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3.14 3.14 INSURANCE\Insurance Agent for 2019-20—Renewal for Marshall&Sterling-Trident-Argonaut—6-17-19 RESOLUTION AUTHORIZING MARSHALL & STERLING UPSTATE, INC. TO RENEW TOWN OF QUEENSBURY INSURANCE COVERAGE WITH TRIDENT/ARGONAUT AND CYBER INSURANCE COVERAGE WITH ASCENT/LLOYDS AND POLLUTION LIABILITY COVERAGE WITH CHUBB EFFECTIVE JULY 1, 2019-JUNE 30, 2020 RESOLUTION NO.: ,2019 INTRODUCED BY: WHO MOVED FOR ITS ADOPTION SECONDED BY: WHEREAS, by Resolution No.: 243,2018, the Queensbury Town Board authorized Marshall & Sterling Upstate, Inc., to renew insurance coverage for the Town of Queensbury effective July Pt, 2018 — June 30th, 2019 from Trident/Argonaut and to renew cyber-coverage for the Town from Ascent CyberPro, and WHEREAS, the Town Board wishes to authorize the renewal of insurance coverages with Trident/Argonaut and Ascent/Lloyds effective July ls`, 2019 —June 30U', 2020, in accordance with Marshall and Sterling Upstate, Inc.'s Proposal dated 7/1/2019 and Ascent/Lloyds' Renewal Proposal dated 7/1/2019, and WHEREAS, the Town Board also wishes to authorizes Pollution Liability coverage with Chubb also as set forth in Marshall and Sterling Upstate, Inc.'s Proposal, 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 coverages for the Town of Queensbury effective July 1st, 2019 — June 30t1', 2020 from Trident/Argonaut in accordance with Marshall and Sterling Upstate, Inc.'s Proposal dated 7/1/2019 and to renew cyber-coverage for the Town from Ascent/Lloyds in accordance with Ascent/Lloyds' Renewal Proposal dated 7/1/2019, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes its Pollution Liability coverage with Chubb also as set forth in Marshall and Sterling Upstate, Inc.'s Proposal, and BE IT FURTHER, RESOLVED, that the Town Board further authorizes and directs the Town Supervisor to execute any and all documentation to effectuate such renewals/insurance coverage and the Town Supervisor and/or Town Budget Officer to take any actions necessary to effectuate the terms of this Resolution. Duly adopted this 17th day of June, 2019,by the following vote: AYES : NOES : ABSENT: Named Insured: Town of Queensbury Proposed Coverage Date: 7/1/2019 Proposal Expires On: 7/1/2019 Proposed Carrier Proposed Expiring Carrier Name/ Admit Expiring Name/ Admit Premium Policy Type A.M.Best Rating in NY Premium A.M.Best Rating In NY REVISED Package Trident/Argonaut Ins. Yes $76,808.50 Trident/Argonaut Ins. Yes $78,304.45 Business Auto Trident/Argonaut Ins. Yes $58,392.00 Trident/Argonaut Ins. Yes $61,685.00 Public Trident/Argonaut Ins. Yes $7,6498.00 Trident/Argonaut Ins. Yes $8,080.00 Official/EPLI Owner Contractor Trident/Argonaut Ins. Yes $200.00 Trident/Argonaut Ins. Yes $200.00 Protective Umbrella Trident/Argonaut Ins. Yes $14,933.00 Trident/Argonaut Ins. Yes $15,457.00 Sub-Total: $158,031.50 Sub-Total: $163,726.45 Cyber Liability Ascent/Lloyds No $9,629.86 Ascent/Lloyds No $9,629.86 Pollution Chubb Ins. No $7,021.00 Chubb No $7,021.00 Premium Totals $174,682.36 Premium Totals: $180,377.31 *Pollution Premium is for a 3 year term Subject To: Signed Forms—Auto SUM,Terrorism, Cyber Total Cost Form, Proposal Summary Acceptance Revised Premium incorporates the following: Amended Auto schedule, Increase Computer limit to$375,000 **Terrorism coverage must be accepted or declined prior to binding of policy. **Higher limits of liability may be available to you. If you would like a quotation for higher limits, please let us know. **Coverages described on the Coverage Options Available page may be available for an additional premium after completing additional applications. Proposal accepted as presented: X Authorized Signature Date Proposal accepted as amended per changes noted on pages: Authorized Signature Date 4. Example Four Insured's Bodily Injury Damages $ 150,000 Insured's Liability Limit $ 100,000 Insured's SUM Limit $ 100,000 Other Motor Vehicle Liability Limit $ 25,000 Result: Suppose the insured and the other motor vehicle owner or operator were each 50 percent at fault for the acci- dent, then the insured's total recovery would be $75,000, in light of comparative negligence of the parties in- volved 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. If you elect to purchase SUM Coverage, please initial and select a SUM limit. (Initials) I select the following SUM Limits: $ per person, per accident OR $ per accident Applicant's/Named Insured's Signature Date IL U 004 09 03 ©ISO Properties, Inc., 2003 Page 3 of 3 • 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 X I hereby elect to purchase terrorism coverage for a prospective premium of$2,706 • 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 icyholder/Applicant's Signature Company 4624684-08 • Print Name Policy Number Date Disclosure-Terrorism Accept/Reject(01/15) Argonaut Group,Inc. ©2015 National Association of Insurance Commissioners Marshall&Sterling Upstate, Inc. 300 Route 23B Leeds, N.Y. 12451 NOTICE OF EXCESS LINE PLACEMENT Date: 06/10/2019 Town of Queensbury 742 Bay Road Queensbury, Ny 12804 Consistent with the requirements of New York Insurance Law and Regulation 41 Town of Queensbury is hereby advised that after a diligent effort to place the required insurance with companies authorized in New York to write coverages of the kind requested, 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. Policies issued by such unauthorized insurers may not be subject to all of the regulations of the Superintendent of Insurance pertaining to policy forms. In the event of insolvency of the unauthorized insurers,losses will not be covered by any New York State Insolvency 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 chargesW and a service fee that includes taxes, stamping fees, and (if indicated) a fee(1) for compensation in addition to commissions received, and other expensestll. I further understand and agree that all fees, inspection charges and other expenses denoted by(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.unassigned Insurer Lloyd's of London Policy Premium $ 8,900.00 Insurer Imposed Charges: Policy Fees(11 $ 380.00 Inspection Fees(1) $ Total Taxable Charges $ 9,280.00 Service Fee Charges: Excess Line Tax(3.60%) $ 334.08 Stamping Fee $ • Broker Fee(11 $ 15.78 Inspection Fee(1) s ther Expenses(specify)(1) $ Total Policy Cost $ 9,629,86 nature of Insured) f11=Fully earned 08/16/2007/Rev.2 a Electronic Record Consent May 30, 2017 RE: Consent to receive electronic records Dear John Strough, We are pleased to announce an additional service to our valued clients. Effective immediately, Marshall & Sterling Upstate, Inc. is now offering to distribute your insurance documents via email. By consenting below, you acknowledge receipt of this consent to receive electronic records and agree to the electronic delivery of any disclosures, policy forms and documents, information or notices required by federal law including any adverse action notices or privacy policy notices(hereinafter"records") through the electronic mail address you provide. If this form is not received back,we will continue to use US Mail for delivery of your insurance documents. Please note: • In order to access documents electronically, you will need a personal computer with Adobe Reader 7.0 or newer(Adobe Reader may be downloaded at no cost at http://www.adobe.com) • You must provide Marshall & Sterling Upstate, Inc. with a current, valid email address. In the event you change your email address, you must notify Marshall & Sterling immediately online through the electronic delivery service by changing your delivery email address • If we are repeatedly unable to deliver your electronic document(s)to the specified email address, Marshall & Sterling Upstate, Inc. reserves the right to terminate the electronic delivery of documents service and deliver the documents to you via U.S. mail. • Marshall & Sterling Upstate, Inc. reserves the right to terminate this service at any time At Marshall& Sterling Upstate, Inc., we are committed to protecting the privacy of your information in our possession. We will not share your email address with anyone outside of our firm except for underwriting purposes. If at any time you need to change the email address or would like to stop receiving policies via email,please contact our office immediately. Thank you for your continued patronage. If you have any questions, please feel free to contact us. Consent and acknowledgment: By furnishing your e-mail address you acknowledge that you can access and retain the electronic records described above, and you consent to having us provide documents to you electr rite lly via e- mail or other electronic media. • Authorized Signature Date Email Address