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POO'k3ti11 fI i .,
<br />ASSURANCE
<br />7501 E Lowry Blvd
<br />Denver, CO 80230 -7006
<br />Phone: (303) 361 -4000 / (800) 873 -7242
<br />Fax: (303) 381 - 50001(888) 329 -2251
<br />www.pinnaccl.coln
<br />Exhibit 1 - Insurance Cost Estimate
<br />December 19, 2012
<br />Policy #: 265
<br />Tier: Superior
<br />City of Louisville Human Resource Dep
<br />Attn: Kathleen Hix
<br />749 Main St
<br />Louisville, CO 80027
<br />The premium estimate provided expires 30 days from issuance. After expiration of the premium estimate, please
<br />contact Pinnacol Assurance for an updated estimate.
<br />Policyholder Disclosure Notice of Terrorism and Catastrophe Insurance Coverage
<br />Coverage for acts of terrorism is included in your policy. Under your existing coverage, any losses resulting from
<br />certified acts of terrorism would be partially reimbursed by the United States government. The United States
<br />government would pay 85% of our insured losses that exceed our insurer deductible.
<br />Premium for terrorism is calculated on the basis of total payroll. The total Colorado payroll is divided by $100 and
<br />multiplied by the approved terrorism rate, $.01 per $100 of payroll. The calculation is expressed as
<br />(Colorado payroll / $100 X Approved Terrorism Rate = Premium). This premium is not subject to any other
<br />modification including, but not limited to, premium discount, experience rating, schedule rating, or retrospective
<br />rating.
<br />Additionally, all workers' compensation carriers are required to charge premium to cover large losses. Premium for
<br />Catastrophe (other than Certified Acts of Terrorism) is calculated on the basis of total payroll. The total Colorado
<br />payroll is divided by $100 and multiplied by the approved Catastrophe (other than Certified Acts of Terrorism) rate,
<br />$.01 per $100 of payroll. The calculation is expressed as (Colorado payroll/ $100 X Catastrophe (other than Certified
<br />Acts of Terrorism) Value = Premium). This premium is not subject to any other modifications including, but not limited
<br />to, premium discount, experience rating, schedule rating, or retrospective rating.
<br />Dividend
<br />Earning dividends is one of the many benefits that come from partnering with Pinnacol. We would like to remind you
<br />that, in the previous 12 months, your company did receive the benefit or $22,485.00 in dividends.
<br />Coverage Information for Policy 265 (Loss Control Dividend Plan)
<br />Location : 1
<br />City of Louisville Human Resource Dept
<br />749 Main St
<br />Louisville, CO 80027
<br />Period : 01/01/2013 - 01/01/2014
<br />Mass $I Description ECM Payroll Rate Preen Charge
<br />550605 EM STREET /ROAD CON 17.00 $689,406 4.470000 $30,816
<br />752005 EM WATERWORKS OPER 15.00 $523,917 2.770000 $14,513
<br />758005 EM SEWAGE DISPOS P 7.00 $303,263 2.150000 $6,520
<br />772005 EM POLICE OFFICERS 36.00 $2,486,267 2.900000 $72,102
<br />838005 EM AUTO SERVICE OR 2.00 $96,002 2.170000 $2,083
<br />881005 EM EXCLUSIVELY OFF 64.00 $2,756,945 .160000 $4,411
<br />881105 BD NON - SALARIED BD 118.00 $1,840,800 .040000 $736
<br />881105 EO NON - SALARIED BD 7.00 $109,200 .040000 $44
<br />901505 EM BUILDING OR PRO 2.00 $86,247 3.470000 $2,993
<br />906317 EM EXERCISE /HLTH 1 168.00 $1,033,562 1.130000 $11,679
<br />910205 EM PARKS N.O.C.-AL 25.00 $668,363 2.820000 $18,848
<br />941005 EM MUNICIPAL/TOWN/ 19.00 $1,382,669 1.140000 $15,762
<br />Pinnacal Assurance ' 7501 13 Lowry Blvd ' Denver, CO 50230
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