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3.10
3.10 INSURANCEIInsurance Agent for 2016-17—Renewal for Marshall&Sterling-Trident-Argonaut—6-6-16 RESOLUTION AUTHORIZING MARSHALL & STERLING UPSTATE, INC. TO RENEW TOWN OF QUEENSBURY INSURANCE COVERAGE WITH TRIDENT/ARGONAUT AND CYBER INSURANCE COVERAGE WITH ASCENT CYBERPRO RESOLUTION NO.: ,2016 INTRODUCED BY: WHO MOVED FOR ITS ADOPTION SECONDED BY: WHEREAS, by Resolution No.: 215,2015, the Queensbury Town Board authorized Marshall & Sterling Upstate, Inc., to obtain insurance coverage for the Town of Queensbury from Trident/Argonaut effective July 1st,2015—June 30'h,2016, and WHEREAS, by Resolution No.: 212,2014, the Town Board authorized the procurement of cyber-coverage for the Town of Queensbury from Ascent CyberPro, and WHEREAS, the Town Board wishes to authorize the renewal of insurance coverage with Trident/Argonaut, and the renewal of cyber-coverage from Ascent CyberPro, effective July 1St 2016 — June 30th, 2017, in accordance with Marshall and Sterling Upstate, Inc.'s May 23, 2016 proposal and Ascent CyberPro's May 10, 2016 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 effective July 1n, 2016 — June 30th, 2017 from Trident/Argonaut and to renew cyber- coverage for the Town from Ascent CyberPro in accordance with Marshall and Sterling Upstate, Inc.'s May 23, 2016 proposal and Ascent CyberPro's May 10, 2016 proposal respectively, substantially in the forms 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 6'h day of June,2016, by the following vote: AYES : NOES : - ABSENT: • 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 AMENDED, 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$2,623 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 4624684-05 Print Name Policy Number Date Disclosure-Terrorism Accept/Reject(01/15) Argonaut Group, Inc. ©2015 National Association of Insurance Commissioners 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: 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: 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: 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 PREMIUM SUMMARY Named Insured: Town of Queensbury Proposed Coverage Date: 7/1/2016 Proposal Expires On: 7/1/2016 Name/ -- - -Admit ,. Expiring Proposed Can'lei Name/. Admit -Proposed Polio•Type: ; _ :A.m.:Best Rating ;:;._: in NY:.:.: pi ultimo A.M.:. Best Rating - :-.In NY :.,;.Pi collo in Property Trident/Argonaut A Yes $44,481.99 Trident/Argonaut A Yes $44,432.15 Inland Marine Trident/Argonaut A Yes $4,020.00 Trident/Argonaut A Yes $4,020.00 Commercial Auto Trident/Argonaut A Yes $63,665.00 Trident/Argonaut A Yes $63,669.00 General Liability Trident/Argonaut A Yes $25,461.00 Trident/Argonaut A Yes $25,507.00 OCP Trident/Argonaut A Yes $200.00 Trident/Argonaut A Yes $200.00 Public Officials Trident/Argonaut A Yes $7,616.00 Trident/Argonaut A Yes $7,637.00 Umbrella Trident/Argonaut A Yes $16,434.00 Trident/Argonaut A Yes $16,363.00 Subtotal $161,877.99 $161,828.15 Cyber Liability Lloyds of London $12,287.55 Lloyds of London $12,292.74 Total Premium $174,165.54 $174,120.89 Subject To: *Acceptance of this coverage is subject to binding requirements on Page#20 **Terrorism coverage must be accepted or declined prior to binding of policy. Proposal accepted as presented: Authorized Signature Date Proposal accepted as amended per changes noted on pages: Authorized Signature Date Proposal of Insurance Page 3 5/23/2016 C-. • • Safeonlinen i 10i l: ;:i'„I ''li ;i 'Ilt', Ilii 1i • Please answer all the questions on this form.Before any question Is answered please carefully read the declaration at • . Iho end of the application form,which you ore required tosign,Underwriterswill 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 THISFORM, You May provide any furlhor additional Information by moans of a Spare to attachment II necessary. Section 1 -General Information 1 a. Name(s)of Applicant T7 end el/e1.4&�///[I(/'//.{_[/L,/ b. Addiesge(2._/a� /Clj P e,Lc�`�7 te/�'/,/, d.Annual gross revenue/turnover Last year[30,5711 ” Current year 36 Next year(est) 7�7 • i GGG e. AppradmatelyhowmanyPThe are retained within your computer network,databases and records? 1? ©O (Pills Mined ase personaltyrdenteabte record on anmdendualreal can bousadto idenalscontact or locales=airs medulla t Section 2-Operational changes/claims and'circumstances e. Since completion of yourprevfoua application form or over the forthcoming 12 months,have(here been,erdoyou anadpals: 1. any significant change to the nature,service or operation ofyour business,Including enymerger or acquIellan7 Yes No ill 2.any change to your responses regarding network aacudtyand risk control? Yes ® No Ell a. anychange to the nature al your media ardlntellectual property controls? Yes ® No a b. Are you aware ofanyclatnu or circumstances that have not already been reported loAscenlUndavailing? Yes ® No all' if you have answered yes to any questions withina cc please provide lull details below: • Data Protection .Byaceep'mglhis haurmenyouconsent IoSeteonik m using thebiermalonwe may hold about you tor Os purposed welding bsuranceand banana claimed'any.and toprocess/senvliveparsenaldela about you where Mists necessary(for example health Irtlormeibnor m4nb lcorstctions).ThIs maymeanwehereto five same dinars to Mod fierier involved mpsovdagneuronescovin.these met Wads mtvarcacaeners.11ed parry claims Beldam,Saud deleslenand praveBronserva:s.answa ve companies andlnsularce regabtoyaulhorilles Where inch sensed persanalWormelfon relates to ne other eonwhom the ., disclosure of Hs use es as Getoutabave.TTheWer alrm must n theexplicitconeamdlhtdance ar bcompaancewflh relevant alePoth otea ( byes pmgeacmafle and tohavednyin ard'nees irocevNhrebvam Dale Protection Iegbleaon.Youhare IhedgNioappy lox eeogolyawblormagon(tor whkhwema/dage lee)asmaaand lohaveany lneamrclee corroded. IMPORTANT-Polley Statement of Pact Byecceptimats balance yea cored that the leas contained brho proposal lormare hue.These sietemenls.andey Womalany000ranyone dnyour bahoe provided beloregeagee tohfssseyou,are incorporated into endlormlhe bests ofymapdcy.II anythlng Ntheseslelemeds Is nor comet waval be entitled muse thielnnnenee as g h Imdnevaadsted,Youahetddlamp this Slerementof Faclande capya the completedproposal lorminryowrecords. Thisappyeaaonmuet be slgredbygre appheare.Slgnhg thislormdoesml bind the company locomplahrld Insurarce.Withrelerenee torisks being applied Iorinthe Uraed Slates please note that meerlatnslates,any person who kmwlnfiyend vAarInlent todefreud enybnurancecompany orother personsubdtsanappywaontar inwmneo containing anyleheInt monomer conceals the purpose of mideadng Wollaston concominganylad material Mad;commhaantedatert Inamenc eaci.withlsa crime. the tudersgnad can eulhea=edpmctpat,padrer,doador,lrskmanager,or, employee of lheeppteant andcedees Mal reasonable may hes been made to oblate the answersberahwhkfi em Irue.cmreel end complete lothabast of hhmerlmowledge and Wel Such reasonable ipuayaxirdesalt necessary expels!mtallow padpats. pontem,daectms.dskmenagers.or employes:toenabloyouto answer thecarnations ecsmategc `I �+/�I/ Name z 7 �U PosWon evil ////O(are/ Prinl6 sign eig Data 3/ r( 1 Marsall&Sterling Upstate Inc. 300 Rt. 23B Leeds,NY 12451 NOTICE OF EXCESS LINE PLACEMENT Date:05/12/2016 Town of Queensbury 742 Bay Road Queensbury,NY 12804 Consistent with the requirements of the New York Insurance Law and Regulation 41 Town of Queensbury_ is hereby advised that all or a portion of the required coverages have been placed by Marshall & Sterling Upstate Inc.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 TRANSACTIONZ 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 chargest'1 and a service fee that includes taxes, stamping fees, and (if indicated) a fee(') for compensation in addition to commissions received, and other expenses". I further understand and agree that all fees, inspection charges and other expenses denoted byt'1 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 $11,380.00 Insurer Imposed Charges: Policy Fees t" $465.00 Inspection Fees t'1 $ Total Taxable Charges $11,845.00 Service Fee Charges: Excess Line Tax(3.60%) $426.42 Stamping Fee $21.32 Broker Fee(') Inspection Feet') s Other Expenses(specify)(') $ Total Policy Cost $ 12 92 2.74 (Signature of Insured) t =Fully earned NYS1D Form:NELP/2011 . ASCENTr" UNDERWRITING INDICATION OF TERMS—QUOTE OPEN UNTIL EXPIRY DATE Quote Date: May 10,2016 INSURED - . Town of Queensbury COUNTRY/STATE USA/NY BROKER . -- Safeonline LLP .CONTACT. Sarah Kennerley BROKERAGE 15% -FORM . . Ascent CyberPro US v2.4 PERIOD OF INSURANCE''.; 12 months at 12.01 a.m.LST from a date to be agreed CURRENCY: _: USD LIMITS—ANY ONE CLAIM AND IN THE AGGREGATE(INCLUDING CLAIMS EXPENSES WHERE APPLICABLE) `INSURING MODULES -` -. OPTION 1 OPTION 2 - ::OPTION 3 - - -:OPTION 4 Aggregate Policy Limit 2,000,000 N/A - N/A N/A Security&Privacy Liability 2,000,000 Multimedia&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&Penalties 500,000 Network Extortion 1,000,000 Electronic Theft,Computer Fraud& 25,000 Telecommunications Fraud Social Engineering Fraud N/A Reputational Damage 2,000,000 ENDORSED COVERAGES Notification Expenses N/A PCI Fines N/A DEDUCTIBLE-EACH AND EVERY CLAIM(INCLUDING CLAIMS EXPENSES WHERE APPLICABLE) INSURING MODULES :: OPTION 1. - OPTION 2 - ,OPTION 3 OPTION 4 Security&Privacy Liability 10,000 --- Multimedia&Intellectual Property Liability 10,000 Technology Services N/A Miscellaneous Professional Services N/A --- Network Interruption and Recovery 10,000 12 hours --- s Event Support Expenses 10,000 Privacy etwo k RegulatorytorDefense&Penalties 10,000 Network Extortion 10,000 Electronic Theft,Computer Fraud& 10,000 --- Telecommunications Fraud Social Engineering Fraud N/A --- Reputational Damage 10,000 --- ENDORSED COVERAGES Notification Expenses N/A PCI Fines N/A Ascent Underwriting LLP, T+44(0)203 642 8250 10-12 Eastcheap,London, EC3M 1AJ www.ascentunderwriting.com Ascent Undenmi&ng LLP is authorised and regulated by the Financial Conduct Authority.Registered in England 0C380469. Registered Once:10-12 Eastcheap,London,EC3M IAJ ASCENT UNDERWRITING PREMIUMS 'OPTION 1'` =OPTION 2 OPTION-8 :OPTION 4 Total Premium11,380.00 --- Ascent Policy Fees 465.00 Total Payable 11,845.00 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 NOTICE OF CLAIM --` R.Kissel.Kissel Hirsh&Wilmer LLP,580 White Plains Rd.5th Floor,Tarrytown NY 10591 Tel:914-750-5933 . In respect of: Privacy Breaches and/or Cyber Extortion Events-IDT911,Breach Hotline:1-800-493-0943,breach@IDT911.com /Mr Eduard Goodman SERVICE OF SUIT Sedgwick,Detert,Moran&Arnold,3 Park Plaza,17th Floor,Irvine,CA 92614-8540 CHOICE OF LAW New York TERRITORIAL LIMITS ;. Worldwide JURISDICTION Worldwide TERMS ARE SUBJECT TO THE FOLLOWING CONDITIONS .>•Terms and conditions based off Revenue Split by Location as specified below •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 '.TDEEMED UNSATISFACTORY '- - - - _ •Satisfactorily completed,signed and dated CyberPro application form(to be signed and dated no more than 30 days prior to inception). •Confirmation of surplus lines details(including name,address,license number and expiry date). •Please confirm your total number of employees. 100%with certain Underwriters at Lloyd's of London Ascent Underwriting LLP, T+44(0)203 642 8250 10-12 Eastcheap,London,EC3M 1AJ www.ascentunderwriting.com Ascent Undenviiting LLP is authorised and regulated by the Financial Conduct Authority.Registered in England 0C380469. Registered Office:10-12 Eastcheap,London,EC3M 1AJ ,^SCENT TM UNDERWRITING -RISK INFORMATION . REVENUE USD 30,500,000 BUSINESSGovernmental&Public Authorities-TBC CLAIMS ' None NO OF P115 - _. 17,000(0-50,000) NO OF EMPLOYEES TBA - - ,REVENUE SPLIT BY LOCATION- - - - United States 100% 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 LLP, T+44(0)203 642 8250 10-12 Eastcheap,London,EC3M 1AJ www.ascentunderwriting.com Ascent Underwriting LLP is authorised and regulated by the Financial Conduct Authority.Registered in England 0C380469. Registered Office:10-12 Eastcheap,London,EC3M 1AJ