJECTIVITIES BE DEEMED UNSATISFACTORY •Application to be signed and dated within 30 days of inception, •Confirmation of surplus lines details(including name,address,license number and expiry date). SECURITY 100%with certain Underwriters at Lloyd's of London RISK INFORMATION Revenues USD 34,632,943 No of Plls 16,000(0-50,000) Business Governmental&Public Authorities-TBC Claims None Ascent Underwriting to issue certificate and all related policy documentation upon binding in respect of all placements where Ascent are providing 100%security. Ascent Underwriting, London Underwriting Centre T+44(0)203 642 8250 3 Minster Court,Mincing Lane, London EC3R 7DD www.ascentunderwriting.com Ascent Underwriting LLP is authorised and regulated by the Financial Conduct Authority.Registered in England 00380469. Registered Office:Suite 2/5,London Underwriting Centre,3 Minster Court,Mincing Lane,London,EC3R 7DD EXPLANATION AND OFFER OF ADDITOINAL COVERAGES: SUPPLEMENTARY UNINSURED/UNDERINSURED MOTORISTS(SUM)INSURANCE NEW YORK EXPLANATION OF THE DIFFERENCE BETWEEN STATUTORY UNINSURED MOTORISTS COVERAGE AND SUPPLEMENTARY UNINSUREDIUNDERINSURED MOTORISTS(SUM)COVERAGES Under New York law you must buy either Statutory Uninsured Motorists Coverage or Supplementary Uninsured/Underinsured Motorists(SUM)Coverage,which includes the Statutory Uninsured Motorists Coverage. This section is an advisory explanation of the primary differences between these two types of coverages, but is not intended to be a substitute for a complete review of both coverages. If there is any conflict between the policy and this explanation, the provisions of your policy apply. If you have any questions regarding this information, please contact your agent, insurance company, or the New York Insurance Department for further explanation. TYPE 1: STATUTORY UNINSURED MOTORISTS COVERAGE Statutory Uninsured Motorists Coverage compensates you,or other persons insured under your motor vehicle insurance policy, for amounts that you or your passengers, may be legally entitled to collect as damages for bodily injury or death from an accident caused by an owner or operator of an uninsured motor vehicle.An uninsured motor vehicle is a motor vehicle that either has no liability insurance coverage or is operated by a hit-and-run driver. In order to drive your automobile upon the roads of this State, you must obtain this coverage as your minimum limits. If someone is injured as a result of an accident with an uninsured motor vehicle,your Statutory Uninsured Motorists Coverage can pay up to$25,000 for each person injured,with a$50,000 maximum for each accident. If someone is killed as a result of such an accident, your Statutory Uninsured Motorists Coverage can pay up to$50,000 for each person killed, with a$100,000 maximum for each accident resulting in death to two or more people. These limits are the only limits you can obtain under Statutory Uninsured Motorists Coverage. Statutory Uninsured Motorists Coverage will pay for bodily injury or death only if the car accident happens in-state,that is, in the State of New York, TYPE 2: SUPPLEMENTARY UNINSUREDIUNDERINSURED MOTORISTS(SUM)INSURANCE COVERAGE You have the right to purchase additional limits of insurance coverage, called Supplementary Uninsured/Underinsured Motorists(SUM) Insurance Coverage.This coverage provides you or other persons insured under your motor vehicle insurance policy, with the Statutory Uninsured Motorists Coverage(described above)plus additional coverages,which may provide you with a greater degree of protection. SUM Coverage, similar to Statutory Uninsured Motorists Coverage, provides you,or other persons insured under your motor vehicle insurance policy, for amounts that you, or your passengers, may be legally entitled to collect as damage for bodily injury if there is an accident. Here, in contrast however, you have the opportunity to choose the amount of uninsured motorists coverage desired (from an offering from the insurance company which is provided below). Additionally, since there is a possibility of an accident occurring between you and an underinsured motorist, SUM insurance can provide you with"underinsured"coverage,which is coverage for an accident between you and a car that has bodily injury liability insurance that is less than your own bodily injury liability limits that you have on your own car. However, please note than the SUM coverage cannot exceed the limits of the third-party liability coverage that you have on your own car. Also, SUM Coverage provides coverage for bodily injury or death for not only in-state accidents, but also out-of-state accidents. IMPORTANT SUM NOTICE: For purposes of further clarification,New York law requires that the following explanation, as provided in 11 NYCRR 60-2,1 be provided to Y ou in this notice: A policyholder should consider purchasing SUM coverage in order to protect against the possibility of an accident involving another motor vehicle whose owner or operator was negligent and who: (1)may have no insurance whatsoever;or (2)even if insured, is only insured for third-party bodily injury at relatively low liability limits, in comparison to the policyholder's own liability limits for bodily injury sustained by third-parties. By purchasing SUM coverage,which cannot be purchased in an amount exceeding the amount of third- party liability coverage purchased,the policyholder and any insured under the policy can: (1)be protected for bodily injury to themselves,up to the limit of the SUM coverage purchased; and (2)receive from the policyholder's own insurer payment for bodily injury sustained due to the negligence of the other motor vehicle's owner or operator. The maximum amount payable under the SUM coverage shall be the policy's SUM limit reduced and thus offset by motor vehicle bodily injury liability insurance policy or bond payments received from,or on behalf of, any negligent party involved in the accident. EXAMPLES: As provided in 11 NYCRR 60-2.2, the following examples(using the per person limits)illustrate the proper application of SUM coverage: (1) Example One: Insured's Bodily Injury Damage $300,000 Insured's Liability Limit $500,000 Insured's SUM Limit $250,000 Other Motor Vehicle Liability $25,000 Note: In this example,the insured has purchased the maximum amount of SUM coverage that must be offered by the insurer, provided that the insured has purchased bodily injury liability limits of at least$250,000. Insured recovers$25,000 from the negligent owner or operator of the other motor vehicle, and$225,000 ($250,000 minus $25,000) under the SUM coverage, for a total recovery of$250,000. However, in the event that the negligent owner or operator of the other motor vehicle had no liability insurance at all,the insured would collect$250,000 in SUM coverage from the insured's own insurer. But, if the owner or operator of the other motor vehicle was not negligent, the insured would receive no SUM payments. ( (2) Example Two: Insured's Bodily Injury Damage $100,000 Insured's Liability Limit $25,000 Insured's SUM Limit $25,000 Other Motor Vehicle Liability $25,000 Result: Insured recovers$25,000 from the negligent other motor vehicle owner or operator. But the insured receives nothing under the SUM coverage,which equals the mandatory uninsured motorists coverage, since the other owner or operator's vehicle did not have less liability insurance than the insured's vehicle. If the insured's liability and SUM limits were both$50,000,the insured would collect another$25,000 in SUM coverage from the insured's own insurer. (3) Example Three: Insured's Bodily Injury Damage $60,000 Insured's Liability Limit $100,000 Insured's SUM Limit $100,000 Other Motor Vehicle Liability $50,000 Result: Insured recovers$50,000 from the other negligent motor vehicle owner or operator and$10,000 under the SUM coverage,which is the difference between the amount of the insured's SUM coverage and the liability coverage available from the other motor vehicle owner or operator,limited by the amount of the insured's bodily injury damage. (4) Example Four: Insured's Bodily Injury Damage $150,000 Insured's Liability Limit $100,000 Insured's SUM Limit $100,000 Other Motor Vehicle Liability $25,000 Result:Suppose the insured and the other motor vehicle owner or operator were each 50 percent at fault for the accident, then the insured's total recovery would be$75,000, in light of comparative negligence of the parties involved in the accident. The insured would recover$25,000 from the other negligent motor vehicle owner or operator and$50,000 under the SUM coverage. On the other hand, if the other motor vehicle owner or operator was totally at fault for the accident, the insured would recover$25,000 from the negligent motor vehicle owner or operator and would then receive$75,000 in SUM coverage from the insured's own insurer. Had the insured purchased liability and SUM limits of$150,000 or more, the SUM recovery would then be$125,000. PLEASE TURN PAGE TO SELECT COVERAGE AND SIGN ACKNOWLEDGEMENT II.OFFERINGS A.OFFER OF STATUTORY UNINSURED MOTORISTS(UM)COVERAGE(SPLIT LIMITS) This box should be marked if this section is applicable to you. Offer of UM Coverage Amount of Premium(if any) $25,000 / 50,000 PLEASE RESPOND HERE: Do you wish to purchase UM coverage with$25,000450,000 split limits?Yes: No: X_ B.OFFER OF SUM COVERAGE(SPLIT LIMITS) This box is marked if this section is applicable to you. Offer of SUM Coverage Amount of Increased Premium(if any) / PLEASE RESPOND HERE: Do you wish to purchase SUM coverage with split limits?Yes: No:_X If you answer is yes, then specify the limits which you desire: I select: C.OFFER OF SUM COVERAGE(COMBINED SINGLE LIMIT) This box is marked if this section is applicable to you. I select: Offer of SUM Coverage Amount of Increased Premium(if any) 1,000,000 / PLEASE RESPOND HERE: Do you wish to purchase SUM coverage with a combined single limit:Yes:_X_No: If your answer is yes, then specify the limit which you desire: I select: ACKNOWLEDGEMENT OF APPLICANT(S) I/We hereby acknowledge that I/we have read, or have had read to me,the above explanations and offers of SUM coverage. I/We have indicated whether or not I/we wish to purchase each coverage in the spaces provided. I/We further understand that the above explanations of these coverages are intended only to be brief descriptions of SUM coverage. SIGNATURE SIGNATURE PRINT OR TYPE NAME PRINT OR TYPE NAME POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE You are hereby notified that under the Terrorism Risk Insurance Act,as amended,you have a right to purchase insurance coverage for losses resulting from acts of terrorism.As defined in Section 102(1)of the Act:The term"act of terrorism"means any act or acts that are certified by the Secretary of the Treasury—in consultation with the Secretary of Homeland Security,and the Attorney General of the United States—to be an act of terrorism;to be a violent act or an act that is dangerous to human life, property, or infrastructure;to have resulted in damage within the United States,or outside the United States in the case of certain air carriers or vessels or the premises of a United States mission;and to have been 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. YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM,SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER, YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE,SUCH AS AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA,THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 85%THROUGH 2015; 84% BEGINNING ON JANUARY 1,2016; 83%BEGINNING ON JANUARY 1, 2017;82%BEGINNING ON JANUARY 1,2018; 81%BEGINNING ON JANUARY 1,2019 and 80%BEGINNING ON JANUARY 1, 2020, OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE.THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT,AS AMEN DED, CONTAINS A$100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS'LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS$100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED$100 BILLION,YOUR COVERAGE MAY BE REDUCED. Acceptance or Rejection of Terrorism Insurance Coverage I hereby elect to purchase terrorism coverage for a prospective premium of$2,625 I hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will have no coverage for losses resulting from certified acts of terrorism. Trident Insurance Brokerage Policyholder/Applicant's Signature Company 4624684-04 Print Name Policy Number Date Disclosure-Terrorism Accept/Reject(01/15) Argonaut Group, Inc. ©2015 National Association of Insurance Commissioners Marshall & Sterling Upstate 125 High Rock Ave Suite 206 Saratoga Springs,NY 12866 NOTICE OF EXCESS LINE PLACEMENT Date:July 1,2015 Town Of Queensbury 742 Bay Road Queensbury,NY 12804 Consistent with the requirements of the New York Insurance Law and Regulation 41 The Town of Queensbury is hereby advised that all or a portion of the required coverages have been placed by Marshall& Sterling Upstate with insurers not authorized to do an insurance business in New York and which are not subject to supervision by this State. Placements with unauthorized insurers can only be made under one of the following circumstances: a) A diligent effort was first made to place the required insurance with companies authorized in New York to write coverages of the kind requested;or b) NO diligent effort was required because i) the coverage qualifies as an "Export List" risk,or ii)the insured qualifies as an"Exempt Commercial Purchaser." Policies issued by such unauthorized insurers may not be subject to all of the regulations of the Superintendent of Financial Services pertaining to policy forms. In the event of insolvency of the unauthorized insurers,losses will not be covered by any New York State security fund. TOTAL COST FORM(NON TAX ALLOCATED PREMIUM TRANSACTION) In consideration of your placing my insurance as described in the policy referenced below,I agree to pay the total cost below which includes all premiums, inspection charges" and a service fee that includes taxes, stamping fees, and (if indicated) a feed) for compensation in addition to commissions received, and other expenses". I further understand and agree that all fees, inspection charges and other expenses denoted by") are fully earned from the inception date of the policy and are non-refundable regardless of whether said policy is cancelled. Any policy changes which generate additional premium are subject to additional tax and stamping fee charges. Re:Policy No. TBD Insurer Lloyds of London Policy Premium $11,380 Insurer Imposed Charges: Policy Fees(') $460 Inspection Fees(I) Total Taxable Charges $11,840 Service Fee Charges: Excess Line Tax(3.60%) $426.24 Stamping Fee $21.31 Broker Fee(1) $ Inspection Fee") s Other Expenses(specify)(') $ Total Policy Cost $ 12,287.55 (Signature of Insured) NYSID Form:NELP/2011 +00lOp VpWA WwN NN NN +00�WtOW WWW WWVV WVIN NtJ�DDLAWWW WWNNNNN t 15 A 2 +N N+N A W N++N+N+W N A W N+N++a W N+A WN+N a W N+PAWN+W V W N A W N . pHp V .; � ; W W O 5_T� O W O O ti O C Q O W � N_W T III W ligt figg$ i## W$ 2 iii 8 n8. . . WX- f� `'y �i�3 x��o��• 3.t � °��$33 3�E3 � �€..5 =��°�.�.s��� � ppa i S , .. 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O$+O 8 0 0 o N 1.0-i N N w g N O O O g O O N§ J H A O O 1°8 N r O I OC?1e g i o-j O g j r g O N O V N K O842OOClg O.V ggE4J0000�01ptig V 0 VU1 C01+11 0f V V 804" C'it§gvT482§i81' • 00000000000000000000000000000000000000000000000000000000. a A A AAA ,8■,;■UTVUNi | itniT£■■¥.. , ƒ. 1 t i| § E t 11i' 7, ,, ! 2 m_k0E3fg.(ƒ§ :SoJ"f11§! 8;-°,34 | I$f iiLi!!iitii YiSEVO -$l| §§11§V §§§ _ ......N000 mar©ig81.1§® Hitt altil (WRBRR aim( 666661kgq �! 4| 7§k-§1-1§§t ■£§j§)�Rs-§!, PgtVERsoi 2 OOQ0000000D RFFE FfFFI -Ig SafeonlineTM rr,orrh..srt Renewal Application Please answer all the questions on this form.Before any question is answered please carefully read the declaration at the end of the application form,which you are required to sign.Underwriters will rely on the statements that you make on this form.In this context,ANY INSURANCE COVERAGE THAT MAY BE ISSUED BASED UPON THIS FORM WILL BE VOID IF THE FORM CONTAINS FALSEHOODS,MISREPRESENTATIONS,OR OMISSIONS.PLEASE TAKE CARE IN FILLING OUT THIS FORM. You may provide any further additional information by means of a separate attachment if necessary. Section 1 —General Information a. Name(s)of Applicant a/ lai, 0,-i.) 9v e an s CJ c' r S/ b. Address 7 Spa 2 //l �! 1 Gr� �JeslS�cJr�r N} iwil d. Amual gross revenue/turnover Last year 134//0 , 1 Current year ,u,1/o 7 611 Next year(est.)( 341.06;0041 0 e. Approximately how many Pre are retained within your computer network,databases and records? `'f 4 n �l (PII is defined as a personally kieridiable record on an mamma that can be used to Identity,contact or locate a single tndrvktuaq y _ Section 2--Operational changes/claims and circumstances a. Since completion of your previous application form or over the forthcoming 12 months,have there been,or do you anticipate: �/ 1.any significant change to the nature,service of operation of your business,Including any merger or acquisition? Yes El No(//O • , a�u 2.any change tome responses regarding network security and risk control? Yes ® No 1 i 3.any change to the nature of your media and Intellectual properly controls? Yes a No Erb. Are you aware of any claims or circumstances that have not already been reported to Ascent Underwriting? Yes ® No II you have answered yes to any questions within a orb please provide lull details below: • Data Protection By accepting Ibis insurance you consent to Soleonline using the mlormefionwe may hold about you t r the purpose of providing insurance and handing claimed'any,and to process sensitive personal data about you whine this is necessary pot example health Intonation or criminal convictions).This may mean we have to give some derails to third parties involved in providing mstaance cover,these may Include insurance canters,third parry clips adjusters,fraud detection and prevention services,reinsurance • companies and Insurance regulatory authori les. Where such sensitive personal inlomatlon relates to anyone other Ihanyou.you must obtain the explicit consent of the person to whom the iniormetion relates both to ihn 1 disclosure of such inhumation to us and its use by us as set out above.The information provided will be treated In confidence end In compliance with relevant Data Proteclio n legislation.You have the right to apply for a copy of your Inlormalion(lot which we may charge a small lee)and to have any inaccuracies concocted. IMPORTANT-Policy Statement of Fact By accepting this insuanco you eonlhm that the lads contained in the proposal form we true.These statements.and all IMa motion you or anyone on your behalf provided belae we awes to lnsureyou.are incorporated into and form the basis of your policy.if anything In these statements is not correct.We win l be entitled to treat this Insurance as II it had never exited You should keep this Statement of Fact and a copy of the completed proposal form for you records. This application must be signed by the applicant.Signing this lam does not bind the company lo complete the insurance.With Tolerance to risks being applied for inn Out Linked Stales.please note that inc ertain slates any person who knowingly and with Intent to defraud any Insurance company or other person submits an apprmation to,instacux:o containing any false Idol elation.or conceals the purpose d mislead'eg Intonation concerning any tact material thereto,correnfs a fraudulent insurance act,which is a cline. I he undersigned is an authorized principal,partner.checks,risk manager,or employee d the applicant and cedillas Mel reasonable inquiry has been made In obtain rho answers hereto which ere bus.coned and compile to the best of hislher knowledge and betel.Suchreasonabto inquiry includes al necessary inquiries to tallow p;tadpole. partners,rib echoes,risk managers.or employees to enable you to answer u the questions accurdely. ' Name e14 n 67—ed I Position an 5 t -or'dvs a'— I p S«�a+ Print d Sign" 11 t Re 1 Date _ �' �—i• 1 i