Delta Dental AgreementMEMORANDUM
January 16, 2002
TO:
FROM:
SUBJECT:
The Honorable Mayor and City Council Members
Michael C. Van Milligen, City Manager
Administrative Services and Financial Agreement Between the City of
Dubuque and Delta Dental Plan of Iowa
Personnel Manager Randy Peck is recommending approval of the Administrative
Services and Financial Agreement Between the City of Dubuque and Delta Dental Plan
of Iowa for services related to the administration of the City's dental plan.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Michael C. Van Milligen
MCVM/jh
Attachment
cc: Barry Lindahl, Corporation Counsel
Cindy Steinhauser, Assistant City Manager
Randy Peck, Personnel Manager
CITY OF DUBUQUE, IOWA
MEMORANDUM
December 7, 2001
TO:
Michael C. Van Milligen, City Manager
FROM:
Randy Peck
Personnel Manager
SUBJECT: Administrative Services and Financial Agreement Between the City of
Dubuque and Delta Dental Plan of Iowa
Attached is the Administrative Services and Financial Agreement between the City
of Dubuque and Delta Dental Plan of Iowa for services related to the administration of the
City's dental plan. The effective date of this agreement is July 1,2001. The administrative
fee for processing dental claims was increased from $2.53 per contract per month to $2.65
per contract per month. The administrative fee went into effect on July 1, 2001 and will
remain in effect through June 30, 2002, and was approved by the Health Care Committee
on May 13, 2001.
The only changes from the previous agreement involve substituting the word
"Deltal" to read "Delta Dental", substituting "schedule of fees" to read "financial exhibit" and
including a paragraph stating that the City has elected to waive aggregate stop-loss
coverage through Delta Dental. The reason for the extensive delay in receiving the final
version of the Administrative Services Agreement is due to the fact that we had to work out
some language issues with Delta Dental.
This agreement has been reviewed by Barry Lindahl and the Segal Company, our
benefit and actuarial consultant, and they found the terms to be acceptable. The Health
Care Committee has also approved the agreement.
I recommend that the agreement be approved. If you have any questions, please
feel free to call.
RP:bf
ADMINISTRATIVE SERVICES and FLNANCIAL AGREEMENT
Tills AGREEMENT is by and between Delta Dental Plan of Iowa (Delta Dental), and
City of Dubuque (Employer).
Group name
WHEREAS, the following circumstances exist:
Delta Dental is a nonprofit corporation authorized by the Commissioner of Insurance for the
state of Iowa to trmas~ business as a demal ser~4ce plan.
Employer desires to create or has established a dental benefits plan for its eligible
Employees.
Employer desires to enter into a financial arrangement with Delta Dental under which
Employer is solely responsible for the Claims Paid for covered dental services provided to its
lvlembers subject to the limitation on Employer's financial liabilky set forth in the stop toss
coverage provisions o£this Agreement.
Employer desires that Delta Dental pay claims for dental services furnished to Members and
provide other administrative services.
NOW, THEREFORE, in consideration oftbe mutual promises and covenants hareinaRer
set foah it is hereby agreed as follows:
1. Definitions.
"Administrative Fee" means either an amount per contract or a percentage
of Claims Paid, whichever is applicable, that Delta Dental charges the
Employer and which includes allocations for Delta Dental's cost of
administering Employer's plan and general operating costs. The
Administrative Fee during the Contract Period is stated in the Financial
Extfibit attached to this Agreement.
"Administrative Services" means those services to be performed by Delta
Dental for Employer in connection with this Agreement, including, but not
limited to the follo~ving: claims processing, customer services, accounting
services, actuarial ser~4ces, enrollment services, data processing services,
and such other related services as the parties may agree are appropriate and
necessary to accomplish the objectives of this Agreement. Administrative
Services expressly excludes any services for the administration of
continued dental coverage pursuant to the Consolidated Omn~us Budget
Reconciliation Act of 1985 (COBRA), as amended, or any state or federal
taw relating to continuation coverage of the Employer's plan.
"Agreement" means this Administrative Services and Financial
Agreemen~ Group Application, Financial Exhibit attached to it initially
and as such may be revised or amended, the Benefits Certificate(s), and the
Subscribers' names and/or applications for coverage.
~'Benefits Certificate" means the written document(s) which describe and
define a welfare benefit plan for dental services which the Employer
established lbr its Members.
"Claims" means claims for dental services that are furnished to Members
with a date of service as defined in the Financial Exhibit as Claims Eligible
for Payment.
"Claims Paid" means the amomat caIcuhted by deducting from the
Covered Cha~ges any amounts attributable to Provider Savings,
deductibles, copayment, coinsurance, or Contract Limitations as defined in
the Benefits Ce~ificate(s). The amount of Claims Paid dnfing the Contract
Period is determined by the date of Delta Dental's check or remittance.
"Contract Limitations" means the amounts which are the liability of the
Subscriber under this Ag~eament. These include the services which are not
covered, charges for dental services which are not dentally necessary,
penalties for failure to follow notification requirements, and charges for
services that have reached a contract max/mum.
"Contract Period" means the period of time set forth in the Financial
Extfibit or the most recent revision to the FinancLal Exhibit.
"Covered Charges" means the amount a provider bills a Member, or Delta
Dental, less services not covered. Services which are covered are those
dentally necessary and dentally appropriate procedures as outlined in the
Benefits Section of the Benefits Certificate(s).
"Delta Dental Allowance" means the amount which equals the lesser of
the Covered Charge for a service, supply, or any dental procedure covered
under the dental plan or an amount which Delta Dental establishes,
annually, as its maximum allowable fee for the same service or supply.
For all dental procedures covered under the plan, the maximum allowable
fee is established by Delta Dental Plan of Iowa for a covered dental
procedure that is dentally necessary and dentally appropriate. It is
developed fi:om various sources, such as contracts with dentists, input from
our dentist consultants, the simplicity or complexity of the procedure, and
the billed charge for the same procedures by dentists in Iowa.
For services billed by providers outside of Iowa, the max/mm allowable
fee is based on information from that state's Delta Dantal Plan.
"Employee" means an active Employee of Employer for purposes of
Social Security laws or who otherwise is included as an Employee as
required by law (or a member of the Board of Directors of an Employer).
"Incurred Date" means the date dental services are provided. With
regard to inpatient hospital or facility services, the date of admission is the
Incurred Date.
"Member" means any person entitled to receive dental benefits as defined
in the Benefits Certificate(s).
"Provider Savings" means the amount saved due to Delta Dental's
cunaacts with providers. It is calculated as the difference between the
Covered Charge and the Delta Dental Allowance.
2
"Subscriber" means any individual identified by Employer as a person
eligible for dental coverage subject to the terms, conditions and limitations
described in the Benefits Ce~ficate(s) and who is named on an
identification card issued by Delta Dental.
Responsibilities of Employer.
a. Furnishing Information. Employer agrees to furnish Delta Dental with
timely reports and irfformation in a form and manner required by Delta
Dental so that Delta Dental properly may discharge its responsibilities
tmd~r this Agreement, including but not limited to, information pertaining
to Members for the purpose of dete~xaining eligibility for coverage under
the Benefits Certificate(s), and information necessary for the proper
administration of coordination of benefits and other limitations and
exclusions contained in the Benefits Ce~ificate(s).
Persons Eligible for Coverage. Prior to the Effective Date of this
Agreement, Employer shall deliver to Delta Dental a list of the names
and/or completed applications for each person that Employer shall
desigrmte as being eligible for banefits set forth in the Benefits
Cc~rl/ficate(s).
On or before the first of each month thereafter Employer shall notify Delta
Dental in writing of those persons who are no longer eligible as of that
month, and thereafter Delta Dental shall not pay Claims for services
furnished such persons on or after the date of termination.
At any time during the Contract Period, Employer may certify to Delta
Dental the names of additional eligible persons. Delta Dental shall, from
and after the commencement date of coverage Delta Dental establishes for
such person, pay Claims with Incurred Dates on or after the effective date
of coverage in accordance with the terms and conditions set fo~h in this
Agreement.
Failure to Provide Information. Employer's failure to provide timely
and accurate information may cause Delta Dental to make incorrect
payments. In that event, Employer may be liable for all or part of any
incorrect payments made.
Payment of Claims and Administrative Fee. Employer authorizes Delta Dental
and Delta Dental agrees to process Claims on a regular basis, subject to the
limitations, conditions, and exclusions stated in the Benefits Certificate(s).
Employer will pay or reimburse Delta Dental for the Claims Paid and
Administrative Fee as set forth in this paragraph.
Weekly Actual Claims PaymenL Delta Dental will bill Employer weekly.
Once each week, Delta Dental will notify Employer of the total billing for
the week by fax (normally on Tuesday). Delta Dental will generate an ACH
transaction and draft the amount of the billing from the bank account
designated by Employer (normally on Friday). The weeldy billing will
include the total of claims for the week and the last week of the month will
also include the ,4dministrative Fee for the current month.
Late Payments. All payments must be paid on time in accordance with paragraph
3. If the Employer fails to make timely payments in full, Delta Dental may, at its
option, immediately stop the payment of all claims for the Employer's Members,
regardless of the Incurred Date and may terminate this Agreement retroactively to
the last day of the month for whinh full payment was made without any further
notice. Payments not made when due also w/ll be subject to an interest charge at
the then prevailing prime rate plus two percent (2%) per annum. The acceptance by
Delta Dental of any late payments or partial payments shall not constitute a waiver
of rids provision.
Aggregate Stop Loss Requirements for Public Entities
As a public entity the State o£Iowa requires the Employer to have Aggregate Stop
Loss Coverage for self-thnded health plans as de£med in the Iowa Admin/strative
Code. Employer has elected to waive Aggregate Stop Loss Coverage through Delta
Dental, th~efore it is the Employar's responsibility to ensure that the Employer
maintains Aggregate Stop Loss as requ/red by the Iowa Administrative Code.
6. Examination of Books and Records.
Delta Dental may examine the financial records of Employer reasonably
related to the administration of this Agreement, upon reasonable notice, as
often as Delta Dental deems appropriate, to determine whether Employar
has sufficient mounts on deposit to ensure payment of Chims and
Administrative Fee.
Employar or its authorized representative may examine or audit Delta
Dental's records reasonably related to Delta Dental's discharge of
Employer's liability to pay Claims. Such examination shall be conducted
during regular business hours, upon reasonable advance written notice.
Records subject to examination shall include case listings, th/rd-party
explanations of dental benefits, eligibility records, clakns history, and
coordination of benefits procedures. The exam/nation period may cover
the current Contract Period and the two years previous only. Upon
completion of the examination, Employer shall share its exam/nation
findings with Delta Dental and conduct an exit conference with Delta
Dental.
It is agreed that disclosure of any information under this paragraph to
Employer or Delta Dental has been made in reliance upon the other party's
representation that such information shall be used by it for the sole and
exclusive purpose of e~:amining or auditing information related to the
admirdstrafion of the dental plan. Such information shall not be disclosed
or otherwise made available to any person or organization not directly
involved in the eXannnation or audit and Delta Dental and Employer shall
implement whatever reasonable safeguards are necessary to ensure that
such information remains confidential, subject to the Iowa Public Records
Act, Iowa Code chapter 22.
7. Change of Agreement.
Delta Dental will provide Employer ninety (90) days prior written notice of
any amendment or termination under this paragraph.
Changes to this Administrative Services and Financial Agreement or
Benefits Cartificate(s) will be effective only when the written amendment
has been signed by authorized representatives of Delta Dental and the
Employer.
Liabilities of the Parties.
Employer has the liability for all Claims payments for its Members. DeRa
Dental has no liability for Claims ff Employer fails to pay or reimburse
Delta Dental in accordance with this Agreement.
Employer agrees to hold harmless and indemnify Delta Dental or any of its
directors, officers, or employees for any and ail loss, liability, damage,
expense, or other cost or obligation, including reasonable attorneys' fees,
resulting from and arising out of claims, demands, or lawsuits brought
against Delta Dental by Members, or other persons by reason of the
performance or nonperformance of Employer's responsibilities under this
Agreement, or in connection with benefits or coverage information
disclosed at Employer's request or disclosed during an examination or
audit of books and records, provided the directors, officers, or employees
of Deha Dental shall have performed their duties with ordinary care and
such directors, officers, or employees of Delta Dental shall not be liable for
any mistake of judgement or other action taken in good faith.
Delta Dental has made a good faith detc~raination of what the premium tax
liability shall be under this Agreement based upon Iowa Code Chapter 432.
If the governmental authority responsible for collecting such taxes
determines that additional taxes should have been assessed for the charges
collected by DeRa Dental under this Agreement, the Employer agrees to
inderunify Delta Dental for such liability.
DeRa Dental agrees to hold harmless and indemnify Employer or any of its
directors, officers, or employees for any and all loss, liability, damage,
expense, or other cost or obligation, including reasonable attorneys' fees,
resulting from and arising out of claims, demands, or lawsuits brought
against Employer by reasons of Delta Dental's failure to perform its
responsibilities under this Agreement (or policy).
Use of Trademarks. DeRa Dental and Employer reserve the right to control the use
of their respective corporate names and any other respective symbols, assumed
names, trademarks, and serv/ce marks, presently existing or subsequently
established. Delta Dental and Employer agree not to use the corporate name,
symbol, assumed names, trademarks, or service marks of the other in advextising,
promotional material, or otherwise without the prior written conscmt of the other.
Any previously approved usage will cease immediately upon the termination of this
Agreement and any materials using such names or marks are the property of the
appropriate namesake and will be returned to the appropriate property owner upon
request or at the termination of this Agreemant.
10. Term and Termination.
Term and Notice of Termination. This Agreemant shall become
effective on the date defined on the Financial Exhibit and shall continue in
force for the time period de£med in the Financial Exhibit. However, either
party may terminate this Agreement at any time by giving written notice of
termination delivered to the other party at least s/xty (60) days in advance
of the effective date of terminatiun.
Renewal Terms. The parties may agree to renew the Agreement for
successive Contract Periods as defined in the Financial Exhibit. Delta
Dental may change Administrative Fee, stop loss premiums and other
fmancial factors upon renewal.
Immediate Termination. Delta Dental may terminate this Agreement at
any time without notice if Employer fails to make timely and complete
payments in accordance with this Agreement, or Delta Dental determines
that the Employer has inadequate fimds to make payments required by this
Agreement. Delta Dental may terminate the Agrecraent retroactively to the
last day of the month for which Employer made full payment. Employer is
solely responsible for notifying its Subscribers of the termination of this
Agreement for nonpayment or for any other reason.
Effects of Termination. If Delta Dental terminates this Agreement for
nonpayment by the Employer, Delta Dental will not pay any Claims
beyond the effective date of the termination regardless of when the services
were received.
11.
12.
Any liability of either party to the other for mounts owed or owing, or for
indemnification for premium taxes under this Agreement shall not be extinguished
by the termination of this Agreement.
Termination and Claims Payments. If, following termination of this Agreement for
reasons other than Employer's nonpayment, Claims for the most recent Contract Period
are submitted to Delta Dental for payment in the period specified in the Benefits
Certificate(s) for timely filing of claims, Delta Dental will pay claims in accordance with
this Agreement and bill Employer in accordance with the procedures set forth in
paragraph 4 above.
Force Majeure. The parties to this Agreement shall be excused from performance
under this Agreement for any period during which they are prevented fi:om performing
any responsibilities under this Agreement, in whole or in part, as a result of an Act of
God, war, civil disturbance, court order, labor dispute, or other cause beyond its
reasonable control and such nonperformance shall not be grounds for termination or
default.
13.
Complete Agreement. The parties agree that this Agreement, including all Benefit
Certificate(s), Financial Exhibit, Amendments, Group Application for Coverage, and the
Subscribers' names and/or applications for coverage constitutes the "Complete
Agreement" between the parties and supersedes ail related discussions and
commun/cafions between the parties. All statements made by the employer to the
Employee or statements made by the Employee or h/s/her family members to their
dentist concerning what is covered in the Complete Agreement is deemed to be a
representation and not a Warranty. No statement by the Employer, Employee, or
members of the Employee's family concerning matters allegedly covered hi the
Complete Agreement shall be relied upon by the Employee's dental provider without
verifying that the coverage is set forth in the Complete Agreement.
14.
Governing Law. To the extent not superseded by the laws of the United States, tiffs
Agreement shall be construed in accordance with the laws of the State of Iowa. Any
action in regard to this Agreement or arising out of the terms of this Agreement shall be
instituted and litigated in the state or federal courts located in the State of Iowa and no
other.
15.
Notices and Communication. Delta Dental shall be entitled to rely upon any
communication or notice from the Employer to Delta Dental hi connection with this
Agreement to be genuine, truthful, and accurate, and to have been authorized, signed, or
6
issued by an officer or agent of Employer empowered to make such representation on
behalf of the Employer.
16. Delta Dental shall secure and maintain during the term of this Agreement insurance
coverage as set fo~di on the attached Insurance Schedule and shall cause the City of
Dubuque, Iowa, to be listed as an additional insured on said Delta Dental insurance
coverage.
The mailthg of written notices or other communications by regular U.S. Mail,
postage prepaid, shall be deemed sufficient service for the purpose of this
Agreement if addressed to the last address famished th writing.
Notice to Delta Dental Plan of Iowa may be addressed:
Delta Dental Plan of Iowa
2401 SE Tones Dr., Suite 13
Ankany, IA 50021
And until another address is furnished in writing, notice to Employer may be
addressed:
City of Dubuque
City Hall - 50 West Thirteenth Street
Dubuque, Iowa 52001-4864
IN WITNESS WHEREOF, the parties have executed this Agreement, in duplicate
counterparts, each counterpart being deemed as original, on the date stated below.
Employer
By
Title City Manager
Date
Title President and CEO
Title S~ecretary
Date
FINANCIAL EXHIBIT
Employer/Plan Sponsor Full Legal Name and Address
City of Dubuque
City Hall - 50 West Thirteenth Street
Dubuque, IA 52001-4864
Contract Period
Original Effective Date of Funding Arrangement
Schedule Date 07/01/01
Contract Period to Which this Schedule is Applicable
Begins 07/01/01 and Ends
07/01/89
06/30/02
C]almn Eligible for Payment
1. [] Incurred means Claims with dates of service within the Contract Period
md means all Clatms regardiess of Incurred Date
Fixed Fees
Aggregate Total
Administrative Stop Loss Fixed
Fee Premium Fees
Single $2.65 $0.00 $2.65
Family $2.65 $0.00 $2.65
Aggregate Stop Loss Coverage
Aggregate Attachment Point is N/A of projected Claims Paid.
Aggregate Attachment Point
Single N/A
Family N/A
Losses Eligible for Reimbursement
1. [] "12/12" means the Losses were Incurred and Paid within the Contract Period
2. [] "Paid" means the Losses were Paid within the Contract Period. Losses must
have been incurred on or after the effective date of the Agreement.
3. [] "12/18" means the Losses were Incurred and Paid within that same Contract
Period er within the six months following the end of the Contract Period.
4. [-~ Not Applicable
Weekly Traost'er Amount Weekly Actual
INSURANCE SCHEDULE C
INSURANCE REQUIREMENTS FOR PROFESSIONAL SERVICES
All policies of insurance required hereunder shall be with an insurer authorized to
do business in Iowa. All insurers shall have a rating of A or better in the current
A.M. Best Rating Guide.
All policies of insurance required hereunder shall be endorsed to provide a thirty
(30) day advanced notice to the City of Dubuque of any cancellation of the policy
pdor to its expiration date. This endorsement supersedes the standard
cancellation statement on the Certificate of Insurance.
shall furnish Certificates of Insurance to the
City of Dubuque, Iowa for the coverage required in Paragraph 7. Such
certificates shall include copies of the endorsements set forth in Paragraphs 2
and 5 to evidence inclusion in the policy. . shall
also be required to provide Certificates of Insurance of all subcontractors, and all
sub-subcontractors who perform work or services pursuant to the provisions of
this contract. Said certificates shall meet the same insurance requirements as
are required of
Each Certificate of Insurance shall be submitted to the contracting department of
the City of Dubuque, Iowa prior to commencement of work/service. (The
contracting department shall submit the certificates to the Finance Director.)
All policies of insurance required in Paragraph 7 shall include the City of
Dubuque, Iowa under the attached Additional Insured Endorsement (CG2026)
and the attached Governmental Immunities Endorsement.
Failure to provide evidence of minimum coverage shall not be deemed a waiver
of these requirements by the City of Dubuque. Failure to obtain or maintain the
insurance required herein shall be considered a material breach of this
agreement.
., subcontractors, and all sub-subcontractors
shall be required to carry the following minimum insurance coverages or greater
if required by law or other legal agreement:
PROFESSIONAL LIABILITY:
$1,000,000
COMMERCIAL GENERAL LIABILITY:
General Aggregate Limit
Products-Completed Operation Aggregate Limit
Personal and Advertising Injury Limit
Each Occurrence Limit
Fire Damage Limit (any one occurrence)
Medical Payments
$ 2,000,000
$'1,000,000
$1,000,000
$1,000,000
$ 50,000
$ 5,000
Commercial general liability shall be written on an occurrence form, not a claims
made form. Coverage to include premises-operations-products-completed
operations, independent contractors coverage, contractual liability, broad form
property damage, and personal injury.
UMBRELLA OR EXCESS LIABILITY:
* TO be determined on a case-by-case basis by Finance Director.
~OLICY NUMBER: COMMERCIAL GENERAL L[AnlL[TY
THIS ENDOESEI~.tENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Pemon or Organization:
The City of Dubuque, including al% i~s elected and appointed officials,
ail' its employees and volunteers, a11 its boards, co~ssio~s and/or
auchoritles and their board members, employees, and volunteers.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II} is amended to include as an insured the person or organization shown
in the Schedule as an insured but only with respect to liability arising out or'your operations or premises
owned by or rented to you.
CITY OF DUBUQUE, IOWA
GOVERNMENTAL IMMUNITIES ENDORSEMENT
Nonwaiver of Governmental Immunity. The insurance carder expressJy agrees and
states that the purchase of this policy and the including of the City of Dubuque, Iowa
as an Additional Insured does not waive any of the defenses of governmental
immunity available to the City of Dubuque, Iowa under Code of Iowa Section 670.4
as it is now exists and as it may be amended form time to time.
CJaJJ2,s~2~e~. The insurance carrier further agrees that this policy of insurance
shall cover only those claims not subject to the defense of governmental immunity
under the Code of Iowa Section 670,4 as it now exists and as it may be amended
from time to time, Those claims not subject to Code of Iowa Section 670.4 shall be
covered by the terms and conditions of this insurance policy.
Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible
for asserting any defense of governmental immunity, and may do so at any time and
shall do so upon the timely written request of the insurance carrier.
Non-Denial of Coverage. The insurance carrier shall not deny coverage under this
policy and the insurance carder shall not deny any of the rights and benefits
accruing to the City of Dubuque, Iowa under this policy for reasons of governmental
immunity unless and until a court of competent jurisdiction has ruled in favor of the
defense(s) of governmental immunity asserted by the City of Dubuque, Iowa.
No Other Change in Policy. The above preservation of governmental immunities shall
not otherwise change or alter the coverage available under the policy.
AC_0_RD 'CERTIFICATE OF LIABILITY INSURANCE
12/27/2001
PRCOUCER Holmes Murphy & Associates
3100 Westown Parkway
West Des Moines
(800) 532-1540
IA 50265
INSURED
Delta Dental Plan of Iowa
2401 SE Tones Drive ~13
Ankeny [ IA 50021
COVERAGES
THIS CERTIFICATE IS ISSUED AS A MA'CFER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
INSURERk Chubb Custom Ins Co
INSURER B:
INSURER C:
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I POMCY EFFECTIVE ' POLICY EXPIRATION
LTR TYPE OF INSURANCE PO!.JCY NUMSER DATE (MM/DD/YY) CATE {M M/DDt) LIMITS
GENERAL LIABILITY EACH OCCURRENCE I $ 1, 000, 000
MMERCIAL GENERAL LIABILITY i l, 0 0 0 0 0 0
FIRE
CAMAGE
(Any
$
A 35357170 1/1/2002 1/1/2003 PERSONAL & ADV INJURY $ 1,000,000
~ GENERAl_AGGREGATE $ 2,000,000
~ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000
AUTOMOBILE LIABILWY
COMBINEC SINGLE LIMIT 1, 0 0 0, 0 0 0
i ~ ANy AUTO (La accident) $
ALL OWNED AUTOS
-- BODILY iNJURY
(Per person) $
A __ SCHEDULED AUTOS 35357170 1/1/2002 1/1/2003
X HIREDAUTOS BODILY INJURY
~ X NON-OWNEDAUTOS (Peraccident) $
X ~usiness Automobile
PROPERTY DAMAGE
(Per accident) $
{ GARAGE LIABILITY AUTO ONLY. EA ACCIDENT $
} AGG $
EXCESS LL~,BILITY EACH OCCURRENCE $ 2, 000, 000
X I OCCUR ~] CLAJMSMADE AGGREGATE $ 2, 000, 000
A 79760138 1/1/2002 1/1/2003 $
DEDUCTIBLE $
' RETENTION $ 10, 0 0 0 $
wOSKERS O..E.SAT,ON ANC x I TORY"M,TS I'
A 71646107 1/1/2002 1/1/2003 E.L. EACH ACCIDENT $ 100 , 000
E.L. DISEASE - EA EMPLOYEE $ 1 0 0 , 0 0 0
I I E.LDISEASE.POUCYLIMJTJ$ 500,000
Additional Insured(GL): City of Dubuque, Iowa
CERTIFICATE HOLDER I I ADDITIONALINSURED;INSURER LETTER:
CANCELLATION
City of Dubuque
Attn: Randy Peck
50 West 13th Street
Dubuque IA 52001
SHOULD ANy OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
CATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~(~ DAYS WRITYEN
NOTICE TO THE CERq]FICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LJABILITY OF ANY KIND UPON THE INSURER, iTS AGENTS OR
ACORD 25'S (7/97) CORPORATION 1988
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