HomeMy WebLinkAbout33433 / 85-11, 1985
(CARkIEU
PURPOSE:
INITIATED BY:
LOST LAID OVER
WORKERS' COMPENSATION INSURANCE
PURCHASING DEPARTMENT
# 11 RESOLUTIUN
WITHDRAWN )
BE IT RESOLVED by the Common Council of the City of Oshkosh that the
proper City officials are hereby authorized and directed to enter into an agree-
ment with Employers Insurance of Wausau for Workers' Compensation Insurance
as specified on the attached proposal. Money for this purpose is hereby appro-
priated from Account No. 012-613, Workers' Compensation Account.
SUBMiT1EU BY
APYROVED
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RESOLIJTION # lI
PROPOSAL
WORKER'S COMPENSATION COVERAGE FOR
THE CZTY OF OSHKOSH
We, the undersiqned, propose to write the following worker's compensation
coverage for the City of Oshkosh, Wisconsin, per attached plan of coverage.
PREMIUM
Standard Premium
Times (x) experience modification
Subtotal
Pius loss Constant
Plus expense constant
Less premium discount 10.5%
Total premium before dividend
Estimated Dividend 32.3%
Es[imated Ad'nual Net Cost
Past 5 year flat dividerYi history:
1984
1983
1982
1981
198a
5 26�,$O1
X
S 204,457. �
+
' R5
- 21.��
S-1&3.250 �
- 59,194
$ 124,066
(if applicable�
Will policy coverage be subject to audit? Yes �^ No
We understand, if the renewal premiums are justifibly reasonable, that the
intent of the City is to stay with tha insuring company three (3) years.
Company to write coverage Emplovers Insurance of Wausau a Mu,�uai Camnanv
Rating in Iatest edition of Hest's Insurance Gllide
Nearest claim adjustment office Oshkosh, Wisconsin
SUBMITTED BY
p(iv 7985
Date
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Authorized Signature ,
IJausau IQsuraQ�� (:�mRdny..
Name of Company
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