PCBDD Insurance - Portage County Board of Developmental ...

PROPOSAL FORM
Proposal Form Instructions: Answer YES or NO to each coverage topic or enter your coverage limit or deductible
proposed. Attach explanations where necessary. Please note on liability coverage, current program is occurrence
but provides prior acts coverage from 7/1/2002 to 5/1/2008. Proposals should provide prior acts coverage for this
time period.
Coverage Current Limits Proposer Limits Premium
I. Commercial General Liability and Professional
Liability
A. Liability Limits [Occurrence Limit] $5,000,000
B Liability Limits [Aggregate Limit] $7,000,000
C
Other Coverage Terms
Sexual Abuse and Molestation Included
Law Enforcement Liability Included
Defense Costs
In addition to
Limit
Unaudited Policy Included
Personal and Advertising Injury Included
Products & Completed Operations Included
Booster/Parent Groups as Additional Insureds See Exhibit I
D. Additional Insureds See Exhibit I
II.
Retroactive Coverage
Fiduciary Liability, Including Employee Benefits Liability
2/1/2002 to
7/1/2008
A. Liability Limits [Occurrence Limit] $5,000,000
B Liability Limit [Aggregate Limit] $7,000,000
C. Deductible $2,500
D. Defense Costs Included in Limit
E. Employee Benefits Liability Included
F Coverage separate from GL Included
G. Claims Made Coverage Form
Fiduciary Liability Retro Date 2/1/2001
Employee Benefits Liability Retro Date 2/1/2002
10