Work%20Comp%20Propsal%20FY25.PDF

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

Text

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.

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

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.

Proposal date: 05/07/2024 Prepared for Randolph County Board of Education

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.

Proposal date: 05/07/2024 Prepared for Randolph County Board of Education

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

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.

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.

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.

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.

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

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

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

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

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)