HomeMy WebLinkAboutResolution - 2002-R0400 - Purchase Of Workers Compensation Coverage - 09/26/2002Resolution No. 2002-80400
September 26, 2002
Item No. 47
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to purchase for and on behalf of the City of Lubbock, workers' compensation
coverage, by and between the City of Lubbock and Texas Municipal League
Intergovernmental Risk Pool, and related documents.
Passed by the City Council this 26th day c
ATTEST:
- a L, , <��, -
Rebecca Garza, City Secretary
APPROVED AS TO CONTENT:
Mary House irector of Human Resources
APPROVED AS TO FORM:
William de Haas
Contract Manager/Attorney
gs:/ccdocsWorkers Comp Coverage.res
September 17, 2002
PROPOSAL ACCEPTANCE FORM
LIABILITY Resolution No. 2002-80400
Directions: This form and the Interlocal Agreement must be completed, signed and returned. If time is of the essence, you
may wish to use an express mail service or a facsimile copier. In the event you submit these documents by facsimile, the
originals must still be sent by regular mail. (Exception: Rural Fire Prevention Districts and Emergency Service Districts must
provide other documents before coverage is effective.) Please indicate with ( X j the coverages and method of payment that you are
accepting.
COVERAGE
[ ] General Liability
[ ] Automobile Liability
RETURN TO:
Texas Municipal League Intergovernmental Risk Pool
Underwriting Department
P.O. Box 149194
Austin, Texas 78714-9194
Phone: 512-491-2300 or 1-800-537-6655
FAX. 512-491-2404
LIMITS DEDUCTIBLE CONTRIBUTION EFFECTIVE ANNIVERSARY
DATE DATE
[ ] Automobile Physical Damage $ $ $
[ ] Automobile Catastrophe $ $ $
[ j Law Enforcement Liability
urlors & Omissions Liability
] **Prior Acts Coverage (LEL)
(5years)
j **Prior Acts Coverage (E&O)
(5years)
Same as LEL Coverage Included
Same as E&O Coverage Included
Method of Payment: [ ] Quarterly [ ] Annually (3% DISCOUNT)
I, the undersigned, as an authorized representative of C; `� �1 (3 �vl 611C'
(Name of Po ical S vision)
do hereby accept on behalf of the above named political subdivision portio ft posal as indicated above.
Signature of Authorized Official: Marc McDougal
Title: ayor
Date: & —L I— d L
The Signed Interlocal OFFICE USE ONLY
Agreement Must Accompany Contribution: Entity [D
Verified by:
This Form New Re -awarding Adding Coverage
** This form must be accompanied by the Warrant of Incident Report if prior acts is elected.
TEXAS MUNICIPAL LEAGUE INTERGOVERNMENTAL RISK POOL
APPROVED AS TO FORM:
William de Haas, Contracts Manager/Attorney
ATT T:
Rebec6a Garza, City Secretary
APPROVED AS TO CONTENT:
j�7�14�
Mary House, DLrbctor of Human Resources
PROPOSAL ACCEPTANCE FORM
WORKERS' COMPENSATION
Resolution No. 2002—RO400
Directions: This form and the Interlocal Agreement must be completed,
signed and returned. If time is of the essence, you may wish to use an
express mail service or a facsimile copier. In the event you submit these
documents by facsimile, the originals must still be sent by regular mail.
Please indicate with [X] the coverages and method of payment that you are
accepting.
Return To: Texas Municipal League Intergovernmental Risk Pool
Underwriting Department, PO Box 149194, Austin, Texas 78714-9194
Phone: (800) 537-6655 or (512) 491-2300 FAX (512) 491-2404
Workers' Compensation Coverages Accepted
[ X
] All Paid Employees
Mandatory
[
] All Outside Volunteers
Optional
[
] Volunteer Firefighters
Optional
[
] Volunteer Ambulance/EMS Attendants
Optional
[
] Police Reserves
Optional
[
] Elected/Appointed Officials
Optional
[
] All Inside Volunteers
Optional
[
] Police Reserves - Motorcycle
Optional
Deductible
Options
Deductible Amount
[ X
] No Deductible
Not Applicable
[
] Accident Deductible
[
] Aggregate Deductible
[
] Self -Insured Retention (Excess Only)
Contribution: $1,859,893 Contribution as Accepted:
Method of Payment: [ ] Quarterly [ ] Annually (3% Discount)
I, the undersigned, as an authorized representative of:
547 Lubbock
------------------------------------------------------
(Name of Political Subdivision)
do hereby accept on behalf of the above named political subdivision
the portions of the proposal as indicated above.
Effective Date: Anniv rsary te:
Signature of Authorized Official:
Marc McDougal
Title:
Mayor
Date:
Official Use Only
The signed n er oca Contribution: Entity Il:
Agreement must accompany Verified by:
this form. [ ]New [ ]Re-awarding]Adding Coverage
Texas unicTpa League Intergovernmental Risko0
APPROVED AS TO FORM:
William de Haas, Contracts Manager/Attorney
ATTEST:
Reba Garza, City Secre ary
APPROVED AS TO CONTENT:
j6", k2�t —
Mary House, DVector of Human Resources