Document type | proposal |
---|---|
Date | 2024-05-07 |
Source URL | https://go.boarddocs.com/wv/rand/Board.nsf/files/D5AR6V6C8331/$file/Work%20Comp%20Propsal%20FY25.PDF |
Entity | randolph_county_schools (Randolph Co., WV) |
Entity URL | https://boe.rand.k12.wv.us/ |
Raw filename | Work%20Comp%20Propsal%20FY25.PDF |
Stored filename | 2024-05-07-ef2078ef349d1fbfc29d2a45c5f1c889-proposal.txt |
Parent document: Regular Board Meeting - 5_30 p.m.-05-21-2024.pdf
Worker’s Compensation Insurance Proposal Randoloh County Board of Education Proprietary, Aint, hie, =| a OMNI (opal & Nath a ie i, wrth 5. th re esl “Pai “NP NETWORK * mm enue, 4, Clverit Biursurvenase c ) / Sh rvalareypurss THE USI ONE a / ADVANTAGE” ra A A. Dave Stacy Account Executive Date Prepared: May 07, 2024 CONFIDENTIAL AND PROPRIETARY: This document and the information contained herein is confidential and proprietary information of USI Insurance Services LLC ("USI"). Recipient agrees not to copy, reproduce, or distribute this document, in whole or in part, without the prior written consent of USI. Estimates are illustrative given data limitation, may not be cumulative and are subject to change based on carrier underwriting. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. © 2021 USI Insurance Services. All rights reserved. Table of Contents About USI Insurance Services .........ccccscccccsssscssssesenessnesesessuesesssnesenessnesessseesesscuesenessnesessuseessessuesenessnesessseessessnenenesseness 3 Service Team ............0 wid InsurLink Client Portal............... wed Schedule of Named Insureds..... ono) Schedulle of LOCATIONS 0... cc ccc cee esecsseceeeeeeeeenseneeceaeueesecsseneceaesuasasegueesesuasaeesueneaeaessesseeuceaeeeasaeeseauseeeeuaeeseeneneaseness 7 Workers’ Compensation ..............:cc::cccssscssssecssscesseeecsseensaeessensuanceeessnensaeessneessneeesuneesauaessasessaeeeseneesaueeeseaessseeessceeessnensans 8 PremiUmM SUMMALY ..........:::cccccccceseneeeeseeeeecseeaeeessaneeeensaeeeecaaaaeeeasaeseeeaaeeeeegeeaeeeasaeseeeasaeeeesseeeeeeasaeseesaneaeeessenseeeaseeaeneees 10 Marketing SUIMMArY ...............::ccsssccsscecsssecssnecssneessceeessnenseuessneusaneesssnenseuessaneuaeceeessnessaeesssesuasceeesneesauesssnsesseesessnenesness 11 USI DiSCIOSUIES ...........00cccccccceccsseeceeeeeecesessecescusesscsneneaeeeeuacaseceeesesuasauenueneaeesesessceneceaeseasauececuseeuseasesaeeneaeesessesseneaeeeenaeesees 12 USI Privacy Notice ...............:ccccccccessssceeeseeeeeeeeeaeeensaeeeeensaeeeecaaeaeeeasaeseeenaeeeecaaeaeeeaaeseeeasaeeeesgeeeeeeasaeseeeaeeaeeesseaseeeaseeaeeeees 13 Insurance Carrier Ratings.................::cccsssccccsssseceeseeeeeeeseneeeeseeaeeeasaeeeeeaaeeeeeaaaaeeeagaeseeeasaeeeesgaaeeesasaeseeeaneaeeeeseeseeensneaeeeees 15 Client Authorization to Bind ........0...0....cccccccccecsesesssceceeeeeecesececeaeeeesaessccnaesueueeaseeneneaeeususcsseauaeaeeeasasesnenseeueesesseeneneaeeness 16 This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. About USI Insurance Services USI is one of the largest insurance brokerage and consulting firms in the world, delivering property and casualty, employee benefits, personal risk, program and retirement solutions to large risk management clients, middle market companies, smaller firms and individuals. Headquartered in Valhalla, New York, USI connects together over 10,000 industry leading professionals across 200+ offices to serve clients’ local, national and international needs. USI has become a premier insurance brokerage and consulting firm by leveraging the USI ONE Advantage®, an interactive platform that integrates proprietary and innovative client solutions, networked local resources and expertise, and enterprise-wide collaboration to deliver customized results with positive, bottom line impact. USI attracts best-in-class industry talent with a long history of deep and continuing investment in our local communities. For more information, visit usi.com. The USI ONE Advantage What truly distinguishes USI as a leading insurance brokerage and consulting firm is the US] ONE Advantage, a game-changing value proposition that delivers clients a robust set of risk management and benefit solutions and exclusive resources with financial impact. USI = «WS ONE® represents Omni, Network, Enterprise—the three key elements Ye %, that create the USI ONE Advantage and set us apart from the competition. , Client Business Omni — USI’s Proprietary Analytics chateres Omni, which means “all,” is USI’s one-of-a-kind solutions platform— eee real time, interactive, dynamic and evolving, and customized for each client. Built in-house by USI subject matter experts, Omni captures the experience of more than 500,000 clients, thousands of professionals and over 150 years of business activity through our acquired agencies into targeted, actionable solutions across property & casualty, employee benefits, personal risk and retirement. Omni features over a thousand solutions, case studies, work products and detailed analysis across industry verticals in a single dashboard. USI consultants input the client’s personalized data into Omni — highlighting their business, employees, and risks. The results feature client specific recommendations with quantified financial impact and the ability to analyze alternative scenarios with the touch of a button. sequnos a . Yags — i a — US| ONE Advantage® Network — USI’s Local and National Resources USI has made a very large investment in local resources and technical expertise, with more than 10,000 professionals networked nationally to build strong vertical capabilities and integrated account teams. Our local and regional experts ensure account team availability, hands-on service, and ongoing diligent follow-through so we can deliver on the solutions we customize for our clients. Enterprise — USI’s Team Based Strategic Planning USI’s enterprise planning is a disciplined, focused, analysis centered on our client’s issues and challenges. Highly consultative meetings integrate USI’s Omni analytics with our broad resource network to build a risk management strategy aligned with client business needs. Our enterprise process is a proven method for identifying, quantifying and minimizing client risk exposures. The USI ONE Advantage—our Omni knowledge engine, with our Network of local and national resources, delivered to our clients through our Enterprise planning process gives USI fundamentally different solutions, the resources to deliver, and a process to bring superior results to our clients. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. 'USI| Service Team USI Insurance Services, LLC 300 Kanawha Blvd. East, Suite 300, Charleston, WV 25301 (304) 347-0611 www.usi.com Your Sales Executive is Dave Stacy Direct Number: (304) 347-0691 E-Mail: Dave.Stacy@usi.com Account Management Team Your Account Executive is Brenda Samples Direct Number: (304) 347-0661 E-Mail: Brenda.Samples@usi.com Your Account Manager is Tammy White Direct Number: (304) 347-0610 E-Mail: Tammy.White@usi.com This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. I, | 4 InsurLink Client Portal InsurLink, USI’s secure, interactive portal for client collaboration and self- service resources, helps streamline the administration of your insurance program with efficient, environmentally friendly, paperless transactions. InsurLink enables you to manage your program online in seamless collaboration with your USI service team 24 hours a day, 7 days a week. With our user-friendly, intuitive software you can: View and reprint Certificates of Insurance. — View Holicies, Cudoisemenis ang uther — key documents. Generate and issue Certificates of insurance| 1 Share documents with your USI service quickly and accurately. wy team Reprint and replace Auto ID cards.* For more information about InsurLink, co ntact your USI service representative. & My Account » Hello Client User My Quick Links Auto Insurance Download Insurance Ca Travelon Certificates eCcollaborate Get our mobile app for Android or Apple and access your InsurLink client portal on the go! *Limitations inNY and NJ This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. I, | 5 Schedule of Named Insureds Workers Compensation Insurance Company: Travelers Indemnity Company Policy Term: 07/01/2024 to 07/01/2025 Named Insureds Randolph County Board of Education Only the Named Insureds shown above are included in this proposal. If any Named Insureds are not shown above and should be included for coverage, please notify us immediately. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. I, 16 Schedule of Locations Workers Compensation Insurance Company: Travelers Indemnity Company Policy Term: 07/01/2024 to 07/01/2025 40 11th Street Elkins 26241 2 Harman School Route 33, E Harman WV 26270 3 Beverly Elementary 505 Main Street Beverly WV 26253 4 Elkins High School 100 Kennedy Drive Elkins WV 26241 5 Midland Elementary 150 Kennedy Drive Elkins WV 26241 6 Randolph Technical Center 200 Kennedy Elkins wy 26241 Drive North Elementary RR 2 Box 320 Elkins WV 26241 Third Ward Elementary 111 Nathan Street | Elkins WV 26241 Elkins Middle 308 Robert E Lee Ave Elkins WV 26241 10 Pickens School One Panther Place Pickens WV 26230 11 Valley Head Elementary Rt 219 South Valley Head WV 26294 2 Jennings Randolph Elementary 101 Scott Elkins wy 26241 Ford Rd 13 Coalton Elementary 278 Broadway Ave Coalton WV 26257 14 eee Ward Elementary 10007 Seneca mill Creek wy 26280 Tygarts Valley Middle/High Rt 1 Box 290 rt F 15 250/219 S Mill Creek WV 26280 Only the locations shown above are included in this proposal. If any locations are not shown above and should be included for coverage, please notify us immediately. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. Workers’ Compensation Insurance Company: Travelers Indemnity Company Policy Term: 07/01/2024 to 07/01/2025 Coverage: Part One — Workers’ Compensation agrees to pay the benefits required under the applicable State’s Workers’ Compensation Law. Part Two — Employers Liability for work-related injuries or disease other than that which is imposed by a state Workers’ Compensation Law. Part Three — Other States. States in which you have no exposure on the policy inception date, but in which you may have a temporary or future worksite or exposure in during the policy term. If listed, statutory benefits will apply as if the state were listed in Part One. Coverage Description Limit Employers Liability - Each Accident $100,000 Employers Liability - Disease (Policy Limit) $500,000 Employers Liability - Disease (Each Employee) $100,000 Experience Mod 1.21 Statutory Limits Apply Y Other States Y Coverage is not automatic in all states. Please notify us immediately if you begin operations in another state. Workers’ Compensation Schedule of Exposures State: WV Class wg: as _— Estimated Annual Classification Description Code Payroll 7380 Drivers, Chauffeurs And Their Helpers Noc--commercial $1,525,000 8868 College: Professional Employees & Clerical $24,000,000 9101 College: All Other Employees $2,500,000 Expiring Experience Modifier: 1.06 Audit Provisions Description Audit based on Payroll - $28,025,000 This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. , | 8 Key Definitions The Key Definitions contain generic definitions for common types of insurance. Not all coverage types are defined and some of those that are defined may not be included in your insurance program. Excluded coverage or other coverages sought may be available: please discuss with USI Other exclusions and policy limitations may apply. Please refer to the actual policies for specific terms, conditions, limitations, exclusions and sublimits that will govern in the event of a loss. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. I, | 9 Premium Summary Expiring Term Proposed Term Premium Premium $115,508.00 $129,398.00 Payroll $26,600,000 $28,025,000 Emod 1.06 1.21 Carrier Description Premium Travelers Terrorism Option: Due to the Terrorism Risk Insurance Act of 2002, you now have the right to purchase coverage for losses arising out of the Acts of Terrorism, as defined in Section 102 (1) of the act. Under Federal Law you may purchase this terrorism coverage for an additional premium as follows. Please note the additional premium is not included in the above quote. We will require written confirmation at the time of binding if you elect or reject this coverage. Binding Requirements: # “Client Authorization To Bind” signed by the insured Payment Terms: Note: In evaluating your exposure to loss, we have been dependent upon information provided by you. If there are other areas that need to be evaluated prior to binding of coverage, please bring these areas to our attention. Should any of your exposures change after coverage is bound, such as your beginning new operation, hiring employees in new states, buying additional property, etc., please let us know so proper coverage(s) can be discussed. Higher limits may be available. Please contact us if you would like a quote for higher limits. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. I, | 10 Marketing Summary This list represents the carriers that were approached to provide a competitive insurance program for your business. Coverage Carrier Result Workers Compensation $158,682.00 This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. USI Disclosures Direct Bill DISCLOSURE: The Insurance Company operates independently for the financing of your insurance premium. Your agreement to finance this premium is directly with the insurance company and not USI Insurance Services. If payment is not received by the due date, the insurance company could cancel your insurance policy(s) for non-payment of premium. The insurance company has the right to honor the cancellation date and NOT offer reinstatement or rewrite the insurance coverage. We are not in a position to make monthly reminders or verify that your payment was received. Please take the necessary action to avoid possible cancellation of your insurance policy(s) which you are paying directly to the insurance company. Information Concerning Our Fees: As a licensed insurance producer, USI is authorized to confer with or advise our clients and prospective clients concerning substantive benefits, terms or conditions of insurance contracts, to sell insurance and to obtain insurance coverages for our clients. You have agreed to pay compensation to USI, for the placement of insurance, pursuant to a written agreement. Document Delivery DISCLOSURE: USI strives to make your interactions with us easy and efficient. Therefore, we intend to deliver your policy and all policy-related documents electronically through our InsurLink client portal or through email. If you do not wish to receive these documents electronically or if you would like a paper copy of any or all documents at no cost to you, please notify your client service representative in writing. If your email or electronic contact information changes, please notify your client service representative in writing. Reviewing Client Contracts DISCLOSURE: As a service to our clients, upon their request, USI will review those portions of your contract regarding the insurance and indemnity requirements as they relate to your insurance program and provide comments and/or recommendations based upon such review. This service should not be taken as legal advice and it does not replace the need for review by the insured’s own legal counsel. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. | 12 USI Privacy Notice Our Privacy Promise to You USI provides this notice to you, our customer, so that you will know what we will do with the personal information, personal financial and health information (collectively referred to as the “protected information”) that we may receive from you directly or receive from your health care provider or receive from another source that you have authorized to send us your protected information. We at USI are concerned about your privacy and assure you that we will do what is required of us to safeguard your protected information. What types of information will we be collecting? USI collects information from you required both for our business and pursuant to regulatory requirements. Without it, we cannot provide our products and services for you. We will be collected protected information about you from: e Applications or other forms, such as name, address, Social Security number, assets and income, employment status and dependent information; e Your transactions with us or your transactions with others, such as account activity, payment history, and products and services purchased; e Consumer reporting agencies, such as credit relationships and credit history. These agencies may retain their reports and share them with others who use their services; e Other individuals, businesses and agencies, such as medical and demographic information; and e Visitors to our websites, such as information from on-line forms, site visitorship data and on-line information collection devices, commonly called “cookies.” What will we do with your protected information? The information USI gathers is shared within our company to help us maximize the services we can provide to our customers. We will only disclose your protected information as is necessary for us to provide the insurance products and services you expect from us. USI does not sell your protected information to third parties, nor does it sell or share customer lists. We may also disclose all of the information described above to third parties with which we contract for services. In addition, we may disclose your protected information to medical care institutions or medical professionals, insurance regulatory authorities, law enforcement or other government authorities, or to affiliated or nonaffiliated third parties as is reasonably necessary to conduct our business or as otherwise permitted by law. Our Security Procedures At USI, we have put in place the highest measures to ensure the security and confidentiality of customer information. We will handle the protected information we receive by restricting access to the protected information about you to those employees and agents of ours who need to know that information to provide you with our products or services or to otherwise conduct our business, including actuarial or research studies. Our computer database has multiple levels of security to protect against threats or hazards to the integrity of customer records, and to protect against unauthorized access to records that may harm or inconvenience our customers. We maintain physical, electronic, and procedural safeguards that comply with federal and state regulations to safeguard all of your protected information. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. | 13 Our Legal Use of Information We retain the right to use ideas, concepts, know-how, or techniques contained in any nonpublic personal information you provide to us for our own purposes, including developing and marketing products and services. Your Right to Review Your Records You have the right to review the protected information about you relating to any insurance or annuity product issued by us that we could reasonably locate and retrieve. You may also request that we correct, amend or delete any inaccurate information by writing to us at the above address. This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. | 14 Insurance Carrier Ratings As a service to our clients, USI is furnishing an assessment by a financial rating service of the insurance companies included in our proposal. We are including the legends used by this service. All ratings are subject to periodic review, therefore, it is important to obtain updated ratings from each service. Should you desire further information concerning the financial statements of any of the insurance companies being proposed, so that you can make your own assessment of the financial strength of the companies being offered, it is available from USI at your request. USI has made no attempt to determine independently the financial capacity of the insurance companies that we are including in our proposal as we believe the nationally recognized services are better equipped to comment. A. M. BEST RATINGS At++ & At Superior D Poor A&A- Excellent E Under Regulatory Supervision B++ & B+ Good F In Liquidation B& B- Fair S Rating Suspended C++ & C+ Marginal NR Not Rated FINANCIAL SIZE CATEGORY (In S Thousands) Class | Less than 1,000 Class Il 1,000 to 2,000 Class Ill 2,000 to 5,000 Class IV 5,000 to 10,000 Class V 10,000 to 25,000 Class VI 25,000 to 50,000 Class VII 50,000 to 100,000 Class VIII 100,000 to 250,000 Class IX 250,000 to 500,000 Class X 500,000 to 750,000 Class XI 750,000 to 1,000,000 Class XIl 1,000,000 to 1,250,000 Class XIIl 1,250,000 to 1,500,000 Class XIV 1,500,000 to 2,000,000 Class XV 2,000,000 to or greater RATING "NOT ASSIGNED" CLASSIFICATIONS NR-1 Insufficient Data NR-2 Insufficient Size and/or Operating Experience NR-3 Rating Procedure Inapplicable NR-4 Company Request NR-5 Not Formally Followed This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. »| 15 Client Authorization to Bind Important Information - Coverage cannot be bound when severe weather is threatening regardless of the expiration date. After careful consideration of your proposal dated May 07, 2024,, we accept your insurance program as presented with the following exceptions, changes, and/or recommendations: Client Signature Date Signed Randolph County Board of Education This proposal is merely a descriptive summary of coverage provided by the insurance companies being proposed and should be used for reference purposes only; it is not a binder and does not amend or alter the insurance contract. Please refer to the policy contract for specific terms, conditions, limitations, and exclusions. Proposal date: 05/07/2024 Prepared for Randolph County Board of Education Confidential. © 2021 USI Insurance Services. All rights reserved. USI Vy.) 16 A TRAVELERS J PREMIUM SUMMARY RATING WORKSHEET WORKERS COMPENSATION TRANSACTION TYPE: RENEWAL Insured Name: RANDOLPH COUNTY BOARD | Policy Period: 07/01/2024— 07/01/2025 OF EDUCATION Transaction Effective Date: 07/01/2024 Address: 40 11TH ST Pro Rata Factor: 1.000 ELKINS, WV, 26241-4502 Governing State: WV PS *d Market CAG Program EL LIMITS: 100000/500000/100000 SIC Code: 8211 po Account Number: 3749N7144 Governing Company : TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA(TIL Quote Version:1 Audit type: Annually Producer Code: CJ645 Office Code:06J WORKERS COMPENSATION SUMMARY Total Standard Premium $122,970.00 §-5,780.00 Expense Constant $160.00 $7,962.00 CAT (Other than Cert Acts of Terrorism) $3,924.00 Total Premium $123,236.00 Taxes / Surcharges $6,162.00 Total Deposit Amount $129,398.00 Total Policy Payroll $28,025,000 Total Other Exposures $0.00 a Pending Rate State(s) pO Rate Hold State(s) PO THE RATES, RATING FACTORS AND PREMIUMS SHOWN ARE APPLICABLE FOR THIS QUOTE, POLICY OR CHANGE ONLY. THIS RATING WORKSHEET DOES NOT AMEND, OR OTHERWISE AFFECT, COVERAGE PROVISIONS OF ANY INSURANCE POLICY OR ENDORSEMENT ISSUED BY TRAVELERS. IT IS NOT A REPRESENTATION THAT COVERAGE DOES OR DOES NOT EXIST FOR ANY PARTICULAR CLAIM OR LOSS UNDER ANY SUCH POLICY OR ENDORSEMENT. COVERAGE DEPENDS ON THE APPLICABLE PROVISIONS OF THE ACTUAL POLICY ISSUED, THE FACTS AND CIRCUMSTANCES INVOLVED IN THE CLAIM OR LOSS AND ANY APPLICABLE LAW. THE INFORMATION PROVIDED TO YOU ON THESE SUMMARIES AND WORKSHEETS ARE PROPRIETARY AND CONFIDENTIAL AND SHOULD NOT BE DISTRIBUTED TO THIRD PARTIES. Date Rated: 05/10/2024 09:36 1 es TRAVELERS J PREMIUM SUMMARY STATE TOTAL PREMIUM: WEST VIRGINIA Writing Company: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA(TIL) Rate Effective Date: 07/01/2024 State Total Manual Premium | $110,465 State Total Deposit Amount $129,398 DETAILED RATING WORKSHEET LOCATION SCHEDULE/RATING: WEST VIRGINIA Location: 001 Filed Legal Name: RANDOLPH COUNTY BOARD OF FEIN: 556000392 Entity Type: CORP Location Street Address: 40 11TH ST. City, State, Zip Code: ELKINS, ,WV,26241 Classification Code| Exposure Basis Rate USL Premium Pro Rata Transaction 1| Type |X X| Fetr | = ($) X| Factor |=| Premium ($) COLLEGE: ALL OTHER | 9101 2,500,000, 100 1.87 1.00 46,750 1.000 46,750 EMPLOYEES COLLEGE: 8868 | 24,000,000 100 0.16 1.00 38,400 1.000 38,400 PROFESSIONAL EMPLOYEES & CLERICAL DRIVERS, 7380 1,525,000 100 1.66 1.00 25,315 1.000 25,315 ICCHAUFFEURS, MESSENG- ERS, AND THEIR HELPERS NOC- COMMERCIAL State Total Manual 110,465 Premium Total Payroll : $28,025,000 Total Other Exposure : $0 STATE RATING PROGRAM/COVERAGES AND TOTAL PREMIUM SUMMARY : WEST VIRGINIA Cc Factor/ Pro Transaction Rati P ode Exposure xX ° ‘ = Premium xX Rat: Pr i ating rogram/Coverage % Adj ( ) tor - “3) THE INFORMATION PROVIDED TO YOU ON THESE SUMMARIES AND WORKSHEETS ARE PROPRIETARY AND CONFIDENTIAL AND SHOULD NOT BE DISTRIBUTED TO THIRD PARTIES. Date Rated: 05/10/2024 09:36 2 MES, TRAVELERS | Factor/ Pro Transaction ; Code Exposure é : Premium |X| Rata Premium Rating Program/Coverage % Adj ($) Factor ($) State Total Manual Premium 110,465 110,465 Total Premium Subject To 110,465 1.000 110,465 Experience Mod. Experience Modification 9999 110,465 0.210 23,198 1.000 23,198 1.21 Final Risk ID : 470140402 Modified Premium 133,663 1.000 133,663 Schedule Credit 9887 133,663 -0.08 -10,693 1.000 -10,693 Total Estimated Annual 122,970 1.000 122,970 Standard Premium Premium Discount 0064 122,970 -0.047 -5,780 1.000 -5,780 Expense Constant 0900 1 160.000 160 1.000 160 Terrorism-Payroll/100 9740 280,250 0.007 1,962 1.000 1,962 Cat(other Than Cert Acts Of 9741 280,250 0.014 3,924 1.000 3,924 Terrorism)-Payroll/100 Total Estimated Premium 123,236 1.000 123,236 Regulatory Surcharge 0069 123,236 0.050 6,162 1.000 6,162 State Total Premium 129,398 129,398 THE INFORMATION PROVIDED TO YOU ON THESE SUMMARIES AND WORKSHEETS ARE PROPRIETARY AND CONFIDENTIAL AND SHOULD NOT BE DISTRIBUTED TO THIRD PARTIES. Date Rated: 05/10/2024 09:36 3 encova INSURANCE 400 Quarrier St. Charleston, WV 25301 NOTICE OF DEPOSIT PREMIUM DUE Quote Number: Q667208-000 Renewal Of: NEW . Quote Date: 05/10/2024 avnieaaaiad Boar) Of education Deposit Due Date: 07/01/2024 Total Policy Premium: $158,682.00 Elkins, WV 26241 Agency: USI Insurance Services LLC Phone: (304) 347-0611 Workers’ Compensation Policy Effective 07/01/2024-07/01/2025 Total Premium: $151,126.00 Total Surcharge: $7,556.00 Total Policy Premium: $158,682.00 Quote Deposit: $39,671.00 Payments Applied to Quote: $0.00 Minimum Deposit Premium Due 07/01/2024 $39,671.00 You must pay the minimum deposit amount due to activate coverage. If you have any questions concerning account payment, please call between the hours of 8:00AM and 5:00PM Monday through Friday at 844-362-6821 or 1-304-941-1000 or visit us at www.encova.com Remove the stub below and return with your payment Make checks payable to: Encova Insurance Credit Card Payments: INSURANCE . Please pay online at www.encova.com please do not remit cash Quote Number: Q667208-000 PAYMENT MUST BE RECEIVED BY DUE DATE Due Date: 07/01/2024 Send Payments to: Randolph County Board Of Education Encova Insurance 40 11th St PO BOX 11285 Elkins, WV 26241 CHARLESTON, WV 25339-1285 0000000000 533368901 000000 Q667208000 encova INSURANCE Workers’ Compensation Insurance Quote Date: 05/10/2024 Quote #: Q667208-000 Proposed Policy Period: 07/01/2024 - 07/01/2025 Installment Schedule Installments Due Date Installment Deposit Premium 07/01/2024 $39,671.00 Installment 09/21/2024 $39,671.00 Installment 12/21/2024 $39,671.00 Installment 03/21/2025 $39,669.00 Please note this Installment Schedule is valid for this quote as written, any change in this quote or its resulting policy is not reflected here in. A $0 fee will be charged for each installment listed above. www.encova.com QP0001 (Ed. 7-21) Page 2 of 6 encova INSURANCE Workers' Compensation Insurance Proposed Policy Period: 07/01/2024 - 07/01/2025 Quote # Q667208-000 Coverage Part I. Workers’ Compensation Insurance - Statutory Part II. Employer's Liability Limit: $100,000.00 Bodily injury by accident, each accident $500,000.00 Bodily injury by disease, policy limit $100,000.00 Bodily injury by disease, each employee West Virginia Broad Form Employers Liability excluded. States Covered WV www .encova.com QP0001 Page 3 of 6 (Ed. 07-21) encova INSURANCE Workers' Compensation Insurance Proposed Policy Period: 07/01/2024 - 07/01/2025 Code State: WV Description Premium Period: 07/01/2024 - 07/01/2025 Location: 1 7380 8868 9101 9898 9887 0900 9740 9741 9703 DRIVERS, CHAUFFEURS, MESSENGERS AND THEIR HELPERS NOC-COMMERCIAL COLLEGE: PROFESSIONAL EMPLOYEES & CLERICAL COLLEGE: ALL OTHER EMPLOYEES Experience Modification Premium Schedule Rating Premium Total Standard Premium Expense Constant Terrorism Catastrophe (Other than certified acts of terrorism) WV Regulatory Budget Surcharge Policy Estimated Annual Premium Policy Total Amount Due Exposure $1,525,000.00 $24,000,000.00 $2,500,000.00 Quote # Q667208-000 Rate 2.03 0.2 2.28 1.21 0.875 0.008 0.017 0.05 Total $30,958.00 $48,000.00 $57,000.00 $28,551.00 $20,564.00CR $143,945.00 $175.00 $2,242.00 $4,764.00 $7,556.00 $151,126.00 $158,682.00 NOTE: Premium listed is an estimated annual premium based upon submitted payroll exposures. This proposal shows the premiums for the coverages described, but in no way changes or affects any terms, conditions or exclusions of the policies currently in existence. Proposed premiums shown are based on information furnished to us. If accepted, the coverages in this proposal will commence upon the expiration of any policies currently in effect. Coverage comparisons are available if desired. This proposal will expire 30 days from the quote date or at the requested effective date whichever occurs first. Please note that the premium indicated may be subject to change prior to activating coverage due to state rate approval that may occur after the quote was issued. QP0001 (Ed. 07-21) .€ncova.com Page 4 of 6 encova INSURANCE Workers' Compensation Insurance Proposed Policy Period: 07/01/2024 - 07/01/2025 Quote # Q667208-000 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE Coverage for acts of terrorism is included in your quote You are hereby notified that under the Terrorism Risk Insurance Act, as amended in 2015, the definition of act of terrorism has changed. 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. Under your coverage, any losses resulting from certified acts of terrorism may be partially reimbursed by the United States Government under a formula established by the Terrorism Risk Insurance Act, as amended. However, your quote 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 2015; 84% beginning on January 1, 2016; 83% beginning on January 1, 2017; 82% beginning on January 1, 2018; 81% beginning on 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 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 exceeds $100 billion in any one calendar year. If the aggregate insured losses for all insurers exceed $100 billion, your coverage may be reduced. The portion of your annual premium that is attributable to coverage for acts of terrorism is $2,242.00 , and does not include any charges for the portion of losses covered by the United States government under the Act. www .encova.com QP0001 Page 5 of 6 (Ed. 07-21) encova INSURANCE Encova 360° Team Approach Account Management: Post-sale and day-to-day servicing of all accounts Liaison for client, broker and Encova Insurance Orientation and On Boarding Account/claim reviews WC practices and RTW training Benchmarking claim performance Medical Provider Selection Assistance Vendor Management CO? CO? CO? CO? CO? CO) CO) CO? Loss Control Services: On-site Risk Assessment Documented Workplace Safety Recommendations OSHA Approved Safety Training National Safety Council Approved Training Free Access to Extensive Safety Video Library Web Based Safety Resources Industry Experienced Safety Specialists laims Services: Twenty four (24) Hour Contact Cost Reduction Programs Case Management Services Medical Cost Containment Procedure/Bill Review by Medical Specialists Return to Work/Rehabilitation Services Medical Provider Selection Assistance Vendor Management § Special Investigative/Fraud Units § Pro-Active Claims handling § Specialized Services OD CO) CO) CO? CO? CO) CO? CO MD OM) cr Litigation Management: § Reduce frequency and extent § Panel counsel § Litigation strategy § Savings to policyholders Underwriting Services: Competitive Coverage and Pricing Options Prompt Response to Coverage Questions Flexible Premium Payment Options Small and Large Deductible Programs Association Safety Discount Programs Dividend Programs Incurred Loss Retrospective Rating Programs Premium Finance Availability Specialized Team Approach CO? COD C2 CO? C2 CO? CO) CO? CO? Audit Services: On-Site Payroll and Classification Verification Telephonic and Mail Audit Options Recordkeeping Assistance Class Dispute Resolution Assistance Detailed Audit Results Statement Extensive Classification Consultation Resource Industry Experienced Premium Auditors Cr Cr Cr) Ch Cn Cn QP0001 Wwww.encova.com Page 6 of 6 (Ed. 7-21)