HomeMy WebLinkAbout2002-151 Insurance Expense-TAP TAP Intertie Joint Venture - TAP Project CCIS City County Insurance Services
155 North First Street Invoice # 03-1026
P.O. Box 3275
Central Point, OR 97502 Invoice bate
(541) 664-6674 09/26/02
INVOICE TO: J [~ r ' - ....
City of Ashland ! ii!'
, ~_:~ -:' I 2002
Attn: Paulo Brown [ L ................. ]
27 1/2 N Main CiTY OFAc~,-,._;.,'~" ND
Ashland OR 97520
DESCRIPTION INVOICE AMOUNT
Insurance Expense $2,382.84
for the period covering
`Tuly 1, 2002 through ,Tune 30, 2003
INVOICE TOTAL $ 2,382.84
For internal use only: Cust#1502 blt: 10-1599 CR: 10-3202-10-100
w ww. tn;cog, org
TAP Intertie Joint Venture - TAP Project CCIS City County Insurance Services Fax.'541-664-7927
Community Development
Rogue Valley Council of Governments
Central Point 541-664-6674 · Medford 541-779-6785 · Grants Pass 541-474-5947
COUNCIL
Council of September 26. '~00'~
voluntary associ~tion :' ,7~:~ ~ ~-:-,-~ · ,
¢'localgovernments ~,.'~, ,_: L 7, /~", ,' ''
in Jackson lltld
Josephine Coutm'es. ~ -
TO: Betty Wheeler. City Administrator, C~-6-fTfiIeht
Member Paula Brown. Public Works Director, City of Ashland
Jurisdictions Jim Wear, Public Works Director, City of Phoenix
Jackson County
FROM' Pat Foley. Community Development Specialist
Josephine County Rogue Valley' Council of Governments
Ashland
Butte Falls RE: TAP Inte~ie Joint Venture
C,v~ J~,~tion Insurance Policy and Invoice
Central Point The long awaited policy and invoice for the TAP Intenie Joint Venture has finally
Eagle Point arrived. Please find enclosed for your review and approval:
Gold Hill
1. Sample Resolution - It is my opinion that the cities have membership with the
Grant Pass
City County Insurance Services Trust.
Jacksonville
M~Uro~d 2. Insurance Policy and associated documents
Phoenix
An invoice covering the TAP Intertie - July 1,2002 thru June 30, 2003, is also
Rogue River enclosed. Make checks payable to TAP Intenie Joint Venture and mail to RVCOG.
Shady Cove City County Insurance Services will be paid a lump sum out of your joint account by
Talent RVCOG.
Associate Members
Bcvs~ If you have questions telephone me at 664-6676 ext. 201.
Bear Creek Xalley
Jackson Soil & ~kater
Conser~ ation District x~
Rogue Valley ~ j
Transp~ntation District
SORED[
Economic Development, Inc.
Applegat¢
RFPI) ~)
Address 155 N. First Street · Mail: P.O Box 3275 · Central Point, OR 97502
TAP Intertie Joint Venture - TAP Project CCIS City County Insurance Services
155 North First Street Invoice # 03-1026
P.O. Box 3275
Central Point, OR 97502 Invoice bate
(541) 664-6674 09/26/02
INVOICE TO:
City of Ashland
Attn: Poula Brown
27 1/2 N AAain
Ashland OR 97§20
DESCRIPTION INVOICE AMOUNT
Insurance Expense $4,096.33
for the period coverin9
July 1, 2002 through June 30, 2003
INVOICE TOTAL . $4,096.33
For internal use only: Cust~l~DR: 10-1599 CR: 10-320~-10-100
TAP Intertie Joint Venture - TAP Project CCIS City County Insurance Services
Ifisurdhce INVOICE
serv ces
Member: Property/Liability Agent:
Talent Ashland Phoenix Intertie Secur~ Insurance Agency, Inc.
C/O Rogue Valley COG 707 Murphy Road
P.O.Box 3275 Medford, OR 97504
Central Point, OR 97502
50282 01-Jul-02 30-Jun-03 23-Aug-02 TAP-12002-01
General Liability $6,230.00
Auto Liability $181.00
Liability Total $6,411.00
Auto Physical Damage
Property (Including $10 Million Earthquake and Flood) $4,971.00
Optional Excess Earthquake $0.00
Boiler and Machinery $1,021.00
Optional Excess Crime $0.00
Annual Contribution $12,403.00
Multi Line Credit ($114.00)
Total $12,289.00
Make Checks Payable to: Total Due: $12,289.00
City County Insurance Services
P.O. Box 31t -Salem, OR 97308
(503) 585-112t or 1-800-922-2684
Fax (503) 585-1140
SAMPLE
Resolution Regarding Membership
In the City County Insurance Services Trust.
Recitals:
1. City County Insurance Services Trust (CIS) is a trust established by the
League of Oregon Cities (LOC) and Association of Oregon Counties (AOC)
to administer pooled retention funds to protect members against the
financial consequence of property, casualty, and workers compensation
losses pursuant to coverage agreements;
2. CIS provides its Members a broad array of risk management services,
including risk financing, loss prevention and loss control programs, claims
management and legal representation, risk management consulting, data
gathering, information sharing, training and related services;
3. finds that membership in CIS is a benefit in
managing the risks involved in providing services to its citizens;
4. has been provided with copies of the CIS
Trust Agreement, Bylaws and Rules which have been recently updated
and revised;
5. The CIS Bylaws, at Articles 2.2.2 and 3.3 provide that Articles 2 and 3 of
the bylaws shall constitute a contract between the Member and CIS and
that the Member shall adopt a resolution acknowledging that contractual
relationship.
Now, therefore, ("Member's does hereby
acknowledge and agree that it has received copies of the CIS Agreement
and Declaration of Administrative Trust, Bylaws, and Rules and accepts
the terms and conditions therein with respect to any CIS coverage
programs in which it elects to participate and for which it is accepted as a
Member by CIS.
Adopted:
?
Nam' City
Coun
Insur?ce
ervices
Certificate of Membership No. 02LTAP
Named Member:
City County Insurance Services
Liability Coverage Declarations
Talent/Ashland/Phoenix Intertie
C/O Rogue Valley COG
P.O.Box 3275
Central Point, OR 97502
Coverage Period: 7/1/2002 through 6/30/2003
Agent of Record:
Security Insurance Agency, Inc.
707 Murphy Road
Medford, OR 97504
Coverage * Per Occurrence
Limit Annual
Aggregate Per Occurrence
Deductible / SIR Aggregate
Deductible Contribution
Public Entity Liability Coverage
including: $1,000,000 None None None $6,230.00
General Liability Included None None None Included
Employment Practices Liability Included None None ** None Included
Employee Benefits Admin. Liability Included None None None Included
Public Officials Liability Included None None None Included
ADA Liability Included None None None Included
Fair Housing Act Liability Included None None None Included
Law Enforcement Liability Included None None None Included
Ethics Complaint Defense $2,500/$5,000 $5,000 None None Included
Pesticide/Herbicide Application $50,000 None None None Included
Auto Liability Included None None None $181.00
Non-Owned/Hired Auto Liability Included None None None Included
Uninsured Motorist $100/$500 None None None Included
* This represents only a brief summary of coverages. Please refer to CIS Liability Coverage Agreement for
detailed coverages, exclusions, and conditions that may apply.
Total Contribution: $6,411.00
Forms applicable: CIS Liability Coverage Agreement - 7/1/2002
** $2,500 conditional deductible on certain employment claims - See Section 2 of Coverage Agreement
)Noel J. Klein
Executive Director, City County Insurance Services 07/01/2002
City County Insurance Services
CME,l General Liability Schedule Policy Year: 07/01/2002 to 06/30/2003
Talent/Ashland/Phoenix Intertie Liability Coverage Limit $1,000,000
Agent: Security Insurance Agency, Inc.
Complete all items that apply to your entity. Mark items that do not apply as NA.
All items are defined on the next page. If you have any questions, please call
Debby Hande (ext. 318) or Bob Kahl (ext. 312) at 800-922-2684.
Description Unit Amount Total
Contribution
Total Personal Services (2001 - 2002) Dollars 0
Total Materials and Supplies (2001 - 2002) Dollars 170,400 156
Law Enforcement Officers - Paid Number 0
Law Enforcement Officers - Non-Paid Number 0
Premises Sq. Feet 1,056 46
Premises Leased to Others Sq. Feet 0
Storm and Sanitary Sewers Miles 0
Water Department (millions of gallons delivered) Gallons 537 5,966
Streets and Roads (paved & unpaved) Miles 0
Streets and Roads (Unpaved) Miles 0
)esticide/Herbicide Application (annual gallons used) Gallons 0
Jails (area) Sq. Feet 0
EMT - Emergency Medical Technicians Number 0
Swimming Pools (annual receipts) Dollars 0
Parks and Playgrounds (total area) Sq. Acre 0
Grandstands and Stadiums (total seats) Number 0
Fairgrounds (total receipts from all uses) Dollars 0
Fireworks Exhibitions Conducted by Member Number 0
Community Colleges (FTE students as of fall term) Number 0
Nurses (RN, LPN, Aides - employed or contracted services) Number 0
Medical Doctors (employed or contracted services) Number 0
Marinas Number 0
Watercraft (over 25 HP) Number 0
Airports Number 0
Rail or Trolley Lines Miles 0
Events or Festivals sponsored - Alcohol provided by Member Events 0
ergency Communications Center (annual # of calls) Number 0
Thursday, August 29, 2002
Page t
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Insura Cc
,Services
City County Insurance Services
Property Coverage Declarations
"'ertificate of Membership No. 02PTAP
:mod Member:
Talent/Ashland/Phoenix Intertie
C/O Rogue Valley COG
P.O.Box 3275
Central Point, OR 97502
Coverage Period: 7/1/2002 through 6/30/2003
Agent of Record:
Security Insurance Agency, Inc.
707 Murphy Road
Medford, OR 97504
Coverage Limits (Per Occurrence):*
Buildings (per Statement of Values) $4,334,045
Contents (per Statement of Values) $830,000
Inland Marine (per Statement of Values) $0
Earthquake $5,000,000
Excess Earthquake - Coverage applies only if coverage limit is shown. None
Flood $5,000,000
Excess Flood - Coverage applies only if coverage limit is shown under Extra Items below. None
Combined Loss of Revenue and Rental Value $100,000
Combined Extra Expense and Rental Expense $100,000
Property in Transit $100,000
Hired, Rented or Borrowed Equipment $100,000
Restoration/Reproduction of Books, Records, etc. $100,000
Electronic Data Restoration/Reproduction $100,000
Pollution Cleanup $25,000
Crime Coverage $50,000
Police Dogs (if scheduled) $10,000
Off Premises Service Interruption $100,000
Miscellaneous Coverages $50,000
Extra Items (if any):
*This represents only a brief summary of coverages. Please refer to the CIS Property Coverage Agreement for
detailed coverages, exclusions, and conditions that may apply.
Locations Covered: Per statement of values on file with CIS.
Perils Covered: Risks of Direct Physical Loss subject to the terms, conditions and exclusions contained in
the coverage forms listed below under Forms Applicable.
Deductibles: $1,000.00 Per occurrence except as noted and as follows
$0.00 Per occurence on inland marine scheduled items.
Earthquake and Flood: See Section 2 of the Property Coverage Agreement
Property Contribution: $4,971.00
Excess Earthquake Contribution: $0.00
Forms Applicable: Property Coverage Agreement
Noel J. Klein
Executive Director, City County Insurance Services 07/01/2002
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?- city City County Insurance Services
I? Count?yy
Insuraicc
-services Equipment Breakdown/Boiler and Machinery Declarations
Certificate of Membership No. 02BTAP
Claim and Inspection Reference #1000348
Named Member:
Talent/Ashland/Phoenix Intertie
C/O Rogue Valley COG
P.O.Box 3275
Central Point, OR 97502
Coverage Period: 7/1/2002 through 6/30/2003
Agent of Record:
Security Insurance Agency, Inc.
707 Murphy Road
Medford, OR 97504
Coverage Limits: *
Property Damage
Rental Value
As per Statement of Values for buildings and contents
filed by the NAMED MEMBER with the Trust or
$50,000,000, whichever is less.
Extra Expense
Drying out following a flood
Hazardous Substance
Computer Equipment
Data Restoration
Portable Equipment
Perishable Goods
CFC Refrigerants
Service Interruption
Included in Equipment Breakdown
Included in Equipment Breakdown
Included in Equipment Breakdown
$50,000
$100,000
$100,000
$100,000
$100,000
$100,000
$250,000
Expediting Expense $250,000
Demolition and Increased Cost of Construction $1,000,000
* This represents only a brief summary of coverages. Please refer to CIS Equipment Breakdown Coverage
Agreement for detailed coverages, exclusions, and conditions that may apply.
Locations Covered: Per statement of values on file with the Trust.
New Locations Automatic coverage 90 days (See A.2.k. Newly Acquired Locations)
Deductibles: $1,000.00 All Coverages
Contribution: $1,021.00
Forms Applicable: Equipment Breakdown Coverage Agreement - CIS B/M 0001 07/01/01
Noel J. Klein
Executive Director, City County Insurance Services 07/0112002
AGENT
Security Insurance Agency, Inc.
707 Murphy Road
Medford, OR 97504 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN
THOSE PROVIDED IN THE COVERAGE DOCUMENT. THIS CERTIFICATE
DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDEC BY
THE COVERAGE DOCUMENTS LISTED HEREIN.
COMPANIES AFFORDING COVERAGE
NAMED MEMBER COMPANY A - City County Insurance Services (CCIS)
Talent/Ashland/Phoenix Intertie COMPANY B - Fidelity and Deposit of Maryland
C/O Rogue Valley COG COMPANY C - NLC Mutual
Central Point, OR 97502
?f?V?RAGES
This is to certify that coverage documents listed herein have been issued to the Named Member herein for the Coverage period indicated. Notwithstanding any
requirement, term or condition of any contract or other document with respect to which the certificate may be issued or may pertain, the coverage afforded by the coverage
documents listed herein is subject to all the terms, conditions and exclusions of such coverage documents.
CO
LTR Type of Coverage Certificate # Effective Date Expiration Date Limits
A , Ge neral Liability 02LTAP 7/1/2002 6/30/2003 General Aggregate None
X Commercial General Liability
Each Occurrence
$1,000,000
X P
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Off
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l
Li
bili
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ic
c
a
s
a
ty
P Employment Practices
X Occurrence
I
A Automobile Liability 02LTAP 7/1/2002 6/30/2003 General Aggregate None
h
l
S
d
d A
t Each Occurrence $1,000,000
X ?
c
e
u
e
u
os
i
i
X
Hired Autos
I X Non-Owned Autos
i
?
A Auto Physical Damage
Scheduled Autos
Hired Autos
Non-Owned Autos
A X Property 02PTAP 7/1/2002 6/30/2003 Per Filed Values
A X Boiler and Machinery 028TAP 7/1/2002 6/30/2003 Per Filed Values
B Excess Crime
C ' Excess Earthquake
C Excess Flood Each Occurrence
A Workers' Comp.
DESCRIPTION:
CERTIFICATE HOLDER CANCELLATION: Should any of the coverage documents herein be cancelled before the
expiration date thereof, CCIS will endeavor to provide 30 days written notice to the
certificate holder named herein, but failure to mail such notice shall impose no obligation
or liability of any kind upon CCIS, its agents or representatives, or the issuer of this
certificate.
BY r?`Z Date: