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2009-1662009-166 Resolution Authorizing Town of Wappinger to Execute a Contract for Adult Group Accident Insurance to Provide Coverage for Town of Wappinger Volunteers At a regular meeting of the Town Board of the Town of Wappinger, Dutchess County, New York, held at Town Hall, 20 Middlebush Road, Wappingers Falls, New York, on May 4, 2009. The meeting was called to order by Christopher Colsey, Supervisor, and upon roll being called, the following were present: PRESENT: Supervisor - Christopher J. Colsey Councilmembers - William H. Beale (arrived at 7:03 PM) Vincent F. Bettina Maureen McCarthy Joseph P. Paoloni (arrived at 7:03 PM) ABSENT: The following Resolution was introduced by Councilman Beale and seconded by Councilman Bettina. WHEREAS, the Town of Wappinger utilizes volunteers throughout its organization, to include the Recycle Center, Recreation, Parks, trail development, annual clean-up projects, and various Boards and committees; and WHEREAS, the Town of Wappinger holds minimal coverage on an excess basis for certain exposures related to volunteers; and WHEREAS, the Town of Wappinger Town Board met with the insurance consultant to the Town as part of the regularly scheduled Town Board meeting of April 13, 2009; and WHEREAS, the Town of Wappinger Town Board believes it to be necessary to increase its insurance coverage in respect to volunteer coverage; and WHEREAS, the estimated number of volunteers on an annualized basis is fifty (50). NOW, THEREFORE, BE IT RESOLVED, that the Town Board of the Town of Wappinger hereby authorizes the Town Supervisor to execute an application and agreement for adult group accident insurance through the Town of Wappinger insurance consultant on an excess coverage basis as paid through Budget Line A1910.400. The foregoing was put to a vote which resulted as follows: CHRISTOPHER COLSEY, SUPERVISOR Voting: AYE WILLIAM H. BEALE, COUNCILMAN Voting: AYE VINCENT F. BETTINA, COUNCILMAN Voting: AYE MAUREEN McCARTHY, COUNCILWOMAN Voting: AYE JOSEPH P. PAOLONI, COUNCILMAN Voting: AYE Dated: Wappingers Falls, New York 5/4/2009 The Resolution is hereby duly declared adopted. HN C. MASTERSON, TOWN CLERK Application 'd JrA rd ... r pp on for Adult Group Accident COMMERCIAL Insurance to Commercial Travelers Mutual TRAVELERS MUTUAL INSURANCE COMPANY Insurance Company, Utica, NY 13502 1. Name of Policyholder: Phone No 2. Address: Number Street City State Zip 3. Policy term requested: 12 months beginning 20_._._ 4. Policy to Cover: Q All Members 5. Plan of Benefits and Premium Rates (Check Plan selected): © Excess © Primary Check Accidental Maximum Annual Rate Per Person Plan Death Medical Deductible Excess Primary Number Benefit Benefit Amount Plan Plan 0 1 $1,000.00 $2,500.00 None $1.90 $2.60 El 2 0 1,000.00 2,500.00 $25.00 1.60 2.15 3 1,000.00 2,500.00 50.00 1.35 1.85 0 4 2,500.00 5,000.00 None 2.40 3.25 El 5 0 2,500.00 5,000.00 25.00 2.10 2.80 6 2,500.00 5,000.00 50.00 1.90 2.50 0 7 5,000.00 10,000.00 None 3.10 4.05 0 8 El 5,000.00 10,000.00 25.00 2.80 3.60 9 5,000.00 10,000.00 50.00 2.55 3.30 0 10 For benefits and rates other than above, contact the Home Office 6. Policy Premium: Number of members x Premium rate of $ =$ 0.00 Total Premium* 'Minimum Policy Premium for Excess coverage is $150.00 'Minimum Policy Premium for Primary Coverage is $200.00 7. 1 understand and agree that (a) if this application is accepted by the Company, coverage will begin on the date of accept- ance or on the date requested in Question 3, whichever is later, subject to the payment of the required premium, and (b) no contribution to the premium will be made by an insured person. Premium computation is subject to audit. Any person who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of mis- leading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and in the state of New York, shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. Policyholder, by Title or Position Date Signed Agent/Broker Name and Address MARSHALL & STERLING, INC. 66 MIDDLEBUSH ROAD Form SR -1 -APP (AG) NY SUITE 200 04 WAPPINGERS FALLS, NY 12590