Chelsea Place Homeowners Association, Inc (Rene Account #: App Type: Prop. Eff. Date: App Status: Agency Code: Producer: 9141 Renewal 2/16/2020 In Rating S120 Joseph Dreher Sent To Rating: 1/9/2020 Last Status Change: 1/9/2020 Last Saved as CAU: 1/8/2020 First Saved as CAU: 1/8/2020 Date Created: 1/8/2020 Submission Count: 1 Producer Notes NOTE FROM PREVIOUS APPLICATION: NOTE FROM PREVIOUS APPLICATION: NOTE FROM PREVIOUS APPLICATION: NOTE FROM PREVIOUS APPLICATION: Association is responsible for .25 of roadway.
Underwriting Notes CAU GEN APP (06/19) Page 1 of 12 I. General Information Community Association Type: ☑ Residential Condominium Cooperative Apartment Homeowners Association (with residential building coverage) Homeowners Association (with NO residential building coverage) Homeowners Association – Master (comprised of members of affiliated community associations) Office Condominium Required Attachments: Complete declarations and bylaws (not just insurance sections) Current financial statement including auditor's management letter Current photographs of representative residential buildings and nonresidential buildings Site plan Currently valued insurance company loss runs Additional attachments may be required. A description of the necessary attachment will follow the symbol.
A. Association Name (Legal name based on articles of incorporation or filings on record with the State): Chelsea Place Homeowners Association, Inc.
B.
Association Mailing Address (C/O, Street, City, State, Zip Code): 414 Drexel Avenue 414 Drexel Avenue Decatur, GA 30030 C. Association Billing Address (C/O, Street, City, State, Zip Code or check ☑ if same as B.): 414 Drexel Avenue 414 Drexel Ave.
Decatur, GA 30030 D. Proposed Effective Date (mm/dd/yy): Is account being quoted midterm?
lling Address (C/O, Street, City, State, Zip Code or check ☑ if same as B.): 414 Drexel Avenue 414 Drexel Ave.
Decatur, GA 30030 D. Proposed Effective Date (mm/dd/yy): Is account being quoted midterm?
02/16/2020 Does your agency currently write this account?
Is this account being brokered?
E. Agency Name: Dreher Insurance Agency F. Independent Community Management Firm Name: None G. Independent Community Management Firm Address: ✓ yes ☐ no Producer Name: Joseph Dreher Site Manager Name: Site Manager Email: Site Manager Phone: Site Manager Fax: H. Inspection Contact Name: Mark Bussey Phone: Fax: Email: Position: BOARD PRESIDENT Phone: (404) 320-4000 Fax: (404) 320-4007 Email: [email protected] Mailing Address: I. Board Member Contact Name: Mark Bussey Mailing Address: Position: Board Member Phone: (404) 320-4000 II. Property Location Fax: Email: [email protected] CAU GEN APP (06/19) Page 2 of 12 County: Dekalb State: GA Zip Code: 30030 City or Municipality: Decatur Fire Protection: Name of the responding fire department: Is the responding fire department located within 2 miles?
Fire hydrants are located within how many feet from the building?
MORTGAGE HOLDERS AND INSURANCE TRUSTEES Provide the following for each: Type: Name: Address: City, State, Zip Code: Loan Number: ☐ yes ☐ no feet III. Residential Ownership and Occupancy Information Indicate total number of units: Built Sold Planned Owner occupied Owner occupied for periods less than 6 months Rented on annual basis Rented for periods less than 6 months Timeshare or Fractional Ownership EXCLUDED EXPOSURES # 11 # 11 # 11 # 10 #0 # 1 # 0 # 0
upied Owner occupied for periods less than 6 months Rented on annual basis Rented for periods less than 6 months Timeshare or Fractional Ownership EXCLUDED EXPOSURES # 11 # 11 # 11 # 10 #0 # 1 # 0 # 0 Endorsement form CAU 3318 Exclusion - Specified Activities is required for secondary residence associations, timeshare and fractional ownership associations. The following exposures are excluded by this endorsement: 1. Armed security or guard dog services; 2. Hunting or archery; 3. Indoor or outdoor pistol, trap, or skeet shooting ranges; 4. Day care, medical, first aid or nursing facilities; 5. All terrain vehicles, ski areas, skiing activities, snowmobiling, parasailing, water skiing, or water ski jets; 6. Saddle animals, horseback riding clubs or any other equestrian activities or facilities; and 7. Beauty, salon, and spa facilities, products, and services including but not limited to therapeutic, massage, wellness, aesthetic, tanning, facials, body treatments, aromatherapy and personal beautification services.
IV. Rating Information - Property and Crime Coverages ALL COVERAGES, LIMITS AND DEDUCTIBLES ARE SUBJECT TO UNDERWRITING APPROVAL.
D. OTHER BUILDINGS AND STRUCTURES: Coverage for other buildings and structures is provided on a guaranteed replacement cost basis.
Year Association was established: 1987 1. Structures: Cabanas, recreation courts and fixtures, pool houses, gates, gate houses, storage sheds, shelters, mailboxes, gazebos, pump houses, fences, walkways, roadways, other paved surfaces, outdoor fixtures, outdoor "swimming pools", flagpoles, light poles, fountains, outside statues, detached signs, temporary seasonal structures, and freestanding walls, other than retaining walls.
$ 90,000 Total 100% Insurable Replacement Cost
", flagpoles, light poles, fountains, outside statues, detached signs, temporary seasonal structures, and freestanding walls, other than retaining walls.
$ 90,000 Total 100% Insurable Replacement Cost 2. Other Buildings and Other Structures Not described in Section D1 : Coverage applies only if other buildings or other structures are listed in the policy declarations addresses and description of buildings.
Is there any building or structure type not shown in D.1?
CAU GEN APP (06/19) Page 3 of 12 E. COMMUNITY PERSONAL PROPERTY AND PROPERTY CONTAINED IN UNITS: 1. Community Personal Property: Do not include the value of any property covered under section IV.I.
OTHER PROPERTY COVERAGES.
100% replacement cost Limit 3. Scheduled Community Personal Property Limit Attach schedule $ 10,000 $0 F. DEDUCTIBLES: The minimum basic deductible is $1,000. Higher optional deductibles are available for: Basic: Water Damage: Sprinkler Leakage: Sewer Backup: $2,500 $ ☐ $ ☐ $5,000 ☐ Apply deductible per unit Apply deductible per unit Apply deductible per unit Apply deductible per unit Wind or Hail: Percentage Deductible OR Occurrence Deductible (Applies per building/community personal property/structure based on replacement cost) Other % $5,000 $10,000 $15,000 $20,000 $25,000 $50,000 $ Other G. CONSEQUENTIAL COVERAGES: Coverage is provided for MAINTENANCE FEES AND ASSESSMENTS, COMMUNITY INCOME and ACCOUNTS RECEIVABLE EXPENSES on an actual loss sustained basis. Coverage is provided for EXTRA EXPENSE on an actual cost basis.
Maintenance Fees and Assessments (Rents on Co-ops) $10,000 Annual Receipts
COUNTS RECEIVABLE EXPENSES on an actual loss sustained basis. Coverage is provided for EXTRA EXPENSE on an actual cost basis.
Maintenance Fees and Assessments (Rents on Co-ops) $10,000 Annual Receipts H. EQUIPMENT BREAKDOWN (Boiler and Machinery): Coverage is included for equipment breakdown on a guaranteed replacement cost basis.
Does any building have a hot water or steam boiler?
Does any building have a central air conditioning system servicing the entire building?
☐ yes ☑ no I. OTHER PROPERTY COVERAGES: Basic Limits are included at no additional premium. Limits may be increased.
Coverage / Covered Property Basic Limit Increased Limit Coverage/Covered Property Basic Limit Increased Limit Bridges, Bulkheads, Docks, Piers, Retaining Walls and Wharves $ 10,000 $ Personal Property of Others: Natural Outdoor Property Maximum per Tree, plant, or shrub $20,000 $ $1,000 Per Person $5,000 $ Per Occurrence $15,000 $ Include golf course Newly Acquired Buildings and Structures $250,000 $ Off Premises Community Newly Conveyed Buildings and Structures $250,000 Personal Property $50,000 $ Community Personal Property Newly Acquired Community Personal Property $250,000 $ In Transit $50,000 $ Fine Arts: Per item Per Occurrence Attach schedule Personal Effects: $15,000 $ $50,000 $ Debris Removal $300,000 $ Property Removal $300,000 $ Per Person Per Occurrence Removal of Fallen Trees Per Occurrence $5,000 $ $15,000 $ $ 10,000 $ Fire Extinguisher Recharge $1,000 $ Pollutant Clean Up and Removal Maximum Per Tree $1,000 $25,000 per 12 month period J. Is EARTHQUAKE AND VOLCANIC ERUPTION Coverage desired?
CAU GEN APP (06/19) Page 4 of 12 K. Is Power Failure or Interruption Coverage- Sump Pump desired?
If yes, Form CAU 3208 applies
riod J. Is EARTHQUAKE AND VOLCANIC ERUPTION Coverage desired?
CAU GEN APP (06/19) Page 4 of 12 K. Is Power Failure or Interruption Coverage- Sump Pump desired?
If yes, Form CAU 3208 applies L. Is Additional Claims Expenses coverage desired?
If yes, Form CAU 3207 applies ☐ yes > no ☐ yes > no M. CRIME COVERAGES: EMPLOYEE DISHONESTY, COMPUTER FRAUD, DEPOSITORS FORGERY: Basic limit is included at no additional premium. Limit may be increased, or Actual Loss Sustained option may be selected. Optional coverage to include the independent community manager and firm is included and is subject to underwriting approval. Coverage can not be increased if the developer, sponsor, builder or their representatives are on the board of directors.
Basic Limit $150,000 *FNMA requires a coverage limit equal to 3 months of assessments plus reserves.
OR ☐ Actual Loss Sustained Limit Option $ 0 total amount of 3 months of association income + the amounts of all reserve accounts ☑ Do not include coverage for independent community manager and firm N. Is Deductible Allowance endorsement CAU 3227 desired?
O. Is Deductible Credit endorsement CAU 3226 desired?
P. Is Cosmetic Damage Exclusion endorsement CAU 3222 desired?
☐ yes > no ☐ yes > no V. Rating Information - Liability Coverages A. GENERAL LIABILITY No General Aggregate applies. Limit equals the sum of primary and excess/umbrella per occurrence limits. The basic GL limit is $1,000,000. The limit may be increased.
Increased GL Limit $2,000,000 B. Is DIRECTORS AND OFFICERS LIABILITY coverage desired?
☑ yes □ no
.
Increased GL Limit $2,000,000 B. Is DIRECTORS AND OFFICERS LIABILITY coverage desired?
☑ yes □ no Coverage is provided on a claims made basis. An Annual Aggregate applies. The minimum offered limit of $1,000,000 may be increased but can not exceed General Liability limit chosen in A. above. Coverage is provided for independent community manager and firm. Full prior acts coverage is provided when "None" is shown as the Retroactive Date on the policy declaration page.
Increased D&O Limit $2,000,000 ☐ $9,000,000 $10,000,000 ☑Do not include coverage for independent community manager and firm ☐ Include Counsel Select form CAU 3042. An additional premium applies. Premium is fully earned.
C. ENVIRONMENTAL IMPAIRMENT LIABILITY Coverage is provided on a claims made basis. Annual Aggregate applies. The basic liability limit is $500,000. The limit may be increased. The minimum retention is $5,000. Coverage for Underground Storage tanks applies only when scheduled on the policy.
Increased EIL Limit ☐ Sewage Treatment Facility EIL Retention ☐ $0 # 0 $10,000 ☐ $25,000 Underground Storage Tanks ☐ Do not include coverage for Environmental Impairment Liability D. CYBER SUITE Annual Aggregate applies. The basic limit is $25,000. The limit may be increased.
CAU GEN APP (06/19) Page 5 of 12 The minimum deductible is $1,000.
Liability coverages are provided on claims made basis.
☑Do not include coverage for Cyber Liability E. GARAGE AND PARKING AREA LEGAL LIABILITY
is.
☑Do not include coverage for Cyber Liability E. GARAGE AND PARKING AREA LEGAL LIABILITY Basic coverage limits of $25,000 apply separately for comprehensive and collision. These limits may be increased. The basic deductible is $500.
Increased Limit Higher Deductible Comprehensive Collision $25,000 $25,000 F. Is EMPLOYEE BENEFITS LIABILITY coverage desired?
G. HIRED AND NONOWNED AUTO LIABILITY Coverage for hired and nonowned auto liability will be included at the general liability occurrence limit. No primary coverage is provided for hired and nonowned auto liability if there is an owned auto exposure.
#0 Owned Autos H. RATING EXPOSURES # of Annual Receipts Square Footage Swimming pools (Not wading pools) 0 Lakes, ponds, retention basins 0 Restaurant Liquor $0 Mercantile $0 and Office Area 0 Acreage of largest lake or pond Golf course $0 Dock slips 0 Boat rental $0 Roadway miles maintained Golf cart rentals $0 the association 1 Facility rental to non-members $0 I. ADDITIONAL INSUREDS Does any additional insured need to be named on the policy?
VI. Other Insurance Information 1. Is a Workers Compensation policy desired?
3. Is Employee Benefits Liability coverage desired?
VII. Underwriting Information A. RESIDENTIAL OWNERSHIP AND OCCUPANCY Average sale/resale price of units: Indicate total number of units in each category: Owned by developer/sponsor/builder Owned by financial institutions Owned by the association $280,000 #0 # 0 #0 Is the developer/builder/sponsor or their representatives on the board?
in each category: Owned by developer/sponsor/builder Owned by financial institutions Owned by the association $280,000 #0 # 0 #0 Is the developer/builder/sponsor or their representatives on the board?
Does association have any ownership or rental restrictions for owners or residents (e.g. over age 55)?
1. Units Rented on an Annual Basis Are the rules governing use of the unit and emergency procedures provided?
Is proof of insurance obtained from all tenants?
☐ yes > no ☐ yes > no ☐ yes > no > no yes ☐ yes > no ☐ yes ☐ no yes ☐ no C. INDEPENDENT CONTRACTORS (e.g. street/road maintenance, snow removal, security, parking, transportation, etc) CAU GEN APP (06/19) Page 6 of 12 Does the association or independent community management firm hire independent contractors?
Does the association hire or arrange transportation for residents?
Does the independent contractor provide a hold harmless or indemnification agreement?
Are current certificates of insurance obtained from all independent contractors?
Is the association named as an additional insured?
Are liability limits at least $1,000,000 per Occurrence with a $1,000,000 General Aggregate?
Does the association indemnify or hold harmless any independent contractor by contractual agreement?
yes yes ☐ no > no yes ☐ no ☑ yes ☐ no > yes ☐ no ☐ yes > no Does the association obtain proof of Workers Compensation coverage from all independent contractors?
> yes ☐ no ☐ yes ☑ no D. ASSOCIATION EMPLOYEES Does the association have any employees?
E. INDEPENDENT COMMUNITY MANAGEMENT FIRM ☐ yes > no Is an independent community management firm utilized?
BUILDING DETAILS, UPDATING and DEFECTS: ☐ yes > no 1. Was any building previously occupied for non-residential purposes?
☐ yes ☑ no
IRM ☐ yes > no Is an independent community management firm utilized?
BUILDING DETAILS, UPDATING and DEFECTS: ☐ yes > no 1. Was any building previously occupied for non-residential purposes?
☐ yes ☑ no 2. Is there an underground mine or quarry on association property?
☐ yes > no 3. Are there Smoke detectors?
☐ yes > no 4. Is there a Sprinkler system?
5. Building shapes and fire walls Choose closest building shape below: шенВ ☐ ☐ Does the building have any masonry fire walls?
ப NONE OF THESE SHAPES APPLY T ☑ Roof: Indicate predominant roof type: Salt Box ☐ Flat Mansard ☐ Gable Hip ☐ yes > no 6. Is there any building with roofing over 20 years old?
7. Does any building or unit have galvanized plumbing (other than main waste lines)?
☐ yes > no ☐ yes > no 8. Is there any aluminum wiring?
☐ yes > no 9. Are there any identified construction defects?
☐ yes > no 10. Does the association have a flood insurance policy?
11. Have there been any water damage claims or mold claims in any building in the past 5 years?
☐ N/A Page 7 of 12 CAU GEN APP (06/19) Is the association named as an additional insured?
Are current certificates of insurance obtained from independent contractors?
Have all water damage issues been repaired with confirmation of no mold?
Have all mold issues been fully remediated by a licensed contractor and certified mold-free?
G. POTENTIAL EXPOSURES: If you answer “YES” to a numbered question, answer the remaining questions in the section.
If you answer "NO" to a numbered question, proceed to the next numbered question.
1. Are there any Day Care, Medical Care or Assisted Living facilities?
2. Are there any Health and Fitness facilities?
If you answer "NO" to a numbered question, proceed to the next numbered question.
1. Are there any Day Care, Medical Care or Assisted Living facilities?
2. Are there any Health and Fitness facilities?
3. Is there a clubhouse or meeting center?
4. Is there a restaurant on premises?
5. Is street or road maintenance the responsibility of the association?
Are any road repairs or road paving done by independent contractors?
Do independent contractors provide a hold harmless or indemnification agreement?
☑ ☑ yes ☐ yes ☑ no yes ☑ no ✓ yes ☐ no yes ☐ no □ no ☑ yes ☐ no Is any road paving done by association employees?
Are the liability limits at least $1,000,000 per Occurrence with a $1,000,000 General Aggregate?
Are any road repairs done by association employees?
yes no yes ☑ no yes > no ☐ yes > no 6. Is snow clearance the responsibility of the association?
☐ yes > no 7. Is there a swimming pool or wading pool?
8. Are there any lakes, ponds, retention basins, rivers or beaches on or adjacent to premises? ( not detention basins ) ☐ yes > no ☐ yes > no 9. Dam, levee or dike?
10. Do any athletic teams or organizations use association amenities or facilities?
☐ yes > no ☐ yes > no 11. Are there any golf courses located on Association property?
12. Are there any equestrian facilities, trails or stables located on association property?
☐ yes > no 13. Are there any skiing activities, including ski in and ski out, allowed on association property?
☐ yes > no 14. Are any association owned facilities or amenities shared with another organization (e.g. another association, hotel, etc.)?
☐ yes > no 15. Is there a water, wastewater or sewage treatment facility located on association property?
☐ yes > no ☐ yes > no
hared with another organization (e.g. another association, hotel, etc.)?
☐ yes > no 15. Is there a water, wastewater or sewage treatment facility located on association property?
☐ yes > no ☐ yes > no 16. Does the association utilize security personnel?
☐ yes > no 17. Is valet parking provided?
VIII. Money & Securities and Crime/Employee Dishonesty A. ASSOCIATION MONEY & SECURITIES VALUE CAU GEN APP (06/19) Page 8 of 12 What does the association, at their premises, estimate the total maximum value for all its Money & Securities at any point in time for the upcoming policy period to be: • Less than $50,000: • Between $50,000 and $100,000: Between $100,000 and $250,000: • Between $250,000 and $500,000: ☑ Above $500,000: If the association's estimate is above $500,000; list the value for each of the below items: • Currency / Coins: $0.00 • Bank notes: $0.00 • Money Order: $0.00 • Travelers Checks / Register Checks: • Tokens / Tickets: • Evidence of debt: $0.00 $0.00 $0.00 .
Any other financial instruments not listed above and its value : : $0.00 B. ASSOCIATION ACCOUNTS Does the association have both an operating account and a reserve account?
Are the account(s) in the association's name?
☑ yes ☐ no > yes ☐ no $500 What is the $ limit on board member's ability to disburse or transfer funds?
What is the $ limit on independent community manager's ability to disburse or transfer funds?
$500 Are the reserve account disbursements specifically authorized by the board?
Are operating account disbursements by the independent community manager limited to approved budgeted > yes items?
☐ no > yes ☐ no ☐ yes ☐ no Is countersignature of the checks required?
If not, who signs or controls?
Are the following Securities subject to control of two or more board members / employees?
s items?
☐ no > yes ☐ no ☐ yes ☐ no Is countersignature of the checks required?
If not, who signs or controls?
Are the following Securities subject to control of two or more board members / employees?
✓ yes ☐ no Does the person performing the reconciliation have the authority to deposit or disburse funds?
Who receives a copy of the account statement(s)?
· Tickets, Tokens, Stamps, Evidence of Debt, and negotiable or non-negotiable instruments or contracts.
Are the bank statements reconciled monthly?
> yes ☐ no ☑ board member ☐ manager C. ASSOCIATION FINANCIAL MANAGEMENT ☑ yes I no Does the association prepare an annual budget?
1. Is there an annual certified audit?
☑ yes ☐ no > yes ☐ no Does an independent CPA perform the audit?
Has there been a qualified opinion issued in the last 3 years?
Is a management letter given directly to the board at the end of each audit?
Were measures taken to correct any deficiency?
Are internal control procedures periodically reviewed as part of the independent audit?
Are the results of the audit given directly to board?
☑ yes ☐ no yes ☐ no yes ☑no ☑ yes ☐ no ✓ yes ☐ no 2. Are all financial transactions reviewed monthly by the board?
3. Does an independent community management firm handle association funds?
4. Does an accounting firm handle association funds?
5. Are background checks done on everyone who has access to association funds?
IX. Environmental Impairment Liability ✓ yes ☐ no ☐ yes ☐ yes ☑ no > no ☑ yes ☐ no CAU GEN APP (06/19) Page 9 of 12 In granting coverage under the Environmental Impairment Liability Coverage Part, we will rely upon the declarations and statements in this application for coverage. Declarations and statements are the basis of coverage and will be
Environmental Impairment Liability Coverage Part, we will rely upon the declarations and statements in this application for coverage. Declarations and statements are the basis of coverage and will be considered as incorporated in and constituting a part of the Environmental Impairment Liability Coverage Part.
A. Have any prior environmental reports, audits or studies been done for this property?
Attach copy of report, audit or study.
Have any of the following ever been on the property?
Indicate which: Automobile maintenance, repair or sales ☐ Commercial oil storage or distribution ☐ Commercial printing ☐ Dry cleaners (other than pickup station) ☐ Gas station ☐ Recycling ☐ Junk/scrap yard Landfill Photo developing Waste reclamation ☐ Waste/sewage treatment, storage or disposal B. Does the association have any wells used for potable water?
☐ yes ☑ no ☐ yes > no C. Does the association have a septic system connected to residential buildings or to third parties?
Does the association have a septic system connected to other association community buildings only?
e.g. clubhouses, pool houses, etc.
D. Is there a sewage treatment facility at the property?
☐ yes ☑ no E. Associations may have above ground or underground tanks if they have any of the following exposures: Gasoline pumps, backup generator, irrigation systems, fire protection system, heated swimming pool, cooking grills, oil or propane heat source, drinking water system or septic system.
yes ☑ no Does the association have any Above ground Storage Tanks (ASTs)?
Does the association have any Underground Storage Tanks (USTs)?
yes > no F. Are any hazardous* substances stored in containers greater than 50 gallons?
☐ yes > no
ny Above ground Storage Tanks (ASTs)?
Does the association have any Underground Storage Tanks (USTs)?
yes > no F. Are any hazardous* substances stored in containers greater than 50 gallons?
☐ yes > no *Hazardous substances include: pesticides, herbicides, paints, solvents, cleaning fluids and other similar chemicals.
G. Have there been any environmental claims against the association?
☐ yes ☐ yes ☑ no > no Has any environmental coverage been declined, canceled or nonrenewed?
H. In the last 5 years: yes > no Has there been environmental coverage in place, other than with CAU?
Have there been any environmental claims against the association?
Has the association been cited or prosecuted for contravention or violation of any standard or law relating to any release of pollutants into sewers, rivers, seas, or onto land?
Iyes > no ☐ yes > no yes > no Has any environmental coverage been declined, cancelled, or nonrenewed?
I. Are you aware of any circumstances that could reasonably be expected to give rise to an environmental liability claim under this policy?
☐ yes ☑ no J. Are there any statutes, standards, or other city, state, or federal regulations relating to the protection of the environment you cannot comply with?
☐ yes > no X. Directors and Officers Liability In granting coverage under the Directors and Officers Liability Coverage Part, we will rely upon the declarations and statements in this application for coverage. Declarations and statements are the basis of coverage and will be considered as incorporated in and constituting a part of the Directors and Officers Liability Coverage Part.
A. BOARD MEMBERS Has board control transferred from developer/builder/sponsor?
Is the developer/builder/sponsor or their representatives on the board?
e Directors and Officers Liability Coverage Part.
A. BOARD MEMBERS Has board control transferred from developer/builder/sponsor?
Is the developer/builder/sponsor or their representatives on the board?
Does any board member own 10% or more of the units?
B. LEGAL COUNSEL CAU GEN APP (06/19) ☑ yes no yes ☑ no yes > no Page 10 of 12 1.
2.
3.
Has any claim been made, or is any claim pending against the association or any person as a director, officer, executive trustee, employee, independent community manager, volunteer, staff or committee member or association member acting on behalf of the board?
Has any legal action been taken by the association against any member other than for collection of fees or assessments?
Is there a procedure in place to promptly deliver all demand letters to the insurance carrier?
Is legal counsel utilized in delinquent assessments, liens, or foreclosure processes?
Is legal counsel utilized in enforcement of covenant process?
C. PRIOR ACTIVITY Has any directors and officers liability coverage ever been declined, cancelled or non-renewed?
yes □ no ☑ ☑ yes ☐ no ☐ yes > no ☐ yes > no ☐ yes > no 4.
Are you aware of any fact, circumstance or situation not reported to your current or past Directors & Officers Liability insurer which you reasonably believe could give rise to a claim?
Drexel Avenue GA XI. List of Streets Street Name XII. Fraud Statement Any Person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a
tement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and civil penalties.
CAU GEN APP (06/19) Page 11 of 12 XIII. Authorization A. Association Name (Legal name based on articles of incorporation or fillings on record with state): Chelsea Place Homeowners Association, Inc.
B. Association Mailing Address(C/O, Street, City, State, Zip Code): 414 Drexel Avenue 414 Drexel Avenue Decatur, GA 30030 C. Property Location City or Municipality: Decatur County: Dekalb State: GA Zip Code: 30030 D. Proposed Effective Date (mm/dd/yy): 02/16/20 I am an authorized representative of the applicant and certify that a diligent inquiry was made to obtain the answers to the questions on this application. To the best of my knowledge, I certify that the answers are accurate and complete.
I understand that the information provided in this application and related attachments were relied upon as the basis of coverage. Declarations and statements made relative to all coverage parts will be considered as incorporated in and constituting a part of the policy.
Signature: Name: App Id: 173634 бол Date: Signature of board member or other authorized representative is required.
Sarah P Collins Title: Account Code: 9141 Document Created: 1/8/2020 at 2:17 PM 01-29-2020 Treasurer CAU GEN APP (06/19) Page 12 of 12 IMPORTANT NOTICE. PLEASE READ IT CAREFULLY.
Disclosure Notice to Policyholders - Georgia You should read your policy exclusions including the endorsements referenced below and review your declaration pages for complete
PLEASE READ IT CAREFULLY.
Disclosure Notice to Policyholders - Georgia You should read your policy exclusions including the endorsements referenced below and review your declaration pages for complete information on the coverages you are provided. If there is any conflict between the policy and this notification, THE PROVISIONS OF THE POLICY SHALL PREVAIL.
The policy contains rot, mold and mildew or other "fungi" exclusions. These exclusions are applicable to the LIABILITY COVERAGE PART, DIRECTORS AND OFFICERS LIABILITY COVERAGE PART, EMPLOYEE BENEFITS LIABILITY COVERAGE PART and ENVIRONMENTAL IMPAIRMENT LIABILITY COVERAGE PART.
"Fungus", Wet Rot and Dry Rot Coverage, CAU 3600 GA.
This endorsement contains limited coverage and exclusions for "fungus", wet rot and dry rot applicable to the PROPERTY COVERAGE PART.
I understand that the policy includes the exclusions referenced above: Signed Title брал Sarah P Collins Date 01-29-2020 Includes copyrighted material of Insurance Services Office, Inc. with its permission CAU 3601 07/17 Page 1 of 1 CAU Community Association Underwriters of America, Inc.
2 Caufield Place Newtown, PA 18940 (267) 757-7100 Preferred Property Program, Inc.
Renewal Quotation For Umbrella Coverage THIS IS NOT A BINDER B) Renewal Effective Dates: 2/16/2020 to 2/16/2021 Quotation Date: January 9, 2020 BASED ON EXPIRING INFORMATION; ASSUMING NO CHANGES IN RISK Only Preferred Property Programs can bind risks. This renewal quote is valid for 60 days from the quotation date shown on this document or until the renewal effective date shown above.
Applicant's Name As it will appear on policy:| Chelsea Place Homeowners Association, Inc.
Producer: Dreher Insurance Agency Attention: Joseph Dreher Location: Per Package Policy Description, Decatur, GA
plicant's Name As it will appear on policy:| Chelsea Place Homeowners Association, Inc.
Producer: Dreher Insurance Agency Attention: Joseph Dreher Location: Per Package Policy Description, Decatur, GA Limits of Insurance Options: Insurance Limit Annual *Terrorism Total Company Premium Premium Fee Fees/ Surcharges Greenwich Ins $5,000,000 $750.00 $8.00 $111.00 $0.00 $869.00 Greenwich Ins $10,000,000 $1,250.00 $13.00 $152.00 $0.00 $1,415.00 Greenwich Ins $15,000,000 $1,650.00 $17.00 $209.00 $0.00 $1,876.00 Greenwich Ins $25,000,000 $2,200.00 $22.00 $253.00 $0.00 $2,475.00 Greenwich $50,000,000 $3,700.00 $37.00 $374.00 $0.00 $4,111.00 Ins/Chubb Surcharges are accurate as of quote date and may vary by company at time of binding.
Chubb Excess Policy Please note second excess policy may only be purchased in conjunction with primary $25,000,000 umbrella policy and is in addition to the first $25,000,000. 50 Million is actually two policies above: $25,000,000 Greenwich Ins and 25 excess of 25 Million with Chubb Insurance Co. EPLI following form D&O is limited to the first $25,000,000; the excess Chubb policy has an EPLI exclusion attached. Directors and Officers is not available for Apartments or LRO risks.
Flat cancellation is not permitted after risk is bound. This quote is provided with % commission on PREMIUM ONLY; Membership Fee and state tax (es) are non-commissionable. Payment would be due 10 days after binding.
9141 CAU Community Association Underwriters of America, Inc.
2 Caufield Place Newtown, PA 18940 (267) 757-7100 Preferred Property Program, Inc.
Minimums For This Risk Type
ers of America, Inc.
2 Caufield Place Newtown, PA 18940 (267) 757-7100 Preferred Property Program, Inc.
Minimums For This Risk Type $750 for $5 Million $1,250 for $10 Million $1,650 for $15 Million $2,200 for $25 Million $5,200 for $50 Million The following Endorsements form part of our policy: COVER PAGE NOTICE TO POLICYHOLDERS U.S. TREASURY DEPARTMENT'S OFFICE OF FOREIGN ASSETS CONTROL (“OFAC”) NOTICE TO POLICYHOLDERS FRAUD NOTICE NOTICE TO POLICYHOLDERS PRIVACY POLICY POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE PURCHASING GROUP CONVERSION ENDORSEMENT IN WITNESS - GREENWICH INSURANCE COMPANY COMMERCIAL EXCESS/UMBRELLA LIABILITY CERTIFICATE HOLDER DECLARATIONS COMMERCIAL EXCESS FOLLOW FORM AND UMBRELLA LIABILITY POLICY CERTIFICATE HOLDER SCHEDULE OF UNDERLYING INSURANCE FORMS SCHEDULE COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE AMENDATORY ENDORSEMENT GEORGIA CERTIFICATE HOLDER AND LOCATIONS CLAIM REPORTING PROVISIONS COVERAGES E AND U COVERAGE X -- DISASTER EVENT RESPONSE EXPENSE EMPLOYMENT PRACTICES LIABILITY FOLLOW FORM COVERAGE E EXCLUSION - CONTAMINATED DRYWALL COVERAGES E AND U EXCLUSION -- EARTH MOVEMENT COVERAGES E AND U EXCLUSION - ERRORS AND OMISSIONS LIABILITY COVERAGE E EXCLUSION - TOTAL POLLUTION WITH CERTAIN EXCEPTIONS COVERAGE E EXCLUSION -- FUNGUS OR RELATED PERILS COVERAGES E AND U EXCLUSION - DATA BREACH LIABILITY COVERAGES E AND U TERRORISM SELF-INSURED RETENTION COVERAGE U CONSTRUCTION AND PRODUCT EXCLUSION -INCLUDING CONSTRUCTION DEFECTS WITH LIMITED EXCEPTION | AMENDED DEFINITION PERSONAL AND ADVERTISING INJURY COVERAGES E AND U ALL OTHER PERTINENT STATE ENDORSEMENTS 9141 CAU
TION AND PRODUCT EXCLUSION -INCLUDING CONSTRUCTION DEFECTS WITH LIMITED EXCEPTION | AMENDED DEFINITION PERSONAL AND ADVERTISING INJURY COVERAGES E AND U ALL OTHER PERTINENT STATE ENDORSEMENTS 9141 CAU Community Association Underwriters of America, Inc.
2 Caufield Place Newtown, PA 18940 (267) 757-7100 Preferred Property Program, Inc.
This renewal quote is based on underwriting information currently on file with our company. This renewal quote is furnished as an accommodation to your office only, and does not automatically renew. If we do not have a recent PPP application on file we will require an updated app and annual membership agreement in order to bind the renewal. The following renewal form must be completed and must accompany the bind order.
THIS RISK CAN BE BOUND ONLY UPON RECEIPT OF YOUR FIRM WRITTEN ORDER AND IS BASED ON THE AFOREMENTIONED COVERAGES WHICH MAY DIFFER FROM THE APPLICATION SUBMITTED BY YOUR OFFICE. THE INFORMATION HEREIN SHOULD BE CHECKED FOR ACCURACY. ALL REQUESTS TO BIND COVERAGE MUST BE IN WRITING AND COVERAGE IS NOT BOUND UNTIL WE PROVIDE YOUR OFFICE WITH WRITTEN CONFIRMATION.
Thank You For Your Business.
Disclaimer: This proposal contains a brief outline of coverages to be included in the policy that may be issued in the future.
This is only a summary, and the terms and conditions of the policy will take precedence over the proposal.
9141 CAU Community Association Underwriters of America, Inc.
2 Caufield Place Newtown, PA 18940 (267) 757-7100 Preferred Property Program, Inc.
RENEWAL APPLICATION FORM Association Name: Chelsea Place Homeowners Association, Inc.
Policy Number: Coverage Effective Dates: 2/16/2020 to 2/16/2021 Fax Back Renewal Form to: 267-757-0321 Quotation Date: January 9, 2020
FORM Association Name: Chelsea Place Homeowners Association, Inc.
Policy Number: Coverage Effective Dates: 2/16/2020 to 2/16/2021 Fax Back Renewal Form to: 267-757-0321 Quotation Date: January 9, 2020 This form must accompany your bind request. Please advise if above Named Insured or any of the following underwriting criteria is incorrect. If information differs, quote will be revised accordingly.
Renewal quote is based on the following rating criteria, currently on file: 11 Units, 0 Total Vehicles, HNOA "if any": Included, Pools, 0 Stories, 0 Employees, 0 Vacant Land Acreage, 0 Commercial Square Footage, 0 Golf Course Number Of Holes, Risk Type (HOA), Developer On Board: No, Underlying GL Limit: $1,000,000 All Mercantile occupants currently on file.
The association “makeup” has NOT changed. All above information is correct: Check Here: Please bind renewal at(circle desired limit): 5 Million 10 Million 15 Million 25 Million 50 Million limit Premium Fee Total The association “makeup” has changed. Please make the following corrections and send a revised quote: Units ; Autos (Yes or No); (does not include board members or leased ; Vacant Land Acreage_ HNOA: Borrowing/Hiring of trucks, passenger vans/buses anticipated Mercantile occupancy has changed: ;Developer On Board: (Yes or No) If applicable, please include updated list of occupants.
Risk is a: Condo Apartment Timeshare Building Owners (LRO) Townhouse Mixed Use (Habitational & Retail) Other (Describe) Square Footage Breakdown(If Applicable): Retail Non-Condominium Office Master Association Common Area.
Parking Warehouse Manufacture Type of Auto (If Applicable): #Private Passenger НОА PUD #Light Trucks #Medium Trucks #Heavy Trucks
icable): Retail Non-Condominium Office Master Association Common Area.
Parking Warehouse Manufacture Type of Auto (If Applicable): #Private Passenger НОА PUD #Light Trucks #Medium Trucks #Heavy Trucks #Buses-list use and # of passengers: If No, are the drain covers on order? Yes No No 9141 CAU Community Association Underwriters of America, Inc.
2 Caufield Place Newtown, PA 18940 (267) 757-7100 Preferred Property Program, Inc.
Minimum Underlying Insurance Requirements Commercial General Liability $1,000,000/$2,000,000 *A-Rated VII or Better AM Best excluding Lloyds of London Automobile Liability $1,000,000 (BI & PD CSL) Employers Liability Directors & Officers Liability $500,000/$500,000/$500,000 $1,000,000/$1,000,000 *A- Rated VII or Better AM Best *A- Rated VII or Better AM Best *A- Rated VII or Better AM Best (Claims Made Required) Note: We cannot write over Lloyd's of London or any of its subsidiaries.
Please issue with the following Underlying Schedule Information: Policy Type GL D&O Auto (incl HNOA) Policy Number Company Name Effective Expiration Limits Employers Liab Other ( ) Is any person/entity proposed for this Insurance aware of any fact, circumstance, or situation which may result in or give rise to a claim against the organization or any of its Members, Officers, or Employees?
☐ yes ☐ no Provide Details, if yes: FRAUD CLAUSE: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime.
Applicant/Authorized Representative Signature Date: Please
ion, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent act, which is a crime.
Applicant/Authorized Representative Signature Date: Please Do Not Renew the policy To be completed by Broker-Reason on Non-renewal: ☐ More competitive quote from Our Agency was not successful in placing coverage either.
Association did not purchase umbrella Premium was: 01-29-2020 Thank you for your business and feedback. We look forward to your bind order. If we can assist you in any way, please do not hesitate to call us.
9141 AAIS Page 1 of 1 PUNITIVE DAMAGES EXCLUSION REQUEST Insurance Company: Greenwich Insurance Company Policy Number: C-389168 Named Insured: Chelsea Place Homeowners Association, Inc.
In exchange for a reduction in premium, I hereby request that a Punitive Damages Exclusion endorsement be made part of my policy. I understand that no coverage will be provided for punitive, exemplary, or vindictive damages in this policy, or in future renewals of this policy.
Policyholder's Signature: Date: Copyright, American Association of Insurance Services, Inc., 2008 AAIS Page 1 of 1 -This endorsement changes the policy PLEASE READ THIS CAREFULLY -EXCLUSION. PUNITIVE DAMAGES -COVERAGES E AND U The Commercial Excess/Umbrella Liability Coverage is amended as follows. All other "terms" of the policy apply, except as amended by this endorsement.
This policy does not apply to a claim or indemnification for punitive or exemplary "damages", or to any costs, attorney fees, interest, or "damages" attributable to an award of punitive or exemplary "damages". Punitive or exemplary "damages" means those "damages" imposed to punish a wrongdoer and to deter others
torney fees, interest, or "damages" attributable to an award of punitive or exemplary "damages". Punitive or exemplary "damages" means those "damages" imposed to punish a wrongdoer and to deter others from similar conduct.
However, if a "suit" seeking both compensatory "damages" and punitive or exemplary "damages" is brought against an "insured" for an "occurrence" or offense covered by this policy, "we" will provide defense coverage.
Copyright, American Association of Insurance Services, Inc., 2010 CAU Community Association Underwriters of America, Inc.
2 Caufield Place Newtown, PA 18940 (267) 757-7100 Preferred Property Program, Inc.
Membership Agreement This Agreement is entered into between Preferred Property Program (PPP) an Illinois corporation, and the Chelsea Place Homeowners Association, Inc. ("Purchaser") which is located at the following address:, Decatur, GA WHEREAS PPP is a risk purchasing group formed pursuant to Illinois law and the Risk Retention Amendments of 1986 (15 U.S.C. 3910 et. seq.) (“Act”) in order to permit a group of individuals who share common or similar liability exposures to join together to purchase umbrella liability insurance on a group basis; and WHEREAS Purchaser represents and has provided information to PPP that Purchaser is engaged in the real estate business and is exposed to liability risks which are the same or similar to those of the other members of the group; and WHEREAS Purchaser seeks to insure its own risks by purchasing umbrella liability insurance under the group umbrella insurance policy issued to the group through PPP; NOW THEREFORE, the parties Agree as follows: Agreement 1. PPP agrees that as of the effective date of this Agreement, Purchaser is a member of the risk-
surance policy issued to the group through PPP; NOW THEREFORE, the parties Agree as follows: Agreement 1. PPP agrees that as of the effective date of this Agreement, Purchaser is a member of the riskpurchasing group and is eligible to participate in certain group umbrella liability insurance policies, including endorsements and renewals, which is issued to PPP for the benefit of its members ("Insurance").
2. Except as otherwise provided herein, so long as Purchaser satisfies the requirements of this Agreement and meets the qualifications of membership as set forth in the Act, PPP shall permit Purchaser to participate in and be insured under insurance.
3. Purchaser shall pay all premiums, which are billed to it for insurance not later than ten (10) days after receipt of a statement therefore.
4. Purchaser shall promptly pay a non-refundable annual membership fee of $111.00 for $ 5,000,000; $152.00 for $10,000,000; $209.00 for $15,000,000; $253.00 for $25,000,000; $374.00 for $50,000,000; depending on limit bound (the 'Membership Fee'). The Membership Fee must be paid not later than the date insurance coverage is bound. The Membership Fee is used, in part, to fund the operations and expenses of PPP in connection with its risk purchasing group activities. PPP has appointed Jacobson Goldfarb Scott Insurance ("JGS") to administer certain risk purchasing group operations of PPP and JGS is paid an administration fee by PPP for such services. JGS is the insurance agent through which PPP currently purchases the insurance coverages for PPP's members and is an affiliate of PPP.
5. Purchaser shall meet the underwriting criteria imposed by each insurer upon all members of the risk purchasing group who are insured or all persons who seek to be insured under the Insurance.
PPP.
5. Purchaser shall meet the underwriting criteria imposed by each insurer upon all members of the risk purchasing group who are insured or all persons who seek to be insured under the Insurance.
CHI1 1001802v2 9141 Purchaser understands that its failure to meet such underwriting criteria may result in the nonrenewal of its coverage under Insurance.
6. Termination a) This Agreement shall terminate: i. Upon failure of Purchaser to pay the annual membership fee or any premiums for insurance as required under the Insurance and this Agreement. Purchaser shall cease to be a member of the purchasing group at such time as the premium is past due. However, if the past due premium or membership fee is subsequently paid, PPP may, in its sole discretion, reinstate Purchaser's membership.
ii. Upon termination or non-renewal of Insurance covering Purchaser or the group through PPP.
b) This Agreement may be terminated by PPP i. if there is a change in the business of Purchaser which results overall in its being exposed to liability risks which are not the same as or similar to those of the other members of the group so that it would no longer qualify for membership within the requirements of the Act; or and PPP shall give not less than thirty (30) days prior written notice of such termination; or ii. upon Purchaser's failure to meet standards, criteria, or conditions of membership which may be established from time to time by PPP for the risk purchasing group as a whole; and PPP shall give not less than thirty (30) days prior written notice of such termination; or c.) This Agreement may be terminated by Purchaser upon Purchaser's withdrawal from the risk purchasing group. Purchaser may withdraw from the risk purchasing group and participation in the
ination; or c.) This Agreement may be terminated by Purchaser upon Purchaser's withdrawal from the risk purchasing group. Purchaser may withdraw from the risk purchasing group and participation in the Insurance at any time by submitting a written notice of its withdrawal to PPP stating the date upon which the withdrawal is to be effective. This Agreement shall terminate upon that date. Purchaser understands that withdrawal from the risk purchasing group will immediately terminate all coverage of insurance for Purchaser under Insurance.
7. Indemnification. Purchaser agrees to indemnify and hold harmless PPP for any liability or expenses, including costs of defense, which PPP may incur as a result of acts or omissions of Purchaser or any of its employees or agents including incorrect or false statements of fact intentionally made to PPP.
This Agreement shall be effective on 20 01 29 2020 PURCHASER By: (Signature) CHI1 1001802v2 Greenwich Ins 9141 CITRIX® RightSignature SIGNATURE CERTIFICATE TRANSACTION DETAILS Reference Number C7C14283-3334-4BF5-866F-804EBBD2C836 Transaction Type Signature Request Sent At 01/29/2020 14:15 EST Executed At 01/29/2020 19:21 EST Identity Method email Distribution Method email Signed Checksum Signer Sequencing Disabled eb181aff1c5d526df798b73c150a7bbcd77393f67f6689de34e7fe3813556820 Document Passcode Disabled SIGNERS REFERENCE NUMBER C7C14283-3334-4BF5-866F-804EBBD2C836 DOCUMENT DETAILS Document Name Chelsea Place Package App Filename Pages 22 pages Content Type application/pdf File Size 1.43 MB Original Checksum fc04e96be85dc862c5b3724cbaclbl5beecb7b7924cd896a3lleebeac53e69e6 E-SIGNATURE Status signed Multi-factor Digital Fingerprint Checksum e6357e2eclled04e728d778c08cf47ce088fce8f12fd401e3146ae2a312133a6 EVENTS
e96be85dc862c5b3724cbaclbl5beecb7b7924cd896a3lleebeac53e69e6 E-SIGNATURE Status signed Multi-factor Digital Fingerprint Checksum e6357e2eclled04e728d778c08cf47ce088fce8f12fd401e3146ae2a312133a6 EVENTS Viewed At 01/29/2020 19:18 EST Identity Authenticated At 01/29/2020 19:21 EST Signed At 01/29/2020 19:21 EST SIGNER Name Sarah Email [email protected] Components 11 IP Address 76.20.252.15 Device Chrome via Mac Drawn Signature брал Signature Reference ID E0608606 Signature Biometric Count 189 AUDITS TIMESTAMP 01/29/2020 19:21 EST 01/29/2020 19:21 EST 01/29/2020 19:18 EST 01/29/2020 14:15 EST 01/29/2020 14:15 EST AUDIT Sarah ([email protected]) signed the document on Chrome via Mac from 76.20.252.15.
Sarah ([email protected]) authenticated via email on Chrome via Mac from 76.20.252.15.
Sarah ([email protected]) viewed the document on Chrome via Mac from 76.20.252.15.
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155.186.148.57.