Proposal of Insurance
City of Santa Ana
20 Civic Center Plaza, M-28
Santa Ana, CA 92701
Presentation Date: June 1, 2025
Arthur J Gallagher Risk Management Services, LLC
AJG License Nos.IL 100292093 / CA 0D69293
City of Santa Ana
2 Table of Contents
Your Gallagher Team ........................................................................................................... ....................................... 3 Program Structure ....................................................................................................................................................... 4 Named Insured ............................................................................................................................... .............................. 5 Market Review ............................................................................................................................... ............................... 6 Year Over Year Comparison ....................................................................................................................................... 9 Full Program Details .................................................................................................................................................. 10 Excess Liability Buffer - $1M xs $2M SIR - General Star Indemnity Company ..................................................... 10 Excess Liability Buffer - $1M xs $2M SIR - Princeton Excess & Surplus Lines Ins Co ......................................... 13 Excess Workers' Compensation - Response Indemnity Company of California ................................................... 16 DIC - $5M Part of $10M - Endurance American Specialty Ins Co ........................................................................ 18 DIC - $2.5M Part of $10M - Palms Insurance Company, Limited ......................................................................... 21 DIC - $2.5M Part of $10M - Landmark American Insurance Company ................................................................ 23 Excess DIC - $5M xs $10M - Mt Hawley Insurance Company, (More) ................................................................. 25 Excess DIC - $10M Excess $15M - Palomar Excess and Surplus Insurance Company, (More) .......................... 27 Terrorism - Lloyd's Syndicate 3623 (Beazley Furlonge Limited) ................................................................. ......... 30 Terrorism - Texas Insurance Company ................................................................................................................ 33 Premium Summary .................................................................................................................................................... 33 Location Schedule ................................................................................................................................................ 35 Payment Plans ................................................................................................................. .................................... 36 Coinsurance Illustration ...................................................................................................... ..................................... 37 Proposal Disclosures ................................................................................................................................................ 38 Proposal Disclosures ............................................................................................................................................ 39 Client Signature Requirements ................................................................................................. ............................... 42 Surplus Lines Notice - California ............................................................................................. ............................. 43 Client Authorization to Bind Coverage .................................................................................................................. 45 Appendix ...................................................................................................................... .............................................. 48 Compensation Disclosure Schedule ..................................................................................................................... 49 Binding Requirements .......................................................................................................... ................................ 51 Claims Reporting By Policy .................................................................................................... .............................. 53 Gallagher STEP Flyer .......................................................................................................... ................................ 56 Attachments
City of Santa Ana - 2025 Schedule of Values
City of Santa Ana
3 Your Gallagher Team
Your Gallagher team is a true partner. We have the expertise to understand your business and we’re here to service and stay alongside you, every step of the way.
Service Team Role Email Phone
Susan Blankenburg
Area Executive Vice President Client Service Executive [email protected] (415) 536-8417 (p) Natalie Bates
Client Service Manager III Client Service Manager [email protected] (949) 349-9856 (p) Kaylee Langron
Client Service Manager Client Service Associate [email protected] (925) 310-1032 (p) Ron Green
Client Service Associate Senior Certificate Specialist [email protected] (415) 536-8432 (p) Ryan Asuncion
Claims Advocate Dedicated Claims Advocate [email protected] (415) 536-4051 (p) Julie Frisbey
Senior Loss Control Specialist
Dedicated Loss Control
Representative [email protected] (303) 889-2505 (p)
City of Santa Ana
4 Program Structure
Program Structure
City of Santa Ana
5 Named Insured
LINE OF COVERAGE NAMED INSURED
All Lines of Coverage included in this proposal City of Santa Ana Excess Liability Buffer
Santa Ana Financing Authority
Santa Ana Police Athletic and Activity League
The Friends of Santa Ana Parks and Recreation Community Services The Housing Authority of the City of Santa Ana
Note: Any entity not named in this proposal may not be an insured entity. This may include affiliates, subsidiaries, LLCs, partnerships, and joint ventures.
City of Santa Ana
6 Market Review
We approached the following carriers in an effort to provide the most comprehensive and cost effective insurance program.
Line Of Coverage
Insurance Company ** (AM
Best Rate/Financial
Strength); Admitted***
Market Response * Premium
Excess Liability
Buffer - $1M xs $2M
SIR
General Star Indemnity
Company (A++ XV); Non-
Admitted
Quoted Rate reduction of 9% over expiring. This
rate reduction is equivalent to a $105K in premium
savings.
They maintained the $2M aggregate and
confirmed they are unable to match the $3M
aggregate proposed by Princeton.
$1,702,470
Princeton Excess & Surplus
Lines Ins Co (A+ XV); Non-
Admitted
Recommended Quote: A 11% rate reduction in
addition to increasing the aggregate from $2M to
$3M. The rate reduction is equivalent to over
$130K in premium savings.
$1,676,675
Chubb Group of Insurance
Companies (A XV); Admitted Declined – outside of underwriting appetite Gemini Insurance Company
(A+ XV) ); Non-Admitted
Declined – not able to improve on the pricing or
terms of the incumbent
Excess Workers'
Compensation
Response Indemnity
Company of California (A- X);
Admitted
Recommended Quote: at a rate increase of 5%
over expiring for the expiring $500K xs $1.5M
retention.
The $750K and $1M limit options were found not
to be competitive with rate increases of 53% and
137%, respectively.
$327,547
DIC - $5M Part of
$10M
Endurance American
Specialty Ins Co ( A+ XV); );
Non-Admitted
Recommended Quote: Rate reduction of 10%,
a premium savings of nearly $32,000 $349,881.32
DIC - $2.5M Part of
$10M
Palms Insurance Company,
Limited (A IX) ); Non-
Admitted
Recommended Quote: Rate reduction of 10%,
a premium savings of nearly $16,000 $176,488.36
DIC - $2.5M Part of
$10M
Landmark American
Insurance Company (A++ X );
Non-Admitted
Recommended Quote: Rate reduction of 9%, a
premium savings of over $14,000 $174,940.66
Excess DIC - $5M xs
$10M
Mt Hawley Insurance
Company (A+ XIV);
Lloyd's Synd 1458
(RenaissanceRe Synd) (A
XV); Non-Admitted
Recommended Quote: Rate reduction of 10%, a
premium savings of nearly $20,000 $217,193.90
City of Santa Ana
7 Line Of Coverage
Insurance Company ** (AM
Best Rate/Financial
Strength); Admitted***
Market Response * Premium
Excess DIC - $10M
Excess $15M
Palomar Excess and Surplus
Insurance Company (A X);
Princeton Excess & Surplus
Lines Ins Co (A+ XV); Non-
Admitted
Recommended Quote: Rate reduction of 10%, a
premium savings of nearly $30,000 $320,559.62
New Option: Excess
DIC - $5M Excess
$25M
Palomar Excess and Surplus
Insurance Company (A X);
Non-Admitted
Princeton Excess & Surplus
Lines Ins Co (A+ XV); Non-
Admitted
Quoted additional $5M in limits to bring the total
DIC coverage the $30M $92,862.00
New Option: Excess
DIC - $10M Excess
$25M
Palomar Excess and Surplus
Insurance Company (A X);
Princeton Excess & Surplus
Lines Ins Co (A+ XV ); Non-
Admitted
Quoted additional $10M in limits to bring the total
DIC coverage the $35M $170,247.00
New Option: Excess
DIC - $15M Excess
$25M
Palomar Excess and Surplus
Insurance Company (A X);
Princeton Excess & Surplus
Lines Ins Co (A+ XV ); Non-
Admitted
Quoted additional $15M in limits to bring the total
DIC coverage the $40M $252,791.00
Terrorism
Lloyd's Syndicate 3623
(Beazley Furlonge Limited) (A
XV); Non-Admitted
Recommended Quote: for $14,919.83 for the
expiring $10M Combined Property/Liability Limit
Also provided options for a $1M or $5M combined
limit
$14,919.83
Texas Insurance Company
(A- XII); Non-Admitted; Non-
Admitted
Quoted - $15,447.00 for the $10M Combined
Property/Liability Limit.
Indian Harbor Insurance
Company (A XV); Non-
Admitted
Quoted – Not competitive
To secure a $10M Property Damage Limit would
be $20,000. To secure a separate $1M Liability
Limit would be $10,000.
*If shown as an indication, the actual premium and acceptance of the coverage requested will be determined by the market after a thorough review of the completed application.
**Gallagher companies use AM Best rated insurers and the rating listed above was verified on the date the proposal document was created.
Best's Credit Ratings™ reproduced herein appear under license from AM Best and do not constitute, either expressly or impliedly, an endorsement of Gallagher’s service or its recommendations. AM Best is not responsible for transcription errors made in presenting Best's Credit Ratings™. Best’s Credit Rati ngs™ are proprietary and may not be reproduced or distributed without the express written permission of AM Best.
A Best’s Financial Strength Rating is an independent opinion of an insurer’s financial strength and ability to meet its ongoing insurance policy and contract obligations. It is not a warranty of a company’s financial strength and ability to meet its obligations to policyholders. Best's Credit Ratings™ are under continuous re view and subject to change and/or affirmation. For the latest Best’s Credit Ratings™ and Guide to Best’s Credit Ratings, visit the AM Best website at http://www.ambest.com/ratings.
City of Santa Ana
8 ***If coverage placed with a non-admitted carrier, it is doing business in the state as a surplus lines or non-admitted carrier, and is neither subject to the same regulations as an admitted carrier nor do they participate in any state insurance guarantee fund.
Gallagher companies make no representations and warranties concerning the solvency of any carrier, nor does it make any representation or warranty concerning the rating of the carrier which may change.
City of Santa Ana
9 Year Over Year Comparison
EXPIRING
2024‐2025
RENEWAL
2025-2026
%
Change
Liability ‐ DE9 Payroll $137,686,727 $142,743,924 4%
Worker's Compensation ‐ payroll $137,686,727 $142,743,924 4% Earth Movement & Flood (DIC) ‐ TIV $763,954,380 $777,575,467 2% Standalone Terrorism ‐ TIV $763,954,379 $777,685,467 2% Liability ‐ Budget 1.3129 1.1746 ‐11%
Worker's Compensation ‐ payroll 0.2179 0.2295 5%
$25M Earth Movement & Flood (DIC) 0.1769 0.1593 ‐10%
Excess Earth Movement & Flood (DIC): $5M xs $25M 0.0133 0.0119 ‐10% Excess Earth Movement & Flood (DIC): $10M xs $25M 0.0246 0.0219 ‐11% Excess Earth Movement & Flood (DIC): $15M xs $25M 0.0339 0.0325 ‐4% Standalone Terrorism 0.0019 0.0019 0%
Liability: $1M/$3M xs $2M SIR $1,807,650.00 $1,676,675.00 ‐7% Workers Compensation: $500K xs $1.5M SIR $300,027.00 $327,547.00 9% $25M Earth Movement & Flood (DIC) $1,351,649.51 $1,239,063.87 ‐8% Excess Earth Movement & Flood (DIC): $5M xs $25M $103,489.54 $92,862.00 ‐10% Excess Earth Movement & Flood (DIC): $10M xs $25M $191,192.54 $170,247.00 ‐11% Excess Earth Movement & Flood (DIC): $15M xs $25M $263,418.54 $252,791.00 ‐4% Standalone Terrorism $14,651.56 $14,919.83 2%
TOTAL PREMIUM / $25M DIC: $3,473,978.07 $3,258,205.70 ‐6% TOTAL PREMIUM / $30M DIC: $3,577,467.61 $3,351,067.70 ‐6% TOTAL PREMIUM / $35M DIC: $3,768,660.15 $3,521,314.70 ‐7% TOTAL PREMIUM / $40M DIC: $4,032,078.69 $3,774,105.70 ‐6%
EXPOSURES
RATES
PREMIUMS
City of Santa Ana
10 Full Program Details
Excess Liability Buffer - $1M xs $2M SIR - General Star Indemnity Company Excess Liability Buffer - $1M xs $2M SIR
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier General Star Indemnity Company
A.M. Best Rating A++ XV
Admitted/Non-Admitted Non-Admitted
Payment Plan Full annual premium payment is due at inception Payment Method Agency Bill
Premium & Exposures Proposed
Premium $1,650,000.00
State Tax: $49,500.00
Stamping Fee: $2,970.00
TRIA $31,187.19
Minimum Type Minimum Earned Premium
Minimum Amount / Description 25%
Estimated Cost $1,702,470.00
Standard Coverages Proposed
Coverage Part A: Each Occurrence Limit $1,000,000
Coverage Part A: Coverage Part Aggregate $2,000,000 (Does not apply to Auto) Coverage Part B: Each Claim Limit $1,000,000
Coverage Part B: Coverage Part Aggregate $1,000,000
Overall Aggregate Will Apply to Coverage Parts
A and B Combined
Deductibles/SIR Proposed
Retention - Coverage Part A $2,000,000 - Each Occurrence Retention - Coverage Part B $2,000,000 - Each Claim
Defense Limitations Proposed
Coverage Part A Claim expenses will erode both the retained limit and the limit of insurance
Coverage Part B Claim expenses will erode both the retained limit and the limit of insurance
Form Type Proposed
Form Type - Coverage Part A: Genesis Public
Entity Liability Policy Occurrence
Form Type - Coverage Part B: Genesis Public
Official Liability Policy Occurrence
Form Type - Medical Incident Liability Claims Made
Retroactive Date - Medical Incident Liability 7/1/2023
City of Santa Ana
11 Definition Of Claim:
Refer to attached policy form
Run Off Provisions:
Refer to attached policy form
Incident/Claim Reporting Provision:
Refer to attached policy form
Claims Made Disclaimer:
Should you elect to change carriers (if a new retroactive date is provided) or non-renew this policy, a supplemental extended reporting endorsement may be available subject to policy terms and conditions. You must request the extended reporting period in writing to the carrier within (60) days of the expiration date. The cost of this extended reporting period is 100%% of the annual premium and is fully earned. The extended reporting period extends only to those claims made during the extended reporting period for wrongful acts that occurred prior to the expiration date and would have been covered by the policy. Claims must be reported to the carrier within (3 Years) days of the end of the policy period. The extended reporting period does not increase the limits of liability and is subject to all policy terms, conditions and exclusions.
Endorsements (including but not limited to)
The Public Policy – Retained Limit Form – Declarations Page - GPE 10 0002 03 25 Coverage Part A – Public Liability - GPE 00 0001 10 21
Coverage Part B – Public Officials Liability – Occurrence - GPE 00 0003 07 21 Common Policy Conditions - GPE 00 0004 07 21
Schedule of Forms and Endorsements - GPE 07 0001 07 21
Personal Injustices - GPE 00 0006 07 21
Medical Incident Liability Coverage - GPE 04 0003 10 21 Employee Benefits Liability - GPE 04 0011 07 23
Claim Expenses Erode Retained Limit and Limit(s) of Insurance - GPE 24 0012 07 12 Service of Suit Clause - IC 24 0002 01 25
Additional Policy Conditions – Trade Sanctions and Specially Designated Nationals (OFAC) - IL 11 0001 07 22 Signature Page - SGN 90 0001 08 22
TRIA (if accepted): Cap on Losses from Certified Acts of Terrorism - IL 09 0021 01 15 TRIA (if accepted): Disclosure Pursuant to Terrorism Risk Insurance Act - IL 09 85 01 15
Exclusions (including but not limited to)
Nuclear Energy Liability Exclusion - GPE 00 0005 07 21
Exclusion – Unmanned Aircraft System - GPE 21 0018 07 21 Total PFAS Exclusion - GPE 21 0044 12 21
Exclusion – Cyber Privacy Event, Cyber Security Event, Data-Related Liability and Interruption or Failure of Services - GPE 21 0055 06 22
Exclusion – Recording and Distribution of Material or Information in Violation of Law - GPE 21 0056 04 23 Exclusion – Human Trafficking - IL 24 0005 01 25
TRIA (if accepted): Exclusion – Nuclear, Biological, Chemical or Radiological Acts of Terrorism - IC 21 0006 01 25 TRIA (if accepted): Exclusion of Punitive Damages Related to a Certified Act of Terrorism - IL 09 0026 01 15 TRIA (if rejected): Exclusion – Nuclear, Biological, Chemical or Radiological Acts of Terrorism - IC 21 0006 01 25
City of Santa Ana
12 Exclusions (including but not limited to)
TRIA (if rejected): Exclusion of Certified Acts of Terrorism - IL 09 0022 01 15
Binding Requirements:
Description
Subject To:
D-1 (Effective January 1, 2020)
Signed TRIA Form.
Confirmation of Binding Coverage must be signed at Binding Copy of signed E&S due diligence affidavit from retail agent must accompany any request to bind coverage.
Other Significant Terms and Conditions/Restrictions:
Description
Type of Insurance:
Coverage Part A: Genesis Public Entity Liability on an Occurrence Basis excess of a Retained Limit on the Genesis Public Entity Policy Form.
Coverage Part B: Genesis Public Entity Liability on an Occurrence Basis excess of a Retained Limit on the Genesis Public Officials Liability Form
TRIA Premium includes additional taxes of $961.19
City of Santa Ana
13 Excess Liability Buffer - $1M xs $2M SIR - Princeton Excess & Surplus Lines Ins Co Excess Liability Buffer - $1M xs $2M SIR
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier Princeton Excess & Surplus Lines Ins Co
A.M. Best Rating A+ XV
Admitted/Non-Admitted Non-Admitted
Payment Plan Premium is payable within 60 days of binding Payment Method Agency Bill
Premium & Exposures Proposed
Premium $1,625,000.00
State Tax: $48,750.00
Stamping Fee: $2,925.00
TRIA $33,533.50
Minimum Type Minimum Earned Premium
Minimum Amount / Description 25%
Estimated Cost $1,676,675.00
Standard Coverages Proposed
Auto Liability: Specific Limit $1,000,000
General Liability: Specific Limit $1,000,000
General Liability: Policy Aggregate Limit **$3,000,000
*Law Enforcement Liability:
- Specific Limit $1,000,000
- Policy Aggregate Limit **$3,000,000
*Sexual Abuse
- Specific Limit $1,000,000
- Policy Aggregate Limit **$3,000,000
Professional Liability:
- Specific Limit $1,000,000
- Policy Aggregate Limit **$3,000,000
*EPLI:
- Specific Limit $1,000,000
- Policy Aggregate Limit **$3,000,000
*Sexual Harassment:
- Specific Limit $1,000,000
- Policy Aggregate Limit **$3,000,000
Additional Coverages Proposed
Annual Aggregate $3M applies to all Lines except Auto Liability
Deductibles/SIR Proposed
Retention: Auto Liability - Underlying Retention $2,000,000 Retention: General Liability - Underlying
Retention $2,000,000
City of Santa Ana
14 Deductibles/SIR Proposed
Retention: *Law Enforcement Liability -
Underlying Retention $2,000,000
Retention: *Sexual Abuse - Underlying
Retention $2,000,000
Retention: Professional Liability - Underlying
Retention $2,000,000
Retention: *EPLI - Underlying Retention $2,000,000
Retention: *Sexual Harassment - Underlying
Retention $2,000,000
Defense Limitations Proposed
Excess Liability Defense cost Inside the Limit
Form Type Proposed
Form Type
Excess Liability: Occurrence; General Liability: Occurrence; *Law Enforcement Liability: Occurrence; *Sexual Abuse: Occurrence; Professional Liability: Occurrence; *EPLI: Occurrence; *Sexual Harassment: Occurrence
Endorsements (including but not limited to)
Automobile Liability Coverage Part - RL 1000 AU
Retained Limit Policy - Common Policy Declarations - RL 1000 CDEC General Liability Coverage Part - OCC - RL 1000 GLOC
Retained Limit Policy - Liability Coverage Parts Declarations - RL 1000 LDEC Misc Professional Liability Coverage Part - OCC - RL 1000 MPOC Retained Limits Policy Conditions - RL 1000 PC
Schedule of Forms and Endorsements - RL 1000 S
WROC Wrongful Acts Liability Coverage Part - OCC - RL 1000 Ultimate Net Loss Amendment - RL 2028
Service of SUIT - PESLIC - RL 2050
Sexual Abuse Occurrence GL - RL 2097
Law Enforcement Endorsement - RL 2191
Cap on Losses from Certified Acts of Terrorism (if TRIA is accepted) - RL VLTERR01 Violation of Economic or Trade Sanctions - VL ES 21 01
U.S. Treasury Department's Office of Foreign Assets Control ("OFAC") Advisory Notice of Policyholders - IL P 001
Exclusions (including but not limited to)
Exclusions (in addition to those contained in agreed policy form) - Liability Claim Administration, Exclusions, Conditions and Definitions - RL 1000 LC Mold/Fungal Pathogens Exclusion - RL 2034
Silica and Silica-Related Dust Exclusion - RL 2090
Watercraft Exclusion - RL 2095
Communicable Disease Exclusion - RL 2177
PFAS Chemicals Exclusion - RL 2193
Exclusion of Certified Acts of Terrorism and Other Acts of Terrorism (if TRIA is rejected) - RL 2203
City of Santa Ana
15 Binding Requirements:
Description
Subject To:
D-1 (Effective January 1, 2020)
Signed TRIA Form
Prior to binding, the Insurer requires a completed, signed, and dated UM/UIM acceptance/rejection form.
Confirmation of Binding Coverage must be signed at Binding
Other Significant Terms and Conditions/Restrictions:
Description
*Sub-limits/Sub-lines are included and not in addition to the major line of business covered above. **$3M Aggregate is a Policy Aggregate and applies to all Lines of Business except Auto Liability Limits Structure: Combined Single Limit
Minimum and deposit annual premium
Cancellation:
(60) Days for Cancellation and Non-Renewal
(10) Days for Non - Payment of Premium
Share: 100%
TRIA Premium includes additional tax of $1,033.50
City of Santa Ana
16 Excess Workers' Compensation - Response Indemnity Company of California Excess Workers' Compensation
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier Response Indemnity Company of California
A.M. Best Rating A- X
Admitted/Non-Admitted Admitted
Payment Plan In Full
Payment Method Agency Bill
Premium & Exposures Proposed
Premium $327,547.00
Exposure / TIV $142,743,924 - Total Payroll
Rate 0.2295
TRIA Included
Minimum Type Minimum And Deposit Premium
Minimum Amount / Description $327,547
Estimated Cost $327,547.00
States
States Covered: CA
States Excluded: OH, ND, WA, WY
Extraterritorial Jurisdictions:
Standard Coverages Proposed
Coverage A - Workers' Compensation Statutory
Per Occurrence, Each Accident: Per Person,
Each Occupational Disease or Cumulative
Trauma
$500,000
Optional Coverages Proposed
$750,000 xs $1,250,000 Premium : $475,721
$1,000,000 xs $1,000,000 Premium : $735,719
Deductibles/SIR Proposed
Retention - Workers Compensation - Limit &
Retention per occurrence, each Accident: per
person, each Occupational Disease or
Cumulative Trauma
$1,500,000
Endorsements (including but not limited to)
Policy form - FSIR 00 01 02 17
Subject to Audit: At Expiration
City of Santa Ana
17 Auditable Exposures:
State Class
Code Description
Expiring
Rate per
$100
Expiring
Exposure
Rate per
$100 Exposure
CA
Workers Compensation & Employers
Liability : Class Codes: 7520, 7720,
7721, 8810, 9033, 9410, 9420
$0.2179 $137,686,727 $0.229465 $142,743,924
City of Santa Ana
18 DIC - $5M Part of $10M - Endurance American Specialty Ins Co DIC - $5M Part of $10M
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier Endurance American Specialty Ins Co
A.M. Best Rating A+ XV
Admitted/Non-Admitted Non-Admitted
Payment Plan In Full
Payment Method Agency Bill
Premium & Exposures Proposed
Premium $339,098.00
Surplus Lines Tax $10,172.94
Stamping Office Fee $610.38
Exposure / TIV $777,575,468
Rate 0.0436
TRIA $34,988.33
Minimum Type Minimum Earned Premium
Minimum Amount / Description 25 %
Estimated Cost $349,881.32
Standard Coverages Proposed
Limit of Liability - Earth Movement and Flood $5,000,000 part of $10,000,000 Per Occurrence and Annual Aggregate
Additional Coverages Proposed
Extra Expense Extra Expense $2,500,000
Ordinance or Law - Coverage A, B & C
Combined Included
Deductibles/SIR Proposed
Deductible - Flood 2% Per Unit of Insurance Per Occurrence Deductible - Flood - Subject to $100,000 Minimum
Deductible - Earth Movement 5% Per Unit of Insurance Per Occurrence Deductible - Earth Movement - Subject to $100,000 Minimum
Valuations Proposed
Replacement Cost Property
Actual Loss Sustained Business Income
Endorsements (including but not limited to)
SN - California - SN 9005 0120 CA
Office Of Foreign Assets Control ("Ofac") - PN 0001 0721 Property Declarations - ECP 0001 0616
Forms And Endorsements Schedule - ECP 0101 0508
Disclosure Pursuant To The Terrorism Risk Insurance Act - IL 1214 1220 Cap On Losses From Certified Acts Of Terrorism - IL 1204 0115
City of Santa Ana
19 Endorsements (including but not limited to)
Easic Specified Perils Policy - ECP 0224 1018
Business Income Endorsement Gross Earnings Form Including Extra Expense - ECP 0628 0416 Occurrence Limit Of Liability Endorsement - ECP 1324A 1220 Flood Coverage Limitation - ECP 0508 0516
Flood Percentage Deductible - ECP 1346 0417
Earth Movement And Optional Earth Movement And Sprinkler Leakage Percentage Deductible - ECP 1348 0417 Sub-Limits Of Liability Endorsement - ECP 0102 0216
Ordinance Or Law Coverage Endorsement With Time Element Coverage - ECP 0611 0716 Loss Adjustment Endorsement - ECP 1301 0616
Notice Of Loss - ECP 1302 0214
Service Of Suit Endorsement - ECP 1307 0316
Actual Total Or Constructive Loss Earned Premium Condition - ECP 0684 0123 Signature Page - IL 1008 0114
Mandatory Policyholder Disclosure RE: Terrorism Insurance Coverage - TRIA TRIB 0115 California Fraud Statement - IL N 018 01 22
Privacy Notice for Insurance Applicants and Policyholders - PN 0017 1120
Exclusions (including but not limited to)
Equipment Breakdown Exclusion - ECP 0510b 0508
Absolute Pollution Exclusion - ECP 0501 0606
Asbestos Exclusion - ECP 0502 0606
Absolute Mold Exclusion - ECP 0505 0606
Exclusion For Certain Computer Related Losses - ECP 0509 0416 War And Military Action, Terrorism, And Nuclear, Biological Or Chemical Exclusion - ECP 0507 0606 Communicable Disease Exclusion - ECP 0519 0817
Post-Loss Assignment Exclusion - ECP 0676 1021
Binding Requirements:
Description
Signed Terrorism Disclosure Form prior to binding
D-1 (Effective January 1, 2020)
Other Significant Terms and Conditions/Restrictions:
Description
TRIA Premium Includes Additional Taxes: $1,078.33
Peril(s) Insured: Risk of Direct Physical Loss or Damage caused by the peril(s) of Earth Movement and Flood only as per Policy Form, Endorsements and Exclusions attached.
Coverage(s): Real Property, Business Personal Property, Business Income including Extra Expense and Rental Value as per Policy Form, Endorsements and Exclusions attached
Cancellation: Cancellation term is 60 days. Term is 10 days for reasons of nonpayment.
Occurrence Definition Must Include an Hourly Limit not to Exceed 96 Hours for Named Windstorm and up to 168 Hours for Flood and Earthquake / Earth Movement
Excluding Flood Zones A & V - 501 N. Newhope St., 2501 N. Flower St., 2615 N. Valencia St., 4812 W. Camile St., 706 N.
Newhope St., 751 Memory Ln., 122 N. Newhope St., 3006 Centennial Way, 2401 N. Bristol St., 4404 W. 1st St., 730 E
City of Santa Ana
20 Other Significant Terms and Conditions/Restrictions:
Description
Memory Ln., 207 S. Mountain View, 2315 N. Bristol St., 2410 N. Bristol St. or any area designated as a 100 year flood plain are excluded (FS C 505).
See Appendix
City of Santa Ana
21 DIC - $2.5M Part of $10M - Palms Insurance Company, Limited DIC - $2.5M Part of $10M
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier Palms Insurance Company, Limited
A.M. Best Rating A IX
Admitted/Non-Admitted Non-Admitted
Payment Plan Payments Terms: 30 Days from Date of Inception Payment Method Agency Bill
Premium & Exposures Proposed
Premium $169,549.00
Surplus Lines Tax $5,131.47
Stamping Office Fee $307.89
Carrier Fees - Carrier Policy Fee / Modeling Fee $1,500.00 Exposure / TIV $777,575,468
Rate 0.0218
TRIA $87,470.84
Minimum Type Minimum Earned Premium
Minimum Amount / Description 35 %
Estimated Cost $176,488.36
Standard Coverages Proposed
Limit of Liability
25.00% being $2,500,000 Per Occurrence and Annual Aggregate as respects Earth Movement and Flood Part of $10,000,000 Excess of Underlying Deductibles
Additional Coverages Proposed
Sub-limits As Per Sompo Quote Dated 4/28/2025
Deductibles/SIR Proposed
Deductible: Deductibles As Per Sompo Quote Dated 4/28/2025
Valuations Proposed
Other As Per Sompo Quote Dated 4/28/2025
Coinsurance Proposed
Coinsurance As Per Sompo Quote Dated 4/28/2025
Endorsements (including but not limited to)
California Surplus Lines Notice - CA SL Notice
Spectrum Declaration Page - Spectrum Dec 08 22
Schedule Of Forms And Endorsements - Spectrum Forms 08 22 Policy Endorsement Page - Change End Page
Spectrum Participation Follow Form Endorsement - Spectrum PFF Spectrum Service Of Suit Clause - Spectrum SOS 08 21
City of Santa Ana
22 Endorsements (including but not limited to)
Communicable Disease Endorsement - LMA5393 25Mar2020
Ofac Advisory Notice To Policyholders - IL P 001 01 04
Several Liability Notice - LSW1001INS 08//94
Spectrum Chemical, Biological, Nuclear And Radioactive Explosion, Pollution - Spectrum NCBR 08 21 Spectrum Asbestos Endorsement - Spectrum Asbestos 08 21 Spectrum Claims Reporting And Adjustment - Spectrum Claim 08 22 Property Cyber And Data Endorsement - LMA5400 11Nov2019 Spectrum Occurrence Limit Of Liability - Spectrum OLLE 08 22 U.S. Terrorism Risk Insurance Act Of 2002 As Amended - Not Purchased - LMA5390 09Jan2020 Minimum Earned Premium Endorsement - Spectrum MEP 08 22 Spectrum Assignment - Spectrum Assignment 06 22
Exclusions (including but not limited to)
All Buildings with Outstanding Damage are Excluded, Contact Underwriter if Waiver Needed Coverage Excludes all Loss or Damage Directly or Indirectly Caused by any Named Storm in Existence at Time of Written Request to Bind or Inception of any New or Additional Exposure Excluding Flood Zones A & V - or any Area Designated as a 100 Year Flood Plain are Excluded (Per Sompo) Sanction Limitation And Exclusion Clause - LMA3100 15Sept2010 War And Terrorism Exclusion Endorsement - NMA2918
Exclusion Of Certified Acts Of Terrorism - Spectrum TRIA EXCL 08 21
Binding Requirements:
Description
Subject to - requested information is received within 30 days, automatic NOC must be sent contingent upon receipt of information
D-1 (Effective January 1, 2020)
Signed TRIA Disclosure Notice(s) (required at binding)
The complete Named Insured listing (if any) is per schedule on file with the Program Manager
Other Significant Terms and Conditions/Restrictions:
Description
Total TRIA Premium Includes Additional Tax of $2,695.84 Covered Perils:
Risk of Direct Physical Loss or Damage caused by the peril(s) of Earth Movement and Flood only.
Final Binder to be reviewed prior to binding
Final wording to be reviewed prior to binding
Subject to no deterioration in loss record or terms to be reviewed This quote is subject to acceptance on both sides with No Cover Given
See Appendix
City of Santa Ana
23 DIC - $2.5M Part of $10M - Landmark American Insurance Company DIC - $2.5M Part of $10M
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier Landmark American Insurance Company
A.M. Best Rating A++ XV
Admitted/Non-Admitted Non-Admitted
Payment Plan In Full
Payment Method Agency Bill
Premium & Exposures Proposed
Premium $169,549.00
Surplus Lines Tax $5,086.47
Stamping Office Fee $305.19
Exposure / TIV $777,575,467
Rate 0.0218
TRIA
Minimum Type Minimum Earned Premium
Minimum Amount / Description 25 %
Estimated Cost $174,940.66
Standard Coverages Proposed
Property Limits $2,500,000 P/O: $10,000,000 per occurrence and annual aggregate earth movement and flood
Sub-limits: Extra Expense per occurrence $625,000 P/O: $2,500,000
Deductibles/SIR Proposed
Deductible : Flood 2.00% *, subject to a minimum of $100,000 per occurrence (Property Damage & Time Element)
Deductible : Earth Movement 5.00% *, subject to a minimum of $100,000 per occurrence (Property Damage & Time Element)
Valuations Proposed
Replacement Cost Applies
Actual Loss Business Income
Endorsements (including but not limited to)
Warranty Coverage Form
Exclusions (including but not limited to)
Asbestos Exclusion
Cyber, Electronic Data and Systems Exclusion
Exclusion - Marijuana
Exclusion of Pathogenic or Poisonous Biological or Chemical Materials
City of Santa Ana
24 Binding Requirements:
Description
D-1 (Effective January 1, 2020)
Other Significant Terms and Conditions/Restrictions:
Description
Coverages: Building, Personal Property, Rental Value, Extra Expense, Ordinance or Law - Coverage A, B & C (Combined) Perils: Earth Movement and Flood
• Excluding Terrorism
• Excluding Mechanical Breakdown
• Excluding Flood Zones A & V (501 N. Newhope St, 2501 N. Flower St., 2615 N. Valencia St., 4812 W. Camille St., 706 N.
Newhope St., 751 Memory Ln., 122 N. Newhope St., 3006 Centennial Way, 2401 N. Bristol St, 4404 W. 1st St., 730 E.
Memory Ln., 207 S. Mountain View, 2315 N. Bristol St, 2410 N. Bristol St., or any area designated as a 100 year flood plain (FS C 505))
* If the Deductible is expressed as a percentage (unless otherwise stated), the Deductible is calculated separately for and applies separately to each building that sustains loss or damage, the personal property at each building at which there is loss or damage to personal property, Personal property in the open, Business Income and Extra Expense. If there is damage to both a building and personal property in that building, separate deductibles apply to the building and to the personal property.
In the event that multiple minimum deductibles apply in any one occurrence, no more than the largest minimum deductible shall apply.
Appraisal Clause Amendment
Loss Reporting Conditions
See Appendix
City of Santa Ana
25 Excess DIC - $5M xs $10M - Mt Hawley Insurance Company, (More) Excess DIC - $5M xs $10M
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier / A.M. Best Rating / Admitted/Non-
Admitted Mt Hawley Insurance Company (A+ XIV, Non-Admitted) Lloyd's Synd 1458 (RenaissanceRe Synd) (A XV, Non-Admitted) Payment Plan In Full
Payment Method Agency Bill
Premium & Exposures Proposed
Premium $210,000.00
Surplus Lines Tax $6,315.00
Stamping Office Fee $378.90
Carrier Fees - Catastrophe Analysis Fee $500.00
Exposure / TIV $777,575,467
Rate 0.0270
Minimum Type Minimum Earned Premium
Minimum Amount / Description 35 %
Estimated Cost $217,193.90
Standard Coverages Proposed
All Coverages Combined $5,000,000 Excess of $10,000,000 per occurrence - Subject to an Annual Aggregate of for the
Perils of Earth Movement and Flood, Applied
Separately
$5,000,000
Deductibles/SIR Proposed
Deductible - Earth Movement 5.00% of the TIV Per Unit (Including Time Element if Applicable) at the Time of Loss or Damage
Deductible - Earth Movement - Subject to a Minimum of $100,000 Per Occurrence Deductible - Flood 2.00% of the TIV Per Unit (Including Time Element if Applicable) at the Time of Loss or Damage
Deductible - Flood - Subject to a Minimum of $100,000 Per Occurrence
Valuations Proposed
Replacement Cost Physical Damage
Actual Loss Sustained Time Element
Coinsurance Proposed
Coinsurance N/A for Physical Damage
Coinsurance N/A for Time Element
Endorsements (including but not limited to)
Earthquake Coverage Form (2025 Version)
Definition of Occurrence
Earth Movement Coverage Endorsement
City of Santa Ana
26 Endorsements (including but not limited to)
Flood Coverage Endorsement
Actual Cash Value (ACV) Definition
Appraisal
Cyber and Data Endorsement
Legal Action Conditions Endorsement
Service of Suit Clause (U.S.A)
Several Liability Clause
Additional Interest Notification Conditions
Fully Earned Premium for Actual Total Loss or Constructive Total Loss Business Income (and Extra Expense) Coverage Endorsement
Exclusions (including but not limited to)
Asbestos Exclusion
Communicable Disease Exclusion
Nuclear, Biological, Chemical or Radioactive Exclusion
Sanction Limitation and Exclusion Clause
Total Pollution Exclusion
Multi-Carrier Schedule:
Carrier Participating Limit
Mt Hawley Insurance Company 85%
Lloyd's Synd 1458 (RenaissanceRe Synd) 15%
Perils Covered:
Type Description
Special Form
Perils
Earth Movement; Flood - Flood excluded for locations located in Federal Zones A prefix and/or V prefix and/or any 100 year Flood Plain area.
Binding Requirements:
Description
Subject to
D-1 (Effective January 1, 2020)
Please include up-to-date additional interest information such as Additional Named Insureds, Additional Insureds, Mortgagees and Loss Payees with the bind request, if applicable.
Conditional binding subject to receipt and review of primary binder within 5 days. Any changes or discrepancies may invalidate this binder
Subject to receipt of the primary policy within 45 days of binding.
Other Significant Terms and Conditions/Restrictions:
Description
Coverages: Building; Business Personal Property; Business Income/Extra Expenses 30 Day Notice of Cancellation, Except 10 Days for Non-Payment of Premium Based on 100% Values all Coverages
Representation(s): There is no Loss or Damage from Covered Perils in the Last Five Years
See Appendix
City of Santa Ana
27 Excess DIC - $10M Excess $15M - Palomar Excess and Surplus Insurance Company, (More) Excess DIC - $10M Excess $15M
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier / A.M. Best Rating / Admitted/Non-
Admitted Palomar Excess and Surplus Insurance Company (A X, Non-Admitted) Princeton Excess & Surplus Lines Ins Co (A+ XV , Non-Admitted) Payment Plan In Full
Payment Method Agency Bill
Premium & Exposures Proposed
Premium $310,080.00
Surplus Lines Tax $9,320.40
Stamping Office Fee $559.22
- Catastrophe Analysis Fee - Fully Earned $600.00
Exposure / TIV $777,575,467
Rate 0.0399
TRIA $159,970.28
Minimum Type Minimum Earned Premium
Minimum Amount / Description 25 %
Estimated Cost $320,559.62
Standard Coverages Proposed
Palomar Excess and Surplus Insurance
Company $7,500,000
Princeton Excess & Surplus Lines Insurance
Company $2,500,000
Layer 1 - Limits Apply Per Occurrence and in
the Aggregate for the Following: Earth-
Movement
$10,000,000 (100.00%) part of $10,000,000 excess of $15,000,000
Additional Coverages Proposed
Building Ordinance Coverage A Included.
ICC/Demo: Sub-limit $10,000,000*
The following program sub-limits is covered in
the primary layer and is allowed to erode
primary aggregate:
Extra Expense, part of and not in addition to the
above business interruption limit(s) $2,500,000
Optional Coverages Proposed
$5,000,000 Part of $5,000,000 Excess of
$25,000,000
Option 1 : $90,000 (Premium) + $900 (Carrier Fee) + $2,727 (CA Surplus Lines Tax) + $163.62 (CA Stamping Fee) = $93,790.62
$10,000,000 Part of $10,000,000 Excess of
$25,000,000
Option 2 : $90,000 (Premium) + $900 (Carrier Fee) + $2,727 (CA Surplus Lines Tax) + $163.62 (CA Stamping Fee) = $93,790.62
$15,000,000 Part of $15,000,000 Excess of
$25,000,000
Option 3 : $245,000 (Premium) + $900 (Carrier Fee) + $7,377 (CA Surplus Lines Tax) + $442.62 (CA Stamping Fee) = $253,719.62
City of Santa Ana
28 Deductibles/SIR Proposed
Deductible : CA - EM - Including Time Element,
Business Income 5 % - per Unit
Deductible : - Minimum EM Deductible: $100,000
Valuations Proposed
Replacement Cost Property Damage
Actual Loss Sustained Time Element including Extra Expense
Endorsements (including but not limited to)
Company Excess Follow Form (subject to review and approval of form we are to follow) Debris Removal clause (Company Form)
Excess Limit of Liability and Participation Clause (Company Form)
Exclusions (including but not limited to)
Pollution (Company Form)
Asbestos / Contamination (Company Form)
Mold (Company Form)
Flood
EQSL
Theft
Boiler and Machinery
Communicable Disease, Virus or Bacteria
Cyber Exclusion Endorsement
Underlying Sublimited Coverages Exclusion
All Risk Perils (Including Windstorm)
Ensuing Loss
Existing Damage
War Exclusion
Nuclear/Radioactive/Biological and Chemical Exclusion
All perils except the peril of Earth Movement
Multi-Carrier Schedule:
Carrier Participating Limit
Palomar Excess and Surplus Insurance Company 75.00%
Princeton Excess & Surplus Lines Ins Co 25.00%
Binding Requirements:
Description
Subject to
D-1 (Effective January 1, 2020)
Signed Insurance Applications and Acknowledgement of State Fraud Warnings.
Notice Regarding Surplus Lines Filing Confirmation and TRIPRA Rejection Forms
City of Santa Ana
29 Other Significant Terms and Conditions/Restrictions:
Description
Total TRIA Premium includes Additional Taxes: $4,930.28 Perils: Earth Movement only Excluding Flood, Excluding Earthquake Sprinkler Leakage Property Covered: Real Property, Business Income, Business Personal Property Conditions:
Warrant All Risk Underlyer
Statement of Values form
‘(collectively for Demo and ICC, not individually)
Catastrophe Analysis Fee Breakdown
Palomar Excess and Surplus Insurance Company - Treaty 1 - $ 300.00 Princeton Excess & Surplus Lines Insurance Company - $ 300.00
See Appendix
City of Santa Ana
30 Terrorism - Lloyd's Syndicate 3623 (Beazley Furlonge Limited) Terrorism
Carrier Information Proposed
Policy Term 7/1/2025 - 7/1/2026
Carrier Lloyd's Syndicate 3623 (Beazley Furlonge Limited) A.M. Best Rating A XV
Admitted/Non-Admitted Non-Admitted
Payment Plan Full Pay
Payment Method Agency Bill
Premium & Exposures Proposed
Premium $14,460.00
Exposure / TIV Total Insured Value - $777,685,467
Minimum Type Minimum Earned Premium
Minimum Amount / Description 75%
Estimated Cost $14,460.00
Standard Coverages Proposed
Limit $10,000,000 - Each Occurrence / Claim / Aggregate Limit
Additional Coverages Proposed
Demolition and Increased Cost of Construction
Extension Sublimit: $25,000,000
EXTENSIONS OF COVERAGE - If the Policy
provides business income coverage and/or
additional coverage(s) (hereinafter, collectively
referred to as Additional Coverages), the
Company will only cover such Additional
Coverages if they are directly caused by an Act
of Terrorism. With respect to the Additional
Coverages shown in the attached policy, the
Sublimits of Insurance shown below replace and
are not in addition to the same or similar
Sublimits of Insurance shown in the Policy. If no
sublimit is shown below, then the sublimit shown
in the Policy applies.
Service Interruption $50,000,000 any one occurrence and in the aggregate for direct suppliers Service Interruption $25,000,000 any one occurrence and in the aggregate for indirect suppliers
Contingent time element $25,000,000 any one occurrence and in the aggregate for direct suppliers only. Indirect coverage excluded.
Civil and Military authority This coverage is sub
limited
$50,000,000. 5 mile distance limitation to apply outside of metropolitan regions. 1 mile distance limitation to apply in metropolitan regions Ingress / Egress - This coverage is sub limited $50,000,000. 5 mile distance limitation to apply outside of metropolitan regions. 1 mile distance limitation to apply in metropolitan regions.
Transportation $5,000,000 any one occurrence and in the aggregate (inland only)
City of Santa Ana
31 Deductibles/SIR Proposed
Deductible - PD/BI and Liability Combined $0
Deductible - Each Occurrence / Claim
Deductible: $0
Deductible - Terrorism - Each Occurrence /
Claim $0
Defense Limitations Proposed
Liability Defense expenses erode the limit
Form Type Proposed
Form Type - Terrorism Occurrence
Endorsements (including but not limited to)
California Surplus Lines Notice 1 (Post Bind) - A01861CA 012024 ed. (Re)Insurers Liability Clause - E17206 122024 ed.
Cap on Losses Arising Out of Certified Act of Terrorism - E10177 062017 ed.
Policyholder Disclosure Notice of Terrorism Insurance Coverage - E06680 082020 ed.
Premium Payment Clause - E17208 122024 ed.
Sanction Limitation Clause - E16415 012024 ed.
Service of Suit Clause (U.S.A.) - E17209 122024 ed.
Participation Clause - E17212 122024 ed.
Demolition and Increased Cost of Construction Extension - E17207 122024 ed.
Exclusions (including but not limited to)
Nuclear, Radioactive
War
Chemical or Biological
Auditable Exposures:
Description Expiring Rate Expiring Exposure Rate Exposure Total Insured Values $777,685,467
Binding Requirements:
Description
Subject to The Return of a Completed and Signed Surplus Lines Verification Form Must be Received in our Office Within Twenty (20) Days of Binding / California Surplus Lines Disclosure Statement (Pre Bind)
Other Significant Terms and Conditions/Restrictions:
Description
Subject to: No material changes; No previous incidents
Choice of Law: New York
VALUES
Deleted and replaced by USD 20,000,000 errors and omissions sublimit Significant Restrictions or Exclusions: As detailed in the attached policy wording We have determined an allocation of the premium for TRIA coverage. The allocation we have made in respect of US exposures to Acts of Terrorism, as defined under TRIA, is 80% of your current premium.
City of Santa Ana
32 City of Santa Ana
33 Terrorism - Texas Insurance Company
Premium Summary
The estimated program cost for the options are outlined in the following table:
Line of Coverage Expiring Proposed
General Star Indemnity
Company
Option 1:
General Star Indemnity
Company
Option 2:
Princeton Excess &
Surplus Lines Ins Co
Excess Liability Buffer –
$1M xs $2M SIR
Estimated Cost* $1,807,650.00 $1,702,470.00 $1,676,675.00 Response Indemnity Company
of California Response Indemnity Company of California
Excess Workers'
Compensation
Estimated Cost* $300,027.00 $327,547.00 $327,547.00
Endurance American Specialty
Ins Co Endurance American Specialty Ins Co
DIC - $5M Part of $10M Estimated Cost* $381,766.00 $349,881.32 $349,881.32 Palms Insurance Company,
Limited Palms Insurance Company, Limited
DIC - $2.5M Part of $10M Estimated Cost* $192,383.00 $176,488.36 $176,488.36 Landmark American Insurance
Company Landmark American Insurance Company
DIC - $2.5M Part of $10M Estimated Cost* $190,883.00 $174,940.66 $174,940.66
Mt Hawley Insurance Company,
Underwriters at Lloyd's London
Mt Hawley Insurance Company,
Lloyd's Synd 1458 (RenaissanceRe Synd)
Excess DIC - $5M xs
$10M
Estimated Cost* $236,901.28 $217,193.90 $217,193.90
Palomar Excess and Surplus
Insurance Company,
Princeton Excess & Surplus
Lines Ins Co
Palomar Excess and Surplus Insurance Company,
Princeton Excess & Surplus Lines Ins Co
Excess DIC - $10M
Excess $15M
Estimated Cost* $349,716.23 $320,559.62 $320,559.62
Lloyd's Syndicate 3623 (Beazley
Furlonge Limited) Lloyd's Syndicate 3623 (Beazley Furlonge Limited) Terrorism Estimated Cost* $14,651.56 $14,919.83 $14,919.83
Total Program Cost $3,473,978.07 $3,284,000.70 $3,258,205.70 % Change -5% -6%
$ Change ($189,977.37) ($215,772.37)
City of Santa Ana
34 *Estimated Cost includes all taxes, fees, surcharges and TRIA premium (if applicable) Quote from General Star Indemnity Company (Berkshire Hathaway Insurance Group) is valid until 7/1/2025
Quote from Response Indemnity Company of California is valid until 7/1/2025 Quote from Endurance American Specialty Ins Co (Sompo Japan US Group) is valid until 7/1/2025 Quote from Palms Insurance Company, Limited is valid until 6/8/2025 Quote from Landmark American Insurance Company (Allegheny Corporation) is valid until 7/1/2025 Quote from Mt Hawley Insurance Company (RLI Group), etc... is valid until 7/1/2025 Quote from Palomar Excess and Surplus Insurance Company (Palomar Insurance Corporation), etc... is valid until 7/1/2025
Quote from Lloyd's Syndicate 3623 (Beazley Furlonge Limited) (Lloyd's Syndicate 3623 (Beazley Furlonge Limited)) is valid until 6/4/2025
Quote from Princeton Excess & Surplus Lines Ins Co (Munich-American Holding Corporation) is valid until 7/1/2025
Quote from Texas Insurance Company is valid until 7/1/2025
Premiums are due and payable as billed and
may be financed, subject to acceptance by an
approved finance company. Following
acceptance, completion (and signature) of a
premium finance agreement with the specified
down payment is required. Note: Unless
prohibited by law, Gallagher may earn
compensation for this optional value-added
service.
Gallagher is responsible for the placement of
the following lines of coverage:
Excess Liability Buffer - $1M xs $2M SIR
Excess Workers' Compensation
DIC - $5M Part of $10M
DIC - $2.5M Part of $10M
DIC - $2.5M Part of $10M
Excess DIC - $5M xs $10M
Excess DIC - $10M Excess $15M
Terrorism
Other Casualty - Underground Storage
Tank Liability
It is understood that any other type of
exposure/coverage is either self-insured or
placed by another brokerage firm other than
Gallagher. If you need help in placing other
lines of coverage or covering other types of
exposures, please contact your Gallagher
representative.
This proposal of insurance features insurance policies which contain cancellation provisions to refund premium other than on a pro-rata basis for such occurrences including but not limited to non-payment of premium (short rate penalty provisions). At your request, we can detail the terms of such cancellation provisions.
City of Santa Ana
35 Location Schedule
LINE OF COVERAGE LOCATION ADDRESS
Difference in Conditions Per Schedule on File
City of Santa Ana
36 Payment Plans
Carrier / Payable Carrier Line Of Coverage Payment Schedule Payment Method
General Star Indemnity Company
(Berkshire Hathaway Insurance Group)
Excess Liability Buffer
- $1M xs $2M SIR
Full annual premium payment is due at
inception
Agency
Bill
Princeton Excess & Surplus Lines Ins
Co (Munich-American Holding
Corporation)
Excess Liability Buffer
- $1M xs $2M SIR
Premium is payable within 60 days of
binding
Agency
Bill
Response Indemnity Company of
California
Excess Workers'
Compensation In Full Agency
Bill
Endurance American Specialty Ins Co
(Sompo Japan US Group)
DIC - $5M Part of
$10M In Full Agency
Bill
Palms Insurance Company, Limited DIC - $2.5M Part of
$10M
Payments Terms: 30 Days from Date of
Inception
Agency
Bill
Landmark American Insurance
Company (Allegheny Corporation)
DIC - $2.5M Part of
$10M In Full Agency
Bill
Mt Hawley Insurance Company (RLI
Group)
Lloyd's Synd 1458 (RenaissanceRe
Synd)
Excess DIC - $5M xs
$10M In Full Agency
Bill
Palomar Excess and Surplus
Insurance Company (Palomar
Insurance Corporation)
Princeton Excess & Surplus Lines Ins
Co (Munich-American Holding
Corporation)
Excess DIC - $10M
Excess $15M In Full Agency
Bill
Lloyd's Syndicate 3623 (Beazley
Furlonge Limited) (Lloyd's Syndicate
3623 (Beazley Furlonge Limited))
Terrorism Full Pay Agency
Bill
Texas Insurance Company Terrorism Agency
Bill
City of Santa Ana
37 Coinsurance Illustration
Coinsurance Formula:
Insurance Carried ÷ Insurance Required x Loss - Deductible = Settlement
Example of Coinsurance formula applied to a hypothetical loss situation:
Property Value = $1,000,000
Coinsurance Amount = 80%
Deductible = $500
Insurance Required = $800,000 (80% of $1,000,000)
Insurance Carried = $400,000
Loss Incurred = $200,000
Settlement determined by applying the coinsurance formula:
$400,000
(Insurance Carried)
x $200,000 (Loss) - $500 (Deductible) = $99,500 Settlement $800,000
(Insurance Required)
Note: If the property in the above example is insured for the full insurance required ($800,000), the insured will recover $199,500. In the above example, the insured will suffer a $100,000 penalty for not being insured to the proper limit.
City of Santa Ana
38 Proposal Disclosures
Proposal Disclosures
City of Santa Ana
39 Proposal Disclosures
The following disclosures are hereby made a part of this proposal. Please review these disclosures prior to signing the Client Authorization to Bind or e-mail confirmation.
Proposal Disclaimer
IMPORTANT: The proposal and/or any executive summaries outline certain terms and conditions of the insurance proposed by the insurers, based on the information provided by your company. The insurance policies themselves must be read to fully understand the terms, coverages, exclusions, limitations and/or conditions of the actual policy contract of insurance. Policy forms will be made available upon request. We make no warranties with respect to policy limits or coverage considerations of the carrier.
Compensation Disclosure
1. Gallagher Companies are primarily compensated from the usual and customary commissions, fees or, where permitted, a combination of both, for brokerage and servicing of insurance policies, annuity contracts, guarantee contracts and surety bonds (collectively “insurance coverages”) handled for a client’s account, which may vary based on market conditions and the insurance product placed for the client.
2. In placing, renewing, consulting on or servicing your insurance coverages, Gallagher companies may participate in contingent and supplemental commission arrangements with intermediaries and insurance companies that provide for additional compensation if certain underwriting, profitability, volume or retention goals are achieved. Such goals are typically based on the total amount of certain insurance coverages placed by Gallagher with the insurance company, not on an individual policy basis. As a result, Gallagher may be considered to have an incentive to place your insurance coverages with a particular insurance company. If you do not wish to have your commercial insurance placement included in consideration for additional compensation, contact your producer or service team for an Opt-out form.
3. Gallagher Companies may receive investment income on fiduciary funds temporarily held by them, or from obtaining or generating premium finance quotes, unless prohibited by law.
4. Gallagher Companies may also access or have an ownership interest in other facilities, including wholesalers, reinsurance intermediaries, captive managers, underwriting managers and others that act as intermediaries for both Gallagher and other brokers in the insurance marketplace some of which may earn and retain customary brokerage commission and fees for their work.
If you have specific questions about any compensation received by Gallagher and its affiliates in relation to your insurance placements, please contact your Gallagher representative for more details.
TRIA/TRIPRA Disclaimer
If this proposal contains options to purchase TRIA/TRIPRA coverage, the proposed TRIA/TRIPRA program may not cover all terrorism losses.
While the amendments to TRIA eliminated the distinction between foreign and domestic acts of terrorism, a number of lines of coverage excluded under the amendments passed in 2005 remain excluded includi ng commercial automobile, burglary and theft insurance; surety insurance, farm owners multiple perils and professional liability (although directors and officers liability is specifically included). If such excluded coverages are required, we recommend that you consider purchasing a separate terrorism policy. Please note that a separate terrorism policy for these excluded coverages may be necessary to satisfy loan covenants or other contractual obligations. TRIPRA includes a $100 billion cap on insurers' aggregate liability.
TRIPRA is set to expire on December 31, 2027. There is no certainty of extension, thus the coverage provided by your insurers may or may not extend beyond December 31, 2027. In the event you have loan covenant s or other contractual obligations requiring that TRIA/TRIPRA be maintained throughout the duration of your policy period, we recommend that a separate ""Stand Alone"" terrorism policy be purc hased to satisfy those obligations.
City of Santa Ana
40 Property Estimator Disclaimer
These property values were obtained using a desktop Property Estimator software operated by non-appraisal professionals. These property values represent general estimates which are not to be considered a certified appraisal. These property values include generalities and assumptions that may produce inaccurate values for specific structures.
Terms and Conditions
It is important that we clearly outline the nature of our mutual relationship. The following terms and conditions (these “Terms”) govern your relationship with Gallagher unless you have separately entered into a written services agreement with Gallagher relative to the policies and services outlined in this Proposal, in which case that services agreement will govern and control with respect to any conflicts with these Terms.
These Terms will become effective upon your execution of the Client Authorization to Bind Coverage (the “CAB”) included in this Proposal and shall survive for the duration of your relationship with Gallagher relative to the policies placed pursuant to the CAB or otherwise at your request.
Services
Gallagher will represent and assist you in all discussions and transactions with insurance companies relating to the lines of insurance coverage set forth in the CAB and any other lines of insurance coverage with which you request Gallagher’s assistance. Gallagher will consult with you regarding any matters involving these or other coverages for which you have engaged Gallagher. You have the sole discretion for approving any insurance policies placed, as well as all other material decisions involving your risk management, risk transfer and/or loss prevention needs.
Although you are responsible for notifying applicable insurance companies directly in connection with any claims, demands, suits, notices of potential claims or any other matters as required by the terms and conditions of your policies, Gallagher will assist you in determining applicable claim reporting requirements.
Treatment of Information
Gallagher understands the need to protect the confidentiality and security of your confidential and sensitive information and strives to comply with applicable data privacy and security laws. Your confidential and sensitive information will be protected by Gallagher and only used to perform services for you; provided that Gallagher may disclose and transfer your information to our affiliates, agents or vendors that have a need to know such information in connection with the provision of such services (including insurance markets, as necessary, for marketing, quoting, placing and/or servicing insurance coverages). We may also disclose such information as required by applicable data protection laws or the order of any court or tribunal, subject to our providing you with prior notice as permitted by law.
We will (i) implement appropriate administrative, physical and technical safeguards to protect personal information; (ii) timely report security incidents involving personal information to affected parties and/or regulatory bodies; (iii) create and maintain required policies and procedures; and (iv) comply with data subjects’ rights, as applicable. To the extent applicable under associated data protection laws, you are a “business” or “controller” and Gallagher is a “service provider” or “data processor.” You will ensure that any information provided to Gallagher has been provided with any required notices and that you have obtained all required consents, if any and where required, or are otherwise authorized to transfer all information to Gallagher and enable Gallagher to process the information for the purposes described in this Propos al and as set forth
in Gallaher’s Privacy Policy located at https://www.ajg.com/privacy-policy/. Gallagher may update its Privacy Policy from time to time and any updates will be posted to such site.
Dispute Resolution
Gallagher does not expect that it will ever have a formal dispute with any of its clients. However, in the event that one should arise, we should each strive to achieve a fair, expedient and efficient resolution and we’d like to clearly outline the resolution process.
A. If the parties have a dispute regarding Gallagher’s services or the relationship governed by this Proposal (“Dispute”), each party agrees to resolve that Dispute by mediation. If mediation fails to resolve the Dispute, you and Gallagher agree to binding arbitration. Each party waives all rights to commence litigation in court to resolve a Dispute, and specifically waives all rights to pursue relief by class action or mass action in court or through arbitration. However, the parties do not waive the ability to seek a court order of injunction in aid of the mediation and arbitration required by these Terms.
B. The party asserting a Dispute must provide a written notice (“Notice”) of the claim to the other party and to the American Arbitration Association (“AAA”) in accordance with its Commercial Arbitration Rules and Mediation Procedures. All Dispute resolutions will take place in Chicago, IL, unless you and Gallagher agree to another location. The parties will equally divide all costs of the mediation and arbitration proceedings and will each pay their own attorneys’ fees. All matters will be before a neutral, impartial and disinterested mediator or arbitrator(s) that have at least 20 years’ experience in commercial and insurance coverage disputes.
C. Mediation will occur within sixty (60) days of filing the Notice with the AAA. Mediation results will be reduced to a memorandum of understanding signed by you, Gallagher and the mediator. A Dispute that is not resolved in mediation will commence to binding arbitration. For Disputes in excess of $500,000, either party may elect to have the Dispute heard by a panel of three (3) arbitrators. The award of the arbitrator(s) must be accompanied by a reasoned opinion prepared and signed by the arbitrator(s). Except as may be required by law, neither
City of Santa Ana
41 you, Gallagher, nor a mediator or arbitrator may disclose the existence, content or results of any Dispute or its dispute resolution proceeding without the prior written consent of both you and Gallagher.
Electronic Delivery
In lieu of receiving documents in paper format, you agree, to the fullest extent permitted by law, to accept electronic delivery of any documents that Gallagher may be required to deliver to you (including, but not limited to, insurance policies and endorsements, account s tatements and all other agreements, forms and communications) in connection with services provided by Gallagher. Electronic delivery of a document to you may be made via electronic mail or by other electronic means, including posting documents to a secure website.
Miscellaneous Terms
Gallagher is engaged to perform services as an independent contractor and not as your employee or agent, and Gallagher will not be operating in a fiduciary capacity.
Where applicable, insurance coverage placements and other services may require the payment of federal excise taxes, surplus lines taxes, stamping or other fees to the Internal Revenue Service, various State(s) departments of revenue, state regulators, boards or associations. In such cases, you will be responsible for the payment of the taxes and/or fees, which Gallagher will separately identify on related invoices.
The Proposal and these Terms are governed by the laws of the State of Illinois, without regard to its conflict of law rules.
If an arbitrator/court of competent jurisdiction determines that any provision of these Terms is void or unenforceable, that provision will be severed, and the arbitrator/court will replace it with a valid and enforceable provision that most closely approximates the original intent, and the remainder of these Terms will remain in effect.
Except to the extent in conflict with a services agreement that you may enter into with Gallagher, these Terms and the remainde r of the Proposal constitute the entire agreement between you and Gallagher with respect to the subject matter of the Proposal, and supersede all prior negotiations, agreements and understandings as to such matters.
City of Santa Ana
42 Client Signature Requirements
Client Signature Requirements
Surplus Lines Notice - California
IMPORTANT NOTICE:
1. The insurance policy that you are applying to purchase is being issued by an insurer that is not licensed by the State of California. These companies are called “nonadmitted” or “surplus line” insurers.
2. The insurer is not subject to th e financial solven cy regulation and enforcement that apply to California licensed insurers.
3. The insurer does not participate in any of the insurance guarantee funds created by California law. Th erefore, these funds will not pay your claims or protect your assets if the insurer becomes insolvent and is unable to make payments as promised.
4. The insurer should be licensed eith er as a foreign insurer in another state in the United States or as a no n-United States (alien) insurer. You should ask questions of yo ur insurance agent, brok er, or “surplus line” broker or contact the California Depart ment of Insurance at the toll-free number 1-800-927-4357 or internet website www.insurance.ca.gov. Ask whether or not the insurer is licensed as a foreign or non-United States (alien) insurer and for additional in formation about the insurer. You may also visit the NAIC’s internet we bsite at www.naic.org. The NAIC—the National Association of Insuran ce Commissioners—is the regulatory support organization created and governed by the chief insurance regulators in the United States.
5. Foreign insurers should be licensed by a state in the United States and you may contact that state’s departme nt of insurance to obtain more information about that insurer. You can find a link to each state from this NAIC internet website: https://naic.org/state_web_map.htm.
6. For non-United States (alien) insure rs, the insurer should be licensed by a country outside of th e United States and shou ld be on the NAIC’s International Insurers De partment (IID) listing of approved nonadmitted non-United States insurers. Ask your agent, broker, or “surplus line” broker to obtain more information about that insurer.
7. California maintains a “List of A pproved Surplus Line Insurers (LASLI).” Ask your agent or broker if the insurer is on that list, or view that list at the internet webs ite of the California Department of Insurance:
www.insurance.ca.gov/01-consumers/120-company/07lasli/lasli.cfm.
8. If you, as the applicant, required that the insurance policy you have purchased be effective immediately, either because existing coverage was going to lapse within two business days or because you were required to have coverage within two business days, and you did not receive this disclosure form and a request for your signature until after coverage became effective, you have the right to cancel this policy within five days of receiving this disclosure. If you cancel coverage, the premium will be prorated and any broker’s fee charged for this insurance will be returned to you.
Date:
Insured:
D-1 (Effective January 1, 2020)
City of Santa Ana
45 Client Authorization to Bind Coverage
After careful consideration of Gallagher's proposal dated 6/1/2025, we accept the following coverage(s). Please check the desired coverage(s) and note any coverage amendments below:
Coverage/Carrier Description/Major Differences
☐ Accept ☐ Reject Excess Liability Buffer - $1M xs $2M SIR ☐ Option # 1 General Star Indemnity Company
☐ Option # 2 Princeton Excess & Surplus Lines Ins Co
☐ Accept ☐ Reject TRIA - Excess Liability Buffer - $1M xs $2M SIR
☐ Accept ☐ Reject Excess Workers' Compensation
☐ Option # 1 Response Indemnity Company of California $500K xs $1,500,000 SIR – Premium:
$327,547
☐ Option # 2 Response Indemnity Company of California $750K xs $1,250,000 SIR - Premium:
$475,721
☐ Option # 3 Response Indemnity Company of Californi $1M xs $1M SIR - Premium: $735,719 Included* TRIA - Excess Workers' Compensation
☐ Accept ☐ Reject DIC - $5M Part of $10M
Endurance American Specialty Ins Co
☐ Accept ☐ Reject DIC - $2.5M Part of $10M
Palms Insurance Company, Limited
☐ Accept ☐ Reject DIC - $2.5M Part of $10M
Landmark American Insurance Company
☐ Accept ☐ Reject Excess DIC - $5M xs $10M
Mt Hawley Insurance Company, Lloyd's Synd
1458 (RenaissanceRe Synd)
☐ Accept ☐ Reject TRIA - Excess DIC - $5M xs $10M
☐ Accept ☐ Reject Excess DIC - $10M Excess $15M
Palomar Excess and Surplus Insurance
Company, Princeton Excess & Surplus Lines Ins
Co
☐ Accept ☐ Reject Excess DIC - $5M Excess $25M
An additional $5M in limits for an additional
$92,862.00 in premium
Palomar Excess and Surplus Insurance
Company, Princeton Excess & Surplus Lines Ins
Co
City of Santa Ana
46 Coverage/Carrier Description/Major Differences
☐ Accept ☐ Reject Excess DIC - $10M Excess $25M
An additional $10M in limits for an additional
$170,247.00 in premium
Palomar Excess and Surplus Insurance
Company, Princeton Excess & Surplus Lines Ins
Co
☐ Accept ☐ Reject Excess DIC - $15M Excess $25M
An additional $15M in limits for an additional
$252,791.00 in premium
Palomar Excess and Surplus Insurance
Company, Princeton Excess & Surplus Lines Ins
Co
☐ Accept ☐ Reject Terrorism
☐ Option # 1 Lloyd's Syndicate 3623 (Beazley Furlonge
Limited)
☐ Option # 2 Texas Insurance Company
☐ Accept ☐ Reject TRIA - Terrorism
*For this coverage, TRIA cannot be rejected
Additional Recommended Coverages
Gallagher recommends that you purchase the following additional coverages for which you have exposure. By checking the box(es) below, you are requesting that Gallagher provide you with a Proposal for this coverage. By not requesting a Proposal for this coverage, you assume the risk of any uncovered loss.
The above coverage(s) does not necessarily represent the entirety of available insurance products. If you are interested in pursuing additional coverages other than those listed in the Additional Recommended Coverages, please list below:
Coverage Amendments and Notes:
Exposures and Values
You confirm the payroll, values, schedules, and any other information pertaining to your operations, and submitted to the underwriters, were compiled from information provided by you. If no updates were provided to Gallagher, the values, exposures and operations used were based on the expiring policies. You acknowledge it is your responsibility to notify Gallagher of any material change in your operations or exposures.
Additional Terms and Disclosures
Gallagher is not an expert in all aspects of your business. Gallagher’s Proposals for insurance are based upon the information concerning your business that was provided to Gallagher by you. Gallagher expects the information you provide is true, correct
City of Santa Ana
47 and complete in all material respects. Gallagher assumes no responsibility to independently investigate the risks that may be facing your business, but rather have relied upon the information you provide to Gallagher in making our insurance Proposals.
Gallagher's liability to you arising from any of Gallagher’s acts or omissions will not exceed $20 million in the aggregate. The parties each will only be liable for actual damages incurred by the other party, and will not be liable for any indirect, special, exemplary, consequential, reliance or punitive damages. No claim or cause of action, regardless of form (tort, contract, statutory, or otherwise), arising out of, relating to or in any way connected with the Proposal, any of Gallagher’s services or your relationship with Gallagher may be brought by either party any later than two (2) years after the accrual of the claim or cause of action.
Gallagher has established security controls to protect Client confidential information from unauthorized use or disclosure. For additional information, please review Gallagher’s Privacy Policy located at https://www.ajg.com/privacy-policy/.
You hav
e read, understand and agree that the information contained in the Proposal and all documents attached to and incorporated into the Proposal, is correct and has been disclosed to you prior to authorizing Gallagher to bind coverage and/or provide services to you. By signing below, or authorizing Gallagher to bind your insurance coverage through email when allowed, you acknowledge you have reviewed and agree with terms, conditions and disclosures contained in the Proposal.
By: _______________________________________________________________________ Print Name (Specify Title)
___
____________________________________________________________________ Company
___
____________________________________________________________________ Signature
Date: _______
________________________________________________________________
POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM
INSURANCE COVERAGE
You are hereby notified that under the Terrorism Risk Insurance Act of 2002, as amended ("TRIA"), that you now have a right to purchase insurance coverage for losses arising out of acts of terrorism, as defined in Section 102(1) of the Act, as amended: The term “act of terrorism” means any act that is 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 an air carrier or vessel 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. Any coverage you purchase for "acts of terrorism" shall expire at 12:00 midnight December 31, 2027, the date on which the TRIA Program is scheduled to terminate, or the expiry date of the policy whichever occurs first, and shall not cover any losses or events
which arise after the earlier of these dates.
YOU SHOULD KNOW THAT COVERAGE PROVIDED BY THIS POLICY FOR LOSSES CAUSED BY CERTIFIED ACTS OF TERRORISM IS PARTIALLY REIMBURSED BY THE UNITED STATES 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 THIS FORMULA, THE UNITED STATES PAYS 80% OF COVERED TERRORISM LOSSES EXCEEDING THE STATUTORILY ESTABLISHED DEDUCTIBLE PAID BY THE INSURER(S) PROVIDING THE COVERAGE. YOU SHOULD ALSO KNOW THAT THE TERRORISM RISK INSURANCE ACT, AS AMENDED, CONTAINS A USD100 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 USD100 BILLION. IF THE AGGREGATE INSURED LOSSES FOR ALL INSURERS EXCEED USD100 BILLION, YOUR COVERAGE MAY BE REDUCED.
THE PREMIUM CHARGED FOR THIS COVERAGE IS PROVIDED BELOW AND DOES NOT INCLUDE ANY CHARGES FOR THE PORTION OF LOSS COVERED BY THE FEDERAL GOVERNMENT UNDER THE ACT.
I hereby elect to purchase coverage for acts of terrorism for a prospective premium of USD $84,774.50
I hereby elect to have coverage for acts of terrorism excluded from my policy. I understand that I will have no coverage for losses arising from acts of terrorism.
Policyholder/Applicant's Signature Syndicate on behalf of Palms Insurance Company, Limited Print Name Policy Number
Date
LMA9184
09 January 2020
X
SIL PN 011 (01 20) SN Page 1 of 1Includes copyrighted material of the National Association of Insurance Commissioners, with its permission.
POLICYHOLDER DISCLOSURE
NOTICE OF TERRORISM INSURANCE COVERAGE
Named Insured: City of Santa Ana Offer Date: April 28, 2025 Policy Number: Effective Date: July 01, 2025
Insurance
Company:
Endurance American Specialty Insurance Company
You are hereby notified that under the Terrorism Risk Insurance Act, as amended, 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.
DISCLOSURE OF FEDERAL PARTICIPATION:
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 EXCLUSION FOR NUCLEAR EVENTS. UNDER THE FORMULA, THE UNITED STATES GOVERNMENT GENERALLY REIMBURSES 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.
DISCLOSURE OF CAP ON LOSSES:
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:
Your signature and the return of this notice are required prior to binding related commercial insurance coverage. Premium is based on exposures at policy inception and may change if exposures change during the policy term.
I hereby elect to purchase certified acts of terrorism
coverage for the prospective premium of:
$33,910
I hereby decline to purchase terrorism coverage for certified acts of terrorism. I understand that I will have no
coverage for losses resulting from certified acts of terrorism.
Insured: Title: Date:
This Notice does not form a part of your insurance contract. If there is any conflict between this Notice and the policy (including its endorsements), the provisions of the policy (including its endorsements) apply.
X
City of Santa Ana
48 Appendix
Appendix
City of Santa Ana
49 Compensation Disclosure Schedule
Client Name: City of Santa Ana
Coverage Carrier Name(s)
Wholesaler, MGA, or
Intermediary Name1
Est. Annual
Premium2
Gallagher U.S. Owned
Wholesaler, MGA, or
Intermediary % and/or Fee
%
Excess Liability Buffer
- $1M xs $2M SIR
General Star Indemnity Company (Berkshire Hathaway
Insurance Group) Apex Insurance Agency, Inc. $1,650,000.00 Excess Liability Buffer
- $1M xs $2M SIR
Princeton Excess & Surplus Lines Ins Co (Munich-American Holding Corporation) Apex Insurance Agency, Inc. $1,625,000.00 Excess Workers'
Compensation Response Indemnity Company of California Aquitaine Underwriters LLC $327,547.00 DIC - $5M Part of
$10M
Endurance American Specialty Ins Co (Sompo Japan US
Group) CRC Wholesale Group $339,098.00
DIC - $2.5M Part of
$10M Palms Insurance Company, Limited CRC Wholesale Group $169,549.00 DIC - $2.5M Part of
$10M
Landmark American Insurance Company (Allegheny
Corporation) CRC Wholesale Group $169,549.00
Excess DIC - $5M xs
$10M
Mt Hawley Insurance Company (RLI Group)
Lloyd's Synd 1458 (RenaissanceRe Synd)
CRC Wholesale Group $210,000.00
Excess DIC - $10M
Excess $15M
Palomar Excess and Surplus Insurance Company (Palomar
Insurance Corporation)
Princeton Excess & Surplus Lines Ins Co (Munich-American Holding Corporation)
CRC Wholesale Group $310,080.00
Terrorism Lloyd's Syndicate 3623 (Beazley Furlonge Limited) (Lloyd's Syndicate 3623 (Beazley Furlonge Limited))
Arthur J Gallagher - Baton
Rouge #338 $14,460.00 5 %
City of Santa Ana
50 Coverage Carrier Name(s)
Wholesaler, MGA, or
Intermediary Name1
Est. Annual
Premium2
Gallagher U.S. Owned
Wholesaler, MGA, or
Intermediary % and/or Fee
%
Terrorism Texas Insurance Company Arthur J Gallagher - Baton Rouge $15,000.00 5 %
1 We were able to obtain more advantageous terms and conditions for you through an intermediary/ wholesaler. 2 If the premium is shown as an indication: The premium indicated is an estimate provided by the market. The actual premium and acceptance of the coverage requested will be determined by the market after a thorough review of the completed application. * A verbal quotation was received from this carrier. We are awaiting a quotation in writing.
Note: When placing business with insurance companies, Gallagher Companies receive commission based on negotiated contractual terms with those carriers. The commission rate is a percentage of the premium excluding taxes and fees. Major lines of coverage, and their typical range of commissions are listed below. If you wish to receive more details on actual compensation paid to Gallagher Companies, please contact your Gallagher representative. Accident & Health: 15-25% Casualty: 14-15% Package / Business Owners Package: 15-16.8% Aviation: 14-15% Commercial Auto: 12.5-15% Executive and Professional Liability: 12-16.5% All Other Commercial: 10-20% Inland Marine: 20-22.5% Property: 15-22% Bonds/Surety: 30-35% Ocean Marine: 15-17.5% Workers Compensation: 8-11% Builders Risk: 15-18%
Compensation to Gallagher may also be disclosed in a Client Services Agreement or Consulting Services Agreement.
City of Santa Ana
51 Binding Requirements
Coverage (Issuing Carrier) Binding Requirements
Excess Liability Buffer - $1M xs
$2M SIR
General Star Indemnity Company
Subject To:
D-1 (Effective January 1, 2020)
Signed TRIA Form.
Confirmation of Binding Coverage must be signed at Binding Copy of signed E&S due diligence affidavit from retail agent must accompany any request to bind coverage.
Excess Liability Buffer - $1M xs
$2M SIR
Princeton Excess & Surplus Lines
Ins Co
Subject To:
D-1 (Effective January 1, 2020)
Signed TRIA Form
Prior to binding, the Insurer requires a completed, signed, and dated UM/UIM acceptance/rejection form.
Confirmation of Binding Coverage must be signed at Binding Excess Workers' Compensation
Response Indemnity Company of
California
N/A
DIC - $5M Part of $10M
Endurance American Specialty Ins
Co
Signed Terrorism Disclosure Form prior to binding
D-1 (Effective January 1, 2020)
DIC - $2.5M Part of $10M
Palms Insurance Company, Limited
Subject to - requested information is received within 30 days, automatic NOC must be sent contingent upon receipt of information
D-1 (Effective January 1, 2020)
Signed TRIA Disclosure Notice(s) (required at binding)
The complete Named Insured listing (if any) is per schedule on file with the Program Manager
DIC - $2.5M Part of $10M
Landmark American Insurance
Company
D-1 (Effective January 1, 2020)
Excess DIC - $5M xs $10M
Mt Hawley Insurance Company
Lloyd's Synd 1458 (RenaissanceRe
Synd)
Subject to
D-1 (Effective January 1, 2020)
Please include up-to-date additional interest information such as Additional Named Insureds, Additional Insureds, Mortgagees and Loss Payees with the bind request, if applicable.
Conditional binding subject to receipt and review of primary binder within 5 days. Any changes or discrepancies may invalidate this binder
Subject to receipt of the primary policy within 45 days of binding.
Excess DIC - $10M Excess $15M
Palomar Excess and Surplus
Insurance Company
Princeton Excess & Surplus Lines
Ins Co
Subject to
D-1 (Effective January 1, 2020)
Signed Insurance Applications and Acknowledgement of State Fraud Warnings.
Notice Regarding Surplus Lines Filing Confirmation and TRIPRA Rejection Forms
City of Santa Ana
52 Coverage (Issuing Carrier) Binding Requirements
Terrorism
Lloyd's Syndicate 3623 (Beazley
Furlonge Limited)
Subject to The Return of a Completed and Signed Surplus Lines Verification Form Must be Received in our Office Within Twenty (20) Days of Binding / California Surplus Lines Disclosure Statement (Pre Bind)
Terrorism
Texas Insurance Company
Subject to :
- The return of a completed and signed Surplus Lines Verification Form must be received in our office within twenty (20) days of binding
City of Santa Ana
53 Claims Reporting By Policy
Immediately report all claims. Each insurer requires notice of certain types of claims depending on the potential exposure or particular injury types. It is important to thoroughly review your policy to ensure you are reporting particular incidents and claims, based upon the insurer's policy requirements.
If you are using a third party administrator ("TPA"), your TPA may or may not report claims to an insurer on your behalf.
Although we will assist you where requested, it is important that you understand whether your TPA will be completing this notification.
Reporting Direct to Carrier [Only When Applicable]
Coverage(s): DIC - $5M Part of $10M Report To:
Insurer: Endurance American Specialty Ins Co
Policy period: 7/1/2025 to 7/1/2026 Insurer/TPA Name: Endurance American Specialty Ins Co Email: [email protected]
Coverage(s): DIC - $2.5M Part of $10M Report To:
Insurer: Palms Insurance Company, Limited
Policy period: 7/1/2025 to 7/1/2026 Insurer/TPA Name: Palms Insurance Company, Limited Phone:
Email:
Web:
Coverage(s): DIC - $2.5M Part of $10M Report To:
Insurer: Landmark American Insurance Company
Policy period: 7/1/2025 to 7/1/2026
Insurer/TPA Name: Landmark American Insurance
Company
Phone: 404-231-2366
Email: [email protected]
Web: https://www.rsui.com/Pages/Claims.aspx
Coverage(s): Excess DIC - $5M xs $10M Report To:
Insurer: Mt Hawley Insurance Company
Policy period: 7/1/2025 to 7/1/2026 Insurer/TPA Name: Mt Hawley Insurance Company Phone: 800-444-0406
Email: [email protected]
Web: https://www.rlicorp.com/how-report-claim
Coverage(s): Excess DIC - $5M xs $10M Report To:
Insurer: Lloyd's Synd 1458
Policy period : 7/1/2025 to 7/1/2026 Insurer/TPA Name: Lloyd's Synd 1458 Phone:
Email:
Web:
City of Santa Ana
54 Coverage(s): Excess Liability Buffer - $1M xs $2M SIR Report To:
Insurer: General Star Indemnity Insu rer/TPA Name: General Star Indemnity Policy period: 7/01/2025 - 7/01/2026 Phone: 203-628-5700 / 312-526-7574 Email: [email protected]
Web: https://www.generalstar.com/claims/report-a-
claim.html
Coverage(s): Excess Liability Buffer - $1M xs $2M SIR Report To:
Insurer: The Princeton Excess and Surplus Lines
Insurance Company
Insurer/TPA Name: The Princeton Excess and Surplus
Lines Insurance Company
Policy period: 7/01/2025 - 7/01/2026 Phone: 1-866-311-9636 Email: [email protected]
Web:
Coverage(s): Excess DIC - $10M Excess $15M Report To:
Insurer: Palomar Excess and Surplus Insurance Company
Policy period: 7/1/2025 to 7/1/2026
Insurer/TPA Name: Palomar Excess and Surplus
Insurance Company
Phone:
Email:
Web:
Coverage(s): Excess DIC - $10M Excess $15M Report To:
Insurer: Princeton Excess & Surplus Lines Ins Co
Policy period: 7/1/2025 to 7/1/2026
Insurer/TPA Name: Princeton Excess & Surplus Lines Ins
Co
Phone: 1-888-729-2242/ 1-866-220-3505
Email:
Web: http://www.peslic.com/en.html
Coverage(s): Excess Workers Compensation Report To:
Insurer: RESPONSE INDEMNITY COMPANY OF
CALIFORNIA
Policy period: 7/1/2025 to 7/1/2026
Insurer/TPA Name: RESPONSE INDEMNITY COMPANY
OF CALIFORNIA
Phone:
Email:
Web:
Coverage(s): Terrorism Report To:
Insurer: Texas Insurance Company In surer/TPA Name: Texas Insurance Company Policy period: 7/1/2025 to 7/1/2026 Phone: 1-855-497-0578 Email: [email protected]
Web:
City of Santa Ana
55 Coverage(s): Terrorism Report To:
Insurer: Underwriters Lloyds at London Insu rer/TPA Name: Underwriters Lloyds at London Policy period: 7/1/2025 to 7/1/2026 Phone: 1-855-497-0578 Email: [email protected]
Web:
Reporting to Gallagher or Assistance in Reporting
Coverage(s): Report To:
Gallagher Claim Center Phone: 855-497-0578
Fax: 225-663-3224
Email: [email protected]
City of Santa Ana
56 Gallagher STEP Flyer
City of Santa Ana
57