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Attachment number I <br /> Page 35 of 42 <br /> PROPOSED WORKERS' COMPENSATION COVERAGE <br /> Insurer: <br /> Preferred Governmental Insurance Trust <br /> Not Rated by A.M. Best <br /> Classifications & Exposures: Subject To Audit <br /> Classification Code No. Gross Payrolls Rate Premium <br /> Bus Co Emp & Drivers 7382 227,038 6.13 $13,917.00 <br /> Police Officers/Drivers 7720 4,027,394 4.45 $179,219.00 <br /> Clerical 8810 3,235,743 .27 $8,737.00 <br /> Attorney—All Empl. 8820 321,548 .21 $675.00 <br /> Bldgs-Owner-Lessee 9015 1,074,897 4.97 $53,422.00 <br /> Park NOC 9102 1,422,650 4.57 $65,015.00 <br /> Street Cleaning& Driv 9402 133,588 8.63 $11,529.00 <br /> Municipality NOC 9410 763,231 _ 2.98 $22,744.00 <br /> Manual Premium $355,259.00 <br /> Standard Limits of Liability $100,000/$500,000/$1 00,000 Included <br /> Increased Limits of Liability $1,000,000/$1,000,000/$1,000,000 $ 4,974.00 <br /> Workplace Safety Program Credit 2% ($ 6,844.00) <br /> Drug-free Workplace Program Credit 5% ($ 18,012.00) <br /> Experience Modification 1.00 $0 <br /> Standard Premium $335,377.00 <br /> Standard Discount ($ 32,588.00) <br /> Schedule & Deductible Adjustment ($132,029.00) <br /> Certified Acts of Terrorism $ 2,241.00 <br /> Expense Constant $ 200.00 <br /> Total Premium $ 173,201.00 <br /> Workers Compensation Premiums Reflect 07/01/13 Rate Increase <br /> Deductible: <br /> $2,500.00 Per Claim <br /> Terms & Conditions Including But Not Limited To: <br /> • Members are required to maintain valid and current certificates of workers' compensation <br /> Insurance on all work performed by persons other than its employees <br /> • Safety and Drug Free program credits are subject to program requirements <br /> • Payrolls are subject to final audit <br /> • Quotation is subject to receipt of the PGIT WC application and signed Drug Free and <br /> Safety applications <br /> Agenda Item No 10A <br /> 35 <br /> 99 <br />