Resolution No. 85061
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} x
RESOLUTION NO. 8506
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
VERNON APPROVING AND RATIFYING THE ACTIONS TAKEN
REGARDING THE PURCHASE OF COMMERCIAL INSURANCE
POLICIES (PROPERTY AND EXCESS LIABILITY) THROUGH
ARTHUR J. GALLAGHER & CO.
WHEREAS, by Resolution No. 8437 adopted on April 21, 2004,
the City Council of the City of Vernon withdrew from the Independent
Cities Risk Management Authority Insurance Program and Liability Pool
(collectively referred to as the "Commercial Insurance Program")
effective July 1, 2004; and
WHEREAS, the City employed the services of Arthur J.
Gallagher & Co. ("Arthur J. Gallagher") to act as the City's broker to
structure and obtain the appropriate Commercial Insurance Program
coverage for the period July 1, 2004 to July 1, 2005; and
WHEREAS, Arthur J. Gallagher has recommended that the City
purchase the following policies for its Commercial Insurance Program:
(i) a Property Policy (including earthquake and equipment breakdown)
with Global Special Risks, Inc. ("Global"); (ii) a First $10 Million
Excess SIR Liability Policy with Insurance Company of the State of PA
("PA"); and (iii) a Second $10 Million Excess Liability Policy with
Gulf Underwriters Insurance Company ("Gulf"); and
WHEREAS, in order to meet the urgent need for the Commercial
Insurance Program, the City Administrator executed a Proposal
Acceptance Page, Statement of Values, SLA D-1 Forms (Lloyds of London,
Arch Specialty Insurance Company and Gulf) and Policy Disclosure Form
required by Terrorism Risk Insurance Act of 2002 (the "Agreement")
with Global, PA and Gulf through Arthur J. Gallagher, dated July 21,
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112004, and authorized the wire transfer of the annual premiums on
July 1, 2004 and July 20, 2004, in the approximate -amount of
$446,644.00, in accordance with the terms thereof, subject to
ratification by the City Council; and
WHEREAS, on July 28, 2004, the Finance Committee considered
the recommendation of Bruce V. Malkenhorst, the Director of Finance,
dated July 22, 2004, that the actions of the City Administrator in
obtaining the necessary insurance coverage for the Commercial
Insurance Program, issuing the annual premium payments and executing
the Agreement with Global, PA and Gulf, be ratified; and
WHEREAS, the City Council desires to approve and ratify the
Agreement, as executed by the City Administrator, and the annual
premium payments in accordance therewith; and
WHEREAS, the City Council of the City of Vernon has
determined that, pursuant to the provisions of subsection (a) of
Section 2.27 of the Vernon City Code, it is in the public interest and
necessity to ratify entering into the Agreement with Global, PA and'
Gulf, through Arthur J. Gallagher.
NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF VERNON AS FOLLOWS:
SECTION 1: The City Council of the City of Vernon hereby
(finds and determines that the recitals contained hereinabove are true
and correct.
SECTION 2: The City Council of the City of Vernon hereby
ratifies the execution of the Proposal Acceptance Page, Statement of
Values, SLA D-1 Forms (Lloyds of London, Arch Specialty Insurance
Company and Gulf) and Policy Disclosure Form required by Terrorism
Risk Insurance Act of 2002 (the "Agreement") with Global, PA and Gulf
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through Arthur J. Gallagher, a copy of which is attached hereto as
Exhibit A and incorporated by this reference.
SECTION 3: The City Council of the City of Vernon hereby
approves and ratifies the annual premium payment of $446,644.00 in
accordance with the terms of the Agreement.
SECTION 4: The City Council of the City of Vernon hereby
authorizes the City Administrator, or his designee, to execute any and
all documents necessary for the purpose of securing the insurance for
the Commercial Insurance Program and to implement and carry out the
purposes specified in the Agreement on behalf of the City of Vernon.
SECTION 5: The City Council of the City of Vernon hereby
directs the City Clerk, or his designee, to send a copy of this
Resolution to:
Arthur J. Gallagher & Co.
Attn. Jayne Sexton Mazziotti, CIC
505 N. Brand Blvd., Suite 600
Glendale, CA 91203-3944
SECTION 6: The City Clerk of the City of Vernon shall
certify to the passage of this resolution, and thereupon and
thereafter the same shall be in full force and effect.
APPROVED AND ADOPTED this 28th day of July, 2004.
ATTEST:
�---- " 1,
BRUCE V. MALKENHORST, City Clerk
ONIS C. MALB RG, M yor
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STATE OF CALIFORNIA )
) ss
COUNTY OF LOS ANGELES )
I, BRUCE V. MALKENHORST, City Clerk of the City of Vernon, do
hereby certify that the foregoing Resolution, being Resolution No.
8506, was duly adopted by the City Council of the City of Vernon at an
adjourned regular meeting of the City Council duly held on Wednesday,
July 28, 2004, and thereafter was duly signed by the Mayor of the City
of Vernon.
(SEAL)
BRUCE V. MALKENHORST, City Clerk
- 4 -
EXHIBIT
0
PROPOSAL ACCEPTANCE
POLICY OPTIONS:
YES
NO
OPTION DESCRIPTION AU Policies As Shown Herein Except As listed Below:
0
0
Bind TRIA Terrorism Coverage As Quoted For the Following Policies:
Both Excess Liability Policies
This proposal is an outline of the coverages proposed by the respective insurers based on
the information provided by your company. It does not include all the terms, coverages,
exclusions, limitations or conditions of the actual contract language. The policies
themselves must be read for those details. Policy forms for your reference will be made
available upon request.
I have reviewed and accept the policies and disclosures as outlined in this
proposal with the changes or choices shown above.
Signature
City Administrator/City Clerk 7/21/04
Title Date
City of Vernon PAGE = 13 =
The proposal is an outline of the coverages proposed by the insurers, It does not include all the terms,
coverages, exclusions, limitations or conditions of the actual contract language. Please read your policy for
these items.
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Named Insured
City f Vernon
4305 Santa Fe Avenue
Vernon, CA 90058
Coverages
Certified Terrorism
Non -Certified Terrorism
Date: June 21, 2004
POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM
INSURANCE COVERAGE
Producer
Global Special Risks
2700 Post Oak Blvd.
Houston, TX 77056
Limits of Liability
$ 21,200,000
$ 21,200,000
per occurrence/annual aggregate
You are hereby notified that under the Terrorism Risk Insurance Act of 2002, effective November 26, 2002, that
you now have a right to purchase insurance coverage for losses arising out of acts of terrorism, as defined in
Section 102(1) of the Act The term "act of terrorism" means any act that is certified by the Secretary of the
Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States —to be an act
of terrorism; 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 an air carrier or vessel or
the premises of a United States mission; and to have been committed by an individual or individuals acting on
behalf of any foreign person or foreign interest, 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. Coverage
under your existing policy may be affected as follows:
YOU SHOULD KNOW THAT COVERAGE PROVIDED BY THIS POLICY FOR LOSSES CAUSED BY
CERTIFIED ACTS OF TERRORISM IS PARTIALLY REIMBURSED BY THE UNITED STATES
UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. UNDER THIS FORMULA, THE UNITED
STATES PAYS 90% 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 COVERED BY THE FEDERAL
GOVERNMENT UNDER THE ACT.
PHN PR SL 08/03
SURPLUS LINES NOTICE
INSURED: CITY OF VERNON
CARRIER: LLOYD'S OF LONDON
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING
ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF
CALIFORNIA. THESE COMPANIES ARE CALLED "NON -ADMITTED" OR
"SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO CALIFORNIA
LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE,
THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR
ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO
MAKE PAYMENTS AS PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINES
INSURERS APPROVED BY THE INSURANCE COMMISSIONER. ASK
YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU SHOULD
ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA
DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE
TELEPHONE NUMBER: 1-800-927-4357.
Your Signature
Bruce V. Malkenhorst
Your Name - Printed
D-1 FORM (1/1999)
July 21, 2004
Date
City Administrator/City Clerk
Your Title or Interest
SURPLUS LINES NOTICE
INSURED: CITY OF VERNON
CARRIER: ARCH SPECIALTY INSURANCE COMPANY
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING
ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF
CALIFORNIA. THESE COMPANIES ARE CALLED "NON -ADMITTED" OR
"SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO CALIFORNIA
LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE,
THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR
ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO
MAKE PAYMENTS AS PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINES
INSURERS APPROVED BY THE INSURANCE COMMISSIONER. ASK
YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU SHOULD
ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA
DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE
TELEPHONE NUMBER: 1-800-927-4357.
Your Signature
Bruce V. Malkenhorst
Your Name - Printed
D-1 FORM (1/1999)
July 21, 2004
Date
City Administrator/City Clerk
Your Title or Interest
SURPLUS LINES NOTICE
INSURED: CITY OF VERNON
CARRIER: GULF UNDERWRITERS INSURANCE COMPANY
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING
ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF
CALIFORNIA. THESE COMPANIES ARE CALLED "NON -ADMITTED" OR
"SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO CALIFORNIA
LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE,
THESE FUNDS WILD. NOT PAY YOUR CLAIMS OR PROTECT YOUR
ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO
MAKE PAYMENTS AS PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINES
INSURERS APPROVED BY THE INSURANCE COMMISSIONER. ASK
YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU SHOULD
ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA
DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE
TELEPHONE NUMBER: 1-800-927-4357.
v Jul 21 y 2004
Your Signature Date
Bruce V. Malkenhorst City Administrator/City Clerk
Your Name - Printed Your Title or Interest
D-1 FORM (1/1999)
SELECTION OR REJECTION OF TERRORISM INSURANCE COVERAGE
IF YOU ELECT TO PURCHASE COVERAGE FOR ACTS OF TERRORISM, AS DEFINED IN THE
ACT, AND YOU FAIL TO PAY THE PREMIUM IN FULL STATED BELOW, YOUR POLICY WILL BE
CANCELLED FOR NONPAYMENT OF PREMIUM IN ACCORDANCE WITH STATE LAW.
SUBJECT TO THE TERMS, CONDITIONS AND LIMITATIONS OF YOUR POLICY, ANY COVERAGE
MANDATED BY APPLICABLE STANDARD FIRE POLICY LAWS OR WORKERS COMPENSATION
LAWS IN YOUR STATE WILL NOT BE AFFECTED BY YOUR REJECTION BELOW OF COVERAGE
FOR TERRORIST ACTS, AS DEFINED IN THE ACT.
I hereby elect to purchase full coverage for acts of terrorism, as defined in the Act.
(Certified Terrorism) ifor a premium of $5,525 plus any appiicabie surcharges,
taxes or fees. I understand that I must also purchase limited coverage (see the
Limits of Liability on the preceding page) for acts of terrorism outside the scope of
the Act (Non -Certified Terrorism) for a premium of $ 975. My total premium for
both Certified Terrorism and Non -Certified Terrorism coverage is $ 6,500. In
addition, I acknowledge that my decision to accept and purchase full coverage for
Certified Terrorism, shall govern throughout the term of the policy.
I hereby reject the offer to purchase full coverage for acts of terrorism, as defined
in the Act (Certified Terrorism), and I understand that a sublimit of $2,500,000 per
occurrence/annual aggregate applicable to both Certified Terrorism and Non -
Certified Terrorism coverages will be automatically included in my policy at no
additional charge. I further understand that if I reject the offer to purchase full
coverage for Certified Terrorism at this time, I will have no coverage for losses
arising from Certified Terrorism which exceed the sublimit in my policy nor will I
have another opportunity during the term of the policy to purchase full coverage for
Certified Terrorism.
/A44��'Qlianz Global Risks
Policyholder/Applicant's Si nature US Insurance Co
9 Insurance Company
_Brure V Malkanhorst
Print Name Policy Number
July 21, 2004
Date
PLEASE RETURN THIS SIGNED DISCLOSURE NOTICE TO YOUR BROKER OR AGENT
Nothing in this letter should be construed as legal advice to you. Consult your attorney
and/or broker or agent to evaluate the terms of this offer.
PHN PR SL 08/03
SUPPORTING
DOCUMENTS
CITY ATTORNEY'S OFFICE
�/ INTER -DEPARTMENT MEMORANDUM
DATE: July 22, 2004
TO: Bruce V. Malkenhorst, City Administrator/City Clerk
FROM: Eric T. Fresch, City Attorney
RE: Commercial Insurance Program: Property Policy (Including
Earthquake and Equipment Breakdown) and Excess Liability
Policies
Dear Bruce:
I recommend the City purchase a Property Policy (including
earthquake and equipment breakdown) and Excess Liability Policies
through its broker, Arthur J. Gallagher & Co., for the period
July 1, 2004 to July 1, 2005. The annual premium and fees for these
policies are approximately $446,644.00.
Because it was necessary to act quickly in this matter to protect
the City's interests as the existing policies expired on June 30,
2004, you executed the Statement of Values, Proposal Acceptance,
Policy Disclosure Form and Surplus Lines Notices (SLA D-1 Forms) on
behalf of the City on July 21, 2004, and wire transferred premium
and fee payments of $158,332.38 on July 1 and $288,311.63 on
July 20, 2004, subject to ratification by the City Council.
I further recommend that you be authorized to execute any other
documents necessary to put these insurance policies in place.
I look forward to discussing this matter with you at your earliest
convenience.
EF: j 1
Attachments
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Named Insured
City f Vernon
4305 Santa Fe Avenue
Vernon, CA 90058
Coverages
Certified Terrorism
Non -Certified Terrorism
Date: June 21, 2004
POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM
INSURANCE COVERAGE
Producer
Global Special Risks
2700 Post Oak Blvd.
Houston, TX 77056
Limits of Liabilitv
$ 21,200,000
$ 21,200,000
per occurrence/annual aggregate
You are hereby notified that under the Terrorism Risk Insurance Act of 2002, effective November 26, 2002, that
you now have a right to purchase insurance coverage for losses arising out of acts of terrorism, as defined in
Section 102(1) of the Act. The term "act of terrorism" means any act that is certified by the Secretary of the
Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States —to be an act
of terrorism; 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 an air carrier or vessel or
the premises of a United States mission; and to have been committed by an individual or individuals acting on
behalf of any foreign person or foreign interest, 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. Coverage
under your existing policy may be affected as follows:
YOU SHOULD KNOW THAT COVERAGE PROVIDED BY THIS POLICY FOR LOSSES CAUSED BY
CERTIFIED ACTS OF TERRORISM IS PARTIALLY REIMBURSED BY THE UNITED STATES
UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. UNDER THIS FORMULA, THE UNITED
STATES PAYS 90% 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 COVERED BY THE FEDERAL
GOVERNMENT UNDER THE ACT.
PHN PR SL 08/03
SELECTION OR REJECTION OF TERRORISM INSURANCE COVERAGE
IF YOU ELECT TO PURCHASE COVERAGE FOR ACTS OF TERRORISM, AS DEFINED IN THE
ACT, AND YOU FAIL TO PAY THE PREMIUM IN FULL STATED BELOW, YOUR POLICY WILL BE
CANCELLED FOR NONPAYMENT OF PREMIUM IN ACCORDANCE WITH STATE LAW.
SUBJECT TO THE TERMS, CONDITIONS AND LIMITATIONS OF YOUR POLICY, ANY COVERAGE
MANDATED BY APPLICABLE STANDARD FIRE POLICY LAWS OR WORKERS COMPENSATION
LAWS IN YOUR STATE WILL NOT BE AFFECTED BY YOUR REJECTION BELOW OF COVERAGE
FOR TERRORIST ACTS, AS DEFINED IN THE ACT.
I hereby elect to purchase full coverage for acts of terrorism, as defined in the Act.
(Certified Terrorism) for a premium of $5,525 plus any appiicaoie surcharges,
taxes or fees. I understand that I must also purchase limited coverage (see the
Limits of Liability on the preceding page) for acts of terrorism outside the scope of
the Act (Non -Certified Terrorism) for a premium of $ 975. My total premium for
both Certified Terrorism and Non -Certified Terrorism coverage is $ 6,500. In
addition, I acknowledge that my decision to accept and purchase full coverage for
Certified Terrorism, shall govern throughout the term of the policy.
I hereby reject the offer to purchase full coverage for acts of terrorism, as defined
in the Act (Certified Terrorism), and I understand that a sublimit of $2,500,000 per
occurrence/annual aggregate applicable to both Certified Terrorism and Non -
Certified Terrorism coverages will be automatically included in my policy at no
additional charge. I further understand that if I reject the offer to purchase full
coverage for Certified Terrorism at this time, I will have no coverage for losses
arising from Certified Terrorism which exceed the sublimit in my policy nor will I
have another opportunity during the term of the policy to purchase full coverage for
Certified Terrorism.
k1lianz Global Risks US Insurance Co
Policyholder/Applicant's Signature Insurance Company
Bruce V Malkenhorst
Print Name Policy Number
July 21, 2004
Date
PLEASE RETURN THIS SIGNED DISCLOSURE NOTICE TO YOUR BROKER OR AGENT
Nothing in this letter should be construed as legal advice to you. Consult your attorney
and/or broker or agent to evaluate the terms of this offer.
PHN PR SL 08/03
PROPOSAL ACCEPTANCE
POLICY OPTIONS:
YES
NO
OPTION DESCRIPTION
Bind All Policies As Shown Herein Except As Listed Below:
7-0
0
i
Bind TRIA Terrorism Coverage As Quoted For the Following Policies:
Both Excess Liability Policies
This proposal is an outline of the coverages proposed by the respective insurers based on
the information provided by ybur company. It does not include all the terms, coverages,
exclusions, limitations or conditions of the actual contract language. The policies
themselves must be read for those details. Policy forms for your reference will be made
available upon request.
have reviewed and accept the policies and disclosures as outlined in this
proposal with the changes or choices shown above.
d
Signature
City of Vernon
City Administrator/City Clerk 7/21/04
Title
Date
PAGE = 11 =
The proposal is an outline of the coverages proposed by the insurers, It does not include all the terms,
coverages, exclusions, limitations or conditions of the actual contract language. Please read your policy for
these items.
SURPLUS LINES NOTICE
INSURED: CITY OF VERNON
CARRIER: LLOYD'S OF LONDON
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING
ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF
CALIFORNIA. THESE COMPANIES ARE CALLED "NON -ADMITTED" OR
"SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO CALIFORNIA
LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE,
THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR
ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO
MAKE PAYMENTS AS PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINES
INSURERS APPROVED BY THE INSURANCE COMMISSIONER. ASK
YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU SHOULD
ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA
DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE
TELEPHONE NUMBER: 1-800-927-4357.
Your Signature
Bruce V. Malkenhorst
Your Name - Printed
D-1 FORM (1/1999)
July 21, 2004
Date
City Administrator/City Clerk
Your Title or Interest
SURPLUS LINES NOTICE
INSURED: CITY OF VERNON
CARRIER: ARCH SPECIALTY INSURANCE COMPANY
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING
ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF
CALIFORNIA. THESE COMPANIES ARE CALLED "NON -ADMITTED" OR
"SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO CALIFORNIA
LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE,
THESE FUNDS WILD NOT PAY YOUR CLAIMS OR PROTECT YOUR
ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO
MAKE PAYMENTS AS PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINES
INSURERS APPROVED BY THE INSURANCE COMMISSIONER. ASK
YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU SHOULD
ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA
DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE
TELEPHONE NUMBER: 1-800-927-4357.
Your Signature
Bruce V. Malkenhorst
Your Name - Printed
D-1 FORM (1/1999)
July 21, 2004
Date
City Administrator/City Clerk
Your Title or Interest
r
SURPLUS LINES NOTICE
INSURED: CITY OF VERNON
CARRIER: GULF UNDERWRITERS INSURANCE COMPANY
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING
ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF
CALIFORNIA. THESE COMPANIES ARE CALLED "NON -ADMITTED" OR
"SURPLUS LINE INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO CALIFORNIA
LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE
GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE,
THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR
ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO
MAKE PAYMENTS AS PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINES
INSURERS APPROVED BY THE INSURANCE COMMISSIONER. ASK
YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU SHOULD
ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA
DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE
TELEPHONE NUMBER: 1-800-927-4357.
Your Signature
Bruce V. Malkenhorst
Your Name - Printed
D-1 FORM (1/1999)
July 21, 2004
Date
City Administrator/City Clerk
Your Title or Interest