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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 /> Gla sfication Code No Gross-Payrolls -._- Rate --__:Pr_emium <br /> Bus Co Emp&Drivers :: 7382 224,400 5.42 $12,162.00 <br /> PoliceOf ,cers/Dicxvkrs:'- 7720 3,724,754 4.21 $156,812.00 <br /> 8810 3,003,556 .27 $8,110.00 <br /> ▪A▪ ttorney-All Empl 8820 282,596 _ .20 $565.00 <br /> Bl-dgs-Owner-1 essee 9015 827,978 4.53 $37,507.00 <br /> Park NOC ° . _ 9102 1,383,645 4.11 $56,868.00 <br /> StreetClean ng&Oriv 9402 50,391 7.94 $4,001.00 <br /> MunicipalityNOC 9410 632,304 2.87 $18,147.00 <br /> Manual Premium $294,169.00 <br /> , <br /> Standard Limits of Liability $100,000/$500,000/$100,000 - Included <br /> Increased Limits of Liability $1,000,000/$1,000,000/$1,000,000 $ __ 1800 <br /> Workplace Safety Program Credit 2% .($ <br /> Drug-free Workplace Program Credit 5% ($:__1.4,915.00) <br /> Experience Modification 1.00 $0 <br /> Standard Premium $277,704.00 <br /> Standard Discount (3-26,071.00 <br /> Schedule Adjustment - ($114,251.04 <br /> Certified Acts of Terrorism _ 3 = 2,0360 <br /> Expense Constant = 2041W <br /> Total Premium ;• $143,608:00: <br /> Workers Compensation Premiums Reflect 01/01/12 Average Rate Increase of 12.2 % <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 Safety <br /> applications <br /> 37 <br />