Attachment_A_-_Coverage_Document.pdf

FLORIDA MUNICIPAL

INSURANCE TRUST

October 1, 2017

RE: Renewal Agreement 10/01/2017 – 9/30/2018 Coverage Year

Dear FMIT Member, Thank you for renewing with the Florida Municipal Insurance Trust (FMIT), administered by the Florida League of Cities (FLC).

We appreciate your continued confidence and support, and are glad you are part of the FMIT family. As a FMIT Member, FLC staff will ensure you continue to receive high quality service. We look forward to continuing our partnership with you during the

10/01/2017 – 9/30/2018 coverage year.

As the FMIT celebrates its 40th Anniversary this year, the financial position of the FMIT remains very strong with almost $195 million in surplus and over $475 million in total assets. Additionally, all the reinsurers for the FMIT are rated A or better by A.

M. Best. We continue to maintain a conservative operating philosophy that will equate to stability when you need us. We have supported our Members in their risk management needs for 40 years, and our financial strength and operating philosophy will ensure we are here to support you in the future.

With this letter, you will find your Renewal Agreement. Please take some time to carefully review the document and give us a call should you have questions or comments.

Below are some of the highlights of the 10/01/2017 – 9/30/2018 coverage period:

A summary of coverage agreement changes may be viewed on FMIT’s website under your Member dashboard. You will see a hyperlink under Your Insurance Policy labeled 2017-18 Coverage Agreement Changes Summary.

In June of this year, your FMIT Board of Trustees approved a Return of Premium totaling $4,500,000. This return of premium is payable on a pro-rata basis to Members renewing their Property Coverage for this year who insured their Property with the FMIT during the 10/01/2015 – 9/30/2016 coverage year. This is the tenth consecutive year for a total return of premium of $7,400,000.

For our property excess flood coverage, we have increased the per-occurrence flood limit from $4.5 Million to $5 Million and instituted a $150 Million aggregate flood limit shared among all Trust Members.

The FMIT continues to provide Employment Practices Liability assistance through a partnership with Littler Mendelson, a nationally-recognized HR specialist that will bring both telephonic and online assistance to our Members. We encourage you to take advantage of this important service, as it helps to mitigate your liability exposure and in turn can result in lower liability premiums.

The FLC provides a Nationally Recognized Special Investigation Claims Unit (SIU) to assist our Members fight and reduce

Workers’ Compensation and General Liability fraud. The SIU unit has been responsible for the arrest of more than 69 claimants and has saved FMIT Members over $7,300,000.

For our property coverage, our disaster preparedness and recovery program is recognized by our reinsurers as “one of the most comprehensive and impressive programs out there”. FMIT has partnered with Synergy for these services as well as technology to support our Members. Included as part of these services, you will receive a complimentary license to FMIT’s proprietary, innovative software package, simpliCity, that will help prepare and manage your property schedule online and also serves as the claims system for all property claims, including catastrophic property claims. We will be in contact soon to make sure you are signed up and explain this valuable system. Members that have already signed up are excited about the capabilities and claims transparency it provides.

Once again, thank you for your continued support of the FMIT. We look forward to being your insurer of choice for many years to come. Please do not hesitate to contact us should you have any questions or concerns.

Sincerely, Jeannie Garner

Deputy Executive Director

FLORIDA LEAGUE OF CITIES

SPONSORED INSURANCE PROGRAMS

DECLARATIONS

I. DESIGNATED MEMBER:

II. COVERAGE PERIOD

III. AGREEMENT NUMBER

IV. COVERAGES INCLUDED

V. ESTIMATED ANNUAL PREMIUM

Address:

From October 1, 2017 to October 1, 2018

12:01 A.M. Standard Time at the address of the Designated Member.

Florida Municipal Insurance Trust (FMIT) FMIT #0079

City of Casselberry

95 Triplet Lake Drive

Casselberry, FL 32707

Incentive

Credit

Net

Premium

$724,744 $(92,542) $632,402

General Liability

Automobile

Property

Workers' Compensation

Normal

Premium

Expense

Constant

$200

October 1, 2017

DateSignature of Authorized Representative

FMIT COND 1016 Page 1 of 3

FMIT COND 1016 Page 2 of 3

FMIT COND 1016 Page 3 of 3

FMIT CA 1017-C Page 1 of 20

FMIT CA 1017-C Page 2 of 20

FMIT CA 1017-C Page 3 of 20

FMIT CA 1017-C Page 4 of 20

FMIT CA 1017-C Page 5 of 20

FMIT CA 1017-C Page 6 of 20

FMIT CA 1017-C Page 7 of 20

FMIT CA 1017-C Page 8 of 20

FMIT CA 1017-C Page 9 of 20

FMIT CA 1017-C Page 10 of 20

FMIT CA 1017-C Page 11 of 20

FMIT CA 1017-C Page 12 of 20

FMIT CA 1017-C Page 13 of 20

FMIT CA 1017-C Page 14 of 20

FMIT CA 1017-C Page 15 of 20

FMIT CA 1017-C Page 16 of 20

FMIT CA 1017-C Page 17 of 20

FMIT CA 1017-C Page 18 of 20

FMIT CA 1017-C Page 19 of 20

FMIT CA 1017-C Page 20 of 20

FLORIDA MUNICIPAL INSURANCE TRUST

GENERAL/PROFESSIONAL LIABILITY COVERAGE AGREEMENT

DECLARATIONS

I. DESIGNATED MEMBER

GOVERNMENT DESCRIPTIONII.

COVERAGE PERIODIII.

City of Casselberry

Agreement No.: FMIT #0079

From October 1, 2017 to October 1, 2018 12:01 A.M. Standard Time at the address of the Designated

Member.

Municipality

IV. $229,446

Net

Premium

$3,000,000

Limit

DSL$25,000

Deductible/

Type

6,193,880

Premium

Basis

Payroll:

General/Professional Liability

1. General Liability

a. Broad Form Property Damage Per Form IncludedDSL$25,000

b. Extra Contractual Legal Expense $25,000 IncludedN/A

c. Fire Legal Liability IncludedDSL$25,000 $500,000

d. Medical Attendants'/Medical

Directors' Malpractice Liability

$3,000,000 IncludedDSL$25,000

2. $3,000,000$25,000Errors and Omissions Liability IncludedDSL

a. Employment Practices Liability DSL$25,000 $3,000,000 Included

b. Employee Benefits Program

Administration Liability

$3,000,000DSL$25,000 Included

Included$3,000,000DSL$25,000Law Enforcement3.

Full Time with Arrest Powers: 57

Clerical: 8

Information Security & Privacy Liability

THESE ARE CLAIMS MADE AND

REPORTED COVERAGES

Insuring Agreement I.A.

a. Information Security & Privacy Liability

Retroactive Date: 10/1/2016 b.

Insuring Agreement I.B.

Privacy Notification Costs

Retroactive Date: 10/1/2016 c.

Insuring Agreement I.C.

Regulatory Defense and Penalties

Retroactive Date: 10/1/2016

$25,000

$10,000

$25,000

Included

Included

Included

4.

Included

Included

Included

$500,000 Each Claim

$500,000 Agreement

Aggregate Limit of

Liability

FMIT GL DEC 1017 Page 1 of 3

Insuring Agreement I.D.

Insuring Agreement I.H.

First Party Network Business

Interruption

Retroactive Date: 10/1/2016 h.

Insuring Agreement I.G.

First Party Data Protection

Retroactive Date: 10/1/2016 g.

Retroactive Date: 10/1/2016

PCI Fines and Costs

Insuring Agreement I.E.

Insuring Agreement I.F.

Cyber Extortion

Retroactive Date: 10/1/2016 f.

e.

Retroactive Date: 10/1/2016

Website Media Content Liabilityd. $25,000

$25,000

$35,000

$35,000

$35,000

Included

Included

Included

Included

Included

Included

Included

Included

Included

Included

This agreement includes these endorsements and schedules: See Schedule AV.

ESTIMATED ANNUAL PREMIUMVI.

Normal

Premium

Florida Municipal Insurance Trust (FMIT)

Incentive

Credit

Net

Premium

Florida League of Cities Sponsored Insurance Programs Since 1977

$286,808 $(57,362) $229,446

THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON

CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED

AGREEMENT.

First Party Network Business

Interruption Sublimits of Liability

(1) Hourly sublimit

(2) Forensic Expense sublimit

(3) Dependent Business Interruption sublimit

(1) $25,000 each claim included in above aggregate

(2) $50,000 each claim included in above aggregate

(3) $50,000 each claim included in above aggregate

FMIT GL DEC 1017 Page 2 of 3

DescriptionForm #

Schedule A

FMIT #0079

FMIT GENERAL/PROFESSIONAL LIABILITY COVERAGES

October 1, 2017 - October 1, 2018 Schedule Coverage Forms List

General Liability Common

Conditions of CoverageFMIT COND 1016

Coverage AgreementFMIT CA 1017-C

Deductible StopLoss EndorsementFMIT DSL 1011

General Liability

Broad Form Property Damage EndorsementFMIT BFPD 1010

Extra Contractual Legal Expense EndorsementFMIT ECLE 1016

Fire Legal Liability EndorsementFMIT FLL 1012

Medical Attendants' / Medical Directors' Malpractice Liability EndorsementFMIT MA 1007

Errors and Omissions Liability EndorsementFMIT EO 1017

Law Enforcement Liability EndorsementFMIT LE 1017

Inverse Condemnation and Bert J. Harris Jr. Private Property Rights

Protection Act

FMIT IC BH A 1016

Specific Excess Endorsement - General LiabilityFMIT SE GL 1012

Privacy/Network Security Liability EndorsementFMIT PNLE 1015

Privacy/Network Security LiabilityFMIT PNL 1012

First Party Computer Security CoverageFMIT PNLX 1012

Crisis Intervention Expense EndorsementFMIT CIE 1011

Sewerline Backup and Initial Cleanup ExpenseFMIT SBU 1016

FMIT GL DEC 1017 Page 3 of 3

FMIT BFPD 1010 Page 1 of 1

FMIT ECLE 1016 Page 1 of 2

FMIT ECLE 1016 Page 2 of 2

FMIT FLL 1012 Page 1 of 1

FMIT MA 1007 Page 1 of 1

FMIT EO 1017 Page 1 of 5

FMIT EO 1017 Page 2 of 5

FMIT EO 1017 Page 3 of 5

FMIT EO 1017 Page 4 of 5

FMIT EO 1017 Page 5 of 5

FMIT LE 1017 Page 1 of 2

FMIT LE 1017 Page 2 of 2

FMIT IC BH A 1016 Page 1 of 1

3,000,000

3,000,000

FMIT SE GL 1012 Page 1 of 1

City of Casselberry

258,174

25,000

X

FMIT DSL 1011 Page 1 of 2

FMIT DSL 1011 Page 2 of 2

FMIT PNLE 1015 Page 1 of 7

FMIT PNLE 1015 Page 2 of 7

FMIT PNLE 1015 Page 3 of 7

FMIT PNLE 1015 Page 4 of 7

FMIT PNLE 1015 Page 5 of 7

FMIT PNLE 1015 Page 6 of 7

FMIT PNLE 1015 Page 7 of 7

FMIT PNL 1012 Page 1 of 21

FMIT PNL 1012 Page 2 of 21

FMIT PNL 1012 Page 3 of 21

FMIT PNL 1012 Page 4 of 21

FMIT PNL 1012 Page 5 of 21

FMIT PNL 1012 Page 6 of 21

FMIT PNL 1012 Page 7 of 21

FMIT PNL 1012 Page 8 of 21

FMIT PNL 1012 Page 9 of 21

FMIT PNL 1012 Page 10 of 21

FMIT PNL 1012 Page 11 of 21

FMIT PNL 1012 Page 12 of 21

FMIT PNL 1012 Page 13 of 21

FMIT PNL 1012 Page 14 of 21

FMIT PNL 1012 Page 15 of 21

FMIT PNL 1012 Page 16 of 21

FMIT PNL 1012 Page 17 of 21

FMIT PNL 1012 Page 18 of 21

FMIT PNL 1012 Page 19 of 21

FMIT PNL 1012 Page 20 of 21

FMIT PNL 1012 Page 21 of 21

FMIT PNLX 1012 Page 1 of 10

FMIT PNLX 1012 Page 2 of 10

FMIT PNLX 1012 Page 3 of 10

FMIT PNLX 1012 Page 4 of 10

FMIT PNLX 1012 Page 5 of 10

FMIT PNLX 1012 Page 6 of 10

FMIT PNLX 1012 Page 7 of 10

FMIT PNLX 1012 Page 8 of 10

FMIT PNLX 1012 Page 9 of 10

FMIT PNLX 1012 Page 10 of 10

FMIT CIE 1011 Page 1 of 1

FMIT SBU 1016 Page 1 of 1

AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE

DECLARATIONS

$2,000,000$25,000 DSL

Municipality

Included$10,000

N/A N/A

N/A N/A

N/APer SchedulePer Schedule $16,030

$38,373

This Agreement includes these endorsements and schedules : See Schedule BV.

Per Schedule

Net

PremiumLimit Deductible/

Type

Premium

Basis

Number of Vehicles:

Automobile Physical Damage

Automobile Medical Payments

Personal Injury Protection

Uninsured Motorists Protection

Automobile Liability

5.

4.

3.

2.

1.

AUTOMOBILE

THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON

CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED

AGREEMENT.

Florida League of Cities Sponsored Insurance Programs Since 1977

$54,403

Normal

Premium

Florida Municipal Insurance Trust (FMIT)

ESTIMATED ANNUAL PREMIUMVI.

IV.

COVERAGE PERIOD

From 10/01/2017 to 10/01/2018 12:01 A.M. Standard Time at the address of the Designated Member

III.

GOVERNMENT DESCRIPTIONII.

DESIGNATED MEMBER: Agreement No.: FMIT #0079

City of Casselberry

I.

FMIT AUTO DEC 1017 Page 1 of 2

FMIT AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE COVERAGES

October 1, 2017 - October 1, 2018 Scheduled Coverage Forms List

City of Casselberry, FMIT #0079

Schedule B

Form # Description

Automobile ScheduleFMIT AUTO SCH 1002

Conditions of CoverageFMIT COND 1016

Coverage AgreementFMIT CA 1017-C

Automobile LiabilityFMIT AL 1016

Uninsured Motorists ProtectionFMIT UM 1013

Personal Injury ProtectionFMIT PIP 1014

Automobile Physical Damage Coverage FormFMIT APD 1016

Rental Reimbursement CoverageFMIT ARR 1009

Specific Excess Endorsement - Automobile LiabilityFMIT SE AL 1012

Deductible StopLoss EndorsementFMIT DSL 1011

Employer - Provided Vehicles - Automobile LiabilityFMIT AE 1008

FMIT AUTO DEC 1017 Page 2 of 2

Automobile Schedule City of Casselberry, FMIT #0079

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$0 HIRED AUTOS10/1/2017 10/1/20180

6619 $94 $0 $0 $0 n/a n/a $0 $94 n/a

$0 NON OWNED AUTOS10/1/2017 10/1/20180

6601 $94 $0 $0 $0 n/a n/a $0 $94 n/a

$17,995 5938VANFORD1995PK19910/1/2017 10/1/20181

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$17,321 48631 TON SIERRAGMC1998SF33810/1/2017 10/1/20182

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$14,396 0785PICKUPCHEVROLET1999PK7010/1/2017 10/1/20183

01499 $250 $6 $0 $0 $1000 $1000 $37 $293 n/a

$25,840 1881TRUCKGMC1999SF34010/1/2017 10/1/20184

01499 $250 $6 $0 $0 $1000 $1000 $58 $314 n/a

$18,058 3946PICKUPGMC2000CE26210/1/2017 10/1/20185

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$17,434 0727ASTRO VANCHEVROLET2000WP47310/1/2017 10/1/20186

7398 $167 $8 $0 $0 $1000 $1000 $41 $216 n/a

$44,695 0691TRUCKINTERNATIONAL2001DC41210/1/2017 10/1/20187

21499 $261 $6 $0 $0 $1000 $1000 $59 $326 n/a

$13,598 3909SONOMAGMC2001PC46110/1/2017 10/1/20188

01499 $250 $6 $0 $0 $1000 $1000 $37 $293 n/a

$39,633 9266TRUCKINTERNATIONAL2001SF34210/1/2017 10/1/20189

21499 $261 $6 $0 $0 $1000 $1000 $44 $311 n/a

$18,644 8495BLAZERCHEVROLET2002PD19510/1/2017 10/1/201810

7398 $167 $8 $0 $0 $1000 $1000 $41 $216 n/a

$21,500 8007MALIBUCHEVROLET2004PD18210/1/2017 10/1/201811

7911 $167 $9 $0 $0 $1000 $1000 $44 $220 n/a

$22,000 2095MALIBUCHEVROLET2003CE25910/1/2017 10/1/201812

7908 $167 $6 $0 $0 $1000 $1000 $20 $193 n/a

$30,000 7207F450FORD2004SF35010/1/2017 10/1/201813

21499 $261 $6 $0 $0 $1000 $1000 $44 $311 n/a

$189,956 1245VAC CONINTERNATIONAL2005DC42010/1/2017 10/1/201814

50499 $762 $6 $0 $0 $1000 $1000 $222 $990 n/a

$16,000 5487F150FORD2002PD14210/1/2017 10/1/201815

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$21,516 7501TRUCKFORD2005LS44810/1/2017 10/1/201816

01499 $250 $6 $0 $0 $1000 $1000 $46 $302 n/a

$13,820 4346SILVERADOCHEVROLET2005WP47610/1/2017 10/1/201817

01499 $250 $6 $0 $0 $1000 $1000 $37 $293 n/a

$14,600 7711CGO VANFORD2006PD15210/1/2017 10/1/201818

01499 $250 $6 $0 $0 $1000 $1000 $37 $293 n/a

$21,660 9378PICKUPSILVERADO2006DC42110/1/2017 10/1/201819

01499 $250 $6 $0 $0 $1000 $1000 $46 $302 n/a

$23,972 6316IMPALACHEVROLET2006PD14610/1/2017 10/1/201820

7398 $167 $8 $0 $0 $1000 $1000 $45 $220 n/a

$23,972 8548IMPALACHEVROLET2006PD14810/1/2017 10/1/201821

7398 $167 $8 $0 $0 $1000 $1000 $45 $220 n/a

$23,972 3973IMPALACHEVROLET2006PD14510/1/2017 10/1/201822

7398 $167 $8 $0 $0 $1000 $1000 $45 $220 n/a

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$33,199 9762TAHOECHEVROLET2006PD15710/1/2017 10/1/201823

7398 $167 $8 $0 $0 $1000 $1000 $47 $222 n/a

$16,578 9230COLORADO 2WD EXT CABCHEVROLET2007PK8210/1/2017 10/1/201824

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$14,953 8864COLORADO 2WD EXT CABCHEVROLET2007MR6210/1/2017 10/1/201825

01499 $250 $6 $0 $0 $1000 $1000 $37 $293 n/a

$16,253 8930COLORADO 2WD EXT CABCHEVROLET2007WP47710/1/2017 10/1/201826

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$17,553 4913IMPALACHEVROLET2007PD51110/1/2017 10/1/201827

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$17,553 4750IMPALACHEVROLET2007PD51010/1/2017 10/1/201828

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$17,553 3797IMPALACHEVROLET2007PD50910/1/2017 10/1/201829

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$17,553 3713IMPALACHEVROLET2007PD50810/1/2017 10/1/201830

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$17,553 1395IMPALACHEVROLET2007PD50710/1/2017 10/1/201831

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$17,553 0890IMPALACHEVROLET2007PD50610/1/2017 10/1/201832

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$17,553 0177IMPALACHEVROLET2007PD50510/1/2017 10/1/201833

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$17,553 8907IMPALACHEVROLET2007PD50410/1/2017 10/1/201834

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$14,955 6661MALIBUCHEVROLET2007PD50110/1/2017 10/1/201835

7911 $167 $9 $0 $0 $1000 $1000 $38 $214 n/a

$14,955 8899MALIBUCHEVROLET2007PD50310/1/2017 10/1/201836

7911 $167 $9 $0 $0 $1000 $1000 $38 $214 n/a

$14,955 8501MALIBUCHEVROLET2007PD50210/1/2017 10/1/201837

7911 $167 $9 $0 $0 $1000 $1000 $38 $214 n/a

$17,631 6665EXTENDED CAB TRUCKFORD2007SF35310/1/2017 10/1/201838

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$17,931 1282EXTENDED CAB TRUCKFORD2007SW38110/1/2017 10/1/201839

01499 $250 $6 $0 $0 $1000 $1000 $43 $299 n/a

$68,834 6869F-150 DUMP TRUCKFORD2008SF35510/1/2017 10/1/201840

21479 $237 $6 $0 $0 $1000 $1000 $98 $341 n/a

$18,591 6177COLORADO EXT CABCHEVROLET2009WP47810/1/2017 10/1/201841

01499 $250 $6 $0 $0 $1000 $1000 $58 $314 n/a

$17,887 6571COLORADO EXT CABCHEVROLET2009PK8410/1/2017 10/1/201842

01499 $250 $6 $0 $0 $1000 $1000 $58 $314 n/a

$17,887 7007COLORADO EXT CABCHEVROLET2009MR6310/1/2017 10/1/201843

01499 $250 $6 $0 $0 $1000 $1000 $58 $314 n/a

$35,833 0511F450FORD2009SW38510/1/2017 10/1/201844

21499 $261 $6 $0 $0 $1000 $1000 $60 $327 n/a

$35,833 0512F450FORD2009SW38410/1/2017 10/1/201845

21499 $261 $6 $0 $0 $1000 $1000 $60 $327 n/a

$207,664 0530STREET SWEEPERINTERNATIONAL2010SW38710/1/2017 10/1/201846

31499 $303 $6 $0 $0 $1000 $1000 $226 $535 n/a

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$64,925 2619BUCKET TRUCKFORD2010SF35710/1/2017 10/1/201847

21499 $261 $6 $0 $0 $1000 $1000 $88 $355 n/a

$19,062 8951IMPALACHEVROLET2010PD52410/1/2017 10/1/201848

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,062 9023IMPALACHEVROLET2010PD52510/1/2017 10/1/201849

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,062 9536IMPALACHEVROLET2010PD52610/1/2017 10/1/201850

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$22,202 8182F250FORD2008SW38210/1/2017 10/1/201851

01499 $250 $6 $0 $0 $1000 $1000 $57 $313 n/a

$19,385 2357IMPALACHEVROLET2010PD51310/1/2017 10/1/201852

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 2463IMPALACHEVROLET2010PD51410/1/2017 10/1/201853

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 2962IMPALACHEVROLET2010PD51510/1/2017 10/1/201854

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 3017IMPALACHEVROLET2010PD51610/1/2017 10/1/201855

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 5206IMPALACHEVROLET2010PD51710/1/2017 10/1/201856

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 2330IMPALACHEVROLET2010PD51810/1/2017 10/1/201857

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 4462IMPALACHEVROLET2010PD51910/1/2017 10/1/201858

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 4678IMPALACHEVROLET2010PD52210/1/2017 10/1/201859

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,385 4813IMPALACHEVROLET2010PD52310/1/2017 10/1/201860

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$18,185 7733F150FORD2010SF35810/1/2017 10/1/201861

01499 $250 $6 $0 $0 $1000 $1000 $64 $320 n/a

$18,849 7234IMPALACHEVROLET2010PD52710/1/2017 10/1/201862

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$18,849 7741IMPALACHEVROLET2010PD52810/1/2017 10/1/201863

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$18,849 8561IMPALACHEVROLET2010PD52910/1/2017 10/1/201864

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$18,849 9052IMPALACHEVROLET2010PD53010/1/2017 10/1/201865

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$20,000 TBDROTATING CARUNDERCOVER2010AVIS10/1/2017 10/1/201866

7911 $167 $9 $0 $0 $1000 $1000 $63 $239 n/a

$19,095 4196F150 PICKUPFORD2011DC42310/1/2017 10/1/201867

01499 $250 $6 $0 $0 $1000 $1000 $68 $324 n/a

$19,456 0506IMPALACHEVROLET2011PD53110/1/2017 10/1/201868

7911 $167 $9 $0 $0 $1000 $1000 $71 $247 n/a

$19,456 3949IMPALACHEVROLET2011PD53210/1/2017 10/1/201869

7911 $167 $9 $0 $0 $1000 $1000 $71 $247 n/a

$19,456 4165IMPALACHEVROLET2011PD53310/1/2017 10/1/201870

7911 $167 $9 $0 $0 $1000 $1000 $71 $247 n/a

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$19,456 5352IMPALACHEVROLET2011PD53410/1/2017 10/1/201871

7911 $167 $9 $0 $0 $1000 $1000 $71 $247 n/a

$19,456 5689IMPALACHEVROLET2011PD53510/1/2017 10/1/201872

7911 $167 $9 $0 $0 $1000 $1000 $71 $247 n/a

$19,456 6956IMPALACHEVROLET2011PD53610/1/2017 10/1/201873

7911 $167 $9 $0 $0 $1000 $1000 $71 $247 n/a

$23,300 9378F150FORD2012CE2010/1/2017 10/1/201874

01499 $250 $6 $0 $0 $1000 $1000 $80 $336 n/a

$23,300 9379F150FORD2012CE2110/1/2017 10/1/201875

01499 $250 $6 $0 $0 $1000 $1000 $80 $336 n/a

$39,197 8496TRUCKFORD2012DC42510/1/2017 10/1/201876

01499 $250 $6 $0 $0 $1000 $1000 $102 $358 n/a

$39,197 8495TRUCKFORD2012DC42410/1/2017 10/1/201877

01499 $250 $6 $0 $0 $1000 $1000 $102 $358 n/a

$17,349 9377F150 DUMP TRUCKFORD2012DC42610/1/2017 10/1/201878

01479 $225 $6 $0 $0 $1000 $1000 $78 $309 n/a

$23,409 7425F250FORD2007SF35410/1/2017 10/1/201879

01499 $250 $6 $0 $0 $1000 $1000 $46 $302 n/a

$72,600 7839F-750 DUMPFORD2012SF35910/1/2017 10/1/201880

31479 $276 $6 $0 $0 $1000 $1000 $140 $422 n/a

$72,600 7838F-750 DUMPFORD2012DC42710/1/2017 10/1/201881

31479 $276 $6 $0 $0 $1000 $1000 $140 $422 n/a

$19,758 8057IMPALACHEVROLET2012PD53810/1/2017 10/1/201882

7911 $167 $9 $0 $0 $1000 $1000 $80 $256 n/a

$19,758 0692IMPALACHEVROLET2012PD53910/1/2017 10/1/201883

7911 $167 $9 $0 $0 $1000 $1000 $80 $256 n/a

$19,758 1166IMPALACHEVROLET2012PD54010/1/2017 10/1/201884

7911 $167 $9 $0 $0 $1000 $1000 $80 $256 n/a

$23,528 8374INTERCEPTORFORD2013PD54210/1/2017 10/1/201885

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$23,528 8375INTERCEPTORFORD2013PD54310/1/2017 10/1/201886

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$23,528 8376INTERCEPTORFORD2013PD54410/1/2017 10/1/201887

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$24,246 8371INTERCEPTORFORD2013PD54510/1/2017 10/1/201888

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$24,246 8372INTERCEPTORFORD2013PD54610/1/2017 10/1/201889

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$24,246 8377INTERCEPTORFORD2013PD54710/1/2017 10/1/201890

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$16,729 4295F150 TRUCKFORD2013PC46410/1/2017 10/1/201891

01499 $250 $6 $0 $0 $1000 $1000 $78 $334 n/a

$24,363 0803EXPLORERFORD2013SW39010/1/2017 10/1/201892

7398 $167 $8 $0 $0 $1000 $1000 $94 $269 n/a

$24,417 2923EXPLORERFORD2013PD54810/1/2017 10/1/201893

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$25,389 2925EXPLORERFORD2013PD54910/1/2017 10/1/201894

7911 $167 $9 $0 $0 $1000 $1000 $98 $274 n/a

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$30,975 9678F-250 TRAFFIC UTILITFORD2013PD17210/1/2017 10/1/201895

01499 $250 $6 $0 $0 $1000 $1000 $106 $362 n/a

$25,389 2924EXPLORERFORD2013PD55010/1/2017 10/1/201896

7911 $167 $9 $0 $0 $1000 $1000 $98 $274 n/a

$19,072 1061ESCAPEFORD2013WP47910/1/2017 10/1/201897

7398 $167 $8 $0 $0 $1000 $1000 $88 $263 n/a

$56,586 7093F550FORD2013DC42810/1/2017 10/1/201898

21499 $261 $6 $0 $0 $1000 $1000 $109 $376 n/a

$20,000 TBDVEHICLEUNDERCOVER200710/1/2017 10/1/201899

7911 $167 $9 $0 $0 $1000 $1000 $41 $217 n/a

$20,416 6519FUSIONFORD2013PD15510/1/2017 10/1/2018100

7398 $167 $8 $0 $0 $1000 $1000 $94 $269 n/a

$85,000 7576FL60FREIGHTLINER1997PD17410/1/2017 10/1/2018101

31499 $303 $6 $0 $0 $1000 $1000 $76 $385 n/a

$21,654 3893F150FORD2013PD 17310/1/2017 10/1/2018102

7912 $228 $9 $0 $0 $1000 $1000 $85 $322 n/a

$20,416 6518FUSIONFORD201310/1/2017 10/1/2018103

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$190,505 5187E450FORD2013DC42910/1/2017 10/1/2018104

21499 $261 $6 $0 $0 $1000 $1000 $267 $534 n/a

$23,972 2868IMPALACHEVROLET2006PD15410/1/2017 10/1/2018105

7911 $167 $9 $0 $0 $1000 $1000 $44 $220 n/a

$23,528 8373INTERCEPTORFORD2013PD54110/1/2017 10/1/2018106

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$24,198 0290EXPLORERFORD2014AD310/1/2017 10/1/2018107

7398 $167 $8 $0 $0 $1000 $1000 $99 $274 n/a

$20,342 5652IMPALACHEVROLET2013PD55110/1/2017 10/1/2018108

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 5777IMPALACHEVROLET2013PD55210/1/2017 10/1/2018109

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 6626IMPALACHEVROLET2013PD55310/1/2017 10/1/2018110

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 6664IMPALACHEVROLET2013PD55410/1/2017 10/1/2018111

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 6711IMPALACHEVROLET2013PD55510/1/2017 10/1/2018112

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 7453IMPALACHEVROLET2013PD55610/1/2017 10/1/2018113

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 7516IMPALACHEVROLET2013PD55710/1/2017 10/1/2018114

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 7641IMPALACHEVROLET2013PD55810/1/2017 10/1/2018115

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$20,342 7712IMPALACHEVROLET2013PD55910/1/2017 10/1/2018116

7911 $167 $9 $0 $0 $1000 $1000 $92 $268 n/a

$43,826 9298F450 DUMP TRUCKFORD2013DC43010/1/2017 10/1/2018117

21479 $237 $6 $0 $0 $1000 $1000 $112 $355 n/a

$43,826 9300F450 DUMP TRUCKFORD201310/1/2017 10/1/2018118

21479 $237 $6 $0 $0 $1000 $1000 $112 $355 n/a

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$28,466 9299F450 4X2 TRUCKFORD201310/1/2017 10/1/2018119

21499 $261 $6 $0 $0 $1000 $1000 $80 $347 n/a

$21,769 0744F150FORD2014DC43310/1/2017 10/1/2018120

01499 $250 $6 $0 $0 $1000 $1000 $93 $349 n/a

$25,360 7045FLEET FUEL TRUCKFORD2014SF36110/1/2017 10/1/2018121

01499 $250 $6 $0 $0 $1000 $1000 $120 $376 n/a

$18,884 9197F150 REG CAB 4X2FORD2014PK70310/1/2017 10/1/2018122

01499 $250 $6 $0 $0 $1000 $1000 $87 $343 n/a

$70,791 7243F550FORD2014DC43410/1/2017 10/1/2018123

31499 $303 $6 $0 $0 $1000 $1000 $160 $469 n/a

$38,964 1295F450 SUPER DUTYFORD201510/1/2017 10/1/2018124

21499 $261 $6 $0 $0 $1000 $1000 $96 $363 n/a

$21,190 7008TRANSIT CONNECTFORD201410/1/2017 10/1/2018125

01499 $250 $6 $0 $0 $1000 $1000 $93 $349 n/a

$28,758 9197F150FORD201410/1/2017 10/1/2018126

01499 $250 $6 $0 $0 $1000 $1000 $120 $376 n/a

$24,455 0374EXPLORERFORD201410/1/2017 10/1/2018127

7398 $167 $8 $0 $0 $1000 $1000 $99 $274 n/a

$103,022 7775F-750FORD201510/1/2017 10/1/2018128

31499 $303 $6 $0 $0 $1000 $1000 $190 $499 n/a

$8,979 5075TRAILERTEXAS201410/1/2017 10/1/2018129

68499 $25 $1 $0 $0 $1000 $1000 $28 $54 n/a

$1,095 32815X8 LS TRAILERUTILITY2014DCSEQ10/1/2017 10/1/2018130

68499 $25 $1 $0 $0 $1000 $1000 $13 $39 n/a

$30,184 6765F250 SERVICE TRUCKFORD2015DC43810/1/2017 10/1/2018131

01499 $250 $6 $0 $0 $1000 $1000 $127 $383 n/a

$34,263 6763F250FORD2015DC43910/1/2017 10/1/2018132

01499 $250 $6 $0 $0 $1000 $1000 $127 $383 n/a

$31,879 6766F250FORD2015DC44910/1/2017 10/1/2018133

01499 $250 $6 $0 $0 $1000 $1000 $127 $383 n/a

$25,353 6950EXPLORERFORD2015AD410/1/2017 10/1/2018134

7398 $167 $8 $0 $0 $1000 $1000 $113 $288 n/a

$25,353 6951EXPLORERFORD2015AD510/1/2017 10/1/2018135

7398 $167 $8 $0 $0 $1000 $1000 $113 $288 n/a

$20,912 0832F-150 TRUCKFORD2015PC46510/1/2017 10/1/2018136

01499 $250 $6 $0 $0 $1000 $1000 $99 $355 n/a

$20,912 0831F-150 TRUCKFORD2015WP48010/1/2017 10/1/2018137

01499 $250 $6 $0 $0 $1000 $1000 $99 $355 n/a

$20,912 0833F-150 TRUCKFORD2015MR6410/1/2017 10/1/2018138

01499 $250 $6 $0 $0 $1000 $1000 $99 $355 n/a

$20,483 8088F-150 TRUCKFORD2015IN5310/1/2017 10/1/2018139

01499 $250 $6 $0 $0 $1000 $1000 $99 $355 n/a

$363,423 5709VAC- CONFREIGHTLINER2016DC45010/1/2017 10/1/2018140

50499 $762 $6 $0 $0 $1000 $1000 $972 $1,740 n/a

$21,853 0834F150FORD2015DC45110/1/2017 10/1/2018141

01499 $250 $6 $0 $0 $1000 $1000 $99 $355 n/a

$19,540 2270TRANSIT CONNECTFORD2016PK70510/1/2017 10/1/2018142

01499 $250 $6 $0 $0 $1000 $1000 $97 $353 n/a

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$25,825 3177F-150FORD2016SW39310/1/2017 10/1/2018143

01499 $250 $6 $0 $8 $1000 $1000 $134 $398 n/a

$28,748 3842F-150 TRUCKFORD2015SW39410/1/2017 10/1/2018144

01499 $250 $6 $0 $8 $1000 $1000 $127 $391 n/a

$24,900 6874EXPLORERFORD2016AD610/1/2017 10/1/2018145

7398 $167 $8 $0 $13 $1000 $1000 $117 $305 n/a

$27,871 2317TRAVERSECHEVROLET2016PD56010/1/2017 10/1/2018146

7398 $167 $8 $0 $13 $1000 $1000 $124 $312 n/a

$25,170 5248TRANSIT WAGONFORD201610/1/2017 10/1/2018147

01499 $250 $6 $0 $8 $1000 $1000 $134 $398 n/a

$30,128 5891EXPLORERFORD2016PD56110/1/2017 10/1/2018148

7398 $167 $8 $0 $13 $1000 $1000 $124 $312 n/a

$19,730 8596SIERRA 2WDGMC201610/1/2017 10/1/2018149

01499 $250 $6 $0 $0 $1000 $1000 $97 $353 n/a

$19,730 4257SIERRAGMC2016MR6510/1/2017 10/1/2018150

01499 $250 $6 $0 $0 $1000 $1000 $97 $353 n/a

$19,730 5375SIERRAGMC2016WP48110/1/2017 10/1/2018151

01499 $250 $6 $0 $0 $1000 $1000 $97 $353 n/a

$19,730 8596SIERRAGMC2016PK70810/1/2017 10/1/2018152

01499 $250 $6 $0 $0 $1000 $1000 $97 $353 n/a

$86,934 9430F550 WITH CRANEFORD201610/1/2017 10/1/2018153

21499 $261 $6 $0 $8 $1000 $1000 $180 $455 n/a

$30,128 4202EXPLORERFORD2016PD56210/1/2017 10/1/2018154

7911 $167 $9 $0 $13 $1000 $1000 $122 $311 n/a

$364,136 8325114SD CHASSISFREIGHTLINER201710/1/2017 10/1/2018155

31499 $303 $6 $0 $0 $1000 $1000 $604 $913 n/a

$25,054 8439F150FORD2017DC45310/1/2017 10/1/2018156

01499 $250 $6 $0 $0 $1000 $1000 $134 $390 n/a

$25,554 3587F150FORD2017PK70910/1/2017 10/1/2018157

01499 $250 $6 $0 $0 $1000 $1000 $134 $390 n/a

$24,359 4659EXPLORERFORD2017CE2310/1/2017 10/1/2018158

7398 $167 $8 $0 $13 $1000 $1000 $117 $305 n/a

$20,554 3588F150FORD2017PK71010/1/2017 10/1/2018159

01499 $250 $6 $0 $0 $1000 $1000 $104 $360 n/a

$20,544 3586F150FORD2017PK71110/1/2017 10/1/2018160

01499 $250 $6 $0 $0 $1000 $1000 $104 $360 n/a

$32,207 4664EXPLORERFORD201710/1/2017 10/1/2018161

7398 $167 $8 $0 $13 $1000 $1000 $124 $312 n/a

$32,122 4665EXPLORERFORD201710/1/2017 10/1/2018162

7398 $167 $8 $0 $13 $1000 $1000 $124 $312 n/a

$30,135 0974F250 SUPERCABFORD201710/1/2017 10/1/2018163

01499 $250 $6 $0 $0 $1000 $1000 $134 $390 n/a

$37,641 4474INTERCEPTORFORD2017PD56510/1/2017 10/1/2018164

7911 $167 $9 $0 $0 $1000 $1000 $122 $298 n/a

$37,641 4475INTERCEPTORFORD2017PD56610/1/2017 10/1/2018165

7911 $167 $9 $0 $0 $1000 $1000 $122 $298 n/a

$37,641 4477INTERCEPTORFORD2017PD56810/1/2017 10/1/2018166

7911 $167 $9 $0 $0 $1000 $1000 $122 $298 n/a

10/01/2017 - 10/01/2018

Veh # Eff Date Exp Date City # Year Make Description ID #

Code

Cost New

Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem

$28,084 4658EXPLORERFORD2017CE2410/1/2017 10/1/2018167

7398 $167 $8 $0 $0 $1000 $1000 $124 $299 n/a

$37,641 4476INTERCEPTORFORD2017PD56710/1/2017 10/1/2018168

7911 $167 $9 $0 $0 $1000 $1000 $122 $298 n/a

$37,641 4478INTERCEPTORFORD2017PD56910/1/2017 10/1/2018169

7911 $167 $9 $0 $0 $1000 $1000 $122 $298 n/a

$20,554 0346F150FORD2017WP48210/1/2017 10/1/2018170

01499 $250 $6 $0 $0 $1000 $1000 $104 $360 n/a

$20,554 0347F150FORD2017MR6610/1/2017 10/1/2018171

01499 $250 $6 $0 $0 $1000 $1000 $104 $360 n/a

$22,157 1863TRANSIT CONNECT VANFORD2017PK71310/1/2017 10/1/2018172

7398 $167 $8 $0 $0 $1000 $1000 $117 $292 n/a

$22,157 1866TRANSIT CONNECT VANFORD2017PK71410/1/2017 10/1/2018173

7398 $167 $8 $0 $0 $1000 $1000 $117 $292 n/a

$54,403$16,030 $123 $0 $1,273 $36,977 Total Normal Premiums

$54,403Normal Premium

$54,403Net Premium

FMIT AL 1016 Page 1 of 4

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FMIT AL 1016 Page 3 of 4

FMIT AL 1016 Page 4 of 4

FMIT UM 1013 Page 1 of 3

FMIT UM 1013 Page 2 of 3

FMIT UM 1013 Page 3 of 3

FMIT PIP 1014 Page 1 of 8

FMIT PIP 1014 Page 2 of 8

FMIT PIP 1014 Page 3 of 8

FMIT PIP 1014 Page 4 of 8

FMIT PIP 1014 Page 5 of 8

FMIT PIP 1014 Page 6 of 8

FMIT PIP 1014 Page 7 of 8

FMIT PIP 1014 Page 8 of 8

FMIT APD 1016 Page 1 of 4

FMIT APD 1016 Page 2 of 4

FMIT APD 1016 Page 3 of 4

FMIT APD 1016 Page 4 of 4

FMIT ARR 1009 Page 1 of 1

2,000,000

2,000,000

FMIT SE AL 1012 Page 1 of 1

75,000

25,000

FMIT AE 1008 Page 1 of 1

PROPERTY, ALLIED LINES AND CRIME

DECLARATIONS

$132,444

Agreement No.: FMIT #0079

Net PremiumLimit Deductible/

Type

Premium

Basis

IV. Property and Allied Coverages

From October 1, 2017 to October 1, 2018 12:01 A.M. Standard Time at the address of the

Designated Member.

Municipality

City of Casselberry

I. DESIGNATED MEMBER

II. GOVERNMENT DESCRIPTION

III. COVERAGE PERIOD

$44,796,769$500 IncludedReal Property*

Included$7,869,355$500Personal Property

Coinsurance: Agreed Amount

Inflation Guard: No

YesBlanket**:

Replacement

Cost

Valuation Basis:

$500,000 IncludedNon-scheduled PITO Sub-Limit*

$0Business Income Per Extension Included

Time Element

Per Extension $0 Included

Inland Marine Valuation Basis: Actual Cash

Value

Per Schedule $1,984,932 Included

Extra Expense

IncludedYesBlanket:

$0

$0

Included

IncludedValuable Papers Per Extension

Accounts Receivable Per Extension

Bond

$50,000$500 IncludedFaithful Performance Position Bond

$50,000$500 IncludedEmployee Theft - Per Employee

**If a blanket limit is selected, the blanket limit applies only to Covered Property at locations contained in the Member’s Property

Schedule, subject to all coverage exclusions, deductible requirement(s) and other provisions of the Coverage Agreement .

*Real Property limit is inclusive of Non-scheduled PITO Sub-Limit.

This agreement includes these endorsements and schedules: See Schedule CV.

THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS, COVERAGE

FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT.

$132,444

VI. ESTIMATED ANNUAL PREMIUM

Florida Municipal Insurance Trust (FMIT)

Normal

Premium

Florida League of Cities Sponsored Insurance Programs Since 1977

FMIT PROP DEC 1017 Page 1 of 2

FMIT PROPERTY AND ALLIED COVERAGES

October 1, 2017 - October 1, 2018 Scheduled Coverage Forms List

FMIT #0079

Schedule C

Form # Description

Property Common

FMIT COND 1016 Conditions of Coverage

FMIT CA 1017-C Coverage Agreement

IL 00 17 1198 Common Policy Conditions

FMIT MPC 1014 Miscellaneous Property Coverages

IL 02 55 0106 Florida Changes - Cancellation and Non-renewal

Property

FMIT PROP EP 1015 Earned Premium

FMIT PROP EIV 1010 Enviromental Improvement Endorsement

PR-SCHED Property Schedule

CP 00 90 0788 Commercial Property Conditions

CP 00 10 0402 Building and Personal Property Coverage Form

FMIT PROP 03 1017 Coverage Extensions

CP 01 25 1007 Florida Changes

CP 10 10 0402 Causes of Loss - Basic Form

CP 10 30 0402 Causes of Loss - Special Form

CP 10 50 0788 Additional Exclusions - Wind Exclusion

FMIT PROP 12 1016 Ordinance or Law Change

CP 10 35 0695 Watercraft Exclusion

FMIT FLOOD 1017 Flood Coverage Excess of Loss

FMIT PROP NS DED-A 1017 Named Storm Percentage Deductible Endorsement

FMIT PROP TER 1015 Terrorism Physical Loss or Physical Damage

CP 14 40 1000 Outside Signs

CP 14 50 1000 Radio or Television Antennas

FMIT EBC 1015 Equipment Breakdown Coverage Schedule

FMIT EBC/EBX 1015 Equipment Breakdown Coverage

FMIT FCR 1009 Fungus Remediation

IL 04 01 1007 Florida-Sinkhole Loss Coverage

CP 00 60 0695 Leasehold Interest Coverage Form

CP 00 50 0402 Extra Expense Coverage Form

CP 00 32 0402 Business Income Coverage

PR MANUSCRIPT Piers, Wharves, Docks

Inland Marine

FMIT IM SCH Miscellaneous Schedule of Inland Marine

FMIT PROP 02 1016 Inland Marine Floater

CM 00 01 0904 Commercial Inland Marine Conditions

CM 00 66 0904 Accounts Receivable Coverage Form

CM 00 67 0904 Valuable Papers and Records Coverage Form

IM MANUSCRIPT Fine Arts Schedule

Crime

CR 00 25 0506 Government Crime Coverage Form

FMIT GC FD 1012 Government Crime Coverage Form Amendment

CR 25 09 1010 Include Volunteer Workers as Employees

CR 25 19 0506 Add Faithful Performance of Duty Coverage

FMIT PROP DEC 1017 Page 2 of 2

IL 00 17 1198 Page 1 of 1

Miscellaneous Property Coverages

FMIT #0079

October 1, 2017 - October 1, 2018

Business Income

All locations are covered under Coverage Extension 5h.

Extra Expense

All locations are covered under Coverage Extension 5e.

Valuable Papers & Records

All locations are covered under Coverage Extension 5b.

Accounts Receivable

All locations are covered under Coverage Extension 5d.

Crime / Bond

Bond Type Deductible AmountBond Limit

Finance Director $0$50,000

Bond - Faithful Performance Position Bond $500$50,000

Employee Theft - Per Employee $500$50,000

FMIT MPC 1014 Page 1 of 1

IL 02 55 0106 Page 1 of 3

IL 02 55 0106 Page 2 of 3

IL 02 55 0106 Page 3 of 3

FMIT PROP EP 1015 Page 1 of 2

FMIT PROP EP 1015 Page 2 of 2

FMIT PROP EIV 1010 Page 1 of 1

Property Schedule

October 1, 2017 - October 1, 2018

AddressLocation # Occupancy Construction Type

Cause of Loss - Building Limit Cause of Loss - Personal Property LimitBldLoc

001001 95 Triplet Lake Drive Casselberry, FL City Hall Masonry

Non-Combustible

$1,050,283 Special Form$3,515,000Special Form

002001 95 Triplet Lake Drive Casselberry, FL Public Works Bldg/Administration Masonry

Non-Combustible

$207,806 Special Form$1,552,000Special Form

003001 95 Triplet Lake Drive Casselberry, FL Tanks - Gas Non-Combustible

$0 $10,551Special Form

004001 95 Triplet Lake Drive Casselberry, FL Boardwalk Frame

$0 $199,455Basic

007001 95 Triplet Lake Drive Casselberry, FL Lawn Playground Artificial Grass

System

Non-Combustible

$0 $16,000Special Form

009001 95 Triplet Lake Drive Casselberry, FL Boardwalk Frame

$0 $687,000Basic

010001 95 Triplet Lake Drive Casselberry, FL Interactive Play Area Fountain & Water

Tank/Vault

Non-Combustible

$0 $111,940Special Form

011001 95 Triplet Lake Drive Casselberry, FL Mobius Play Structure Non-Combustible

$0 $20,000Special Form

012001 95 Triplet Lake Drive Casselberry, FL Ornamental Fountain Non-Combustible

$0 $45,000Special Form

013001 95 Triplet Lake Drive Casselberry, FL Two Pond Fountains Non-Combustible

$0 $33,248Special Form

014001 95 Triplet Lake Drive Casselberry, FL Feature Fountain Non-Combustible

$0 $114,212Special Form

015001 95 Triplet Lake Drive Casselberry, FL Composite Boardwalk Frame

$0 $64,000Basic

016001 95 Triplet Lake Drive Casselberry, FL Two Entry Walls at 17-92 & Triplet Lake

Dr

Non-Combustible

$0 $91,295Special Form

001002 1040 Seventh Street Casselberry, FL Fleet Maintenance Building (A) Joisted Masonry

$79,445 Special Form$477,000Special Form

002002 1040 Seventh Street Casselberry, FL Distribution & Collection Division (D) Non-Combustible

$33,427 Special Form$1,109,000Special Form

003002 1040 Seventh Street Casselberry, FL 100 Ft Tower & Antenna Non-Combustible

$0 $8,612Special Form

004002 1040 Seventh Street Casselberry, FL Lift Station Division (B) Non-Combustible

$0 $326,000Special Form

005002 1040 Seventh Street Casselberry, FL Stormwater Division (C) Non-Combustible

$300,000 Special Form$307,000Special Form

006002 1040 Seventh Street Casselberry, FL Tanks - Gas Non-Combustible

$0 $10,551Special Form

001003 808 Mark David Boulevard Casselberry, FL Picnic Shelter @ Wirz Recreation Center Frame

$0 $9,688Special Form

002003 808 Mark David Boulevard Casselberry, FL Wirz Recreation Center Joisted Masonry

$6,018 Special Form$169,000Special Form

PR-SCHED 1014 Page 1 of 16

October 1, 2017 - October 1, 2018

AddressLocation # Occupancy Construction Type

Cause of Loss - Building Limit Cause of Loss - Personal Property LimitBldLoc

003003 808 Mark David Boulevard Casselberry, FL Restrooms/Storage - Wirz Park Joisted Masonry

$2,900 Special Form$131,000Special Form

004003 808 Mark David Boulevard Casselberry, FL Swimming Pool & Recreation Center Joisted Masonry

$5,665 Special Form$25,358Special Form

005003 808 Mark David Boulevard Casselberry, FL Dressing Room Facilities - Wirz Park Joisted Masonry

$0 $81,018Special Form

009003 808 Mark David Boulevard Casselberry, FL 5-Portable Bleachers $1,430 each Non-Combustible

$0 $7,150Special Form

010003 808 Mark David Boulevard Casselberry, FL 5-Canopies Frame

$0 $12,500Special Form

016003 808 Mark David Boulevard Casselberry, FL 1-Lifeguard Stand Frame

$0 $2,900Special Form

024003 808 Mark David Boulevard Casselberry, FL 1-Pedestrian Bridge Frame

$0 $3,530Basic

025003 808 Mark David Boulevard Casselberry, FL 2-Picnic Shelters (#1-$23,860 #2-$19,520) Frame

$0 $43,380Special Form

030003 808 Mark David Boulevard Casselberry, FL 2-Baseball Scoreboards Joisted Masonry

$0 $6,800Special Form

031003 808 Mark David Boulevard Casselberry, FL 2-Basketball Backboards Non-Combustible

$0 $3,880Special Form

032003 808 Mark David Boulevard Casselberry, FL 3-Chain Link Fences (300 LF-$2,930 60

LF-$587 420 LF-$6,010)

Non-Combustible

$0 $9,527Special Form

033003 808 Mark David Boulevard Casselberry, FL 1-MCC Panel Non-Combustible

$0 $1,570Special Form

034003 808 Mark David Boulevard Casselberry, FL 31-Metal Garbage Cans Non-Combustible

$0 $13,640Special Form

035003 808 Mark David Boulevard Casselberry, FL 1-Retaining Wall Non-Combustible

$0 $3,810Special Form

036003 808 Mark David Boulevard Casselberry, FL 2-Swimming Pool Concrete

(1-306sf-$18,800 1-2,220sf-$136,000)

Masonry

Non-Combustible

$0 $154,800Special Form

037003 808 Mark David Boulevard Casselberry, FL 1-Park Sign Non-Combustible

$0 $2,500Special Form

038003 808 Mark David Boulevard Casselberry, FL 3-Baseball Backstops (Full $5,710-Lg

$7,820-Sm $3,980)

Non-Combustible

$0 $17,510Special Form

039003 808 Mark David Boulevard Casselberry, FL Barbecue Pit Non-Combustible

$0 $140Special Form

040003 808 Mark David Boulevard Casselberry, FL 1-Basketball Court w/Lighting Non-Combustible

$0 $33,800Special Form

041003 808 Mark David Boulevard Casselberry, FL 4-Dugouts Non-Combustible

$0 $56,000Special Form

042003 808 Mark David Boulevard Casselberry, FL 1-Flagpole Frame

$0 $1,360Special Form

043003 808 Mark David Boulevard Casselberry, FL 2-20' Light Poles Wood Frame

$0 $2,900Special Form

PR-SCHED 1014 Page 2 of 16

October 1, 2017 - October 1, 2018

AddressLocation # Occupancy Construction Type

Cause of Loss - Building Limit Cause of Loss - Personal Property LimitBldLoc

044003 808 Mark David Boulevard Casselberry, FL 7-50' Light Poles Frame

$0 $33,250Special Form

045003 808 Mark David Boulevard Casselberry, FL 1-Modular Play System Non-Combustible

$0 $22,550Special Form

046003 808 Mark David Boulevard Casselberry, FL 2-Motors (1.5hp-$1,470 5hp-$1,550) Non-Combustible

$0 $3,020Special Form

047003 808 Mark David Boulevard Casselberry, FL 1-Pump 1.5hp Non-Combustible

$0 $4,370Special Form

048003 808 Mark David Boulevard Casselberry, FL 3-Swing 2 Seats Non-Combustible

$0 $3,870Special Form

049003 808 Mark David Boulevard Casselberry, FL Park Sign Frame

$0 $2,500Special Form

050003 808 Mark David Boulevard Casselberry, FL Horizontal Monkey Ladder Frame

$0 $880Special Form

051003 808 Mark David Boulevard Casselberry, FL 7-Park Benches Frame

$0 $3,640Special Form

052003 808 Mark David Boulevard Casselberry, FL 13-Picnic Tables Frame

$0 $9,360Special Form

053003 808 Mark David Boulevard Casselberry, FL 18-Pool Lounge Chairs @ $120 each Frame

$0 $2,160Special Form

054003 808 Mark David Boulevard Casselberry, FL 1-Water Fountain Spout Frame

$0 $1,300Special Form

001004 700 Cross Street Casselberry, FL Administration Building - WWTP Joisted Masonry

$64,759 Special Form$301,000Special Form

002004 700 Cross Street Casselberry, FL Pump Station - WWTP Masonry

Non-Combustible

$208,200 Special Form$106,000Special Form

003004 700 Cross Street Casselberry, FL Diesel Fuel Tank - WWTP Non-Combustible

$2,700 Special Form$85,000Special Form

004004 700 Cross Street Casselberry, FL Vertical Tanks - WWTP Frame

$200 Special Form$8,000Special Form

005004 700 Cross Street Casselberry, FL Extended Aeration Tanks - WWTP (Plant

1)

Masonry

Non-Combustible

$97,200 Special Form$3,059,000Special Form

006004 700 Cross Street Casselberry, FL Headworks - WWTP Non-Combustible

$92,300 Special Form$140,000Special Form

007004 700 Cross Street Casselberry, FL Casselberry Animal Control - WWTP Joisted Masonry

$68,300 Special Form$68,000Special Form

009004 700 Cross Street Casselberry, FL Surge Tanks - WWTP Masonry

Non-Combustible

$63,000 Special Form$507,000Special Form

010004 700 Cross Street Casselberry, FL Concrete Tanks - WWTP Masonry

Non-Combustible

$545,600 Special Form$17,000Special Form

011004 700 Cross Street Casselberry, FL Dyna Sand Filters - WWTP Masonry

Non-Combustible

$3,800 Special Form$119,000Special Form

PR-SCHED 1014 Page 3 of 16

October 1, 2017 - October 1, 2018

AddressLocation # Occupancy Construction Type

Cause of Loss - Building Limit Cause of Loss - Personal Property LimitBldLoc

012004 700 Cross Street Casselberry, FL ABW Filter - WWTP Masonry

Non-Combustible

$44,800 Special Form$382,000Special Form

013004 700 Cross Street Casselberry, FL Chlorine Contact Chamber Masonry

Non-Combustible

$9,200 Special Form$162,000Special Form

014004 700 Cross Street Casselberry, FL 2 MG Water Storage Tank - WWTP Masonry

Non-Combustible

$25,000 Special Form$1,157,000Special Form

015004 700 Cross Street Casselberry, FL 1 MG Water Storage Tank - WWTP Masonry

Non-Combustible

$25,000 Special Form$786,000Special Form

016004 700 Cross Street Casselberry, FL TPS - WWTP Masonry

Non-Combustible

$33,400 Special Form$33,000Special Form

017004 700 Cross Street Casselberry, FL Chlorine Building - WWTP Masonry

Non-Combustible

$25,100 Special Form$72,000Special Form

018004 700 Cross Street Casselberry, FL Horizontal Metal Tank - WWTP Non-Combustible

$87,000 Special Form$87,000Special Form

019004 700 Cross Street Casselberry, FL Sludge Drying Beds Masonry

Non-Combustible

$3,300 Special Form$103,000Special Form

020004 700 Cross Street Casselberry, FL Digester 1 - WWTP Masonry

Non-Combustible

$48,600 Special Form$436,000Special Form

021004 700 Cross Street Casselberry, FL Digester 2 - WWTP Masonry

Non-Combustible

$38,400 Special Form$115,000Special Form

022004 700 Cross Street Casselberry, FL High Service Pumps Non-Combustible

$146,900 Special Form$5,000Special Form

023004 700 Cross Street Casselberry, FL Animal Control Bldg Joisted Masonry

$3,343 Special Form$34,500Special Form

001005 101 W. Melody Lane Casselberry, FL Storage Bldgs Non-Combustible

$10,000 Special Form$57,500Special Form

001006 720 N. Semoran Boulevard Casselberry, FL WTP Office - Howell Park Water Plant Masonry

Non-Combustible

$20,727 Special Form$140,000Special Form

002006 720 N. Semoran Boulevard Casselberry, FL 750K Water Storage Tank - Howell Park

Water Plant

Masonry

Non-Combustible

$112,930 Special Form$763,000Special Form

003006 720 N. Semoran Boulevard Casselberry, FL 250K Water Storage Tank - Howell Park

Water Plant

Masonry

Non-Combustible

$499,829 Special Form$435,000Special Form

004006 720 N. Semoran Boulevard Casselberry, FL Generator Bldg - Howell Park Water

Plant

Masonry

Non-Combustible

$174,692 Special Form$152,000Special Form

005006 720 N. Semoran Boulevard Casselberry, FL Pump Bldg - Howell Park Water Plant Masonry

Non-Combustible

$2,562 Special Form$17,000Special Form

PR-SCHED 1014 Page 4 of 16

October 1, 2017 - October 1, 2018

AddressLocation # Occupancy Construction Type

Cause of Loss - Building Limit Cause of Loss - Personal Property LimitBldLoc

001007 530 Bridle Path Casselberry, FL 1 MG Water Storage Tank - North WTP Joisted Masonry

$908,588 Special Form$831,000Special Form

002007 530 Bridle Path Casselberry, FL WTP Office - North Water Treatment

Plant

Masonry

Non-Combustible

$305,422 Special Form$490,000Special Form

003007 530 Bridle Path Casselberry, FL 1 MG Water Storage Tank - North WTP Masonry

Non-Combustible

$908,588 Special Form$831,000Special Form

001009 100 Casselton Drive Casselberry, FL WTP Office - South WTP Masonry

Non-Combustible

$66,854 Special Form$397,000Special Form

002009 100 Casselton Drive Casselberry, FL Elevated Storage Tank - South WTP Masonry

Non-Combustible

$0 $690,000Special Form

003009 100 Casselton Drive Casselberry, FL Ground Storage Tank - South WTP Joisted Masonry

$105,749 Special Form$756,000Special Form

004009 100 Casselton Drive Casselberry, FL 500K Water Storage Tank - South WTP Masonry

Non-Combustible

$61,863 Special Form$442,000Special Form

001010 200 N Triplet Lake Drive Casselberry, FL Restrooms - Secret Lake Park Joisted Masonry

$0 $34,500Special Form

002010 200 N Triplet Lake Drive Casselberry, FL Storage Bldg/Workshop - Secret Lake

Park

Frame

$28,078 Special Form$93,000Special Form

003010 200 N Triplet Lake Drive Casselberry, FL Picnic Shelter - Secret Lake Park Frame

$0 $2,308Special Form

004010 200 N Triplet Lake Drive Casselberry, FL Senior Center - Secret Lake Park Masonry

Non-Combustible

$8,023 Special Form$1,198,000Special Form

005010 200 N Triplet Lake Drive Casselberry, FL Gazebo - Secret Lake Park Frame

$0 $6,657Special Form

006010 200 N Triplet Lake Drive Casselberry, FL Racquetball Bldg - Secret Lake Park Joisted Masonry

$0 $23,064Special Form

009010 200 N Triplet Lake Drive Casselberry, FL 7-Portable Bleachers Frame

$0 $10,010Special Form

010010 200 N Triplet Lake Drive Casselberry, FL 1-Boardwalk Frame

$0 $520,840Basic

011010 200 N Triplet Lake Drive Casselberry, FL 2-Canopies Frame

$0 $5,000Special Form

020010 200 N Triplet Lake Drive Casselberry, FL 3-Marinas (#1 420sf-$20,350 #2

560sf-$26,820 #3 243sf-$12,320)

Joisted Masonry

$0 $59,490Basic

024010 200 N Triplet Lake Drive Casselberry, FL 2-Picnic Shelters (1@$24,990 1@3$9,600) Frame

$0 $34,590Special Form

034010 200 N Triplet Lake Drive Casselberry, FL Pavilion Frame

$0 $37,086Special Form

035010 200 N Triplet Lake Drive Casselberry, FL Fishing Pier Frame

$0 $65,029Basic

PR-SCHED 1014 Page 5 of 16

October 1, 2017 - October 1, 2018

AddressLocation # Occupancy Construction Type

Cause of Loss - Building Limit Cause of Loss - Personal Property LimitBldLoc

036010 200 N Triplet Lake Drive Casselberry, FL 1-10' Chain Link Fences Non-Combustible

$0 $5,370Special Form

037010 200 N Triplet Lake Drive Casselberry, FL 3-20' Light Poles (1@$4,350/2@

$2,480ea/2@$3,100ea)

Non-Combustible

$0 $15,510Special Form

038010 200 N Triplet Lake Drive Casselberry, FL 7-50' Light Poles (2-$6,500ea 1-$7,130

4-$10,870ea)

Non-Combustible

$0 $63,610Special Form

039010 200 N Triplet Lake Drive Casselberry, FL 16-Metal Garbage Cans @ $440each Non-Combustible

$0 $7,040Special Form

040010 200 N Triplet Lake Drive Casselberry, FL 1-Racquetball Court Non-Combustible

$0 $107,180Special Form

041010 200 N Triplet Lake Drive Casselberry, FL 3-Retaining Walls (1-148sf-$3,810

1-108sf-$2,780 1-120sf-$3,090)

Non-Combustible

$0 $9,680Special Form

042010 200 N Triplet Lake Drive Casselberry, FL 1-Baseball Backstop Lg. Non-Combustible

$0 $7,820Special Form

043010 200 N Triplet Lake Drive Casselberry, FL 3-Barbecue Pits Non-Combustible

$0 $420Special Form

044010 200 N Triplet Lake Drive Casselberry, FL 1-Basketball Court w/Lighting Frame

$0 $38,174Special Form

045010 200 N Triplet Lake Drive Casselberry, FL 1-Tennis Court w/Fence & Lighting Frame

$0 $102,077Special Form

046010 200 N Triplet Lake Drive Casselberry, FL 2-Dugouts 10x20 Non-Combustible

$0 $28,000Special…