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Home My WebLink About#5172 Risk Management Agreement & Enrollment RESOLUTION NO. 5172 A RESOLUTION APPROVING AN AGREEMENT AND ENROLLMENT BETWEEN THE CITY OF CANTON AND THE ILLINOIS PUBLIC RISK FUND FOR THE GROUP WORKERS COMPENSATION PLAN AND DIRECTING THE MAYOR AND THE CITY CLERK TO EXECUTE AND DELIVER SAID AGREEMENT ON BEHALF OF THE CITY OF CANTON ILLINOIS. WHEREAS, the City Council of the City of Canton, has determined that it is necessary and in the best interest to enter into an agreement with the Illinois Public Risk Fund for the City of Canton workers compensation insurance carrier. NOW, THEREFORE, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF CANTON, FULTON COUNTY, ILLINOIS, AS FOLLOWS: 1. That the agreement attached hereto and incorporated herein as Exhibit A was hereby approved by the Canton City Council. 2. That the Mayor and the City Clerk of Canton, Illinois, are hereby authorized and directed to execute and deliver said agreement on behalf of the City of Canton. 3. That this Resolution shall be in full force and effect immediately upon its passage by the City Council of the City of Canton, Fulton County, Illinois, and approval by the Mayor thereof. PASSED by the City Council of the City of Canton, Illinois, at a regular meeting this 20th day of November, 2018, upon a roll call vote as follows: AYES: Aldermen Ryan Mayhew, Justin Nelson, John Lovell, Craig West, Angela Hale, Tad Purich, Angela Lingenfelter, Quin Mayhew NAYS: None ABSENT: None AP'ROVED: )e-0, nt A. McDowell, Ma r ATTES f opA Diana 'ley, City C erk LPRF Illinois Public Risk Fund Workers' Compensation Information Page Policy Number: P1444-2018-02 Named Insured and Mailing Address: City of Canton 2 N.Main Street Canton, IL 61520 The policy period is from: 12/01/2018 to 12/01/2019 12:01 a.m. Standard Time of the Insured's mailing address Coverage: Part One of the policy applies to the Workers Compensation Law of the State of Illinois. Part Two of the policy applies to Employers Liability in the State of Illinois: The limits of our Liability under Part Two are: Bodily Injury by Accident $3,000,000 each accident Bodily Injury by Disease $3,000,000 policy limit Bodily Injury by Disease $3,000,000 each employee This Policy includes these endorsements and schedules: See listing of endorsements—Extension of Information Page Broker Name and Address: Kiesewetter Insurance Agency 115 E.Fort Street PO Box 239 Farmington,IL 61531 Total Estimated Premium: $274,338.00 Administrative Fee: $8,230.00 Total Estimated Cost: $282,568.00 Cancellation: In the event that the Policy is Cancelled prior to the expiration date,then the total annual premium stated on page 2 will be 100%fully earned Terms and Conditions: The premium for this policy will be determined by our rules, classifications, rates and rating plans. All required information is subject to verification and change by audit at policy expiration. As per Safety National Casualty Corp. Excess policy, and Illinois Public Risk Fund's By-Laws and Pooling Agreement. Page 1 of 4 LPIE EXTENSION OF INFORMATION PAGE ENDORSEMENT SCHEDULE IPRF WC 00 001 18 Broad Form All States for Employee Travel IPRF WC 00 00218 Federal Employers' Liability Act Coverage IPRF WC 00 003 18 Foreign Voluntary Workers'Compensation and Employers' Liability For Traveling Employees IPRF WC 00 004 18 Longshoremen's and Harbor Workers' Compensation Act Coverage IPRF WC 00 005 18 Maritime Coverage IPRF WC 00 006 18 Voluntary Compensation Page 2 of 4 ORF ILLINOIS PUBLIC RISK FUND Cost Control Through Cooperation Since 1985 1444 City of Canton 2 N.Main Street Canton,IL 61520 The premium for this policy will be determined by Illinois Public Risk Fund rules,classifications,rates and rating plans. All information required is subject to verification and change by Audit. Class Code Description Payroll Rate/100 Premium 0170 Animal Control $ 53,686 $ 3.552 $ 1,907 5506 Street Maintenance $ 297,382 $ 8.732 $ 25,967 7520 Waterworks $ 722,640 $ 3.448 $ 24,913 7580 Sewage Disposal $ 487,817 $ 2.876 $ 14,028 7610 Radio/TV Broadcasting $ 288,660 $ 0.701 $ 2,023 7710 Firefighters $ 1,163,253 $ 9.618 $ 111,878 7720 Policeman $ 1,519,188 $ 2.449 $ 37,201 8380 Auto Repair $ 46,410 $ 3.673 $ 1,705 8810 Clerical $ 467,718 $ 0.137 $ 641 8820 Attorney $ 86,700 $ 0.121 $ 105 9015 Building NOC $ 69,360 $ 2.868 $ 1,989 9102 Parks NOC $ 3,366 $ 3.359 $ 113 9220 Cemetery $ 86,274 $ 5.904 $ 5,093 9402 Street Cleaning $ 445,322 $ 5.236 $ 23,316 9403 Garbage $ 237,164 $ 9.892 $ 23,459 Subtotal: $ 274,338 3%Administrative Fee: $ 8,230 TOTAL: $ 282,568 Selected payment plan: 12 Equal Monthly Installments Prepared on: Fri November 16 10:54:10 2018 Page 3 of 4 Ulf ILLINOIS PUBLIC RISK FUND Cost Control Throuph Cooperation Since 1985 Installment Schedule 1444 City of Canton 2 N. Main Street Canton,IL 61520 12 Equal Monthly Installments Due Date Amount Due 12/01/2018 $23,551 01/01/2019 $23,547 02/01/2019 $23,547 03/01/2019 $23,547 04/01/2019 $23,547 05/01/2019 $23,547 06/01/2019 $23,547 07/01/2019 $23,547 08/01/2019 $23,547 09/01/2019 $23,547 10/01/2019 $23,547 11/01/2019 $23,547 Page 4 of 4 Off BROAD FORM ALL STATES FOR EMPLOYEE TRAVEL It is hereby understood and agreed that this endorsement applies to the insurance provided and is subject to the terms and conditions of the Fund's By-Laws and the Pooling Agreement executed by the parties for each claim tendered to and covered by the Fund. 1. If the Member undertakes operations in or, at the request of the Member, an employee travels to or is temporarily assigned to, any State not designated in Part One of the Declarations, this agreement applies to such operations, travel or temporary assignment. Should the Member undertake operations in a State not designated in Part One of the Declarations,the Member shall give notice to the Illinois Public Risk Fund before or within a reasonable time after the commencement of such operations. The Member shall take whatever action is necessary to come within the Workers' Compensation and Occupational Disease laws of such State. 2. Should an Employee, at the direction of the Member, travel to or be temporarily assigned to any State or States not designated in Part One of the Declarations, this agreement shall provide coverage for loss sustained by the Member because of liability imposed upon the Member by the Workers' Compensation or Employers' Liability laws of such non-designated State. 3. This agreement also applies to loss sustained by the Member because of liability imposed upon the Member by the Workers' Compensation and Employers' Liability laws of such non-designated State. 4. Any loss covered by this agreement shall be subject to all the limitations of this agreement including but not limited to the limitation per occurrence and the maximum limit of liability for the liability period. 5. The word "State" as used in this agreement shall mean any State of the United States of America and the District of Columbia. 6. The insurance afforded by this agreement does not cover fines or penalties imposed on the Member for failure to comply with the requirements of any Workers' Compensation law. 7. All of the provisions of this agreement, insofar as such provisions are not inconsistent herewith, are applicable to the insurance afforded by the agreement by virtue of this endorsement. All other terms and conditions remain unchanged. IPRF WC 00 001 18 Off FEDERAL EMPLOYERS' LIABILITY ACT COVERAGE ENDORSEMENT It is hereby understood and agreed that this endorsement applies to the insurance provided and is subject to the terms and conditions of the Fund's By-Laws and the Pooling Agreement executed by the parties for each claim tendered to and covered by the Fund. The unqualified termWorkers' Compensation and Employers' Liability Laws including law for damages" includes theFederal Employers' Liability Act ("FELA"), (45 USC Sections 51-60) and any amendment to that Act that is in effect during the liability period. All other terms and conditions remain unchanged. IPRF WC 00 002 18 ORE FOREIGN VOLUNTARY WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY FOR TRAVELING EMPLOYEES It is hereby understood and agreed that this endorsement applies to the insurance provided and is subject to the terms and conditions of the Fund's By-Laws and the Pooling Agreement executed by the parties for each claim tendered to and covered by the Fund. SECTION 1 — SCOPE OF INSURANCE a. The coverage afforded by this agreement also applies to employees, as defined in Section 2 of this endorsement, who are traveling for work at locations within the following country or countries: Anywhere in the world outside the United States or United States possessions and territories, except: Afghanistan, Algeria, Belarus, Burkina Faso, Burma, Burundi, Cameroon, Central African Republic, Chad, Colombia, Cote d'Ivoire, Cuba, Democratic Republic of Congo, Djibouti, El Salvador, Eritrea, Honduras, Iran, Iraq, Israel, Kenya, Lebanon, Libya, Mali, Mauritania, Niger, Nigeria, North Korea, Pakistan, Philippines, Republic of South Sudan, Saudi Arabia, Somalia, Sudan, Syria, Turkey, Ukraine, Venezuela, West Bank and Gaza, Yemen, and Zimbabwe. b. Benefits payable under this endorsement are the same as those that would be payable if the employees in question were subject to the Workers' Compensation law of the State or States: ILLINOIS c. The Fund's Foreign Voluntary Endorsement Limit of Liability for Coverage B— Employer's Liability is limited to $100,000 and applies in excess of the Self Insured Retention per Occurrence. SECTION 2— EMPLOYEES COVERED a. It is agreed that the coverage afforded by this agreement applies to those employees of the Member who are traveling at the direction of the Member to work at locations within the country or countries not excluded by this endorsement. Page 1 of 2 IPRF WC 00 003 18 Off b. With respect to any such employee traveling at the direction of the Member to work at locations within the country or countries not excluded by this agreement, the coverage afforded by this agreement shall apply in the same manner as if said employee was performing work within the United States of America and subject to the Workers' Compensation law of the following State or States: ILLINOIS c. The coverage afforded by this agreement shall not apply to persons other than citizens or residents of the United States of America within the country or countries stated in this agreement except as stated herein: NONE All other terms and conditions remain unchanged. Page 2 of 2 IPRF WC 00 003 18 LLPIRF LONGSHORE AND HARBOR WORKERS' COMPENSATION ACT COVERAGE ENDORSEMENT It is hereby understood and agreed that this endorsement applies to the insurance provided and is subject to the terms and conditions of the Fund's By-Laws and the Pooling Agreement executed by the parties for each claim tendered to and covered by the Fund. The term, "Workers' Compensation Law" includes the Longshoremen's and Harbor Workers' Compensation Act (*USL&H) (33 USC Sections 901-950), and any amendment to that Act that is in effect during the liability period. This endorsement does not apply to work subject to the Defense Base Act, the Outer Continental Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. All other terms and conditions remain unchanged. IPRF WC 00 004 18 LPff MARITIME COVERAGE ENDORSEMENT It is hereby understood and agreed that this endorsement applies to the insurance provided and is subject to the terms and conditions of the Fund's By-Laws and the Pooling Agreement executed by the parties for each claim tendered to and covered by the Fund. The coverage afforded by Employers' Liability Laws, as specified in this agreement shall include loss on account of bodily injury to a master or member of the crew of a vessel, subject to the following additional provisions: This coverage does not include loss on account of: 1. Bodily injury covered by a Protection and Indemnity policy or similar policy issued to the Member or for the Members benefit. This exclusion applies even if the other policy does not apply because of an other insurance clause, deductible or limitation of liability clause, or any similar clause. 2. The Member's duty to provide transportation, wages, maintenance and cure. All other terms and conditions remain unchanged. IPRF WC 00 0005 18 OR, VOLUNTARY COMPENSATION ENDORSEMENT It is hereby understood and agreed that this endorsement applies to the insurance provided and is subject to the terms and conditions of the Fund's By-Laws and the Pooling Agreement executed by the parties for each claim tendered to and covered by the Fund. It is hereby understood and agreed that this endorsement adds voluntary compensation insurance as follows: A. Coverage It is the intent of this endorsement to extend the coverage provided by this agreement to non-compensated volunteer employees, operating at the direction of the Member, as if the volunteer employees were subject to the Workers' Compensation and Employers Liability Laws stipulated in the schedule below, even though these laws may not require payment of benefits to such volunteer employees. This insurance applies to loss sustained by the Member because of bodily injury and occupational disease, including death resulting therefrom, due to occurrences taking place within the liability period of this agreement. 1. The bodily injury or occupational disease must be sustained by an employee included in the group of employees described in the schedule. 2. The bodily injury or occupational disease must occur in the course of employment necessary or incidental to work in a State listed in the schedule. 3. The bodily injury or occupational disease must occur in the United States of America, its territories or possessions or Canada and may occur elsewhere if the employee is an American or Canadian citizen temporarily away from their home country. B. Indemnification The Fund will indemnify the Member for loss in satisfaction of statutory benefits that would be imposed if the Member and employee described in the schedule were subject to the Workers' Compensation law shown in the schedule. Page 1 of 3 IPRF WC 00 006 18 ORF Naturally, indemnification for any such loss is subject to the maximum limits of liability as specified in the declarations. C. Exclusions This insurance does not cover: 1. Any obligation imposed by a workers' compensation or occupational disease law, or any similar law. 2. Bodily injury intentionally caused or aggravated by the Member. D. Before Indemnification Before the Fund indemnifies the employee of a Member, or the employee's legal representative due to the employee's incapacity or death, the employee, or legal representative must: 1. Release the Member and the Fund, in writing, of all responsibility for the injury or death; 2. Transfer to the Member and the Fund, the employee's right to recover from third parties who may be responsible for the injury or disease sustained by the employee; and 3. Cooperate with Member and the Fund, including but not limited to completing all acts necessary, so as to enable the Member and the Fund to enforce the right to recover from third parties. If the injured employee, or his legal representative(s), fails to perform as required above, or if they claim damages from the Member or the Fund for the injury or disease, the Fund's duty to indemnity is immediately terminated. E. Recovery from Others If the Fund makes a recovery from others, the Fund will keep an amount equal to its expenses of recovery and the loss paid. The Fund will pay the balance to the parties entitled to payment. If the parties entitled to the benefits of this insurance make a Page 2 of 3 IPRF WC 00 006 18 ORF recovery from others, they must reimburse the Fund for the loss previously paid by the Fund to such parties. F. Employers' Liability Insurance Employers' Liability Insurance applies to loss covered by this endorsement as though the State of employment shown in the Schedule were shown in Part One of the Declarations. Schedule Designated Workers' Employees State of Employment Compensation Law Authorized volunteers, Illinois State of Illinois student workers, etc. while not subject to any Workers' Compensation law All other terms and conditions remain unchanged. 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