FOR THE
PURMS JOINT SELF-INSURANCE AGREEMENT
AND OPERATIONAL RULES
Amended and Restated as of
These Definitions govern the
meanings of the words defined when used in the PURMS Joint Self-Insurance
Agreement ("SIA") and Operational Rules ("Op. Rules");
provided, however, that any specific definitions set forth in the Coverages
Sections of the SIA (§§ III-VI, §§ X-XI and § XIV) shall control the
interpretation of those Sections to the extent those definitions are different
from the Definitions contained in this § II.
These Definitions were unanimously re-adopted by the Members of the Fund
effective
Accident -- With respect to the Liability Coverage,
shall mean an unusual, unintended, unexpected and unforeseen happening,
including continuous or repeated exposure to the same conditions, causing
Bodily Injury or Property Damage resulting from the ownership, maintenance or
use of a Covered Vehicle by an Insured, and which occurred during the Coverage
Period. Multiple Liability Claims arising out of a single Accident, even if
asserted against different Members or Employees, shall be deemed to be a single
Liability Claim arising from a single Accident. (See § V, ¶ 2.1).
With respect to the Property Pool, shall mean an unusual, unintended, unexpected and unforeseen happening, including continuous or repeated exposure to the same conditions, that causes Direct Physical Loss or Damage to a Covered Auto arising from the use thereof by a Member (as defined specifically in § XI, ¶ 1.13) and which occurred during the Coverage Period. Multiple Property Claims arising out of a single Property Loss, even if filed by multiple Members, shall be deemed to be a single Property Claim arising from a single accident.
Accrued Stop Loss Payments -- shall mean the total of the payments made by or on behalf of a Member under sub-¶¶s (a) through (c) of ¶ 3.3.1 of the H&W General Assessment Formula (§ XV) which accrue toward satisfying a Member’s Aggregate Stop Loss Point.
Actual Cash Value -- Actual Cash Value shall mean Replacement
Cost less depreciation (see § X, ¶ 10).
Actual Liability Pool Balance -- shall mean the cash investments, and any other assets held by
the Fund for and on behalf of the Liability Pool at any particular point in
time for the payment of Incurred Liabilities, Defense Costs, Direct
Administrative Expenses and the Liability Pool's allocation of Shared
Administrative Expenses, but excluding any cash or other assets allocated to
any Special Purpose Accounts for the Liability Pool (see § I, ¶ 13.1.2).
Actual Property Pool Balance -- shall mean the cash, investments, and any other assets held by
the Fund for and on behalf of the Property Pool at any particular point in time
for the payment of Coverage Payments, Property Claim Costs, Direct
Administrative Expenses and the Property Pool's allocation of Shared
Administrative Expenses, but excluding any cash or other assets allocated to
any Special Purpose Accounts for the Property Pool (see § I, ¶ 13.1.2).
Actual Risk Pool Balance -- shall mean the cash, investments, and any other assets actually held by the Fund for and on behalf of a Risk Pool at any particular point in time for the payment of the Risk Pool's Operational Costs, but excluding any cash or other assets allocated to any Special Purpose Accounts for that Risk Pool. In determining the level of any Risk Pool's Actual Risk Pool Balance, it shall be assumed that all Members of that Risk Pool, and where applicable, Former Members thereof, have paid their Assessment Shares of all previous Assessments for that Risk Pool, except to the extent that it is determined by the Administrative Committee that a Member or Former Member will not pay its Assessment Share thereof.
Added Exposure Contracts -- shall mean those contracts Members enter into with Third Parties which the Administrative Committee determines pose unique or substantial additional exposure to the Fund and therefore should be considered in determining a Member's Employee Hours Worked for purposes of applying the General Assessment Formula, as provided in § VIII., ¶ 5.
Added-Risk Pass Through -- shall
mean the portion of the Excess Premium specifically allocated by the Excess
Carrier in its normal underwriting to one or more particularly identified risks
of a Member's operations that are beyond the types of risks considered by the
Excess Carrier in determining its basic premium charge (e.g., a specific
premium allocation to the risk posed by a Member's dam). (See, § IX, ¶
3).
Additional Insured -- shall mean any person or entity constituting an Insured Agent or an Insured Volunteer pursuant to § III, ¶ 2.4, Pre-Approved as required by § III, ¶¶ 2.5.3 and 2.6, and in accordance with the Op. Rules, § III, ¶ 2.5.3. “Additional Insured” shall also mean any person or entity which has been granted the rights of an insured by an Excess Carrier under any of the Fund's Excess Liability Policies, in accordance with § III, ¶ 2.5.3 and the related provisions in the Op. Rules, § III, ¶ 2.5.3.
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Adjusted Initial Deposit |
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shall mean an H&W Pool Member’s Initial Deposit after any adjustments to increase or decrease the amount of the Member’s Initial Deposit are made by the Administrative Committee to reflect changes in such Member’s H&W Claims Experience, as provided in § I, ¶ 13.2.2. |
Administrative Committee -- shall mean the Standing Committee established pursuant to § I, ¶ 9.4.
Administrative Expenses -- shall mean all costs, expenses and obligations, including all Administrator and all general Legal, Broker and Accounting fees, and similar or other charges, incurred by the Fund in connection with the operation and administration of the Fund and its Risk Pools; provided, however:
(a) with respect to the Liability Pool, “Administrative Expenses” shall not include Liability Coverage Payments for Damages or Defense Costs;
(b) with respect to the Property Pool, “Administrative Expenses” shall not include Property Coverage Payments or Property Claim Costs; and
(c) with respect to the H&W Pool, “Administrative Expenses” shall not include H&W Claims Costs, whether such are Direct or Shared (ie. shall not include Coverage Payments for H&W Claims) or PPO Charges or Stop Loss Insurance Premiums, but shall include Per Capita Administrative Fees (which shall be considered a “Direct Administrative Expense” of the H&W Pool, and therefore, and “Administrative Expense”).
Administrative Expenses shall either be “Direct” Administrative Expenses or “Shared” Administrative Expenses.
Administrator -- shall mean the person or entity retained by the Board pursuant to § I, ¶ 10.
Agenda -- shall mean the document prepared pursuant to § I, ¶ 7.4, identifying issues to be discussed and/or voted upon by the Board.
Agent (or Agency) -- shall mean a person or entity whose relationship with a Member meets the legal requirements necessary to make such person or entity the legal agent of the Member and authorized to act on behalf of the member with respect to issues within the scope of the Agency.
Agreement -- shall mean the Self-Insurance Agreement or SIA.
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Allowed H&W Claim |
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shall mean an H&W Claim which is not within the terms of an H&W Pool Member’s Coverage Booklet, but which is paid by the H&W Pool according to § XV, ¶¶ 5.2.2.2 and 5.2.3. |
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Alternate ISL Method |
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shall mean the secondary method for determining a Member’s Individual Stop Loss Point if such Stop Loss Point, calculated under the Primary ISL Method in § XV, ¶3.2.4.1, does not satisfy the Primary ISL Method Cross Check set forth in § XV, ¶ 3.2.4.2. |
Annual AC Members -- shall mean the two (2) members of the Administrative Committee that may be appointed from time-to-time by the Board to serve one-year term.s on that Committee, as provided in § I, ¶¶ 9.4.1 and 9.4.2.
Annual Assessment Limit -- shall mean the limit on the total amount of General Assessments the Fund may levy on an individual Member of a Risk Pool in any calendar year, as provided in § I., ¶ 13.6.
Annual Automatic General
Assessment -- shall mean a General Assessment for a Risk
Pool automatically levied in accordance with §
Annual Appraisal -- shall mean the Detailed Appraisal or the
Updated Appraisal obtained by the Fund on behalf of the Property Pool on an
annual basis to establish the Insured Values of Members' Insured Property for
purposes of applying the Property Assessment Formulas (see § X, ¶ 14).
Appeal Issue -- shall mean any issue that is identified in
§ I, ¶¶ 19.1 and/or 19.2.1, and therefore is subject to the mandatory Appeal
Procedures set forth in § I., ¶ 19.2 (see also § I, ¶ 9.4.4 re
Administrative Committee's "Primary Jurisdiction" to first decide
Appeal Issues, subject to the Board's authority in § I, ¶ 19.1 (a) and (b)).
Appeal Procedures -- shall mean the procedures Members and Employees
are required to follow to obtain decisions from the Administrative Committee on
issues relating to subjects within its Primary Jurisdiction, and the review of
those decisions by the
Assessment(s) -- shall mean one or more of the two different classes of assessments for the cost of operating the Fund's Risk Pools, as provided in this Agreement: General Assessments and Premium Assessments. “Assessments” can also refer to Special Purpose Assessments pursuant to § I, ¶ 13.4.4.
Assessment Formulas -- with respect to the Liability Pool, shall mean the Liability General Assessment Formula (§ VIII) and/or the Liability Premium Assessment Formula (§ IX).
-- with respect to the Property Pool, shall mean the Property General Assessment Formula (§ XII) and/or the Property Premium Assessment Formula (§ XIII).
-- with respect to the H&W Pool, shall mean the Formula for calculating a Member’s Monthly H&W Assessment, which consists of a Member’s Direct H&W Claims Costs paid by the H&W Pool in the preceding month and such Member’s H&W Assessment Share of Shared H&W Costs determined under the H&W General Assessment Formula (§ XV).
Assessment Limit Overage -- shall mean the amount by which a Member's Assessment Share of a General Assessment exceeds the amount of such Assessment the Member is required to pay after application of the Annual Assessment Limit, in accordance with § VIII, ¶ 3.
Assessment Methodology -- with respect to Assessments generally, shall mean the factors considered and the calculations performed under one or more particular Assessment Formulas, as set forth in the SIA Sections containing such Formulas.
-- with respect to Special Purpose Assessments, shall mean the particular factors and calculations established by the Board by Super-Majority Vote to determine the amounts of Members respective Assessments for the funding of a Special Purpose Account (see § I, ¶ 13.4.4) or such other funding methodology or combination thereof established by the Board pursuant to that paragraph.
-- with
respect to Inter-Pool Loans by the H&W Pool (see ¶ 13.3.1.2) and
Program Development by the H&W Pool (see ¶ 13.3.2.2), and Special
Assessments for the H&W Pool (see ¶ 13.4.4), “Assessment
Methodology” shall mean the formula adopted by the
Assessment Share -- shall mean the amount of money a Member becomes obligated to pay to the Fund as a result of an Assessment.
Assets -- shall mean, without limitation, all
monies, bank accounts, securities, accounts receivable, collateral,
debt
instruments, investments, and any other thing of
value owned by the Fund and held by the Fund for
the benefit of its respective Risk Pools.
Assigned Deductible -- shall
mean the Deductible a Member chooses to assign to a specific item or specific
types of Insured Property as reflected in the Schedule of Values maintained by
the Administrator (see § X, ¶ 7.1), or the Deductible otherwise
established for the Member's property pursuant to § X, ¶ 7.2.
Assumed Liability -- shall mean property owned by a Third Party, excluding property owned by an Employee, for which the Member has agreed to be legally responsible by contract, which is not listed in the Schedule of Values at the time a Property Assessment is issued, but with respect to which Property Coverage is provided pursuant to § X, ¶¶ 3.2.1 and 12.1.1 and the Property Coverage Section.
Attachment Point -- shall mean the level of expenditures by the Fund on behalf of a Risk Pool for a Covered Claim, for Coverage Payments, and Defense Costs and/or Property Claim Costs, at which the Risk Pool's Coverage Limit is exhausted and the Risk Pool's Primary Excess Coverage attaches and begins to provide coverage for the Covered Claim.
Authorizing Resolution -- shall
mean the formal resolution duly adopted by the governing body of each Member
and New Member specifically authorizing the Member to execute the SIA and
agreeing to be bound by its terms, including its Amendment Procedures
permitting amendment of some of the provisions of the Program Documents by less
than a Unanimous Vote of the Board. “Authorizing Resolution” shall also mean
the formal resolution of the governing body of a Member approving any
subsequent enactment with respect to or amendment of the Program Documents
which requires approval by a Unanimous Vote.
(See, § I, ¶ 5.5); provided, however, that an Authorizing
Resolution may specifically ratify the prior Board Votes of Members’ Directors,
the documents previously executed by Members’ Directors, and such Member’s de
facto operation under or acceptance of the benefits under and terms
thereof.
Auto -- shall mean a land motor vehicle, trailer or semi-trailer designed for travel on public roads, but does not include Mobile Equipment, except for the types of "self-propelled" Mobile Equipment as described in § V, ¶ 1.7(f), regarding Auto Liability Coverage, and in § XI, ¶ 1.14, regarding Auto Physical Damage Coverage.
Auto Claim -- shall mean a Property Claim for an Auto Loss.
Auto Loss -- shall mean a Property Loss to a Covered Auto arising from an Accident.
Auto Loss Amount -- shall mean the Property Loss Amount for an Auto Loss.
Auto Liability Coverage
(or “Auto Coverage”) -- shall mean the Automobile Liability Coverage provided by the Fund for Members of the Liability Pool under the Auto Liability Coverage Section of the SIA (§ V).
Auto Physical Damage Coverage -- shall mean the Auto Physical Damage Coverage which is offered to Members of the Property Pool for Direct Physical Loss or Damage to a Covered Auto arising from an Accident as part of the Fund's Property Coverage Program, as set forth in § XI.
Auto Physical Damage Coverage
Limit -- shall mean the Property Coverage Limit for the General Property Coverage Section (§ X) which shall be applied in the manner set forth therein to all Covered Auto Physical Damage Claims and/or to all Covered Property Claims involving Property Loss (including Auto Loss) arising from a single Property Loss.
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Average Claims Frequency Ratio -- |
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shall mean the average of all H&W Members’ Claims Frequency Ratios, as provided in § XV, ¶ 2.1(a). |
Basic Per Capita -- shall mean the 10% portion of a Liability or a Property General Assessment that is allocated equally among all Members for purposes of calculating a Member's Assessment Share of the General Assessment, as provided in § VIII, ¶ 2.1.
Benefits -- shall mean “Health & Welfare Benefits” (or “H&W Benefits”).
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Benefits Check |
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shall mean a check issued by the Administrator for the H&W Pool to a Medical Provider to pay for Medical Services provided to an Eligible Employee or Dependent. |
Board -- shall mean the Board of Directors of the
Fund, as provided in §
Board Decisions -- shall mean those decisions by the Board,
made in compliance with the applicable Voting Standard and consistent with the
terms of this Agreement, which, as a result, are binding on all Members. (See,
§ I, ¶ 6.3).
Board Remedies -- shall mean those actions the Board may take with respect to a Member's violation of the Fund's Risk Management Program, as provided in § I, ¶ 17.4.
Bodily Injury -- shall mean physical injury, sickness, disease or death sustained by any Third Party, and/or mental anguish, mental illness, emotional upset or anguish sustained by any Third Party connected with or arising out of such physical injury, sickness, disease or death, and any loss of consortium.
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Borrowing Risk Pool |
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shall mean the Risk Pool receiving the Inter-Pool Loan. |
Broker -- shall mean the person or entity retained
by the Board pursuant to §
Business Activities -- shall
mean those activities of a Member that normally relate to the types of Services
the Member provides in its Public Utility Operations and which are reasonably
necessary to providing those Services or to producing income for the Member
from those Services or for related business activities for which the Member
specifically charges Customers or other Third Parties. (See, § III, ¶ 3.15(b)).
CGL Coverage -- shall mean the Commercial General
Liability Coverage provided by the Fund for Members of the Liability Pool under
the CGL Coverage section of the SIA (§ III).
Claim -- shall mean either a Liability Claim, a Property Claim or an H&W Claim.
Claimant -- shall mean the Third Party that has asserted a Liability Claim against a Member and/or an Employee, Insured Agent or Insured Volunteer.
Claim Resolution (Rules & Procedures) -- shall mean the section of the SIA that addresses the rules and procedures for resolving Claims, including Defense, selection of Defense Counsel, Member participation in litigation and payment of Coverage Payments. (§ VII).
Claim Resolution Costs -- shall mean any attorneys fees, court and legal costs
and similar related costs incurred by the Fund in connection with a Member’s Assessment delinquency. (See § I, ¶ 13.7(d)).
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Claims Experience |
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with respect to the H&W Pool, shall mean a Member’s or a potential New Member’s experience regarding the amounts and frequency of Health & Welfare Benefits claims for its Employees and Dependents. |
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Claims Frequency Factor |
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shall mean the percentage that a Member’s Claims Frequency Ratio is to the total of all Claims Frequency Ratios of all H&W Pool Members. A Member’s Claims Frequency Factor is used to weight a Member’s 30% Formula Component relating to its H&W Claims Experience based on the frequency of such Member’s H&W Claims in relation to the frequency of the H&W Claims of all H&W Pool Members. (see § XV, ¶ 2.1). |
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Claims Frequency Ratio |
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shall mean the Ratio resulting from dividing the total of all Benefits Checks issued by the H&W Pool to Medical Providers for each Member’s Eligible Employees and Dependents in the preceding month by the total number of each Member’s Eligible Employees in the preceding month, as provided in § XV, ¶ 2.1(b). |
Cleanup Costs (or Cleanup) -- shall mean the portion of Remediation Costs that relate to treating, incinerating, neutralizing, removing or otherwise cleaning up or disposing of Pollution (as distinguished from Containment Costs).
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COBRA Coverage |
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shall mean the requirements of 26 CFR, Parts 54 and 602, applicable to non-federal governmental group health plans under the Public Health Service Act, and any applicable similar federal or State law, requiring the Members of the H&W Pool to which it applies to provide continuing H&W Coverage to any Employee of a Former Member or to an Eligible Employee that has ceased his/her employment relationship with a Member, or similar circumstance. |
Colorable Claim of Liability -- shall mean any Liability Claim with respect to which the Administrative Committee concludes that there is some reasonable basis in both fact and in law to believe that the Claim asserted could result in a judgment of liability against a Member and/or Employee.
Colorable Dispute -- shall mean a dispute regarding the existence of coverage between a Member and an Excess or Stop Loss Carrier which involves facts or legal issues determined by the Administrative Committee to constitute legitimate grounds for pursuing Coverage Litigation against such Carrier, as referenced in § I, ¶¶15.1 and 15.7.
Commissioner -- shall mean any duly elected commissioner in good standing of any of the public utility district Members.
Community Activities -- shall
mean those activities or services, including the use of a Member's Equipment,
donated by a Member or its Employees to or for the benefit of community,
charitable or civic organizations. (See,
§ III, ¶ 3.15(a).
Compliance Date -- shall mean the date stated in a Remediation Letter by which the correction or remedy of an Unreasonable Risk needs to occur for the Member to avoid the potential imposition of Board Remedies under § I, ¶ 17.4.2 for violation of the Fund's Risk Management Program.
Conditional Coverage Payment -- shall mean the Fund's payment of a portion or all of its Coverage for a Covered Liability Claim to or on behalf of a Member under a Reservation of Rights, pending ultimate resolution of the Reservation, as permitted in § VII, ¶ 7.5.
Containment Costs (or Containment) -- shall
mean the costs of designing, building, installing, maintaining and monitoring a
system for containing a Pollution Release and preventing further migration of
the Pollution. In the context of a
Remediation Action or Pollution Claim, "Containment Costs" shall be
such actual costs of containing the Pollution, whether on a Member's property
or Third Party Property, as may be imposed upon or agreed to by the Member with
the Environmental Enforcement Agency, subject to the Liability Coverage Limit. In the context of a Claim by a Member for
Property Damage to the Member's Owned Property resulting from a Pollution
Release that occurred on the Owned Property, "Containment Costs"
shall mean reasonable, or a reasonable estimate of, Containment Costs to prevent
the migration of Pollution to Third Party Property or to prevent further
Environmental Damage to such Third Party Property, subject to the Liability
Coverage Limit (see, § VI,
¶¶ 3.1.5 and 3.1.6).
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Continuing Treatment |
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shall mean the right, if provided for under the terms of such Employee’s applicable Coverage Booklet and otherwise consistent with the H&W Coverage provided under the SIA, of an Eligible Employee of a Former Member to receive continuing Medical Services after the Withdrawal Date for a Medical Condition for which Medical Services were first provided to such Employee during the H&W Coverage Period. |
Contract Conversion Hours -- shall
mean the hours the Administrative Committee determines should be added to a
Member's Employee Hours Worked because of an Added Exposure Contract such
Member has or proposes with a Third Party, for purposes of applying the
Liability General Assessment Formula. (See, § VIII, ¶ 5.2).
Contribution -- shall mean the legal obligation to pay a proportionate share of a whole liability as one of several joint tortfeasors, joint debtors or otherwise.
Cost of Substitute Service -- shall
mean the difference between the cost to the Member of acquiring the raw
material that is the subject of its services (i.e., electricity, water, gas or
sewer) under Normal operations and the cost to the Member of acquiring such
material from alternative sources in order to continue its operations as the
result of a Property Loss (see § X, ¶ 2.4).
Coverage(s) -- shall mean the protection provided by the Fund under the SIA for Members of its Risk Pools (see §§ III-VI, X-XI, and XIV).
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Coverage Booklet |
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shall mean the written materials a Member provides to its Employees describing the scope and terms governing the Health & Welfare Benefits the Member is providing its Eligible Employees and their Dependents though the H&W Coverage provided by the H&W Pool. |
Coverage Determination -- shall mean the decision of the Administrative Committee as to whether a Claim is in fact a Covered Claim, as provided for in § VII, ¶ 2.1 and Op. Rules, § I, ¶ 9.4.3(d).
Coverage Limit -- shall mean the maximum amount the Fund may be required to pay, including Coverage Payments, Defense Costs and Property Claim Costs, for all Covered Claims arising from one Loss Event, as provided in § III, ¶ 2.2; § IV, ¶ 2.2; § V, ¶¶ 2.2 and 2.4.2; § VI, ¶ 2.1; § X, ¶ 4; and § XII, ¶ 4.
Coverage Litigation -- shall
mean any lawsuit brought by the Fund against any Excess Carrier or Stop Loss
Carrier, or by an Excess Carrier against the Fund or its Members or Employees,
in which coverage is sought for a Claim, in accordance with § I, ¶ 15. "Coverage Litigation" shall also
refer to such a lawsuit brought by members of a Subgroup against a Subgroup
Carrier. (See, Op. Rules, § I, ¶ 16.7).
Coverage Litigation Costs -- shall
mean the total of the legal fees, costs and expenses, and expert fees incurred
by the Fund in connection with Coverage Litigation. (See § I, ¶ 15).
Coverage Payments -- shall mean any and all payments the Fund makes to or on behalf of a Member or Employee because of a Covered Claim: ie. payments for Damages for a Covered Liability Claim; Property Coverage Payments for a Covered Property Claim; and payments for H&W Claim Costs for a Covered H&W Claim.
Coverage Period -- shall mean, with respect to a Liability Claim against a Member or a Property Claim by a Member, the time period during which the Member was a Member of the Risk Pool, and with respect to a Liability Claim against an Employee or a Property Claim by a Member on behalf of an Employee, the time period during which the Employee was employed by a Member while the Member was a Member of the Risk Pool, for purposes of determining whether the Loss Event took place within the period of time for which the Fund provides Coverage.
Coverage Qualifications -- shall mean the requirements set forth in § III, ¶ 2.4 as conditions precedent to Liability Coverage by the Fund for an Employee, Insured Agent or Insured Volunteer. The "Coverage Qualifications" for the PO&E Coverage are set forth in § IV, ¶ 2.4.
Coverage Territory -- This Auto Physical Damage Coverage shall apply to all Covered Autos worldwide.
Coverages -- shall mean §§ III through VI and §§ X-XI of the SIA that set forth the protection provided by the Fund for Members of its Risk Pools and their Employees for Covered Claims.
Covered Auto -- for purposes of the Auto Physical Damage Coverage Section, shall have the meaning set forth in § XI, ¶ 1.8.
Covered Auto Physical Damage Claim -- shall
mean a Property Claim filed with the Administrator by a Member, on behalf of
the Member or one or more of its Employees, arising out of an Accident causing
Direct Physical Loss or Damage to a Covered Auto, which occurred at a time when
the Member requesting Auto Physical Damage Coverage for the Property Claim was
a Member of the Property Pool, and for which Auto Physical Damage Coverage is
provided by the Fund pursuant to the terms of the Auto Physical Damage Coverage
Section (see § XI).
Covered Automobile Liability Claim -- shall mean a Liability Claim for which Coverage is provided under the Automobile Liability Coverage Section (§ V).
Covered Claim -- shall mean a Covered Liability Claim, a Covered Property Claim, or a Covered H&W Claim.
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Covered H&W Claim |
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shall mean an H&W Claim for which H&W Coverage is provided to an Eligible Employee (or Dependent) under the terms of the applicable Coverage Booklet and the SIA. |
Covered Liability Claim -- shall mean a Liability Claim asserted against a Member or Employee, or a Director, Fund Officer or member of the Fund's Standing Committees for which Liability Coverage is provided by the Fund pursuant to the terms of §§ III-VI, or with respect to which the Fund is proceeding to provide Defense under a Reservation of Rights.
Covered PO&E Claim -- shall mean a Liability Claim for which Coverage is provided under the Public Officials and Entity Liability Coverage Section (§ IV).
Covered Pollution Claim -- shall mean a Liability Claim for which Coverage is provided under the Pollution Liability Coverage Section (§ VI).
Covered Property Claim -- shall mean a Property Claim filed by a Member, on behalf of the Member or one or more of its Employees, for which Property Coverage is provided by the Fund pursuant to the terms of § X and/or § XI.
Covered Vehicle -- for purposes of the Auto Liability Coverage Section, shall have the meaning set forth in § V, ¶ 1.3.
Customer -- shall mean a person or entity that purchases Services or Products from a Member in connection with its Public Utility Operations.
Damages -- generally throughout the SIA, and in particular with respect to the CGL Coverage (§ III), shall mean the amount of monetary compensation or recovery a Member or Employee is or becomes legally obligated to pay to a Third Party for liability arising out of a Covered Liability Claim, including any award of costs or attorneys fees against a Member or Employee. When appropriate in the context, "Damages" can also mean the amount of compensation demanded by a Claimant. With respect to the PO&E Coverage (§ IV), "Damages" shall have the meaning in ¶ 1.2 thereof.
Date of Default -- shall mean the date a Member's Assessment Share of any Assessment levied by the Fund is due under the terms of § I, ¶ 13.4.
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Date of Membership |
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shall mean the date a Member of the Fund becomes a Member of a particular Risk Pool. |
De Minimis Premium -- shall
mean that additional portion of a settlement offered by an Environmental
Enforcement Agency to a Potentially Responsible Party involved in a Pollution
Claim who qualifies under the circumstances for a de minimis treatment as the
quid pro quo for release or conditional Release of such party from the
obligation it would have otherwise had to participate in paying its share of
all Remediation Costs actually ultimately incurred. (See, § VII, ¶
7.3.2.3).
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Debatable H&W Claims |
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shall mean an H&W Claim for which H&W Coverage is neither clearly provided for, nor clearly precluded, by the terms of a Member’s Coverage Booklet and the SIA (see § XV, ¶ 5). |
Debris Removal Expense -- shall mean the Property Coverage the Fund provides for removal of debris caused by a Property Loss to Insured Property, as provided in § X, ¶ 17 of the Property Coverage Section.
Decision
Issue -- shall mean any issue a Member is entitled
to have placed on the Agenda for discussion and decision by Board Vote at the
next General or Special Meeting: (a) by providing the Administrator with the
written request required by § I, ¶ 7.4 and Op. Rules, § I, ¶ 7.4 at least 30
days prior to the date set for the Meeting at which the issue is to be decided;
or (b) with respect to Appeal Issues only, by exhausting the Appeal Procedures
through the
Deductible -- shall mean the amount of money the Member or Employee must pay for or toward the liability for a Covered Liability Claim before the Fund's Coverage obligation begins, as required in § III., ¶ 2.3; § IV, ¶ 2.3; § V, ¶ 2.3; and § VI, ¶ 2.1.
Defense
(or "Right of Defense" or
"Defend" or "Duty to Defend") -- shall mean the Fund's obligation to provide a Member or
Employee with a defense against a Covered Liability Claim by paying the Defense
Costs thereof, as required by § VII, ¶ 5, and subject to any restrictions
thereon in the SIA (see also § III, ¶ 2.1; § IV, ¶ 2.1; § V, ¶
2.1; and § VI, ¶ 2.1).
Defense Costs -- shall mean all costs and expenses the Fund incurs in connection with resolving a Covered Liability Claim, including without limitation, investigation and expert expenses, witness fees, court costs and attorneys fees, but excluding any "Coverage Payments" or related Administrative Expenses. "Defense Costs" shall also mean the same types of reasonable expenses when used to refer to Defense Costs Members have reasonably incurred that may be reimbursable by the Fund. With respect to the PO&E Coverage (§ IV), "Defense Costs" shall have the meaning in ¶ 1.3 thereof.
Defense Counsel -- shall mean the attorney retained by the Fund to defend Members and Employees from Covered Liability Claims, as provided in § VII., ¶ 4.
Definitions -- shall refer to the section of the SIA that
contains the definitions for words commonly used throughout all Program
Documents (see § II), subject to modification by the specific
definitions contained in the Coverage sections (§§ III-VI and §§ X-XI).
Demand for Arbitration -- shall mean the notice invoking the arbitration procedures set forth in § I, ¶ 24.4.3.
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Dependent Coverage |
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shall mean H&W Coverage provided for Medical Services rendered to an Eligible Employee’s Dependents, as that term is defined in the applicable Coverage Booklet. |
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Dependents |
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shall mean, without limitation, an Employee’s spouse or children or other dependents eligible for H&W Coverage, as determined by the terms in the applicable Coverage Booklet. |
Designated Liability Pool Balance -- shall mean the Designated Risk Pool Balance for the Liability Pool, as established by the Board from time to time pursuant to § I, ¶ 13.1.1.
Designated Property Pool Balance -- shall
mean the Designated Risk Pool Balance for the Property Pool, which shall be an
amount equal to two (2) times the currently applicable Maximum Property
Retention, as established by the Board from time to time pursuant to § I, ¶
13.1.1 (see also § X, ¶4).
Designated Risk Pool Balance -- shall
mean the amounts designated by the Board for each Risk Pool pursuant to §
Detailed Appraisal -- shall mean the comprehensive Annual Appraisal obtained by the Fund on behalf of the Property Pool in the first calendar year of the Property Pool's operation, and in every third calendar year thereafter, as provided in § X, ¶ 14.
Direct Administrative Expenses -- generally,
shall mean those Administrative Expenses that are not Shared
Administrative Expenses, i.e. they are the Administrative Expenses the Fund
incurs as a direct result of the operations of a particular Risk Pool, which
shall be allocated in total to the financial responsibility of that Risk Pool (see
§ I, ¶ 13.1.5).
-- with respect to the Liability Pool,
“Direct Administrative Expenses” shall not include Liability Coverage Payments
for Damages or Defense Costs.
-- with respect to the Property Pool, “Direct
Administrative Expenses” shall not include Property Coverage Payments or
Property Claim Costs.
-- with respect to the H&W Pool, “Direct
Administrative Expenses” shall mean and include Administrator, Broker, Accounting, Legal and similar or
other fees and charges directly attributable to operation of the H&W Pool,
including Per Capita Administrator Fees, but shall not include PPO Charges or Stop
Loss Insurance Premiums, or H&W Claims Costs (i.e. Direct H&W Claims
Costs and Shared H&W Claims ).
|
Direct H&W Claims Costs |
--- |
shall mean the dollar amount of a Member’s H&W Claims Costs which does not qualify for treatment as “Shared H&W Claims”, and which is passed through directly to a Member on a monthly basis as part of the Member’s Monthly H&W Assessment. |
Direct Physical Loss or Damage -- shall
mean destruction of or damage to Insured Property as a result of an Insured
Peril(s) (see definition of "Property Loss", § X, ¶ 1.42, and
terms of "Property Coverage" set forth in § X, ¶ 4).
Director -- shall mean the Commissioner, or other
representative from a Member's governing body, or Employee designated of record
to serve as a Member's representative on the Board, as provided in § I., ¶ 6.1,
and shall include alternate Directors and Employee Designees (see also
Op. Rules, § I, ¶ 6.1).
Disbursement Procedures -- shall mean the general requirements set forth in § I, ¶ 12.4, and in particular, the written procedures and which govern how the Fund disburses money and approves and issues payments for the Fund’s respective Risk Pools as contained in the Financial Procedures Manual retained in the offices of the Administrator. (See Op. Rules, § I, ¶ 12.4).
Discretionary General Assessment -- shall
mean a General Assessment levied by the Board in accordance with §
Discussion Issue -- shall mean any issue a Member is entitled to have placed on the Agenda for discussion by the Board by providing the Administrator with the written request required by § I., ¶ 7.4 and Op. Rules, § I, ¶ 7.4 at least 14 days prior to the date set for the General or Special Meeting at which the issue shall be discussed.
Dissolution Vote -- shall mean a Super-Majority Vote of the Directors
entitled to vote to dissolve a Risk Pool or the Fund and windup its operations
and affairs. (See, § I,
¶ 21.1).
Dissolution Date -- shall mean effective date of a Risk Pool's
or the Fund's dissolution, which shall be at the end of the calendar year in
which the Dissolution Vote occurred. (See,
§ I, ¶ 21.1).
Disputes -- shall mean the types of disagreements
among Fund Members or between a Member and the Fund relating to the Program
Documents or actions of the Board or Committees that are subject to mandatory
binding arbitration under § I, ¶ 24.4.1, or resolution by a court under §
I, ¶ 24.4.7, after exhaustion of the Appeal Procedures. (See, § I, ¶ 24.4.2).
Dollar Percentage-of-Completion -- for purposes of determining the Insured Value of Property-Under-Construction, shall mean the dollar value of the construction work in place, measured by the total dollar obligation the Member has incurred under the construction contract as reflected by the construction progress payment schedule at the time the Property Assessment was issued.
|
Eligibility |
--- |
shall mean the terms and conditions established by each Member for its Employees, as reflected in such Member’s Coverage Booklet, determining when such Employees and their Dependents are entitled to H&W Coverage. |
||
|
Eligible Employee |
--- |
shall mean an Employee who is enrolled by the Member with the Administrator for the H&W Pool as entitled to receive H&W Coverage for Medical Services, as determined by the terms of the applicable Coverage Booklet and the SIA. |
||
|
Eligible Employee Assessment Allocation |
-- |
shall mean the dollar amount of the Formula Component of a Member’s H&W Assessment Share of 70% of the Shared H&W Cost based on the number of the Member’s Eligible Employees in relation to the number of Eligible Employees of all H&W Pool Members, as determined under the H&W General Assessment Formula, (see § XV, ¶ 2.2). |
|||
|
Eligible Employee Factor |
-- |
shall mean the percentage of an H&W Pool Member’s Eligible Employees in relation the number of Eligible Employees of all Members, (see § XV, ¶ 2.2(a)). |
|||
|
Eligible Insured |
-- |
shall mean either an Eligible Employee of a Member or a Dependent of an Eligible Employee entitled to H&W Coverage through a Member according to the terms of such Member’s Coverage Booklet. The “Eligible Insureds” of a Member shall be all Eligible Employees and Dependents of such Member. |
|||
Emergency Decisions -- shall
mean those decisions the
Emergency Response Costs -- shall
mean the reasonable costs incurred by or on behalf of a Member, including
reasonable wages and overhead allocations for a Members' use of its own
Employees and/or equipment (as provided in the Op. Rules § VII, ¶ 7.1), in
taking emergency measures to contain a Pollution Release and prevent it from
imminently spreading to or causing further Environmental Damage to Third Party
Property. (See, § VI, ¶ 3.1.4).
Employee -- generally, shall mean any commissioner, director, officer or employee of any Member of a Risk Pool. Where reasonable and appropriate in the context, “Employee” shall include any former officer, commissioner, or employee of a Member of a Risk Pool.
-- with respect to the CGL Coverage (§ III), the term “Employee” shall also include any Insured Agent and Insured Volunteer, except where specifically provided otherwise.
-- with respect to the PO&E Coverage (§ IV), the term “Employee” shall also have the meaning in ¶¶ 1.4 and 1.8(d) thereof.
-- with respect to the H&W Pool, the term “Employee” shall mean the Employee of a Member of the H&W Pool, and unless otherwise inconsistent in the context, shall include such Employee’s Dependents, as determined by the terms of the applicable Coverage Booklet.
-- with respect to a Former Member, “Employee”
shall include such Employees who were Employees of the Former Member when such
Member was a Member of a Risk Pool, to the extent any rights are afforded such
Former Member or its Employees under the SIA.
|
Employee Demographic Categories |
--- |
shall mean the three weighted risk categories that are used in connection with the H&W General Assessment Formula to establish the amount of a Member’s Aggregate Stop Loss and a Member’s Individual Stop Loss. The three categories consist of (a) an Eligible Employee, (b) an Eligible Employee and one Dependent, and (c) an Eligible Employee and 2 or more Dependents, as provided more specifically in § XV, ¶ 3.2.3. |
|
Employee Demographics |
--- |
shall mean the number or percentage of Eligible Employees and/or Dependents for each Member, verses the H&W Pool as a whole, with respect to each of the Employee Demographic Categories. |
Employee Designee -- shall mean the Employee designated by a
Member to serve as the Director-representative at a Board meeting, as provided
for in §
Employee Hours Worked -- shall mean the 70% portion of a Liability General Assessment that is allocated to a Member based on the ratio of the Member's total Employee Hours Worked divided by the total of such Hours for all Members (as reflected on the reports Members file with Washington Department of Labor & Industries entitled "Employers Quarterly Report of Hours for Industrial Insurance," or similar report required of Members located outside of Washington) for purposes of calculating a Member's Assessment Share of the General Assessment, as provided in § VIII, ¶ 2.3. "Employee Hours Worked" shall include the Contract Conversion Hours approved by the Administrative Committee for any Added Exposure Contract pursuant to § VIII, ¶ 5.2.
Employee's Auto -- shall mean an Auto owned by an Employee, or a Member of his or her family, which shall be treated as a Non-Owned Auto for purposes of determining Coverage under the Auto Physical Damage Coverage Section (§ XI).
Employee's Property -- shall mean property owned by the Employee which is covered under the General Property Coverage Section under the circumstances set forth in § X, ¶ 2.1.5, and shall include "Employee's Autos", which are covered under the Auto Physical Damage Coverage Section under the circumstances set forth in § XI, ¶ 1.8.3.
Environmental Damage -- generally, shall mean the injurious presence of Pollution in or upon land, the atmosphere, or any water course or body of water as a result of a Pollution Release. In the context of a Remediation Action by an Environmental Enforcement Agency, to constitute "Environmental Damage," the Pollution must rise to the threshold level authorizing an Environmental Enforcement Agency under the applicable law to take any Remediation Action or resulting in such Agency taking such Action against a Member for Remediation Costs. In all other contexts, "Environmental Damage" shall mean a Pollution Release that results in Personal Injury or Property Damage which may or in fact does give rise to a Pollution Claim.
Environmental Enforcement Agency -- shall mean any agency of any state or federal government having jurisdiction over alleged Environmental Damage.
Equipment -- shall mean tools, equipment, mobile heavy
equipment (e.g., tractors with backhoes) and equipment attached to
vehicles (like the hydraulic basket on line trucks).
Excess Coverage (or Excess Insurance) -- shall mean Excess Liability Coverage or Excess Property Coverage.
Excess
Liability Coverage (or
Excess Liability Insurance) -- shall mean the coverage provided by the Fund's Excess Liability Policies for Members of the Liability Pool for Incurred Liabilities and Defense Costs in excess of the Fund's Liability Coverage Limit, consisting of the Primary Excess Liability Coverage (§ I, ¶ 14.1) and any Supplemental Excess Liability Coverage (§ I., ¶ 14.2).
Excess Liability Policies -- shall mean the insurance policies that reflect the Excess Liability Coverages for Members of the Liability Pool.
Excess Carrier -- shall mean an insurance company that has issued an Excess Policy to the Fund.
Excess Policies -- shall mean the insurance policies reflecting the Excess Liability Coverages and/or the Excess Property Coverages the Fund acquires for the Members of the Liability or Property Pool, respectively.
Excess Premium -- shall mean the total premium charged by an Excess Carrier for issuance of an Excess Policy.
Excess Premium Base Amount -- in
connection with applying the Liability Premium Assessment Formula, shall mean
the amount remaining after all Members' Added-Risk Pass Throughs are subtracted
from the Excess Premium for Excess Liability Coverage. (See, § IX., ¶ 3).
Excess
Property Coverage
(or Excess Property Insurance) -- shall mean the Coverage provided by the Fund's Excess Property Policies for Members of the Property Pool for Property Coverage Payments and Property Claim Costs in excess of the Fund's Property Coverage Limit, consisting of the Primary Excess Property Coverage (§ I, ¶ 14.1) and any Supplemental Excess Property Coverage (§ I, ¶ 14.2).
Excess Property Policies -- shall mean the insurance policies that reflect the Excess Property Coverages for Members of the Property Pool.
Exclusions -- shall mean the provisions in the Coverages
sections of the SIA entitled "Exclusions" which identify the types of
Claims that are excluded from Coverage under the Insuring Agreements (see,
¶ 3 of §§ III-VI, § X, ¶¶ 8 and 9; and § XI, ¶¶ 8 and 9).
Executive Session -- shall mean a closed session or portion of a meeting of the Board or any Committee to discuss issues permitted by applicable Public Disclosure Laws to be conducted in such fashion pursuant to § I, ¶ 11.5.
Expediting Expenses -- shall mean those expenses a Member incurs to expedite repair or replacement of the damaged Insured Property, as provided in § X, ¶ 2.5; provided that such expenses are approved by the Administrator in advance, as required by § X, ¶ 12.5.
|
Extended Coverage H&W Claim |
-- |
shall mean any H&W Claim for which H&W Coverage is provided by the H&W Pool for the Employee of a Former Member, after the effective date of such Member’s withdrawal from the H&W Pool, for a Medical Condition that gives rise to a right to Continuing Treatment for such Former Member’s Employee in accordance with such Member’s Coverage Booklet, or that involves mandated Continuing Treatment under the H&W Coverage for such Employee beyond the Former Member’s Withdrawal Date under the terms of COBRA, or similar law. |
Extra Expense -- shall mean the excess of the total cost to
the Member during the Period of Restoration of the damaged Insured Property
chargeable to the operation of the Member's Public Utility Operations over and
above the total cost the Member would have incurred to conduct its Normal
operations during the same period of time had no Property Loss occurred (see
§ X, ¶ 2.4).
Extraordinary Activities -- shall
mean all Community Activities, and shall include those Business Activities of a
Member, including sales of Products, that are beyond or fall outside of what a
reasonable person would believe constituted the normal and expected Business
Activities of a local governmental entity providing Services consistent with
the Member's type of local governmental entity.
(See, § III, ¶¶ 2.5.5 and 3.16).
Failure to Supply -- shall mean circumstances where a Service provided by a Member is either substantially diminished or not supplied at all for a period of time to a Member's Customer.
Fair Market Value -- shall mean the amount a third-party purchaser, who is not under compulsion, would pay for the Insured Property at the time and place of the Property Loss if the Property had not been damaged; provided that the Fair Market Value shall never exceed the Actual Cash Value thereof.
Final Quote -- shall mean the second and final quote for
the premium for the Proposed Coverage which shall be provided by the
Administrator to the Remaining Subgroup Participants under the Subgroup
Procedures. (See, Op. Rules, § I,
¶ 16.2).
Financial Officer -- shall mean the auditor, director of
finance or other financial officer or employee of a Member, which shall be a
qualification to be appointed as Auditor for the Fund. (See § I, ¶
12.1).
Financial Procedures Manuel -- shall mean the manuel retained at the offices of the
Administrator that, among other things, contains copies of the Fund’s currently
applicable Investment Procedures and Disbursement Procedures.
First Quote -- shall mean the first quote for the premium
for the Proposed Coverage which shall be provided by the Administrator to all
Subgroup Participants under the Subgroup Procedures. (See, Op. Rules, § I, ¶ 16.1(B)).
Follow-Up Assessment -- shall mean a Property Assessment for Newly Acquired Property, Leased Property, Assumed Liability or Property-Under-Construction, issued retroactively to one or more Members of the Property Pool under the circumstances set forth in § X, ¶¶ 12.1.2 and 12.2.2.
Former Member -- shall mean any prior Member of a Risk Pool which has withdrawn from that Risk Pool pursuant to § I, ¶ 21.
Formula Component -- shall mean the basic elements for
determining a Member's Assessment Share under the General and Premium
Assessment Formulas. For the Liability
Pool, the Formula Components consist of the Basic Per Capita, Employee Hours
Worked, and Historical Claims Experience (see, §§ VIII and IX). For the Property Pool, the Formula Components
consist of the Basic Per Capita, the Relative Insured Value and the Fire Rate
Adjusted Relative Insured Value (see §§ XII-XIII).
Fund -- shall mean the unincorporated association of local governmental entities, including any New Members, established pursuant to this Self-Insurance Agreement.
|
Fund’s Fiscal Year |
--- |
shall mean the annual accounting year for the Fund, which shall be the calendar year, unless otherwise determined by Majority Vote of the Board. |
Fund Officer -- shall mean the President, Vice-President or Secretary-Treasurer of the Fund, as provided in § I, ¶ 8.1.
General Assessment -- shall
mean any Assessment calculated pursuant to the Liability General Assessment
Formula (see, § VIII) or the Property General Assessment Formula (see,
§ XII) and levied to provide assets allocable to the Actual Risk Pool
Balance to pay the Operational Costs of a Risk Pool (see, § I,
¶ 13), and including any Special Purpose Assessments for such Risk Pool
pursuant to § I, ¶ 13.2.4, but excluding any Assessment for the payment of
premiums for Excess Policies or Subgroup Policies, which shall be purchased
through Premium Assessments, and excluding any Reserve Assessments.
General
Assessment Formulas -- shall mean the formula for calculating
Members' Assessment Shares of a Liability General Assessment applicable to
Members of the Liability Pool (see § VIII) or a Property General
Assessment applicable to Members of the Property Pool (see § XII).
General Counsel -- shall mean the attorney(s) retained by the Administrative Committee and approved by the Board to serve as General Counsel to the Fund on all legal matters and to represent the Fund in actions involving the Fund, as set forth in § I, ¶ 10.3.
General Meeting -- shall mean the two semi-annual meetings of
the Board provided for under §
General Property Coverage -- shall mean the Coverage provided to a Member of the Property Pool as part of the Fund's Property Coverage Program for Direct Physical Loss or Damage to Insured Property under the General Property Coverage Section (§ X).
Gross Revenues -- shall mean, for purposes of determining application of the Annual Assessment Limit under the General Assessment Formulas, the annual total of revenue dollars received by a Member from sales of electricity, water, gas and/or sewer Services, less the amount of any municipal/urban taxes that the Member collects from Customers and remits to the taxing authority.
|
H&W Assessments |
--- |
shall mean any and all Assessments issued by the H&W Pool to its Members. |
|
H&W Assessment Share |
--- |
shall mean the amount of money a Member of the H&W Pool becomes obligated to pay the H&W Pool on a monthly basis for Shared H&W Costs paid in the preceding month, as determined by the H&W General Assessment Formula. A Member’s H&W Assessment Share, together with its Direct H&W Claims Costs from the preceding month, shall comprise a Member’s Monthly H&W Assessment. |
|
H&W Claim |
--- |
shall mean a claim submitted by or on behalf of an Eligible Employee (or Dependent) arising from the provision of H&W Benefits, including the rendering of Medical Services, to an Eligible Employee (or Dependent) by a Medical Provider. |
|
H&W Claim(s) Costs (ie. H&W Coverage Payments) |
|
used in the plural or with respect to the H&W Pool, shall mean the total dollar amount the H&W Pool paid to and on behalf of the Employees and Dependants of H&W Pool Members for H&W Benefits, including Medical Services, in the preceding month as a result of Covered H&W Claims made by all Members’ Eligible Employees and their Dependents. |
|
|
|
used in the singular or with respect to a particular H&W Claim (ie. “H&W Claim Costs”), shall mean all costs and expenses directly related to providing the particular H&W Benefit (eg. the cost of Medical Services), but excluding any otherwise allocable H&W Pool Operational Costs. |
|
H&W Claims Cut Off Date |
--- |
shall mean the date upon which a Former Member assumes total financial responsibility for any unpaid Incurred H&W Claims and any Extended Coverage H&W Claims, and thereafter the H&W Pool ceases to have any financial responsibility with respect thereto, as determined in accordance with § I, ¶ 20.4.2.1(a) or (b). When applied to the H&W Pool in the context of the H&W Pool’s Dissolution, the “H&W Claims Cut Off Date” shall mean the date when any remaining financial responsibility for unpaid H&W Claims ceases for the H&W Pool. |
|
H&W Claims Experience |
--- |
with respect to the Initial H&W Members, and any proposed New Members, “H&W Claims Experience” shall mean the factors considered in determining the amount of such Initial or New Member’s Initial Deposit. (See definition of “Initial Deposit” herein). |
|
|
-- |
with respect to existing Members of the H&W Pool, for purposes of the evaluation by the Administrative Committee under ¶ 13.2.2 of whether any adjustments are needed to the amount of Members’ Initial Deposits, among others, “H&W Claims Experience” shall mean the total dollar amount of H&W Claims paid by the H&W Pool on behalf of a Member over a designated period of time. |
|
H&W Claims Experience Assessment Allocation |
--- |
shall mean the dollar amount of the Formula Component of a Member’s H&W Assessment Share of 30% of the Shared H&W Costs based on the Member’s H&W Claims Experience in relation to the H&W Claims Experience of all H&W Pool Members, weighted by the Member’s Claims Utilization Frequency Factor as determined under the H&W General Assessment Formula (see § XV, ¶ 2.1). |
|
H&W Claims Handling Fee |
--- |
shall mean the dollar amount of the administrative fee per H&W Claim established annually by the H&W Pool and the Administrator, as reflected in the Administrator’s Contract, to cover the Administrator’s cost of processing and paying H&W Claims on behalf of a Former Member after expiration of the Mandatory H&W Claims Runout Period, but before the H&W Claims Cut‑off Date. |
|
H&W Coverage |
--- |
shall mean the insurance coverage provided by the H&W Pool for Health & Welfare Benefits, including Medical Services, provided to each Member’s Eligible Employees and Dependents, in accordance with each Member’s Coverage Booklet and the terms of the SIA. |
|
H&W Coverage Period |
--- |
shall mean the time period during which a Member is a Member of the H&W Pool, starting upon the effective date of such Member’s participation therein, and ceasing upon the effective date of a Member’s withdrawal from the H&W Pool or on the H&W Pool’s Dissolution Date. |
|
H&W Coverage Year |
--- |
shall mean the annual or other period of time over which H&W Pool Members’ H&W Claims are accrued against their respective Stop Loss Points, which shall be the same period of time as encompassed by the Stop Loss Policy Year. |
|
H&W General Assessment Formula |
--- |
shall mean the General Assessment Formula for the H&W Risk Pool, set forth in § XV. |
|
H&W Pool |
--- |
shall mean the Risk Pool operated by the Fund that provides protection to its Members’ Eligible Employees and Dependents for Heath & Welfare Benefits, as specified in Members’ respective Coverage Booklets. |
|
H&W Pool Aggregate Stop Loss |
--- |
shall mean the total dollar amount of established by contact with the Stop Loss Carrier at which any further payments by the H&W Pool for the H&W Claims of any and all Members are thereafter covered by Stop Loss Insurance. |
|
H&W Pool Fiscal Year |
--- |
shall mean the annual accounting year for the H&W Pool, which shall be the calendar year, or the period of time encompassed by the Stop Loss Policy Year, if different from the calendar year. |
|
H&W Pool Individual Stop Loss |
--- |
shall mean the dollar amount that is established by contact with the Stop Loss Carrier at which any further payments the H&W Pool would otherwise make in connection with a particular H&W Claim and/or an Eligible Employee or Dependent, or on some other basis established by the Stop Loss Carrier, are instead covered by Stop Loss Insurance, even though the H&W Pool’s Aggregate Stop Loss has not been reached. |
|
H&W Pool Operational Costs |
--- |
shall mean
all of the costs and expenses the Fund incurs with respect to operation of
the H&W Pool, including without limitation, Direct Administrative
Expenses (including Per Capita Administrative Fees), its allocation of Shared
Administrative Expenses, PPO Charges, Stop Loss Insurance Premiums, and
H&W Claims Costs (ie. Direct H&W Claims Costs and Shared H&W
Claims). |
|
H&W Pool Reserves |
--- |
shall mean the total of all H&W Pool Members’ Initial Deposits and Adjusted Initial Deposits, which yields a number designed to approximate three (3) months of reasonably anticipated H&W Claims Experience for all Members of the H&W Pool (see § I, ¶ 13.2.1), and which is replenished on a monthly basis through Monthly H&W Assessments (see § I, ¶ 13.2.3.1). |
|
Health
& Welfare Benefits |
--- |
shall mean any and all Health and Welfare Benefits authorized by RCW 48.62, et. seq. for the H&W Pool to provide for Members’ Eligible Employees and Dependents, including but not limited to Medical Services, but only as and to the extent such Benefits are defined in the Members’ respective Coverage Booklets, and only to the extent such Benefits are consistent with the SIA. |
Historical Claims Experience -- shall mean the 20% portion of a Liability General Assessment that is allocated to a Member based on the ratio of the Member's Historical Claims Experience divided by the total of such Experience of all Members for purposes of calculating a Member's Assessment Share of the Liability General Assessment, as provided in § VIII., ¶ 2.2. A Member's Historical Claims Experience shall consist of the total of the amounts the Fund has paid or incurred in connection with resolving Covered Liability Claims asserted against the Member and its Employees, Insured Agents and Insured Volunteers during the preceding five (5) year time period for Liability Incident investigation costs (once the Claim has been asserted), Defense Costs and Coverage payments.
Imminent Re-pollution -- shall mean the situation where, without certain Remediation measures for Pollution on a Member's Owned Property, the Pollution from the original Pollution Release would migrate to and/or otherwise imminently and in the natural course cause further Environmental Damage to Third Party Property after Remediation of the Third Party Property.
Imminent Threat -- shall mean the situation where it is probable that a Pollution Release on a Member's Owned Property will cause Environmental Damage to Third Party Property unless the Member takes immediate emergency measures to contain the Pollution.
Incidental Medical Malpractice Injury -- shall mean Bodily Injury resulting from the rendering of or failure to render the following services by a Member or Employee:
(a) medical, surgical, dental, x-ray or nursing
services or treatment, or the furnishing of food or beverages in connection
therewith; or
(b) the furnishing or dispensing of drugs or
medical, surgical or dental supplies or appliances;
but only if such services are provided incidentally in connection with a Member's Public Utility Operations.
|
Incurred |
-- |
with respect to a Liability Claim, shall mean the date of the Occurrence, Wrongful Act, Accident or Pollution Release, as applicable. |
|
|
-- |
With respect to a Property Claim, shall mean the date of the Wrongful Act. |
|
|
--- |
with respect to an H&W Claim, shall mean the date that an H&W Benefit, including a Medical Service, was provided to an Eligible Employee or Dependent. |
|
Incurred H&W Claims |
--- --- |
with respect to current H&W Pool Members, shall mean the Claims of Eligible Employees or Dependents for H&W Coverage which are allocable to a particular Coverage Year, or other time period, based on the date Medical Services are rendered to such Employee or Dependent. with respect to a Former Member of the H&W Pool, shall mean all H&W Claims arising from Medical Services provided to Eligible Employees of a Former Member, or such Employee’s Dependents, during the H&W Coverage Period applicable to the Former Member, and shall include all Extended Coverage H&W Claims with respect to such Former Member. |
Incurred Liability -- with respect to the Liability Pool, shall mean the amount of a Member's or Employee's legal obligation to a Third Party for Damages, including any liability for payment of costs and attorneys fees to a Third Party, arising from a Covered Liability Claim, as established by legal proceedings or by settlement approved by the Fund;
-- with respect to the Property Pool, shall mean the Property Loss Amount established in connection with a Covered Property Claim.
-- with respect to the H&W Pool, shall mean the financial obligation Incurred by the H&W Pool to pay for H&W Claims for the delivery of Medical Services to Employees and Dependents.
Incurred Liability Exposure -- shall mean all the liabilities and obligations of a Risk Pool,
or the Fund at a particular point in time, including those related to Loss
Events that have already taken place, whether known or unknown, and whether
liquidated, contingent, or contested, along with all expenses which will be
incurred to settle, contest, liquidate or otherwise resolve any existing
Covered Claims or Incurred Liabilities, including, all Defense Costs and all
Property Claim Costs, if any, related thereto and all Administrative
Expenses. (See, § I,
¶ 20.2.3 re Former Members and ¶ 21.4 re Dissolution of the Fund).
|
Incurred Shared H&W Claims |
--- |
shall mean the Incurred H&W Claims of the Former Member and the H&W Claims of the remaining Members of the H&W Pool that constitute Shared H&W Claims on the Former Member’s Withdrawal Date. |
Independent Contractor -- shall mean a Third Party with whom a Member has a business or contractual relationship to provide products or services to or on behalf of the Member, and who may or may not legally constitute an Agent of the Member.
Industrial Insurance Act -- shall
mean the
|
Initial Deposit |
--- |
shall mean the amount of money an Initial H&W Pool Member or a New H&W Pool Member deposits with the H&W Pool in order to become a Member thereof, measured by three (3) times such Member’s Prior Monthly H&W Claims Experience, if available, or three (3) times such Member’s Prior Monthly H&W Premium, or as may be otherwise determined for a New H&W Member pursuant to § I, ¶ 18.2.2.2. The amount of the Initial Deposit may be reevaluated and adjusted every three (3) years, or sooner, as determined by the Administrative Committee, pursuant to § I, ¶ 13.2.2. Unless otherwise specified, the term Initial Deposit shall include and mean any Adjusted Initial Deposit. |
|
Initial H&W Member |
--- |
shall mean
each of those local government entities that became a Member of the H&W
Pool upon its formation on |
Insured -- with respect to the Liability Pool, shall mean a Member of the Liability Pool and its Employees, including Public Officials, and including Insured Agents and Insured Volunteers where applicable in the context. With respect to Auto Coverage (§ V), “Insured” shall have the meaning in ¶ 1.4 thereof.
-- with respect to the Property Pool, shall mean a Member of the Property Pool, or an Employee to the extent Property Coverage is provided therefore under the terms of §§ X and XI of the SIA.
-- with respect to the H&W Pool, shall mean an Employee or Dependant.
Insured Agent -- shall mean an Agent of a Member of the Liability Pool which has been named as an Additional Insured under the SIA and/or the Fund's Excess Liability Policies in accordance with § III ¶ 2.5.3 and Op. Rules, § III, ¶ 2.5.3. An Insured Agent shall have the same rights and obligations under the SIA as an Employee, except where specifically provided otherwise.
Insured Contract -- for purposes of the Auto Coverage section (§ V), shall have the meaning in ¶ 1.5 thereof.
Insured Perils -- shall mean all perils covered under the
all-risk General Property Coverage Section, except for the perils that are
Excluded (see, § X, ¶ 8).
Insured Premises -- shall mean the buildings, structures and improvements on real property thereon identified to the Member as Insured Property in the Schedule of Values maintained by the Administrator.
Insured Property -- shall mean property identified to the Member in the Schedule of Values maintained by the Administrator or property subject to one of the exceptions thereto set forth in § X, ¶¶ 3.2.1 and 12.1.1 or in ¶ 3.2.2, and shall include all Autos identified for Coverage under § XI.
Insured Values -- shall mean the value(s) assigned to items
or types of Insured Property listed in the Schedule of Values established
pursuant to an Annual Appraisal (see § X, ¶ 3.1), or the value(s)
otherwise assigned to the property by the Administrator in accordance with § X,
¶ 3.3, which shall be used for purposes of determining Members' Assessment
Shares under the Property General Assessment and Premium Assessment Formulas.
Insured Volunteer -- shall mean a person who volunteers time and/or services to a Member of the Liability Pool or to Third Parties for or on behalf of such Member or in connection with Services provided by such Member, who is an Agent of the Member and who qualifies as an Additional Insured under § III, ¶ 2.5.3 and Op. Rules § III, ¶ 2.5.3. An Insured Volunteer shall have the same rights and obligations under the SIA as an Employee, except where specifically provided otherwise.
Insuring Agreement -- with respect to the Liability Pool, shall mean the provisions in the Liability Coverage Sections of the SIA (§§ III-VI) identified as the "Insuring Agreement," stating the Liability Coverages provided by the Fund to Members of the Liability Pool, subject to the applicable Exclusions and any other provisions of the SIA providing for limitation or revocation of such Coverages.
-- with respect to the Property Pool, shall mean the provisions in the Property Coverage Sections of the SIA (§§ X-XI) identified as "Interest and Property Insured," subject to the applicable Exclusions and any other provisions of the SIA providing for limitation or revocation of such Coverages.
Interim
Automatic General Assessment -- shall mean a General Assessment
automatically levied in accordance with §
Interlocal Agreement -- shall
mean the inter-local agreement pursuant to RCW 39.34 et seq.
which constitutes § I of the SIA and which shall be executed by all Members of
any Risk Pool established by the Fund.
|
Inter-Pool Loan |
--- |
shall mean a short-term Loan by one Risk Pool to another under the terms and restrictions identified in § I, ¶ 13.2.3.2. |
Investment Policy -- shall mean the general requirements set forth in § I, ¶ 12.2, and in particular, the written policy contained in § XVI, Appendix-A, as amended from time to time, by the Board by Two-Thirds Vote, which governs the nature and manner of investments the Fund makes of its Assets on behalf of its respective Risk Pools.
Investment Procedures -- shall
mean the general requirements set forth in § I, ¶ 12.2, and in
particular, the written procedures which
govern the manner in which the Fund invests
the Assets held on behalf of the respective Risk Pools and the delegations of
certain authority regarding the same to the Administrator, which are contained
in the Financial Procedures Manual retained in the offices of the Administrator.
Joint Venture -- shall mean an association of one or more Members with one or more Third Parties to carry out a single business enterprise or project for profit for which purpose they combine a portion of their property, money, effects, skills or knowledge, such as an electrical co-generation project between a Member and a Third Party lumber mill.
Jones Act -- shall mean 48 U.S.C. § 668 et seq.,
as may be amended from time to time.
Layer of Coverage -- shall mean one of two or more layers of Excess Coverage constituting the Fund's mandatory Primary Excess Coverage, as permitted under § I, ¶ 14.1.2.
Leased Autos -- shall mean Hired Autos and/or Substitute Autos, which shall be subject to Property Coverage as "Leased Property" pursuant to § X, ¶¶ 3.2.1 and 12.1.1 and shall be subject to Property Assessments based on their Insured Values as determined for Leased Property in § X, ¶ 3.3.
Leased Property -- shall mean property owned by a Third Party which a Member, or an Employee at the direction of the Employee's Supervisor, borrows or leases for use in the Member's Public Utility Operations, which is not listed in the Schedule of Values at the time a Property Assessment is issued, but with respect to which Property Coverage is provided pursuant to § X, ¶¶ 3.2.1 and 12.1.1 and the Property Coverage Section.
Liability Assessment -- shall
mean an Assessment of the Liability Pool Members by the Fund on behalf of the
Liability Pool under one of the Liability Assessment Formulas (see
§§ VII and IX).
Liability Claim -- shall mean a formal demand for payment of Damages asserted by a Third Party against a Member or Employee. A "Liability Claim" shall also include any enforcement action against a Member by any governmental agency. A "Liability Claim" may or may not be a "Covered Claim."
Liability Coverage -- shall mean the Coverage provided to a Member of the Liability Pool for Commercial General Liability (§ III), Public Officials and Entity Liability (§ IV), Auto Liability (§ V) and Pollution Liability.
Liability Coverage Limit -- shall mean the maximum amount the Fund may be required to pay, including Defense Costs, for all Covered Liability Claims asserted against one or more Members and /or their Employees arising from any one Occurrence, as provided in § III, ¶ 2.2; § IV,¶ 2.2; § V, ¶¶ 2.2 and 2.4.2; and § VI, ¶ 2.1.
Liability Coverage Payments -- shall mean the payment(s) the Fund makes to or on behalf of a Member or Employee for Damages in connection with a Covered Liability Claim, and shall not include Defense Costs or Direct or Shared Administrative Expenses.
Liability Exposure -- shall
mean the reasonably estimated amount of a Member's or Employee's potential
liability to a Third Party arising out of a Covered Liability Claim, including
possible awards of costs and attorneys fees where applicable in the context, so
long as there is Coverage therefor under the SIA. (See, § VII, ¶ 7.3.2.2).
Liability Incident -- shall mean any Occurrence, Wrongful Act, Accident or other event that causes Personal Injury or Property Damage, or otherwise gives rise to a Claim with respect to which the Fund may provide Liability Coverage, whether or not a Claim has been filed with or asserted against a Member or Employee.
Liability Pool -- shall mean the Risk Pool operated by the Fund that provides protection to its Members against Liability Claims.
Liability Pool Operational Costs -- shall mean all of the costs and expenses the Fund incurs with respect to operation of the Liability Pool, including without limitation, Direct Administrative Expenses, its allocation of Shared Administrative Expenses, Liability Coverage Payments for Damages and Defense Costs.
Liability Program -- shall mean the rights and obligations of Members of the Liability Pool with respect to Defense and Liability Coverages, and the entire range of Administrative services provided by the Fund in connection therewith.
|
Loaning Risk Pool |
--- |
shall mean the Risk Pool making the Inter-Pool Loan. |
Local Governmental Entity
(or “Entity”) -- shall mean a local governmental entity as defined in RCW 48.62.020, as now enacted or hereafter amended.
Loss Amount -- when used in connection with a Liability Claim, shall mean the amount of Damages incurred by or awarded against a Member or Employee as a result of such Liability Claim.
-- when used in connection with a Property Claim, shall mean the Property Loss Amount of such Property Claim.
-- when used in connection with an H&W Claim, shall mean the H&W Claim Cost of such H&W Claim.
Loss Control Guidelines -- shall mean the Guidelines governing certain aspects of Members operations for the purposes of reducing the risk of loss, as adopted from time to time by the Board pursuant to § I., ¶ 17.2.
Loss Event -- with respect to Liability Coverage, shall mean an Occurrence, Wrongful Act, Accident or Pollution Release, depending on the particular Liability Coverage involved.
-- with respect to Property Coverage, shall mean a Property Loss.
-- with respect to H&W Coverage, shall mean a Medical Incident.
Loss of Coverage
(or Loss of Coverage Period) -- shall mean the period of time during which the Member of a particular Risk Pool is in default on its Assessment obligations and its applicable Coverage is irrevocably suspended, and is defined as the period beginning 180 days after the Date of Default and continuing until all amounts in default, including accrued interest thereon and the Fund’s costs and attorneys fees incurred with respect thereto, are paid in full. (See § I, ¶ 13.7(b)).
Majority Vote -- with respect to issues affecting the Fund
or more than one Risk Pool, shall mean the affirmative vote of more than half
of the total number of Directors of all Members of the Fund; provided that
there is a Quorum of Directors of all Members entitled to vote on the issue.
-- with respect to issues affecting only one
Risk Pool, shall mean the affirmative vote of more than half of the Directors
of such Risk Pool; provided that there is a Quorum of Directors of all Members
entitled to vote on the issue.
Management -- with respect to the PO&E Coverage section (§ IV), shall mean the Member's officers, manager, department heads, administrators and supervisory personnel, Employees performing engineering and surveying activities to the extent not excluded by § IV, ¶ 3.15, and any other job positions that may from time to time be established in the Operational Rules, but excluding elected public officials and directors, and excluding all other Employees of the Member. "Management" shall have this same meaning in § III, ¶ 3.25.
|
Mandatory H&W Claims Run-out Period |
--- |
shall mean the three (3) month period of time from the effective date of a Former Member’s withdrawal from the H&W Pool to the end of the third (3rd) month following the Withdrawal Date during which the Former Member shall be assessed in accordance with § I, ¶ 20.2.2.2. |
Maximum Property Retention -- shall
mean the amount established by the Board by Super-Majority Vote which sets the
ceiling for any increases the Board can make in the Property Coverage Limit
from time-to-time by Majority Vote (see § I, ¶ 13.1.1 and § X, ¶ 4).
|
Medical Condition |
--- |
shall mean an Eligible Employee’s or Dependent’s physical health or other condition for which Medical Services are provided to such Employee or Dependent during the H&W Coverage Period. |
|
Medical Incident |
--- |
shall mean the occasion(s) upon which Medical Services are provided during the H&W Coverage Period to an Eligible Employee or Dependent for a Medical Condition. |
|
Medical Information |
--- |
shall mean any and all data relating to the Medical Services provided to Eligible Employees and their Dependents to the extent confidentiality and disclosure of such Information is governed by applicable State or Federal law. |
Medical Expenses -- All reasonable expenses reasonably incurred in the treatment of injuries sustained in an Accident for which Uninsured Vehicle Coverage is provided under § V, ¶ 2.4, including all charges for hospitalization, doctors' fees, dental fees, charges by treatment centers or nursing homes, costs of physical therapy, costs of prostheses or other medical devices, and charges for medications, laboratory and diagnostic procedures, or other reasonably necessary medical charges.
|
Medical Provider |
--- |
shall mean a person or entity that provides Medical Services to an Eligible Employee or Dependent for whom H&W Coverage is provided under the terms of the applicable Coverage Booklet and the SIA. |
|
Medical Services |
--- |
shall mean medical, drug prescription, dental, vision or other types of Health and Welfare Benefits provided to an Eligible Employee or Dependent by a Medical Provider. |
Member -- shall mean a Local Governmental Entity signatory to this Agreement that is participating in one or more of the Fund's Risk Pools, but shall not include a Former Member. "Member" with reference to a particular Risk Pool shall mean a Member of that Risk Pool.
-- for purposes of ¶ 2 of the Auto Physical Damage Coverage Section (§ XI), shall have the meaning set forth in ¶ 1.13 thereof.
|
Member Aggregate Stop Loss |
--- |
shall mean the total dollar amount at which any further payments by the H&W Pool on H&W Claims by a Member’s Eligible Employees or Dependents shall constitute Shared H&W Claims and shall be reimbursed to the H&W Pool by Assessment of all Members (except for the Member that has reached its Aggregate Stop Loss) under the H&W General Assessment Formula, rather than being passed through to the Member as Direct H&W Claims Costs. The amount of each Member’s Aggregate Stop Loss shall be determined in accordance with § XV, ¶ 3.2.3. |
|
Member Individual Stop Loss |
--- |
shall mean the dollar amount at which any further payments by the H&W Pool on a particular H&W Claim or for an Eligible Employee or Dependent, or on some of other basis established by the Stop Loss Carrier, shall constitute a “Shared H&W Claim” and shall be reimbursed to the H&W Pool by Assessment of all Members (except for the Member that has reached its Individual Stop Loss) under the H&W General Assessment Formula, rather than being passed through to the Member as Direct H&W Claims Costs. The amount of each Member’s Individual Stop Loss shall be determined in accordance with § XV, ¶ 3.2.4. |
Member Settlement Ceiling -- shall mean the maximum amount the Fund will pay for a Covered Liability Claim a Member settles without prior notice to and approval of the Administrator, as provided in § VII, ¶ 6.3.
Member’s Representative -- shall mean any person that may from time to time be appointed by a Member as its Representative to the Administrative Committee for specific purposes in accordance with the provisions of § I, ¶¶ 15.3 or 19.2.6, or § VII, ¶¶ 3.1 and 3.2, and shall be subject to any limitations contained therein and in the Operational Rules.
Mobile Equipment -- for purposes of the Auto Liability Coverage Section (§ V), shall have the meaning in ¶ 1.7 thereof, and for purposes of the Auto Physical Damage Coverage Section (§ XI), shall have the meaning set forth in ¶ 1.14 thereof.
Month -- shall mean thirty (30) consecutive days.
|
Monthly H&W Assessment |
--- |
shall mean the Assessment issued by the Administrator on a monthly basis to each Member (and as applicable, Former Member) of the H&W Pool to replenish such Members’ Initial Deposit which, as to each Member, shall consist of the Member’s Assessment Share of the total amount of all Members’ Shared H&W Costs paid in the preceding month, in an amount determined by the H&W General Assessment Formula, and the total amount of that Member’s Direct H&W Claims Costs paid in the preceding month. |
Monthly Receipts and Expenditures
Analysis -- shall mean the schedule reflecting the
Fund's receipts and expenditures, prepared monthly under the supervision of the
Auditor and the Administrative Committee, per Op. Rules, § I, ¶ 9.4.3(n) and
SIA § I, ¶ 12.6, and reviewed and approved by the
Multi-Member Claim -- shall
mean Covered Liability Claims asserted against two or more Members, and/or
against one or more Employees of at least two different Members, or a Covered
Property Claim filed by two or more Members, arising out of the same, single
Loss Event. (see, § VII, ¶ 3.1.2
re participation in litigation; ¶ 4.4 re selection of Defense Counsel; ¶ 4.4 re
Defense; and ¶ 7.3 re Coverage Payments).
Multiple Liability Claim -- shall
mean Covered Liability Claims asserted against more than one Insured (counting
both Members and Employees) arising out of a single Loss Event, and shall
include the meaning of a “Multi-Member Claim” (which contemplates the
involvement of at least two (2) different Members).
"Necessarily Related" Remediation
Costs -- shall mean the Remediation Costs Covered by the Fund under § VI, ¶ 3.1.5 in the situation where some Remediation of the Pollution on the Member's Owned Property is necessarily required in order to fully Remediate the Environmental Damage to Third Party Property.
|
New H&W Member |
--- |
shall mean any local government entity that becomes a Member of the H&W Pool after its formation, in accordance with § I, ¶ 18. |
New Member -- shall mean a Local Governmental Entity that has been accepted for membership in one or more of the Fund's Risk Pools pursuant to § I, ¶ 18.
New Subgroup Member -- shall mean any Member that is granted admission to a Subgroup under Op. Rules, § I, ¶ 16.1(I) during the Subgroup Procedures or during the Subgroup Policy year.
Newly Acquired Autos -- shall mean an Owned Auto acquired by a Member which is subject to Property Coverage as "Newly Acquired Property" pursuant to § X, ¶¶ 3.2.1 and 12.1.1, and shall be subject to Property Assessments based on their Insured Values as determined for "Newly Acquired Property" in § X, ¶ 3.3.
Newly Acquired Property -- shall mean property acquired by a Member which is not listed in the Schedule of Values at the time a Property Assessment is issued, but with respect to which Property Coverage is provided pursuant to § X, ¶¶ 3.2.1 and 12.1.1 and the Property Coverage Section.
Not-For-Profit Organization -- shall mean: (a) An organization, no part of the income or
assets of which is distributable to its owners, stockholders or members and
which is formed and operated for a purpose other than the pecuniary profit or
financial gain of its owners, stockholders or members; or (b) A political
action committee which is defined for these purposes as a separate segregated
fund to be utilized for political purposes as described in the United States
Federal Election Campaign Act (2 U.S.C. 441b(2)(C)). (see, §
IV, ¶ 1.5).
Notice of Appeal -- shall mean a Member's written notice to the Administrative Committee of its desire to invoke the Appeal Procedures with respect to any Appeal Issue, except a Coverage Determination, as provided in Op. Rules, § ¶ 19.2.5(b).
Notice Date -- shall mean the date a Member delivers a
notice of intent to withdraw from one or more Risk Pools to the Administrator,
provided it is delivered prior to October 1 of the calendar year of
withdrawal. (see, § I, ¶ 20.1).
Notice of Meeting -- shall mean the notice provided to
Directors by the Administrator of a General, Special or Emergency Meeting. (See § I, ¶¶ 7.1, 7.2 and 7.3).
Occurrence -- with respect to the Liability Coverage’s
generally, shall mean an act or event, including, without limitation, repeated
or continuous exposure to substantially the same harmful conditions, or the
performance or failure of performance by an Employee of his or her duties for a
Member of the Liability Pool, that happens during the Coverage Period and which
results in Personal Injury, Property Damage, diminution in value or loss of use
of intangible property, or other injury, loss, or damage to a Third Party
compensible by monetary damages. With
respect to the Pollution Coverage Section, “Occurrence” shall have the
additional meaning set forth § VI, ¶1.10.
Official Records -- shall mean those documents identified in § I, ¶ 11 and in Op. Rules, § I, ¶ 11.1.
Operational Costs -- with respect to the Fund, shall mean all
costs and expenses incurred in connection with operation of the Fund and all of
its Risk Pools.
-- with respect to a particular Risk Pool, shall mean all costs and expenses the Fund
incurs in connection with the operation of that Risk Pool (ie. the Liability
Pool Operational Costs, the Property Pool Operational Costs, or the H&W
Pool Operational Costs. (See § I, ¶ 13.1.5).
Operational Rules -- shall mean the rules, regulations, and
procedures governing the operation of the Fund and its Risk Pools under the
SIA, as provided for in § I, ¶¶ 5.1 and 5.6, as may be adopted or amended from
time to time by the Board. (See,
SIA Notebook).
Operations Committee -- shall mean the Standing Committee established pursuant to § I, ¶ 9.3.
Order of Coverage Payments -- The terms and conditions of § X, ¶ 13 of the General Property Coverage Section shall apply to Covered Auto Physical Damage Claims filed under this Auto Physical Damage Coverage Section, and for purposes of determining the "Order of Coverage Payments" for any Property Loss involving a Covered Auto, a Covered Auto Physical Damage Claim shall be paid under Coverage A of the General Property Coverage Section.
Other Insurance -- shall mean any insurance issued by any
insurance carrier that provides coverage for a Liability Claim against a Member
or Employee, or provides coverage for a Property Claim by a Member, with
respect to which the Fund also potentially provides Coverage, and shall include
all applicable Third Party Indemnifications.
(See, § III, ¶ 2.7; § IV, ¶ 2.5; § V, ¶ 2.5; § VI, ¶ 2.1; §
X, ¶ 18; and § XI, ¶ 16).
Owned Property -- shall mean any real or personal property
that falls within the terms of the Owned Property Exclusion contained in § III,
¶ 3.14 of the CGL Coverage (see also Pollution Coverage, § VI, ¶
3.1.1).
Owned Property Exclusion -- shall
mean § III, ¶ 3.14 which generally excludes from CGL Coverage Claims for damage
to property owned, occupied, rented to or controlled by a Member (see also
Pollution Coverage, § VI, ¶ 3.1.1).
|
Per Capita Administrative Fee |
--- |
shall mean the amount charged by the Administrator to the H&W Pool on a per Eligible Employee and/or Dependent basis for administration of the H&W Pool and the handling and processing of H&W Claims, as agreed between the Administrator and Administrative Committee, and approved by the Board. The “Per Capita Administrative Fee” shall be considered a “Direct Administrative Expense” for the H&W Pool. |
|
Per Capita Costs |
--- |
shall mean the charges for H&W Pool Operational Costs that are part of a Member’s Monthly H&W Assessment and are based on the number of Eligible Employees and/or Dependents of a Member, including but not limited to, the Stop-Loss Per Capita Rate, PPO Charges (if applicable to the Member) and the Per Capita Administrative Fee. |
Period of Restoration -- shall
refer to Insured Property that has suffered a Property Loss and is being
rebuilt, repaired or replaced, and for purposes of Extra Expense Coverage, such
property shall be considered within the "Period of Restoration" for
the length of time required for the Member, with the exercise of due diligence
and dispatch, to rebuild, repair or replace the damaged property (see §
X, ¶ 2.4).
Personal Injury -- shall mean Bodily Injury, and shall also include damage to reputation from libel, slander, and defamation, humiliation, invasion of privacy, loss of personal freedom, wrongful entry or eviction, false arrest, wrongful detention, malicious prosecution, discrimination, sexual harassment, and mental anguish, mental illness, emotional upset and other compensable emotional damages relating thereto or arising therefrom.
PO&E Claim -- shall mean any formal demand, suit or proceeding asserted by a Third Party against any Public Official or a Member which seeks actual monetary Damages and which may result in any Public Official or Member becoming legally obligated to pay such Damages by reason of any Wrongful Act actually or allegedly caused, committed or attempted during the Coverage Period as a result of acts or omissions in the capacity of a Public Official while the Public Official was employed by a Member or, with respect to the PO&E Coverage provided to Members in § IV, ¶ 2.1(c), as a result of a Wrongful Act by any Employee acting within the scope of his/her actual or apparent authority while employed by the Member. Multiple demands or suits arising out of the same Wrongful Act or interrelated acts shall be deemed to be a single PO&E Claim.
PO&E Coverage -- shall mean the Public Officials and Entity Liability Coverage provided under the PO&E Coverage Section of the SIA (§ IV).
Pollution -- shall mean any solid, liquid, gaseous or thermal irritant or contaminant, including smoke, vapor, soot, fumes, acids, alkalis, chemicals and waste. Waste includes materials to be recycled, reconditioned or reclaimed.
Pollution Claim -- shall mean any Claim for Damages or Contribution asserted against a Member or Employee by any Third Party for Personal Injury or Property Damage arising out of a Pollution Release. Depending upon the context, the term "Pollution Claim" may also include a "Remediation Action."
Pollution Coverage -- shall mean the Pollution Liability Coverage provided by the Fund under the "Pollution Coverage" Section of the SIA (§ VI).
Pollution Occurrence -- with respect to the Pollution Liability Coverage (§ VI), shall mean a Pollution Release during the Coverage Period that results in Environmental Damage. Multiple Liability Claims arising out of a single Pollution Release, even if asserted against different Members or Employees, shall be deemed to be a single Claim arising from a single Pollution Occurrence.
Pollution Release -- shall mean the emission, discharge, release or escape of Pollution, whether sudden and accidental or gradual over time, into or upon any person, thing or place, including the land, the atmosphere, any man-made structure and any above or below ground watercourse or body of water, provided that such emission discharge release or escape results in Environmental Damage. The entirety of any such Release shall be deemed to be a single Pollution Occurrence.
|
Pool Recognized Aggregate Stop Loss Point |
--- |
shall mean the point at which the total of all Covered H&W Claims and all Pool Recognized H&W Claims equal the H&W Pool’s Aggregate Stop Loss. |
|
Pool Recognized H&W Claims |
--- |
shall mean all H&W Claims where the H&W Coverage for such claim is reasonably debatable, as determined by the Administrative Committee, and which the Administrative Committee determines should be recognized by the H&W Pool for payment and for accrual toward the Member’s Stop Loss Points and the Pool Recognized Stop Loss Point. |
Possession -- shall mean a Member's taking care, custody or control of property.
Post-Admission
Loss Event -- shall mean an Occurrence, Wrongful Act, Accident or Property
Loss that takes place with respect to any Member of a Risk Pool or its
Employees, or a New Member of such Risk Pool, after the date the New Member
became a Member thereof. (See, §
I., ¶ 18.3).
|
Post-Stop-Loss H&W Assessments |
--- |
shall mean those portions of Member’s Monthly H&W Assessments relating to the H&W Pool paying Post-Stop-Loss H&W Claims, which shall be refunded to Members when and to the extent the H&W Pool has been reimbursed by the Stop Loss Carrier, as provided in § I, ¶¶ 4.2.2 and 4.2.3. |
|
Post-Stop-Loss H&W Claims |
--- |
shall mean the total dollar amount paid by the H&W Pool on H&W Claims after the H&W Pool reached the Pool Recognized Aggregate Stop Loss Point. |
Potentially Responsible Party -- shall mean any Third Parties, including Members of the Fund, that are potentially liable under the applicable law to pay for or make Contribution to the Remediation Costs for a Pollution Release imposed by or agreed to in a Remediation Action or as a result of a Pollution
|
PPO Charges |
--- |
shall mean the additional expenses incurred by the H&W Pool for the services provided by a preferred provider organization which shall be treated as a Shared H&W Cost under the H&W General Assessment Formula. |
|
PPO Plan |
--- |
shall mean the terms and conditions and services offered by a Preferred Provider Organization. |
Pre-Approval (also, Pre-Approved) -- shall mean those requirements and procedures contained in § III, ¶¶ 2.5 and 2.6 and in the Op. Rules, § III, ¶ 2.5, requiring Members to submit certain specified types of Risks to the Administrator for approval as a condition precedent to Liability Coverage by the Fund. “Pre-Approved” shall mean that the particular Risk had been approved by the Administrator or Administrative Committee in writing, for Coverage by the Fund, or was conditionally Pre-Approved under § III, ¶ 2.6, at the time the Risk gave rise to the Liability Claim at issue.
Predecessor SIAs -- shall mean the previous versions of the Self-Insurance Agreement that governed the Fund and the rights and obligations of its Members, as identified in § I, ¶ 1.
|
Preferred Provider Organization (or “PPO”) |
--- |
shall mean an organization that has contracts with certain Medical Providers to accept reduced fees and charges for Medical Services. |
Premium Assessments -- shall
mean those Assessments levied to provide assets for the payment of premiums for
Excess Policies obtained by the Fund to provide Excess Coverage for the Members
under § I, ¶¶ 14.1 and 14.2. Where appropriate in the context, "Premium
Assessment" shall also mean the Assessment for the premium for a Subgroup
Policy. (See, § I, ¶ 16).
Premium Assessment Formulas -- shall
mean the formula for determining Liability Pool Members' Assessment Shares of
the premium for the Excess Liability Policies under the Liability Premium
Assessment Formula (see § IX), or for determining Property Pool
Members' Assessment Shares of the premium for the Excess Property Policies
under the Property Premium Assessment Formula (see § XIII), as
provided in § I, ¶ 13.3.2, and for determining each Subgroup Member's
Assessment Share of the premium for a Subgroup Policy, as provided in Op.
Rules, § I, ¶ 16.1(E).
Pre-Withdrawal Loss Event -- shall mean an Occurrence, Wrongful Act, Accident or Property Loss that takes place with respect to any Member or Employee prior to the effective date of a Member's withdrawal from a Risk Pool and with respect to which the withdrawing Member continues to be obligated to pay its Assessment Share of the costs of resolving, even as a Former Member, in accordance with § I, ¶ 20.2.3.
Primary Excess Coverage
(or Primary Excess Insurance) -- shall mean the insurance or coverage provided by the Primary Excess Policies purchased by the Fund pursuant to § I, ¶ 14.1.
Primary Excess Liability Coverage
(or Primary Excess Liability Insurance) -- shall mean the insurance or coverage provided by the Primary Excess Liability Policies purchased by the Fund pursuant to § I, ¶ 14.1.
Primary Excess Liability Policies -- shall mean the one or more insurance policies that comprise the Primary Excess Coverage for Members of the Liability Pool in which all such Members must participate.
Primary Excess Policies -- shall mean the one or more insurance policies that comprise the Fund's Primary Excess Coverage for a Risk Pool in which all Members of that Risk Pool must participate.
Primary Excess Property Coverage
(or Primary Excess Property Insurance) -- shall mean the insurance or coverage provided by the Primary Excess Property Policies purchased by the Fund pursuant to § I, ¶ 14.1.
Primary Excess Property Policies -- shall mean the one or more insurance policies that comprise the Primary Excess Coverage for Members of the Property Pool in which all such Members must participate.
|
Primary ISL Method |
-- |
shall mean the preferred method for calculating an H&W Pool Member’s Individual Stop Loss Point, as provided in § XV, ¶3.2.4.1. |
|
Primary ISL Method Cross Check |
-- |
shall mean the calculations set forth in § XV, ¶ 3.2.4.2 requiring the dollar amount of the Member’s Individual Stop Loss (calculated pursuant to the Primary ISL Method) to be multiplied times the number of that Member’s Eligible Employees to determine if the resulting number is equal to or greater than such Member’s Aggregate Stop Loss. If so, then the Member’s Individual Stop Loss Point shall be that calculated under the Primary ISL Method. If not, then the Alternative ISL Method in § XV, ¶ 3.2.4.3 shall be applied. |
Primary
Jurisdiction -- shall mean the Administrative Committee's authority to
decide in the first instance, and each Member's obligation to submit to the
Administrative Committee, all issues relating to the subjects identified § I,
¶¶ 19.1 and 19.2.1, subject to decision by the Board directly under § 19.1(a)
and (b) (see also § I, ¶ 9.4.4).
|
Prior Monthly H&W Claims Experience |
--- |
shall mean the monthly average of the total cost of the Claims an Initial H&W Member or a New H&W Member experienced for a Health & Welfare Benefits package for its Employees, similar to the Benefits package proposed for H&W Coverage by the H&W Pool, in the most recent consecutive twelve (12) months preceding the date of the application, provided that the last month of said 12 consecutive months does not end more than 3 months prior to the Date of Membership. |
|
Prior Monthly H&W Premium |
--- |
shall mean the most recent monthly premium the Initial H&W Member or a New H&W Member paid prior to the Date of Membership in the H&W Pool for a Health & Welfare Benefits package for its Employees similar to the package proposed for H&W Coverage by the H&W Pool. |
Procedural
Rights -- shall mean a Member's rights that prescribe or govern the
methods for implementing or enforcing Members' (or Employees') Substantive
Rights with respect to Coverage provided by a particular Risk Pool, or that
relate to the basic operation and administration of the Fund. (See, § I, ¶ 5.4.2.1).
Procedural Memoranda -- shall mean the memoranda that the Administrative Committee publishes to Members reflecting discussions by the Committee on issues falling within the Administrative Committee's Primary Jurisdiction, as provided in § I, ¶ 5.1.
Products -- shall mean a Member's products sold to Third Parties; provided that electricity, water, sewer and gas Services shall not be considered Products.
Professional
Independent Contractor -- shall mean an Independent Contractor
whose relationship with the Member involves the rendering of professional
services to the Member (like architects, engineers and appraisers). (See, § III, ¶ 3.6).
Program
Development -- shall
mean and refer to the authority in § I, ¶ 13.3.2 for the Board, by Super
Majority Vote, to authorize and/or allocate
the use of specified portions of the Assets of the Actual Risk Pool
Balances of one or more Risk Pools, to be replenished in the normal course
through the applicable Assessment Formulas, for the development or
establishment of additional or expanded self-insurance, or other types of
insurance, bonding, or risk management programs that, at the time of the
expenditures, may not directly benefit the current Members of such Risk Pools,
but which Programs will ultimately be available to all Members of the Fund.
Program Documents -- shall mean the documents containing the various agreements, rules and procedures that govern the operation of the Fund and its Risk Pools, as identified in § I, ¶ 5.1, and shall include Predecessor SIAs.
Property Assessment -- shall
mean an Assessment of the Property Pool Members by the Fund on behalf of the
Property Pool under one of the Property Assessment Formulas (see §§ XII
and XIII).
Property Assessment Formula -- shall mean either the Property General Assessment Formula (see
§ XII) or the Property Premium Assessment Formula (see § XIII).
Property Claim -- shall mean a Claim filed by a Member of
the Property Pool, on behalf of the Member or one or more of its Employees,
requesting Property Coverage for a Property Loss. "Property Claim" shall also include
a claim for Direct Physical Loss or Damage to a Covered Auto under the Auto
Physical Damage Coverage Section (see § XI). A "Property Claim" may or may not
be a "Covered Claim."