HomeMy WebLinkAboutResolution - 2016-R0336 - Purchase - American Home Insurance Company - Property Insurance - 09/22/2016Resolution No.2016-R0336
Item No.6.20
September 22,2016
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the City Manager of the City of Lubbock is hereby authorized and directed
to purchase for and on behalf of the City of Lubbock,property insurance coverage from
American Home Insurance Company, for a premium amount not to exceed a rate of .0907
per $100.00:and
THAT the City Manager may execute any routine documents and forms
associated with saiJ insurance coverage.
Passed by the City Council this September 22,2016 .
DANIEL M.POPE MAY >
ATTEST:
Leisa mitcheson.Director of Human Resources
and Risk Management
APPROVED AS TO FORM:
"0/h*4Kl^«£-ds
Jeff Hartsell.Chief Litigation Attorney
RES.Risk Mgmt-American Home Ins.
September 15.2016
Resolution No. 2016-RO336
AIG
Property Performance"
American Home Assurance Company
(A CAPITAL STOCK COMPANY)
EXECUTIVE OFFICES: 175 Water Street 18th Floor, New York, New York, 10038
PROPOSAL OF INSURANCE
Issued: 09/12/2016
Renewal of: 021469181
Item 1. Named Insured and Address:
CITY OF LUBBOCK
1625 13TH ST P.O. BOX 2000
LUBBOCK, TX 79401-3830
The Named Insured includes you and/or your affiliated and subsidiary companies and/or
corporations as now exist or may hereafter be incorporated, constituted or acquired, including
their interests as may appear in partnerships or joint ventures which you are legally obligated to
insure.
Item 2. Mortgagees, Loss Payees, and Additional Insureds: Per Certificates on File with the Company.
Item 3. Policy Period:
From: 10/01 /2016 To: 10101 /2017
(12:01 a.m., Standard Time at the Address of the Named Insured shown in Item 1. above.)
Item 4. Coverage Territory:
United States, its territories and possessions and Puerto Rico, including their respective coastal
waters. If any coverage is provided on a worldwide basis, such worldwide coverage shall not
include any jurisdiction prohibited or restricted under United Nations resolutions or the trade or
economic sanctions, laws or regulations of the European Union or the United States of America.
Losses are only covered within the coverage territory.
US TIV:
Canada TIV:
Rest of World TIV:
Total TIV:
$1, 294, 565,207
Not Covered
Not Covered
$1, 294, 565, 207
Item 5. Premium and Engineering Fees
A. Total Premium:
B. US Premium:
C. US Terrorism Premium:
$1,173,818 (Worldwide including any applicable
Terrorism Premium)
$1,173,818 (including Terrorism Premium)
$10,878 (included within US Premium)
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D. Rest of World Premium: Not Covered
E. Rest of World Terrorism Premium: Not Covered
F. Commissions: NET
G. Surcharges: (If Applicable)
H. Engineering Fees: $ (not included within the Total Premium)
Above premiums are exclusive of all taxes, surcharges, and fees unless otherwise shown. State
surcharges to be paid by the Insured are not included in the premium above.
Item 6. Limit of Liability: $500,000,000 (hereinafter, the "Policy Limit") This is our maximum liability
in any one occurrence as a result of all covered loss or damage regardless of the number of
covered locations, coverages, or Covered Causes of Loss under this Policy.
Item 7. Sublimits of Liability: Sublimits of liability stated below are part of and not in addition to the
Policy Limit shown in Item 6. above. The sublimits are the maximum amount we will pay for all
loss or damage arising out of the specific perils or coverages shown below or the maximum
number of days for a specific coverage, if applicable. These sublimits of liability and the
specified limits of liability contained in the forms, endorsements and extensions attached, if
any, are per occurrence unless otherwise indicated.
If the words, NOT COVERED are shown, instead of a limit, sublimit amount or number of days,
or if a specified amount or number of days is not shown corresponding to any coverage or
Covered Cause of Loss, then no coverage is provided for that coverage or Covered Cause of
Loss
A. Sublimits Applicable to Specified Covered Causes of Loss:
1. Earth Movement:
a. Annual Aggregate: $50,000,000
b. Subject to A.1.a. above, the Annual Aggregate for all loss or damage arising out of
earth movement for any location wholly or partially within the following states and
territory combined: California, Alaska, Hawaii, and Puerto Rico: Not Covered
c. Subject to A.1.a. above, the Annual Aggregate for all loss or damage arising out of
earth movement for any location wholly or partially within the Pacific Northwest
Earthquake Zone Counties: Not Covered
d. Subject to A.1.a. above, the Annual Aggregate for all loss or damage arising out of
earth movement for any location wholly or partially within the New Madrid
Earthquake Zone Counties: Not Covered
e. Other Sublimit(s) Applicable to Earth Movement: Not Applicable
2. Flood:
a. Annual Aggregate: $50,000,000
b. Subject to A.2.a. above, the Annual Aggregate for all loss or damage due to all
flood for any location wholly or partially within Special Flood Hazard Areas (SFHA)
as defined by the Federal Emergency Management Agency (FEMA): $25,000,000
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c. Other Sublimit(s) Applicable to Flood: Not Applicable
3. Named Storm: $500,000,000 This is our maximum liability in any one occurrence for
named storm as a result of all loss or damage (to the extent covered) including, but not
limited to, loss or damage from wind, hail, lightning, tornado, rain or water (whether
driven by wind or not), flood, or any wind driven objects or debris, regardless of the
number of covered locations, coverages, or Covered Causes of Loss under this Policy.
Other Sublimit(s) Applicable to Named Storm: Not Applicable
Subject to the applicable Named Storm Sublimit, in the event loss or damage by flood
that occurs concurrently or in any sequence with a named storm, the maximum amount
we will pay per occurrence for all such loss or damage by flood shall be the sublimits of
liability for flood as shown in A.2.a. and/or A.2.b., and/or A.2.c. whichever is/are
applicable. However, if flood is not covered, the maximum amount we will pay per
occurrence for all such loss or damage by named storm shall exclude loss or damage by
flood.
4. Terrorism:
[ ] NOT COVERED [XI Covered and Included Within the Policy Limit
This is our maximum liability in any one occurrence for terrorism as a result of all loss or
damage regardless of the number of covered locations, coverages, or Covered Causes
of Loss under this Policy.
5. Equipment Breakdown: $125,000,000 This is our maximum liabilitv in anv one
occurrence for equipment breakdown as a result of all loss or damage regardless of the
number of covered locations, coverages, or Covered Causes of Loss under this Policy.
Other Sublimit(s) Applicable to Equipment Breakdown: Not Applicable
B. Sublimits Applicable to Additional Coverages — Each of these sublimits is part of, and not in
addition to the Policy Limit and any other sublimits shown in Item 7.A. of the Declarations.
1. Accounts Receivable: $10,000,000
2. Arson or Theft Reward: $100,000
3. Brands and Labels: $5,000,000
4. Building Materials at Off Premises
Storage for Property Under
Construction: $5,000,000
5. Debris Removal: $2,500,000 or 25% of direct physical loss or
damage to all covered property, whichever is less.
6. Deferred Payments: $250,000
7. Demolition and Increased Cost of
Construction:
Demolition Coverage A: No Sublimit Applies
Demolition Coverage B: $25,000,000
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Demolition Coverage C:
$25,000,000
8. Electronic Data and Media:
Covered Causes of Loss (Other Than
Cyber Perils):
$500,000,000
Cyber Perils:
$2,500,000
9. Errors or Omissions:
$5,000,000
10. Expediting Expenses:
$5,000,000
11. Fairs or Exhibitions:
$5,000,000
12. Fine Arts:
$25,000,000
13. Fire Brigade Charges and
Extinguishing Expenses:
$500,000
14. Fungus, Mold or Spore:
$250,000
15.Installation Coverage:
$1,000,000
16. Land and Water Clean -Up:
$1,000,000
17. Locks and Keys:
$100,000
18. Machinery or Equipment Startup
Option:
$2,500,000 Applicable to a separate occurrence only
19. Miscellaneous Unnamed Locations:
$5,000,000
20. Money and Securities:
$100,000
21. Newly Acquired Property:
$50,000,000
22.Outdoor Property:
$500,000
23. Pairs or Sets:
No Sublimit Applies
24. Personal Property Not at a Covered
Location:
$1,000,000
25. Preservation of Property:
$1,000,000
26. Professional Fees:
$250,000
27. Property Removed From a Covered
Location:
$100,000
28. Railroad Rolling Stock:
$1,000,000
29. Salespersons Samples:
$500,000
30. Service Interruption:
$5,000,000
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31. Spoilage:
32. Transit:
33. Upgrade to Green°:
34. Valuable Papers and Records:
35. Additional Sublimits:
$5,000,000
$5,000,000
25% of the amount payable for direct physical loss
or damage, subject to a maximum of $1,000,000.
This includes any Time Element loss attributed to
Upgrade to Green.
$5,000,000
a. Fine Arts Per Item Limitation: $100,000 Per Item
C. Sublimits Applicable to Additional Time Element Coverages - Each of these sublimits is part
of, and not in addition to the Policy Limit and any other sublimits shown in Item 7.A, of the
Declarations.
1. Attraction Property: 30 days, subject to a maximum of $1,000,000
2. Contingent Time Element: $5,000,000
The following sublimits are subject to the Contingent Time Element Sublimit shown in
Subsection C.2. above:
a. Named Supplier/Customer: $5,000,000
b. Unnamed Supplier/Customer: $5,000,000
c. Other Sublimits of Liability: Not Applicable
3. Contractual Penalties:
4. Crisis Management:
5. Extended Period of Indemnity:
6. Extra Expense:
7. Ingress & Egress:
8. Interruption by Civil or Military
Authority:
9. Logistics Extra Cost:
10. Rental Value:
11. Royalties:
12. Service Interruption:
13. Soft Costs:
$100,000
30 days, subject to a maximum of $100,000
365 days
$25,000,000
30 days, subject to a maximum of $1,000,000
30 days, subject to a maximum of $1,000,000
$100,000
$1,000,000
$100,000
$1,000,000 Qualifying period: 24 hours
$1,000,000
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14. Additional Sublimits:
a. Business Income/Business Interruption at Power Generation locations only:
$1,000,000 but only for loss or damage caused directly by a defined peril
excluding the cause of loss being explosion or equipment breakdown in which
coverage would be NOT COVERED.
b. Extra Expense at Power Generation Locations: $100,000
c. Time Element: 24 Hours
D. Contractor's Equipment
$750,000 per item subject to a maximum per occurrence sublimit of $10,000,000
Item 8. Additional Time Element Provisions
A. Ordinary Payroll:
[XI Provided for 180 days [ ] Not Provided
B. Maximum Operations Period of Indemnity (Gross Profits): 12 months
C. Maximum Construction Period of Indemnity (Gross Profits): 12 months
Item 9. Maximum Amount Payable:
In the event of covered loss or damage hereunder, our liability shall be limited to the lesser of the
following:
A. The actual adiusted amount of loss or damage, less applicable deductible(s), or
B. The limit of liability or applicable sublimit of liability shown in this Policy or endorsed onto this Policy
Item 10. Deductibles: The deductibles shown below apply per occurrence unless otherwise stated.
A. Policy Deductible: $250,000 Applicable to all covered loss or damage unless otherwise
stated below or in this Policy.
B. Earth Movement:
1. $250,000 for all loss or damage arising out of earth movement, except if B.2., B.3.,
B.4. or B.S. below applies;
2. Not Applicable% of Total Insurable Values at the time of the loss at each covered
location involved in the loss or damage, subject to a minimum of Not Applicable any one
occurrence for all loss or damage arising out of earth movement in California, Hawaii,
Alaska, and Puerto Rico;
3. Not Applicable% of Total Insurable Values at the time of the loss at each covered
location involved in the loss or damage, subject to a minimum of Not Applicable any one
occurrence for all loss or damage arising out of earth movement in the Pacific
Northwest Earthquake Zone Counties;
4. Not Applicable% of Total Insurable Values at the time of the loss at each covered
location involved in the loss or damage, subject to a minimum of Not Applicable any one
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occurrence for all loss or damage arising out of earth movement in the New Madrid
Earthquake Zone Counties.
5. Other Earth Movement Deductible: Not Applicable
C. Flood:
1. $250,000 for all loss or damage arising out of flood, except if C.2. or C.3. below
applies;
2. 5% of Total Insurable Values at the time of the loss at each covered location involved in
the loss or damage, subject to a minimum of $1,000,000 any one occurrence for all
loss or damage arising out of flood at any location wholly or partially within Special
Flood Hazard Areas (SFHA) as defined by the Federal Emergency Management Agency
(FEMA).
3. Other Flood Deductible: Not Applicable
D. Named Storm
Not Applicable% of Total Insurable Values at the time of the loss at each covered location
involved in the loss or damage, subject to a minimum of Not Applicable any one occurrence
for all loss or damage arising out of named storm.
Other Named Storm Deductible:
a. Named Storm: 3% of Per Unit of Insurance at the time of the loss at each
covered location involved in the loss or damage, subject to a minimum of
$250,000 any one occurrence for all loss or damage arising out of named storm,
subject to a max deductible of $10,000,000 any one occurrence.
E. Equipment Breakdown
1. Not Applicable for all loss or damage to covered equipment and any time element
coverage provided under SECTION VI — TIME ELEMENT COVERAGES per occurrence
2. If one or more deductibles are shown below, each will be applied separately:
a. $25,000 for all loss or damage to covered equipment per occurrence
b. Not Applicable for time element coverage provided under SECTION VI — TIME
ELEMENT COVERAGES per occurrence
c. Not Applicable for time element coverage provided under SECTION VI — TIME
ELEMENT COVERAGES during the period of indemnity
d. 24 hours following the occurrence per covered location for time element coverage
provided under SECTION VI — TIME ELEMENT COVERAGES
As used above, average daily value means your business income that would have been
earned during the period of indemnity, divided by the number of operating days in that
period.
3. Other Equipment Breakdown Deductible:
a. Transformers: $1.50 per KVA, $25,000 minimum per occurrence
b. Electrical Generating Equipment: $100,000 per occurrence
c. Power Generating Stations: $100,000 per occurrence
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d. Steam and Gas Turbines and Driven Generators: $250,000 per occurrence
e. Cook #2 54.3 MW Turbine or Generator: $350,000 per occurrence
f. Massengale #8 43 MW Turbine or Generator: $500,000 per occurrence
F. Additional Deductibles:
1. Windstorm or Hail: 3% of Per Unit of Insurance at the time of the loss at each
covered location involved in the loss or damage, subject to a minimum of $250,000
any one occurrence for all loss or damage arising out of windstorm or hail, subject
to a max deductible of $10,000,000 any one occurrence.
2. LIA Hanger Building #310 (Chaparral) — 5417 N. Walnut: $ 50,000
3. LIA Hanger #32 (G&G Avionics) — 5902 N. Cedar: $50,000
4. LIA Warehouse Building #710 (Nortec) — 2828 E. Dubuque: $50,000
5. LIA Warehouse Building #714 (Marco) — 5612 N. David Ave.: $50,000
6. LIA Warehouse Building #716 (Marco Steel) - 5618 N. David Ave.: $50,000
7. Contractor's Equipment: $25,000 (applies to equipment less than $250,000 in
value)
S. Contractor's Equipment: $50,000 (applies to equipment valued $250,000 or
greater)
9. Electronic Data Processing Equipment (Hardware): $25,000
The following two paragraphs apply to the deductibles set forth in Item 10.A. through Item
10.F. above, inclusive:
In each case of loss or damage covered by this Policy, we shall not be liable unless you sustain
loss or damage in a single occurrence greater than any applicable deductible described herein.
When this Policy covers more than one covered location, the deductible shall apply against the
total loss or damage covered by this Policy in any one occurrence, unless otherwise stated
herein.
If two or more deductible amounts provided in this Policy apply to a single occurrence, the total
to be deducted shall not exceed the largest deductible applicable unless otherwise stated in this
Policy. If covered loss or damage by flood occurs concurrently or in any sequence with a
named storm, then we shall apply the flood deductible set forth in Item 10.C. or the named
storm deductible set forth in Item 10.D., whichever is greater.
Special Terms and Conditions:
The following provision shown in Subsection B. of SECTION I — INSURING AGREEMENT AND
COVERED PROPERTY:
5. Equipment breakdown, which means direct physical loss or damage to covered equipment that is the
direct result of an accident.
is deleted in its entirety and replaced with the following:
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5. Equipment breakdown, which means direct physical loss or damage to covered equipment at a
covered location that is the direct result of an accident.
The following provision shown in Subsection B. of SECTION III — VALUATION:
12. Contractor's equipment shall be valued at actual cash value, unless an agreed value applies is
deleted in its entirety and replaced with the following:
12. Contractor's equipment shall be valued at replacement cost.
The following provisions are added to Subsection B. of SECTION III — VALUATION:
14. Covered Equipment greater than 25 years old shall be valued at actual cash value.
15. GasTurbine Generator Units greater than 15 years old shall be valued at actual cash value.
The following provision shown in SECTION IV — PROPERTY NOT COVERED:
15. Transmission and distribution lines of any type or description; except when located on the covered
location or within 1000 feet thereof; and
is deleted in its entirety and replaced with the following:
15. Transmission and distribution lines of any type or description; and
The following provisions are added to SECTION IV — PROPERTY NOT COVERED:
17. Plastic media used in trickle filters and/or sewage processing equipment.
18. Idle Unit(s) at Massengale Station including but not limited to Steam Turbine Generator Unit(s) 4
and 5 and Nordberg Diesel Generator Unit(s). Unit means a boiler, turbine or generator.
19. Any Unit(s) that is off-line and/or otherwise inoperative for a period of 90 or more consecutive
days, unless the Unit(s) is undergoing repairs. As respects off-line or an otherwise inoperative Unit(s)
not undergoing repairs, coverage will be subject to 72-hour waiting period on such a Unit(s) returned to
active service. Unit means a boiler, turbine or generator. We shall be notified in advance of any Unit(s)
scheduled to undergo startup operations.
The following exclusion is added to SECTION V — PERILS EXCLUDED:
We will not pay for the cost to purchase power for resale or to meet your contractual obligations.
The following provision is added to Subsection 4. of SECTION IX — DEFINITIONS:
4. Covered equipment means the following:
i. Any rotating biological contractor.
The following provision shown in Subsection 1. of SECTION IX — DEFINITIONS:
1. Accident means a fortuitous event that causes direct physical loss or damage to covered equipment.
The event must be one of the following:
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f. Accident does not include cracking of any part exposed to the products of combustion of any gas
turbines.
Designated Adjuster: Trey Johnson, EGA, York Claims Service, 5501 LBJ Freeway, Suite 300, Dallas,
TX 75240
Any sublimit(s) of liability applicable to additional coverages and/or additional time element coverages
referenced either below or in the Special Terms and Conditions Schedule, and/or identified in any
endorsements/extensions attached to this Policy are part of, and not in addition to the Policy Limit and
any other sublimits shown in Item 7.A. of the Declarations. Such sublimits are per occurrence, unless
otherwise indicated, and are the maximum amount we will pay for all loss or damage arising out of the
specific perils or coverages, or the maximum number of days for a specific coverage, if applicable.
The last two paragraphs of Item 10. Deductibles shall apply to any deductible(s) referenced either
below or in the Special Terms and Conditions Schedule, and/or identified in any
endorsements/extensions attached to this Policy.
Form Name
Commercial Property Policy
Cancellation Non -Renewal Endorsement
Applicable Amendatory Endorsements
Producer: WELLS FARGO INS SERVICES USA INC.
BOB BOOKHAMMER
Address: 5151 BELT LINE RD
DALLAS, TX 75254
Submission Number: 175292544 Product: F
Form Number Form Edition
113813 2/14
74802 7/11
This Proposal of Insurance shall not be valid unless signed at the time of issuance by our authorized
representative.
This Proposal of Insurance does not afford coverage nor any other binding obligations on the
Company and contains only a general description of the coverage provided. It is an offer for coverage
made subject to the warranties, terms and conditions as detailed herein. Coverage will not be afforded
until a Binder of Insurance is executed and issued by the Company.
This Proposal of Insurance is based on information provided by the producer and found in the
submission. The Company reserves the right to rescind this Proposal of Insurance if there are any
material changes in the losses, exposure, protection, management or ownership of the insured
property prior to binding.
The Company may withdraw this Proposal of Insurance at any time prior to acceptance and in no
event will it remain open for acceptance beyond the effective shown in the policy period. Coverage
may not be bound without the authorization of the Company.
As respects acts of terrorism as defined in the Terrorism Risk Insurance Act of 2002, as amended by
the Terrorism Risk Insurance Program Reauthorization Act of 2007, the Insured has the option to
accept or reject coverage. Rejection of cover would be evidenced by the Insured signature on the
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attached Policyholder Disclosure Statement and returning it to us prior to binding.
Unless otherwise amended by a State Amendatory Endorsement, we shall not be deemed to provide
cover and we shall not be liable to pay any claim or provide any benefit hereunder to the extent that
the provision of such cover, payment of such claim or provision of such benefit would expose us, our
parent company or our ultimate controlling entity to any sanction, prohibition or restriction under
United Nations resolutions or the trade or economic sanctions, laws or regulations of the European
Union or the United States of America.
Premium must be remitted within 30 days from the effective date or 15 days from billing, whichever
is later.
Sincerely,
Dora E. Hedrick
Authorized Representative
09/12/2016
Date
09/12/2016
Date Revised (If Applicable)
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POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM INSURANCE COVERAGE
(RIGHT TO PURCHASE COVERAGE)
You are hereby notified that under the Terrorism Risk Insurance Act, as amended, that you have a right to purchase
insurance coverage for losses resulting from acts of terrorism. As defined in Section 1020) of the Act: The term "act of
terrorism" means any act or acts that are certified by the Secretary of the Treasury —in consultation with the Secretary of
Homeland Security, and the Attorney General of the United States —to be an act of terrorism; to be a violent act or an act
that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside
the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been
committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to
influence the policy or affect the conduct of the United States Government by coercion.
YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING
FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE
UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER,
YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS
AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT
GENERALLY REIMBURSES 85% THROUGH 2O15; 84% BEGINNING ON JANUARY 1, 2016; 83% BEGINNING
ON JANUARY 1, 2017; 82% BEGINNING JANUARY 1, 2018; 81% BEGINNING JANUARY 1, 2019 and 80%
BEGINNING ON JANUARY 1, 2020, OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY
ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE
PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY
CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT
UNDER THE ACT.
YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A
$100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS'
LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF
SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED
LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED.
Acceptance or Rejection of Terrorism Insurance Coverage
hereby elect to purchase terrorism coverage for a prospective premium of $10,878.
hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will have
o coverage for losses resulting from certified acts of terrorism.
Policyholder/Applicant's Signature
Policyholder/Applicant's Printed Name Date
96555 (1/15)
0 2015 National Association of Insurance Commissioners
Forms a part of Policy No.:
Issued to: CITY OF LUBBOCK
SPECIAL TERMS AND CONDITIONS SCHEDULE
(CONTINUED FROM QUOTE)
VEHICLE PHYSICAL DAMAGE COVERAGE EXTENSION 017395 (02/14))
(ON -PREMISES COVERAGE)
SCHEDULE
Vehicle Physical Damage Sublimit: $10,000,000 per occurrence
The following provision is added to the ADDITIONAL COVERAGES Section:
VEHICLE PHYSICAL DAMAGE:
Subject to the Vehicle Physical Damage Sublimit, the following changes constitute the addition of
on -premise Vehicle Physical Damage Coverage to this Policy.
I. The following provision, "[vjehicles licensed for highway use and railroad rolling stock;" of
SECTION IV —PROPERTY NOT COVERED is deleted in its entirety and replaced with the
following:
(a) Vehicles licensed for highway use, unless such vehicles are your owned or leased
vehicles and located at or within 1000 feet of the covered location, or (b) railroad rolling
stock;
II. The following provision is added to Subsection 2. of SECTION V — PERILS EXCLUDED:
Collision of a covered vehicle licensed for highway use with any other vehicle or property.
III. The following provision is added to Subsection B. of SECTION III — VALUATION:
Covered vehicles licensed for highway use at or within 1000 feet of the covered location
will be valued at the least of the following:
a. The actual cash value of the damaged or stolen property at the time and place of the
loss;
b. The cost of repairing or replacing the damaged or stolen property with other property
of like kind and quality at the time and place of the loss; or
c. The reported value shown in the Schedule corresponding to the damaged or stolen
covered vehicle.
This Additional Coverage does not apply to any Time Element coverage.
All other terms and conditions of the Policy remain the same.
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Authorized Representative
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ENDORSEMENT #XX
This endorsement, effective 12:01 A.M., XX/XX/XXXX
Forms a part of Policy No.:
Issued to:
By:
PER UNIT OF INSURANCE DEDUCTIBLE ENDORSEMENT
(APPLICABLE TO NAMED STORM)
This endorsement modifies insurance provided by this Policy:
PER UNIT OF INSURANCE DEDUCTIBLE (APPLICABLE TO NAMED STORM):
The following provision set forth in Item 10.D. of the DECLARATIONS:
"Total Insurable Values at the time of the loss at each covered location involved in the loss or
damage"
is deleted and replaced with:
"Total Insurable Values at the time of the loss for each unit of insurance involved in the loss or
damage at each covered location involved in the loss or damage"
No other revisions are made to Item 10.D.
The following definitions apply to this endorsement:
1 • Unit of insurance means:
a. All buildings and/or all structures (whether or not involved in the loss or damage) at
the covered location;
b• All personal property (whether or not involved in the loss or dama e
within all buildings and/or all structures at the covered location; g) contained
C. All property in the open (whether or not involved in the loss or d
covered location; and/or damage) at the
d. All time element values at the covered location.
2• Building means a building or structure, including all additions, improvements and
betterments and includes all associated property used to ser
conditioning units, heating units, utility units or other similar ro a such building, such as air
All other terms and conditions of the Policy remain property.
ain the same.
Authorized Representative
XXXXXX (XX/XX)
02014 American International Group, Inc.
All Right Reserved. Page 1 of 1
CERTIFICATE OF INTERESTED PARTIES FoRM 1295
Lori
Comptete Nos.1- 4 and a If there are Interested MGM OFFICE USE ONLY
Complete Nos.1, 2, 3, 6, and 6It there are no interested parties CERTIFICATION OF FLUNG
i Name of buslaess entity thing farm, and the city, state and country of the business entity's place Ce ffeate Number
of bustness. 2016-IL%16
Amedcan International Group, Inc.
Now York, NY United States Date Piled:
2 Name of governmental enutv arstate agency that is a party to the contract erwh ch the form Is OW2I2016
being tiled
City of Lubbock Date Acknowledged:
3 provide the Idengfkatlon number used by the governmental entity or state agency to track or identify the contract. and provide a
descrfptlon of the services, goods, or other property to be provided under the contract
Policy Number 021469181
Commenclal Property LkWVAy Insurance
4 Nature of Interest
Dame of Interested Party Clty, State, Country (place of buslness) (chock appllcablo)
Controlling Intermediary
American Home Assarance Company New York, NY United States X
Douglas Sanford Lubbock, TX United States X
b Check only N there Is NO Interested Party.
6 AFRDAViT I swear, or aftm, under penaity of perjury, that tine above dbsslosum is true and correct.
(BE
ilZAtiEiH ANN t31dRH
NO�rW PSIBUO Ar)(
BiATEOFTE A8
17tR gnadve of 49WIPM of contradng business eniky
AFFIX NOTARY STAMP I Si AL ABOVE
Swum to and subscribed before me, by the said A `Y this the Z-20 di day or r
20lk—r, to ceruly Aft, v&ness my hard and sew or drw&
4yu Sd - 1AJ �Z�d. l*joAA
of ottk:er admlydstedng oath P name of oWce radmhrlsterfng oath TWO of Weer admNsteft oath
Forms provided by Texas Ethks CommWon www.ethics.state tx.us Version V1.0.277
Resolution No. 2016-RO336
Item No. 6.20
September 22, 2016
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the City Manager of the City of Lubbock is hereby authorized and directed
to purchase for and on behalf of the City of Lubbock, property insurance coverage from
American Home Insurance Company, for a premium amount not to exceed a rate of .0907
per $100.00; and
THAT the City Manager may execute any routine documents and forms
associated with sa..::nsurance coverage.
Passed by the City Council this September 22, 2016
ATTEST:
DANIEL M. POP , MAYOR
Reb ca Garza, City Secreta
AS TO CONTENT:
Director of Human Resources
and Risk Management
APPROVED AS TO FORM:
J'eKHbxtsell, Chiei litigation Attorney
RES.Risk Mgmt-American Home Ins.
September 15, 2016
Resolution No. 2016-RO336
AIG
Property Performance°
American Home Assurance Company
(A CAPITAL STOCK COMPANY)
EXECUTIVE OFFICES: 175 Water Street 18th Floor, New York, New York, 10038
PROPOSAL OF INSURANCE
Issued: 09/12/2016
Renewal of: 021469181
Item 1. Named Insured and Address:
CITY OF LUBBOCK
1625 13TH ST P.O. BOX 2000
LUBBOCK, TX 79401-31330
The Named Insured includes you and/or your affiliated and subsidiary companies and/or
corporations as now exist or may hereafter be incorporated, constituted or acquired, including
their interests as may appear in partnerships or joint ventures which you are legally obligated to
insure.
Item 2. Mortgagees, Loss Payees, and Additional Insureds: Per Certificates on File with the Company.
Item 3. Policy Period:
From: 10/01 /2016 To: 10/0112017
(12:01 a.m., Standard Time at the Address of the Named Insured shown in Item 1. above.)
Item 4. Coverage Territory:
United States, its territories and possessions and Puerto Rico, including their respective coastal
waters. If any coverage is provided on a worldwide basis, such worldwide coverage shall not
include any jurisdiction prohibited or restricted under United Nations resolutions or the trade or
economic sanctions, laws or regulations of the European Union or the United States of America.
Losses are only covered within the coverage territory.
US TIV:
Canada TIV:
Rest of World TIV:
Total TIV:
$1, 294, 565, 207
Not Covered
Not Covered
$1, 294, 56 5, 207
Item 5. Premium and Engineering Fees
A. Total Premium:
B. US Premium:
C. US Terrorism Premium:
$1,173,818 (Worldwide including any applicable
Terrorism Premium)
$1,173,818 (including Terrorism Premium)
$10,878 (included within US Premium)
12013 American International Group, Inc. Page 1 of 11
113812Q (02/14) All Rights Reserved.
D. Rest of World Premium: Not Covered
E. Rest of World Terrorism Premium: Not Covered
F. Commissions: NET
G. Surcharges: (If Applicable)
H. Engineering Fees: $ (not included within the Total Premium)
Above premiums are exclusive of all taxes, surcharges, and fees unless otherwise shown. State
surcharges to be paid by the Insured are not included in the premium above.
Item 6. Limit of Liability: $500,000,000 (hereinafter, the "Policy Limit") This is our maximum liability
in any one occurrence as a result of all covered loss or damage regardless of the number of
covered locations, coverages, or Covered Causes of Loss under this Policy.
Item 7. Sublimits of Liability: Sublimits of liability stated below are part of and not in addition to the
Policy Limit shown in Item 6. above. The sublimits are the maximum amount we will pay for all
loss or damage arising out of the specific perils or coverages shown below or the maximum
number of days for a specific coverage, if applicable. These sublimits of liability and the
specified limits of liability contained in the forms, endorsements and extensions attached, if
any, are per occurrence unless otherwise indicated.
/f the words, NOT COVERED are shown, instead of a limit, sublimit amount or number of days,
or if a specified amount or number of days is not shown corresponding to any coverage or
Covered Cause of Loss, then no coverage is provided for that coverage or Covered Cause of
Loss
A. Sublimits Applicable to Specified Covered Causes of Loss:
1. Earth Movement:
a. Annual Aggregate: $50,000,000
b. Subject to A.1.a. above, the Annual Aggregate for all loss or damage arising out of
earth movement for any location wholly or partially within the following states and
territory combined: California, Alaska, Hawaii, and Puerto Rico: Not Covered
c. Subject to A.1.a. above, the Annual Aggregate for all loss or damage arising out of
earth movement for any location wholly or partially within the Pacific Northwest
Earthquake Zone Counties: Not Covered
d. Subject to A.1.a. above, the Annual Aggregate for all loss or damage arising out of
earth movement for any location wholly or partially within the New Madrid
Earthquake Zone Counties: Not Covered
e. Other Sublimitis) Applicable to Earth Movement: Not Applicable
2. Flood:
a. Annual Aggregate: $50,000,000
b. Subject to A.2.a. above, the Annual Aggregate for all loss or damage due to all
flood for any location wholly or partially within Special Flood Hazard Areas (SFHA)
as defined by the Federal Emergency Management Agency (FEMA): $25,000,000
102013 American International Group, Inc. Page 2 of 11
113812Q (02/14) All Rights Reserved.
c. Other Sublimit(s) Applicable to Flood: Not Applicable
3. Named Storm: $500,000,000 This is our maximum liability in any one occurrence for
named storm as a result of all loss or damage (to the extent covered) including, but not
limited to, loss or damage from wind, hail, lightning, tornado, rain or water (whether
driven by wind or not), flood, or any wind driven objects or debris, regardless of the
number of covered locations, coverages, or Covered Causes of Loss under this Policy.
Other Sublimit(s) Applicable to Named Storm: Not Applicable
Subject to the applicable Named Storm Sublimit, in the event loss or damage by flood
that occurs concurrently or in any sequence with a named storm, the maximum amount
we will pay per occurrence for all such loss or damage by flood shall be the sublimits of
liability for flood as shown in A.2.a. and/or A.2.b., and/or A.2.c. whichever is/are
applicable. However, if flood is not covered, the maximum amount we will pay per
occurrence for all such loss or damage by named storm shall exclude loss or damage by
flood.
4. Terrorism:
[ l NOT COVERED [XI Covered and Included Within the Policy Limit
This is our maximum liability in any one occurrence for terrorism as a result of all loss or
damage regardless of the number of covered locations, coverages, or Covered Causes
of Loss under this Policy.
5. Equipment Breakdown: $125,000,000 This is our maximum liabilitv in anv one
occurrence for equipment breakdown as a result of all loss or damage regardless of the
number of covered locations, coverages, or Covered Causes of Loss under this Policy.
Other Sublimit(s) Applicable to Equipment Breakdown: Not Applicable
B. Sublimits Applicable to Additional Coverages — Each of these sublimits is part of, and not in
addition to the Policy Limit and any other sublimits shown in Item 7.A. of the Declarations.
1. Accounts Receivable: $10,000,000
2. Arson or Theft Reward: $100,000
3. Brands and Labels: $5,000,000
4. Building Materials at Off Premises
Storage for Property Under
Construction: $5,000,000
5. Debris Removal: $2,500,000 or 25% of direct physical loss or
damage to all covered property, whichever is less.
6. Deferred Payments: $250,000
7. Demolition and Increased Cost of
Construction:
Demolition Coverage A: No Sublimit Applies
Demolition Coverage B: $25,000,000
02013 American International Group, Inc. Page 3 of 11
113812Q (02114) All Rights Reserved.
Demolition Coverage C:
$25,000,000
8. Electronic Data and Media:
Covered Causes of Loss (Other Than
Cyber Perils):
$500,000,000
Cyber Perils:
$2,500,000
9. Errors or Omissions:
$5,000,000
10. Expediting Expenses:
$5,000,000
11. Fairs or Exhibitions:
$5,000,000
12. Fine Arts:
$25,000,000
13. Fire Brigade Charges and
Extinguishing Expenses:
$500,000
14. Fungus, Mold or Spore:
$250,000
15.Installation Coverage:
$1,000,000
16. Land and Water Clean -Up:
$1,000,000
17. Locks and Keys:
$100,000
18. Machinery or Equipment Startup
Option:
$2,500,000 Applicable to a separate occurrence only
19. Miscellaneous Unnamed Locations:
$5,000,000
20. Money and Securities:
$100,000
21. Newly Acquired Property:
$50,000,000
22. Outdoor Property:
$500,000
23. Pairs or Sets:
No Sublimit Applies
24. Personal Property Not at a Covered
Location:
$1,000,000
25. Preservation of Property:
$1,000,000
26. Professional Fees:
$250,000
27. Property Removed From a Covered
Location:
$100,000
28. Railroad Rolling Stock:
$1,000,000
29. Salespersons Samples:
$500,000
30. Service Interruption:
$5,000,000
02013 American International Group, Inc. Page 4 of 11
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31. Spoilage:
32. Transit:
$5,000,000
$5,000,000
33. Upgrade to Green°: 25% of the amount payable for direct physical loss
or damage, subject to a maximum of $1,000,000.
This includes any Time Element loss attributed to
Upgrade to Green.
34. Valuable Papers and Records: $5,000,000
35. Additional Sublimits:
a. Fine Arts Per Item Limitation: $100,000 Per Item
C. Sublimits Applicable to Additional Time Element Coverages - Each of these sublimits is part
of, and not in addition to the Policy Limit and any other sublimits shown in Item 7.A. of the
Declarations.
1. Attraction Property: 30 days, subject to a maximum of $1,000,000
2. Contingent Time Element: $5,000,000
The following sublimits are subject to the Contingent Time Element Sublimit shown in
Subsection C.2. above:
a. Named Supplier/Customer: $5,000,000
b. Unnamed Supplier/Customer: $5,000,000
c. Other Sublimits of Liability: Not Applicable
3. Contractual Penalties:
4. Crisis Management:
5. Extended Period of Indemnity
6. Extra Expense:
7. Ingress & Egress:
8. Interruption by Civil or Military
Authority:
9. Logistics Extra Cost:
10. Rental Value:
11. Royalties:
12. Service Interruption:
13. Soft Costs:
$100,000
30 days, subject to a maximum of $100,000
365 days
$ 25, 000, 000
30 days, subject to a maximum of $1,000,000
30 days, subject to a maximum of $1,000,000
$100,000
$1,000,000
$100,000
$1,000,000 Qualifying period: 24 hours
$1,000,000
02013 American International Group, Inc. Page 5 of 11
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14. Additional Sublimits:
a. Business Income/Business Interruption at Power Generation locations only:
$1,000,000 but only for loss or damage caused directly by a defined peril
excluding the cause of loss being explosion or equipment breakdown in which
coverage would be NOT COVERED.
b. Extra Expense at Power Generation Locations: $100,000
c. Time Element: 24 Hours
D. Contractor's Equipment
$750,000 per item subject to a maximum per occurrence sublimit of $10,000,000
Item 8. Additional Time Element Provisions
A. Ordinary Payroll:
[XI Provided for 180 days [ I Not Provided
B. Maximum Operations Period of Indemnity (Gross Profits): 12 months
C. Maximum Construction Period of Indemnity (Gross Profits): 12 months
Item 9. Maximum Amount Payable:
In the event of covered loss or damage hereunder, our liability shall be limited to the lesser of the
following:
A. The actual adjusted amount of loss or damage, less applicable deductible(s), or
B. The limit of liability or applicable sublimit of liability shown in this Policy or endorsed onto this Policy
Item 10. Deductibles: The deductibles shown below apply per occurrence unless otherwise stated.
A. Policy Deductible: $250,000 Applicable to all covered loss or damage unless otherwise
stated below or in this Policy.
B. Earth Movement:
1. $250,000 for all loss or damage arising out of earth movement, except if B.2., B.3.,
B.4. or B.S. below applies;
2. Not Applicable% of Total Insurable Values at the time of the loss at each covered
location involved in the loss or damage, subject to a minimum of Not Applicable any one
occurrence for all loss or damage arising out of earth movement in California, Hawaii,
Alaska, and Puerto Rico;
3. Not Applicable% of Total Insurable Values at the time of the loss at each covered
location involved in the loss or damage, subject to a minimum of Not Applicable any one
occurrence for all loss or damage arising out of earth movement in the Pacific
Northwest Earthquake Zone Counties;
4. Not Applicable% of Total Insurable Values at the time of the loss at each covered
location involved in the loss or damage, subject to a minimum of Not Applicable any one
102013 American International Group, Inc. Page 6 of 11
113812Q (02/14) All Rights Reserved.
occurrence for all loss or damage arising out of earth movement in the New Madrid
Earthquake Zone Counties.
5. Other Earth Movement Deductible: Not Applicable
C. Flood:
1. $250,000 for all loss or damage arising out of flood, except if C.2. or C.3. below
applies;
2. 5% of Total Insurable Values at the time of the loss at each covered location involved in
the loss or damage, subject to a minimum of $1,000,000 any one occurrence for all
loss or damage arising out of flood at any location wholly or partially within Special
Flood Hazard Areas (SFHA) as defined by the Federal Emergency Management Agency
(FEMA).
3. Other Flood Deductible: Not Applicable
D. Named Storm
Not Applicable% of Total Insurable Values at the time of the loss at each covered location
involved in the loss or damage, subject to a minimum of Not Applicable any one occurrence
for all loss or damage arising out of named storm.
Other Named Storm Deductible:
a. Named Storm: 3% of Per Unit of Insurance at the time of the loss at each
covered location involved in the loss or damage, subject to a minimum of
$250,000 any one occurrence for all loss or damage arising out of named storm,
subject to a max deductible of $10,000,000 any one occurrence.
E. Equipment Breakdown
1. Not Applicable for all loss or damage to covered equipment and any time element
coverage provided under SECTION VI - TIME ELEMENT COVERAGES per occurrence
2. If one or more deductibles are shown below, each will be applied separately:
a. $25,000 for all loss or damage to covered equipment per occurrence
b. Not Applicable for time element coverage provided under SECTION VI - TIME
ELEMENT COVERAGES per occurrence
c. Not Applicable for time element coverage provided under SECTION VI - TIME
ELEMENT COVERAGES during the period of indemnity
d. 24 hours following the occurrence per covered location for time element coverage
provided under SECTION VI - TIME ELEMENT COVERAGES
As used above, average daily value means your business income that would have been
earned during the period of indemnity, divided by the number of operating days in that
period.
3. Other Equipment Breakdown Deductible:
a. Transformers: $1.50 per KVA, $25,000 minimum per occurrence
b. Electrical Generating Equipment: $100,000 per occurrence
c. Power Generating Stations: $100,000 per occurrence
102013 American International Group, Inc. Page 7 of 11
113812Q f02/14) All Rights Reserved.
d. Steam and Gas Turbines and Driven Generators: $250,000 per occurrence
e. Cook #2 54.3 MW Turbine or Generator: $350,000 per occurrence
f. Massengale #8 43 MW Turbine or Generator: $500,000 per occurrence
F. Additional Deductibles:
1. Windstorm or Hail: 3% of Per Unit of Insurance at the time of the loss at each
covered location involved in the loss or damage, subject to a minimum of $250,000
any one occurrence for all loss or damage arising out of windstorm or hail, subject
to a max deductible of $10,000,000 any one occurrence.
2. LIA Hanger Building #310 (Chaparral) — 5417 N. Walnut: $50,000
3. LIA Hanger #32 (G&G Avionics) — 5902 N. Cedar: $50,000
4. LIA Warehouse Building #710 (Nortec) — 2828 E. Dubuque: $50,000
5. LIA Warehouse Building #714 (Marco) — 5612 N. David Ave.: $50,000
6. LIA Warehouse Building #716 (Marco Steel) - 5618 N. David Ave.: $50,000
7. Contractor's Equipment: $25,000 (applies to equipment less than $250,000 in
value)
8. Contractor's Equipment: $50,000 (applies to equipment valued $250,000 or
greater)
9. Electronic Data Processing Equipment (Hardware): $25,000
The following two paragraphs apply to the deductibles set forth in Item 10.A. through Item
10.F. above, inclusive:
In each case of loss or damage covered by this Policy, we shall not be liable unless you sustain
loss or damage in a single occurrence greater than any applicable deductible described herein.
When this Policy covers more than one covered location, the deductible shall apply against the
total loss or damage covered by this Policy in any one occurrence, unless otherwise stated
herein.
If two or more deductible amounts provided in this Policy apply to a single occurrence, the total
to be deducted shall not exceed the largest deductible applicable unless otherwise stated in this
Policy. If covered loss or damage by flood occurs concurrently or in any sequence with a
named storm, then we shall apply the flood deductible set forth in Item 10.C. or the named
storm deductible set forth in Item 10.D., whichever is greater.
Special Terms and Conditions:
The following provision shown in Subsection B. of SECTION I — INSURING AGREEMENT AND
COVERED PROPERTY:
5. Equipment breakdown, which means direct physical loss or damage to covered equipment that is the
direct result of an accident.
is deleted in its entirety and replaced with the following:
®2013 American International Group, Inc. Page 8 of 11
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5. Equipment breakdown, which means direct physical loss or damage to covered equipment at a
covered location that is the direct result of an accident.
The following provision shown in Subsection B. of SECTION III — VALUATION:
12. Contractor's equipment shall be valued at actual cash value, unless an agreed value applies is
deleted in its entirety and replaced with the following:
12. Contractor's equipment shall be valued at replacement cost.
The following provisions are added to Subsection B. of SECTION III — VALUATION:
14. Covered Equipment greater than 25 years old shall be valued at actual cash value.
15. GasTurbine Generator Units greater than 15 years old shall be valued at actual cash value.
The following provision shown in SECTION IV — PROPERTY NOT COVERED:
15. Transmission and distribution lines of any type or description; except when located on the covered
location or within 1000 feet thereof; and
is deleted in its entirety and replaced with the following:
15. Transmission and distribution lines of any type or description; and
The following provisions are added to SECTION IV — PROPERTY NOT COVERED:
17. Plastic media used in trickle filters and/or sewage processing equipment.
18. Idle Unit(s) at Massengale Station including but not limited to Steam Turbine Generator Unit(s) 4
and 5 and Nordberg Diesel Generator Unit(s). Unit means a boiler, turbine or generator.
19. Any Unit(s) that is off-line and/or otherwise inoperative for a period of 90 or more consecutive
days, unless the Unit(s) is undergoing repairs. As respects off-line or an otherwise inoperative Unit(s)
not undergoing repairs, coverage will be subject to 72-hour waiting period on such a Unit(s) returned to
active service. Unit means a boiler, turbine or generator. We shall be notified in advance of any Unit(s)
scheduled to undergo startup operations.
The following exclusion is added to SECTION V — PERILS EXCLUDED:
We will not pay for the cost to purchase power for resale or to meet your contractual obligations.
The following provision is added to Subsection 4. of SECTION IX — DEFINITIONS:
4. Covered equipment means the following:
i. Any rotating biological contractor.
The following provision shown in Subsection 1. of SECTION IX — DEFINITIONS:
1. Accident means a fortuitous event that causes direct physical loss or damage to covered equipment.
The event must be one of the following:
102013 American International Group, Inc. Page 9 of 11
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f. Accident does not include cracking of any part exposed to the products of combustion of any gas
turbines.
Designated Adjuster: Trey Johnson, EGA, York Claims Service, 5501 LBJ Freeway, Suite 300, Dallas,
TX 75240
Any sublimit(s) of liability applicable to additional coverages and/or additional time element coverages
referenced either below or in the Special Terms and Conditions Schedule, and/or identified in any
endorsements/extensions attached to this Policy are part of, and not in addition to the Policy Limit and
any other sublimits shown in Item 7.A. of the Declarations. Such sublimits are per occurrence, unless
otherwise indicated, and are the maximum amount we will pay for all loss or damage arising out of the
specific perils or coverages, or the maximum number of days for a specific coverage, if applicable.
The last two paragraphs of Item 10. Deductibles shall apply to any deductible(s) referenced either
below or in the Special Terms and Conditions Schedule, and/or identified in any
endorsements/extensions attached to this Policy.
Form Name
Commercial Property Policy
Cancellation Non -Renewal Endorsement
Applicable Amendatory Endorsements
Producer: WELLS FARGO INS SERVICES USA INC.
BOB BOOKHAMMER
Address: 5151 BELT LINE RD
DALLAS, TX 75254
Submission Number: 175292544 Product: F
Form Number Form Edition
113813 2/14
74802 7/1 1
This Proposal of Insurance shall not be valid unless signed at the time of issuance by our authorized
representative.
This Proposal of Insurance does not afford coverage nor any other binding obligations on the
Company and contains only a general description of the coverage provided. It is an offer for coverage
made subject to the warranties, terms and conditions as detailed herein. Coverage will not be afforded
until a Binder of Insurance is executed and issued by the Company.
This Proposal of Insurance is based on information provided by the producer and found in the
submission. The Company reserves the right to rescind this Proposal of Insurance if there are any
material changes in the losses, exposure, protection, management or ownership of the insured
property prior to binding.
The Company may withdraw this Proposal of Insurance at any time prior to acceptance and in no
event will it remain open for acceptance beyond the effective shown in the policy period. Coverage
may not be bound without the authorization of the Company.
As respects acts of terrorism as defined in the Terrorism Risk Insurance Act of 2002, as amended by
the Terrorism Risk Insurance Program Reauthorization Act of 2007, the Insured has the option to
accept or reject coverage. Rejection of cover would be evidenced by the Insured signature on the
122013 American International Group, Inc. Page 10 of 11
113812Q (02/14) All Rights Reserved.
attached Policyholder Disclosure Statement and returning it to us prior to binding.
Unless otherwise amended by a State Amendatory Endorsement, we shall not be deemed to provide
cover and we shall not be liable to pay any claim or provide any benefit hereunder to the extent that
the provision of such cover, payment of such claim or provision of such benefit would expose us, our
parent company or our ultimate controlling entity to any sanction, prohibition or restriction under
United Nations resolutions or the trade or economic sanctions, laws or regulations of the European
Union or the United States of America.
Premium must be remitted within 30 days from the effective date or 15 days from billing, whichever
is later.
Sincerely,
Dora E. Hedrick
Authorized Representative
09/ 12/2016
Date
09/ 12/2016
Date Revised (If Applicable)
02013 American International Group, Inc. Page 11 of 11
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POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM INSURANCE COVERAGE
(RIGHT TO PURCHASE COVERAGE)
You are hereby notified that under the Terrorism Risk Insurance Act, as amended, that you have a right to purchase
insurance coverage for losses resulting from acts of terrorism. As defined in Section 102(1) of the Act: The term "act of
terrorism" means any act or acts that are certified by the Secretary of the Treasury —in consultation with the Secretary of
Homeland Security, and the Attorney General of the United States —to be an act of terrorism; to be a violent act or an act
that is dangerous to human life, property, or infrastructure; to have resulted in damage within the United States, or outside
the United States in the case of certain air carriers or vessels or the premises of a United States mission; and to have been
committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to
influence the policy or affect the conduct of the United States Government by coercion.
YOU SHOULD KNOW THAT WHERE COVERAGE IS PROVIDED BY THIS POLICY FOR LOSSES RESULTING
FROM CERTIFIED ACTS OF TERRORISM, SUCH LOSSES MAY BE PARTIALLY REIMBURSED BY THE
UNITED STATES GOVERNMENT UNDER A FORMULA ESTABLISHED BY FEDERAL LAW. HOWEVER,
YOUR POLICY MAY CONTAIN OTHER EXCLUSIONS WHICH MIGHT AFFECT YOUR COVERAGE, SUCH AS
AN EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT
GENERALLY REIMBURSES 85% THROUGH 2O15; 84% BEGINNING ON JANUARY 1, 2016; 8')% BEGINNING
ON JANUARY 1, 2017; 82% BEGINNING JANUARY 1, 2018; 81% BEGINNING JANUARY 1, 2019 and 80%
BEGINNING ON JANUARY 1, 2020, OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY
ESTABLISHED DEDUCTIBLE PAID BY THE INSURANCE COMPANY PROVIDING THE COVERAGE. THE
PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY
CHARGES FOR THE PORTION OF LOSS THAT MAY BE COVERED BY THE FEDERAL GOVERNMENT
UNDER THE ACT.
YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A
$100 BILLION CAP THAT LIMITS U.S. GOVERNMENT REIMBURSEMENT AS WELL AS INSURERS'
LIABILITY FOR LOSSES RESULTING FROM CERTIFIED ACTS OF TERRORISM WHEN THE AMOUNT OF
SUCH LOSSES IN ANY ONE CALENDAR YEAR EXCEEDS $100 BILLION. IF THE AGGREGATE INSURED
LOSSES FOR ALL INSURERS EXCEED $100 BILLION, YOUR COVERAGE MAY BE REDUCED.
Accept nce or Rejection of Terrorism Insurance Coverage
I hereby elect to purchase terrorism coverage for a prospective premium of $10,878.
hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will have
o coverage for losses resulting from certified acts of terrorism.
Policyholder/Applicant's Signature
Policyholder/Applicant's Printed Name Date
96555 (1/15)
0 2015 National Association of Insurance Commissioners
Forms a part of Policy No.:
Issued to: CITY OF LUBBOCK
SPECIAL TERMS AND CONDITIONS SCHEDULE
(CONTINUED FROM QUOTE)
VEHICLE PHYSICAL DAMAGE COVERAGE EXTENSION (117395 (02/14))
(ON -PREMISES COVERAGE)
SCHEDULE
Vehicle Physical Damage Sublimit: $10,000,000 per occurrence
The following provision is added to the ADDITIONAL COVERAGES Section:
VEHICLE PHYSICAL DAMAGE:
Subject to the Vehicle Physical Damage Sublimit, the following changes constitute the addition of
on -premise Vehicle Physical Damage Coverage to this Policy.
I. The following provision, "[v)ehicles licensed for highway use and railroad rolling stock;" of
SECTION IV —PROPERTY NOT COVERED is deleted in its entirety and replaced with the
following:
(a) Vehicles licensed for highway use, unless such vehicles are your owned or leased
vehicles and located at or within 1000 feet of the covered location, or (b) railroad rolling
stock;
II. The following provision is added to Subsection 2. of SECTION V — PERILS EXCLUDED:
Collision of a covered vehicle licensed for highway use with any other vehicle or property.
III. The following provision is added to Subsection B. of SECTION III — VALUATION:
Covered vehicles licensed for highway use at or within 1000 feet of the covered location
will be valued at the least of the following:
a. The actual cash value of the damaged or stolen property at the time and place of the
loss;
b. The cost of repairing or replacing the damaged or stolen property with other property
of like kind and quality at the time and place of the loss; or
c. The reported value shown in the Schedule corresponding to the damaged or stolen
covered vehicle.
This Additional Coverage does not apply to any Time Element coverage.
All other terms and conditions of the Policy remain the same.
117390 (02/14) c2014 American International Group, Inc. Page 1 of 2
All Right Reserved.
Authorized Representative
117390 (02/14) 02014 American International Group, Inc. Page 2 of 2
All Right Reserved.
ENDORSEMENT #XX
his endorsement, effective 12:01 A.M., XXIXXIXXXX
T art of Policy No.:
Forms Pa
rt
Issued to:
By:
NT
PER UNIT
OF INSURANCE DEDUCT ISTo MLE NDORSEME
(APPLICABLE TO NAMED
This endorsement modifies insurance provided by this Policy:
PER UNIT OF INSURANCE DEDUCTIBLE (APPLICABLE TO NAMED STS RM):
The following provision set forth in item 10.D. of the DECLARATION
"Total Insurable Values at the time of the loss at each covered location involved in the loss or
damage"
is deleted and replaced with:
"Total Insurable Values at the time oflthe loss ved in the loss insurance involved in the loss or
loss or damagen
damage at each covered location invo
No other revisions are made to Item 10.D.
The following definitions apply to this endorsement:
1. Unit of insurance means:
a. All buildings and/or all structures (whether or not involved in the loss or damage) at
the covered location;
b. All personal property (whether or not involved in the loss or damage) contained
within all buildings and/or all structures at the covered location;
C. All property in the open (whether or not involved in the loss or damage) at the
covered location; and/or
d. All time element values at the covered location.
2. Building means a building or structure, including all additions, improvements and
betterments and includes all associated property used to service such building, such as air
conditioning units, heating units, utility units or other similar property.
All other terms and conditions of the Policy remain the same.
Authorized Representative
XXXXXX (XX/XX) 02014 American International Group, Inc. Page 1 of 1
All Right Reserved.
CERTIFICATE OF INTERESTED PARTIES
FORM 3.295
1 of i
Complete Nos. 1-4 and6Irthereare f Wested partles.
OFFICE USE ONLY
Comptate Nos.1, 2.3, s, and 6 It there are no Interested perdes.
CERTIFICATION OF FILING
Certificate Number
2016-116416
1 Name of business entity filing form, and the city, state and country of the business entity's place
of business.
American International Group, Inc.
New York, NY Untied States
Date Filed:
09122=6
2 Name of governmental antW crstate agency ffiat is a party to the contract ortrrh ch the form Is
being filed
City of Lubbock ]Date
Acknowledged:
3 ProvIde the Identification number used by the govemmental entity or state agency to tracts or identify the contract, and pnwwe a
descrfptron of the services, goods, or other property to be provided under the contract
Polley Number021469181
Commercial Property UaWFAy Insurance
4
Name of Interested Party
Clty, State, Country (place of business)
Nature of interest
(chock applicable)
Controlling
Intermedlary
American Home Assurance Company
New York, NY Untied States
X
Douglas Sanford
Lubbock, TX United States
X
S Check only If there Is NO Interested Party. ❑
6 AFFIDAVIT I swear. at affirm, under penalty of perjury, that the above disdostue Istrue and correct.
BRABEIHM i11
I< ONW 91.10
19 WATEOF7131018
NXSMM(FtaWt7 gnattge of ad agent or comracling business en*
AFFIX NOTARY STAMP ISEAL ABOVE
1
Swum to and subscribed before me, by the said A -- l -act A Cr es a "T this the day of
20l k , to ceary %iCb, v&ness rry hand and seal of ofFxe.
&:14. 4VAJ all "LAI P'jM-ta
Stgneture of officer admtrdsterIng oath Pdntdd name of ofiiceradministering oath We of officer admMistdIng oath
Fors provided by Texas Eth}cs Commissbn www.ethirs,state.tx.tls Version V1.0.277