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t <br />Attachment n n1ber 1 <br />Page 43 of 43 <br />PROPOSED WORKERS' COMPENSATION COVERAGE <br />Insurer• <br />Preferred Governmental Insurance Trust <br />Not Rated by A.M. Best <br />Classifications & Exposures: Subiect To Audit <br />Classification Code No. Gross Payrolls Rate Premium <br />Bus Co Emp & Drivers <br />7382 <br />269,914 <br />5.68 <br />$15,331.00 <br />Police Officers/Drivers <br />7720 <br />4,663,097 <br />4.42 <br />$206,109.00 <br />Clerical <br />8810 <br />4,782,634 <br />.26 <br />$12,435.00 <br />Attorney — All Em 1. <br />8820 <br />327,287 <br />.21 <br />$687.00 <br />Bld s -Owner — Lessee <br />9015 <br />1,415 280 <br />5.14 <br />$72,745.00 <br />Park NOC <br />9102 <br />1,975,839 <br />4.66 <br />$92,074.00 <br />Street Cleaning & Driv <br />9402 <br />145,346 <br />9.45 <br />$13,735.00 <br />Munici alit NOC <br />9410 <br />1,112,752 <br />2.91 1 <br />$33,494.00 <br />Standard Limits of Liability <br />Increased Limits of Liability <br />Workplace Safety Program Credit <br />Drug -free Workplace Program Credit <br />Experience Modification <br />Standard Premium <br />Standard Discount <br />Schedule & Deductible Adjustment <br />Certified Acts of Terrorism <br />Expense Constant <br />Total Premium <br />$100,000 /$500,000 /$100,000 <br />$1,000,000 /$1,000,000 /$1,000,000 <br />2% <br />5% <br />.74 <br />$445,498.00 <br />Included <br />6,237.00 <br />( 8,583.00) <br />( 22,587.00) <br />(109,347.00) <br />311,218.00 <br />( 29,858.00) <br />(97,187.00) <br />2,938.00 <br />200.00 <br />$ 187,311.00 <br />Workers Compensation Premiums Reflect 01/01/14 Rate Increase <br />Deductible: <br />$2,500.00 Per Occurrence <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 Safety �. <br />applications <br />Agenda Item No. l0A <br />42 149 <br />