member coverage contribution summary sheetinternet.oakland.k12.mi.us/cip/fy 2012 setseg... ·...

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MASB-SEG Property/Casualty Pool Member's Name: Member's Address: Account Number: Coverage Reference: Coverage Period: Oakland Schools 2111 Pontiac Lake Rd Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates of 7/1/2011 - 7/1/2012 415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871 Toll-Free 800-292-5421 Fax 517-482-0800 Member Coverage Contribution Summary Sheet Contribution Property $74,200.00 Crime Included Employee Dishonesty Blanket Bond Included Equipment Breakdown (Boiler & Machinery) Included Inland Marine Included SafeGuard (SM) (Terrorism & School Violent Acts) Included Liability $11,143.00 Commercial General Liability Included Excess Liability Included SafeGuard (SM) (Terrorism & School Violent Acts) Included Fleet $15,584.00 Fleet - Auto Physical Damage Included Fleet - Automobile Liability Included Garage and Garagekeeper's Legal Liability Included Educators Legal Liability Errors & Omissions $7,470.00 Total: $108,397.00 Endorsement Reason On October 27, 2011 an endorsement was created with an effective date of October 24, 2011. The endorsement was for the following reason: Add new building at 1820-1856 N Perry, Pontiac, MI. This endorsement resulted in an additional charge of $1,061.00.

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Page 1: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Member Coverage Contribution Summary Sheet

ContributionProperty $74,200.00Crime IncludedEmployee Dishonesty Blanket Bond IncludedEquipment Breakdown (Boiler & Machinery) IncludedInland Marine Included

SafeGuard(SM) (Terrorism & School Violent Acts) Included

Liability $11,143.00Commercial General Liability IncludedExcess Liability Included

SafeGuard(SM) (Terrorism & School Violent Acts) Included

Fleet $15,584.00Fleet - Auto Physical Damage IncludedFleet - Automobile Liability IncludedGarage and Garagekeeper's Legal Liability IncludedEducators Legal Liability Errors & Omissions $7,470.00

Total: $108,397.00

Endorsement Reason

On October 27, 2011 an endorsement was created with an effective date of October 24, 2011. The endorsementwas for the following reason: Add new building at 1820-1856 N Perry, Pontiac, MI. This endorsement resultedin an additional charge of $1,061.00.

Page 2: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Property DeclarationBasic Coverage(s): Coinsurance /

Loss Settlement: Limit(s):

Buildings Blanket Agreed ValueLimit of Coverage shown on the

Property Statement of Values minus a $5,000 deductible

Business Personal Property Blanket Agreed ValueLimit of Coverage shown on the

Property Statement of Values minus a $5,000 deductible

Replacement Cost Building & BusinessPersonal Property

Additional Coverage(s): Deductible /Occurrence: Limit(s):

Business Income & Extra Expense $5,000 $5,000,000 / Occurrence

Debris Removal $5,000 25% of loss or $250,000 / Occurrence,whichever is less

Fire Department Service Charge $0 $25,000 / OccurrencePollutant Clean Up and Removal $5,000 $50,000 / Occurrence

Coverage Extension(s): Deductible /Occurrence: Limit(s):

Accounts Receivable $5,000 $150,000 / Occurrence

Earth Movement $5,000$25,000 / Occurrence

$75,000 / Coverage Year

Electronic Data $5,000$25,000 / Occurrence

$25,000 / Coverage YearFine Arts - Non-Scheduled $5,000 $50,000 / OccurrenceLibrary Restocking Cost $5,000 $25,000 / OccurrenceNewly Acquired Business PersonalProperty $5,000 $1,000,000 / Building

Page 3: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Property Declaration (continued)

Coverage Extension(s): Deductible /Occurrence: Limit(s):

Newly Acquired Real Property $5,000 $1,000,000 / BuildingNon-Owned Detached Trailers $5,000 $5,000 / OccurrenceOff Premises Utility Service Interruption -Direct Damage $5,000 $25,000 / Occurrence

Ordinance or Law $5,000 Limit of Coverage shown on theProperty Statement of Values

Outdoor Property (PIO) Non-Scheduled $5,000 $100,000 / Occurrence

Personal Effects and Property of Others $0$2,500 / Person

$25,000 / Occurrence

Preservation of Property $5,000 Limit of Coverage shown on theProperty Statement of Values

Property in Transit $5,000 $50,000 / OccurrenceProperty off Premises $5,000 $500,000 / Occurrence

Sewer, Drain or Sump Backup or Overflow $5,000$50,000 / Occurrence

$100,000 / Coverage YearValuable Papers $5,000 $500,000 / Occurrence

Water / Flood / Wind Driven Rain $5,000$25,000 / Occurrence

$75,000 / Coverage Year

Page 4: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Crime DeclarationCoverage(s): Deductible /

Occurrence: Limit(s) / Occurrence:

Employee Dishonesty Blanket Bond $250 $1,000,000Computer Fraud $250 $100,000Forgery or Alteration $500 $150,000Funds Transfer Fraud $250 $100,000Inside the Premises- Robbery or Safe Burglaryof other Property $250 $20,000

Inside the Premises- Theft of Money &Securities $250 $50,000

Outside the Premises- Theft of Money &Securities $250 $50,000

Money Orders & Counterfeit Currency $500 $50,000

Page 5: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Equipment Breakdown (Boiler & Machinery) Declaration

Coverage(s): Deductible /Occurrence: Limit(s) / Occurrence:

Property Damage $1,000 $100,000,000Business Income $1,000 $1,000,000Extra Expense $1,000 $1,000,000Utility Interruption 24 hours $2,500,000Spoilage $1,000 $100,000Ordinance or Law (Including Demolition andIncreased Cost of Construction) $1,000 $1,000,000

Expediting Expenses $1,000 $100,000Hazardous Substances $1,000 $2,000,000Ammonia Contamination $1,000 $100,000Data or Media Coverage $1,000 $100,000Transportable Covered Equipment $1,000 $25,000Newly Acquired Locations $1,000 $1,000,000Water Damage $1,000 IncludedError in Description $1,000 Included

Other Conditions:

Extended Business Income 30 DaysNewly Acquired Locations 90 DaysNotice of Cancellation other than non-payment of premium 30 DaysUnless the interruption exceeds four (4) hours we will not pay for any loss under Utility Interruption or theUtility Interruption component of Perishable Goods

Page 6: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Inland Marine DeclarationCoverage(s): Deductible /

Occurrence: Limit(s) of Coverage:

Audio / Visual Equipment $250 $1,433,600.00Data / Voice Technology Property $500 $11,242,837.36Tools and Grounds Equipment $250 $144,282.40

Total: $12,820,719.76

Page 7: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Commercial General Liability Declaration

Coverage(s): Deductible /Occurrence: Limit(s):

A. Bodily Injury / Property Damage $0$1,000,000 / Occurrence

No Annual Aggregate

B. Personal and Advertising Injury $0$1,000,000 / Offense

No Annual Aggregate

C. Premises Medical Payments $0$5,000 / Person

$25,000 / OccurrenceD. Employee Benefits Liability*

Retro-active Date 7/1/2002$1,000

$1,000,000 / Claim

$3,000,000 / Annual Aggregate

E. Law Enforcement Legal Liability $0$1,000,000 / Wrongful Act

No Annual Aggregate

F. Sexual Misconduct $0$1,000,000 / Occurrence

$1,000,000 / Annual AggregateFire Legal Liability $0 $500,000 / Occurrence

*Claims Made Coverage

Page 8: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Excess Liability Declaration

Schedule of Underlying CoverageUnderlying Coverage(s): Required Limit of Coverage:

Commercial General Liability

Coverages A, B, C, D, E and F$1,000,000 C.S.L.*

Fleet - Automobile Liability $1,000,000 C.S.L.*

Garage Liability $1,000,000 C.S.L.*

Employers' Liability - Part B** $1,000,000 C.S.L.*

Coverage(s): Deductible /Occurrence: Limit(s):

Commercial General Liability

Coverages A, B, C, D and E$0

$7,000,000 / Occurrence

No Annual Aggregate

Fleet - Automobile Liability $0$7,000,000 / Occurrence

No Annual Aggregate

Garage Liability $0$7,000,000 / Occurrence

No Annual Aggregate

Employers' Liability - Part B** $0$7,000,000 / Claim

No Annual Aggregate

Commercial General Liability Coverage F -Sexual Misconduct $0

$5,000,000 / Occurrence

$5,000,000 / Annual Aggregate

*C.S.L. = Combined Single Limit** Employers' Liability - Part D applies only to MASB-SEG Workers' Compensation Fund Coverage.

Page 9: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

SafeGuard(SM) Program Declaration

Specified Coverage(s): Deductible /Occurrence: Limit(s):

Terrorism Property Protection: $5,000

$100,000,000 Pool Wide perOccurrence and Aggregate Limit with

a $25,000,000 per Occurrence andAggregate Sub-limit for Biological and

Chemical Terrorism

Terrorism Liability Protection: $0Combination of Members CGLand Excess limit not to exceed

$8,000,000.00School Violent Acts Coverage:Annual Aggregate $0 $500,000 Pool Wide basisLimit per Event $0 $30,000 per PersonDeath Benefit $0 $10,000 per PersonLimit of Coverage for Upgrading Expenses $0 $25,000 per Event

Page 10: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Automobile Liability Declaration$1,000,000 Combined Single Limit per Occurrence

No Annual Aggregate

Coverage(s): Limit(s) / Occurrence:Covered Autos Per Schedule of Covered VehiclesResidual Bodily Injury / Property Damage $1,000,000 C.S.L.*Uninsured / Underinsured Motorist $1,000,000 C.S.L.*Hired and Non-owned Liability $1,000,000 C.S.L.*Personal Injury Protection (PIP) Stated per StatuteProperty Protection Coverage (PPC) Stated per Statute

*C.S.L. = Combined Single Limit

Page 11: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Automobile Physical Damage DeclarationCoverage(s): Deductible /

Occurrence: Limit(s) / Occurrence:

Covered Autos Per Schedule of Covered Vehicles

Comprehensive $1,000

Actual cash value or cost to repair,whichever is less, minus the deductible.

Eligible buses* will receive replacementcost or cost to repair, whichever is less

minus the deductible.

Broad Form Collision $1,000 Actual cash value or cost to repair,whichever is less, minus the deductible.

Hired & Non-owned Physical Damage $0 $50,000Towing $0 $250 / Vehicle

Rental Reimbursement $0$50 / Day $1500 / Maximum

30 Day Maximum$0 If Repaired

Glass Repair$1,000 If Replaced

Designated garaging location for ReplacementCost eligible buses*:*See fleet auto coverage document for details

Page 12: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Garage Coverage Declaration

Coverage(s):Deductible /Occurrence:

Limit(s):

Garage Liability $0 $1,000,000 / OccurrenceGaragekeepers' Legal Liability $1,000 $250,000 / Occurrence

Page 13: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Educators Legal Liability Errors & Omissions DeclarationCoverage(s): Deductible /

Claim: Limit(s):

Errors & Omissions $5,000$10,000,000 / Claim

$10,000,000 / Coverage Year

Non-Monetary Relief Defense Costs $0$100,000 / Claim

$100,000 / Coverage Year

Special Education Defense Costs $5,000$100,000 / Claim

$100,000 / Coverage Year

Page 14: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Schedule of Covered VehiclesDescription VIN Contribution Coverages

Liab Comp Coll

2005 Dodge SW Campus student transportation ID4GP24R45B111082 $478.10 [X] [X] [X]

2006 Dodge NW Campus student transportation 1D4GP24R26B725761 $478.10 [X] [X] [X]

2005 Dodge NE Campus student transportation ID4GP24RX5B111085 $478.10 [X] [X] [X]

2003 GMC NW Campus student transportation 1GTGG29U031133125 $478.10 [X] [X] [X]

2005 Dodge Job Link client transportation 2D4GP44L36R836067 $478.10 [X] [X] [X]

2006 GMC Savana Cutaway Van 1GDJG31U361166112 $478.10 [X] [X] [X]

2005 Dodge SE Campus student transportation ID4GP24R65B111083 $478.10 [X] [X] [X]

2005 Dodge SE Campus student transportation ID4GP24R35B111087 $478.10 [X] [X] [X]

2005 Dodge SW Campus student transportation ID4GP24R15B111086 $478.10 [X] [X] [X]

2005 Dodge NE Campus student transportation ID4GP24R85B111084 $478.10 [X] [X] [X]

2005 Dodge Job Link client transportation 2D4GP44L76R876961 $478.10 [X] [X] [X]

1993 Dodge W200 Pickup (SE Campus) 1B7KM26C8PS223055 $589.16 [X] [X] [X]

2007 GMC Sierra NW Campus Truck 1GTHK24U17E135345 $589.16 [X] [X] [X]

2007 GMC Savana Van 1GTGG25V671205854 $589.16 [X] [X] [X]

2007 GMC Savana Van 1GTGG25V671144814 $589.16 [X] [X] [X]

2002 GMC Shipping Van 1GTHG35R521101894 $589.16 [X] [X] [X]

2007 GMC Savana Van 1GTGG25V371153597 $589.16 [X] [X] [X]

1997 FORD Pickup (SW Campus) 1FTHF26H5VEA65866 $589.16 [X] [X] [X]

2007 GMC Northeast Campus HD 2500 Pickup 1GTHK24U97E136002 $589.16 [X] [X] [X]

2007 GMC Sierra SW Campus Truck 1GTHK24U87E135391 $589.16 [X] [X] [X]

2006 GMC Savana Cutaway Van 1GDJG31U361166112 $589.16 [X] [X] [X]

2007 GMC SE Campus 2500 HD Pickup 1GTHK24U07E136552 $589.16 [X] [X] [X]

1989 Chevrolet Blazer Maintenance Truck 1GTGK29TF89PE557084 $589.16 [X] [X] [X]

1993 Dodge W200 Pickup (NW Campus) 1B7JM26Y8PS199587 $589.16 [X] [X] [X]

1993 GMC Sierra Maintenance Truck 1GTGK29F89PE557084 $589.16 [X] [X] [X]

2005 GMC Envoy - Deputy Superintendent 1GKDT13S2525368269 $589.16 [X] [X] [X]

2008 GMC Envoy-Superintendent 1GKDT13S282185331 $589.16 [X] [X] [X]

Page 15: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

2005 Dodge NW Campus student transportation 1D4GP24R45B381901 $589.16 [X] [X] [X]

1997 Interstate Trailer (NW Campus) 1UK500E17V1020492 $103.40 [X] [X] [X]

2002 Express NE Campus Cargo Trailer 4U01C222X3A011837 $103.40 [X] [X] [X]

1991 R&W NW Campus Trailer 4RWUD1828YN018396 $103.40 [X] [X] [X]

Number of Vehicles: 31

Page 16: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Property Statement of Values

Description and Location of Property

Agreed Value

1000 Beck Road Wixom, MI 48393

SW Campus Structure $24,373,872.00 [ ]

OTC SW Garage Structure $34,434.01 [ ]

OTC SW Pole Barn Structure $45,912.01 [ ]

Furnishings & Equipment at OTC SWGarage Contents $11,478.00 [ ]

Furnishings & Equipment at OTC SW PoleBarn Contents $22,956.01 [ ]

Furnishings & Equipment at SW Campus Contents $7,764,869.98 [ ]

street/parking lot lights Lighting $33,431.08Misc PIO-NOC $21,218.00Fence - 3 sides of property PIO-NOC $55,718.47Lighted Informational at entrance and miscsigns Signs $8,826.69

1371 Perry Street Pontiac, MI 48340

NE Campus Structure $0.00 [ ]

OTC NESmall 4 car garage Structure $0.00 [ ]

OTC NE Pole barn Structure $0.00 [ ]

Furnishings & Equipment at NE Campus Contents $7,959,030.09 [ ]

Furnishings & Equipment at OTC NESmall4 car garage Contents $11,478.00 [ ]

Furnishings & Equipment at OTC NE Polebarn Contents $11,478.00 [ ]

street/parking lot lights Lighting $26,744.87PIO PIO-NOC $21,218.00

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MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Lighted Informational at entrance and miscsigns Signs $12,136.70

1820-1856 N Perry Pontiac, MI 48340

JobLink Program Structure $4,000,000.00 [ ]

Furnishings & Equipment at JobLinkProgram Contents $300,000.00 [ ]

2111 Pontiac Lake Road Waterford, MI 48328

Oakland Schools Office & ProfessionalDevelopment Center Structure $35,467,033.62 [ ]

Furnishings & Equipment at OaklandSchools Office & ProfessionalDevelopment Center

Contents $13,518,361.74 [ ]

Oakland Network for Education (ONE) Cabling $10,609,000.00street/parking lot lights Lighting $222,873.87PIO PIO-NOC $21,218.00Lighted Informational at entrance and miscsigns Signs $26,038.73

2214 Mall Drive East Waterford, MI 48328

Summit North (Leased) Structure $0.00 [ ]

Furnishings & Equipment at Summit North(Leased) Contents $531,276.00 [ ]

22915 Commerce Drive Farmington Hills, MI 48336

Oakland Schools Visions Unlimited Structure $4,137,877.41 [ ]

Furnishings & Equipment at OaklandSchools Visions Unlimited Contents $200,000.00 [ ]

street/parking lot lights Lighting $2,228.73Lighted Informational at entrance and miscsigns Signs $3,310.01

5055 Delemere Street Royal Oak, MI 48073

OTC SE Greenhouse Structure $0.00 [ ]

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MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Carport - Enclosed on 3 side, 4th side has agate Structure $0.00 [ ]

SE Campus Structure $0.00 [ ]

Furnishings & Equipment at SE Campus Contents $8,000,282.71 [ ]

Furnishings & Equipment at OTC SEGreenhouse Contents $11,478.00 [ ]

street/parking lot lights Lighting $40,117.29Fence on side of building PIO-NOC $13,240.03Misc PIO-NOC $21,218.00Lighted Informational at entrance and miscsigns Signs $6,840.68

8211 Big Lake Road Clarkston, MI 48346

OTC NW Garage Structure $34,434.01 [ ]

Oakland Technical Center - NW Campus Structure $24,326,730.00 [ ]

Misc Furniture & Equipment at OaklandTechnical Center - NW Campus Contents $8,408,604.20 [ ]

Furnishings & Equipment at OTC NWGarage Contents $11,478.00 [ ]

street/parking lot lights Lighting $33,431.08PIO PIO-NOC $21,218.00Lighted Informational at entrance and miscsigns Signs $12,136.70

8351 Big Lake Road Clarkston, MI 48346

Bellairs Metal Pole Building (Storage) Structure $34,434.01 [ ]

Shed next to pole barn Structure $1,721.71 [ ]

Shed next to pole barn Structure $1,721.71 [ ]

Bellairs Property (Farm) (Shop) Structure $430,425.17 [ ]

Furnishings & Equipment at Shed next topole barn Contents $2,295.59 [ ]

Furnishings & Equipment at Bellairs MetalPole Building (Storage) Contents $11,478.00 [ ]

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MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Furnishings & Equipment at Shed next topole barn Contents $2,295.59 [ ]

Furnishings & Equipment at BellairsProperty (Farm) (Shop) Contents $11,478.00 [ ]

Limit of Coverage: $150,891,078.50

Page 20: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Inland Marine Schedule of Values

Audio/Visual Equipment

Security System Summit at 2214 Mall Drive East, Waterford $30,900.00A/V Equipment Summit North at 2214 Mall Drive East, Waterford $24,115.00Misc. Video Equipment at 1371 Perry Street, Pontiac $159,135.00Misc. Video Equipment at 1000 Beck Road, Wixom $244,007.00Misc. Video Equipment at 2111 Pontiac Lake Road, Waterford $434,385.00Misc. Video Equipment at 5055 Delemere Street, Royal Oak $238,702.00Misc. Video Equipment at 8211 Big Lake Road, Clarkston $175,048.00A/V Equipment at 2111 Pontiac Lake Road, Waterford $127,308.00

Limit of Coverage for Audio/Visual Equipment: $1,433,600.00

Tools and Grounds Equipment (Contractor's Equipment)

John Deere Tractor with attachments at 8211 Big Lake Road, Clarkston $20,157.10Fork Lift at 5055 Delemere Street, Royal Oak $12,730.80Fork Lift at 8211 Big Lake Road, Clarkston $12,730.80Troy Built Snow Blower at 8211 Big Lake Road, Clarkston $10,609.00Toyota Fork Lift at 1000 Beck Road, Wixom $13,049.072003 ExMark Zero Turn Rider Lawn Mower at 1000 Beck Road, Wixom $8,805.472003 ExMark Zero Turn Rider Lawn Mower at 1371 Perry Street, Pontiac $8,805.472002 Minuteman Floor scrubber at 1371 Perry Street, Pontiac $7,638.481998 Snapper Rider lawn Mower at 1371 Perry Street, Pontiac $8,805.47Toyota Fork Lift at 1371 Perry Street, Pontiac $12,730.80John Deere Lawn Mower at 1000 Beck Road, Wixom $5,516.682003 Sky Jack 3226 Scissor Lift at 2111 Pontiac Lake Road, Waterford $9,548.10Minuteman Floor scrubber at 8211 Big Lake Road, Clarkston $7,638.48Button Walk Behind Mower at 8211 Big Lake Road, Clarkston $5,516.68

Limit of Coverage for Tools and Grounds Equipment: $144,282.40

Page 21: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Data/Voice Technology PropertyVoice Various in NE Campus at 1371 Perry Street, Pontiac $47,740.50Mixed Sierra Video Yosemite Router in Oakland Schools Office & ProfessionalDevelopment Center at 2111 Pontiac Lake Road, Waterford $93,783.56

Data Various in OTC SW Garage at 1000 Beck Road, Wixom $1,172,824.95Mixed Avid DS System in Oakland Schools Office & Professional DevelopmentCenter at 2111 Pontiac Lake Road, Waterford $90,914.89

Voice Various in SE Campus at 5055 Delemere Street, Royal Oak $47,740.50Mixed Various in Oakland Schools Visions Unlimited at 22915 Commerce Drive,Farmington Hills $25,376.73

Mixed Sony 7- UVW 1400 Betacam Recorders in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $60,242.15

Mixed Misc Instructional Equip in NE Campus at 1371 Perry Street, Pontiac $106,090.00Mixed Sony 1800 Betacam SP1, SP2, SP3, SP4 in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $35,306.75

Data Various Information Technology Misc in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $19,860.05

Data Various in SW Campus at 1000 Beck Road, Wixom $1,172,824.95Mixed Polycom Accore MCG 100 Conference Bridge in Oakland Schools Office& Professional Development Center at 2111 Pontiac Lake Road, Waterford $265,131.64

Mixed FVC V-Gate ATM/ISDN Gateway in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $17,874.04

Voice Various in SW Campus at 1000 Beck Road, Wixom $47,740.50Mixed Misc Instructional Equip in SE Campus at 5055 Delemere Street, RoyalOak $106,090.00

Data Minolta 2 -MS6000 Fiche Reader/Printer in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $18,756.71

Mixed Various in Summit North (Leased) at 2214 Mall Drive East, Waterford $257,500.00Mixed Various in Summit North (Leased) at 2214 Mall Drive East, Waterford $56,650.00Mixed Misc Instructional Equip in Oakland Technical Center - NW Campus at8211 Big Lake Road, Clarkston $106,090.00

Page 22: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800

Mixed Panasonic 2- aj D200 in Oakland Schools Office & ProfessionalDevelopment Center at 2111 Pontiac Lake Road, Waterford $15,446.70

Data Various in Oakland Schools Office & Professional Development Center at2111 Pontiac Lake Road, Waterford $3,182,700.00

Mixed Panasonic DVCPRO aj D650 1/2/3 in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $16,550.04

Mixed Sony 2-DXC (a) SP Back in Oakland Schools Office & ProfessionalDevelopment Center at 2111 Pontiac Lake Road, Waterford $35,306.75

Voice Various in Oakland Schools Office & Professional Development Center at2111 Pontiac Lake Road, Waterford $599,408.50

Mixed Various Distributed Learning Misc in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $49,650.12

Mixed Marconi 5-ATV 300 A/V Decoders in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $27,583.40

Mixed Panasonic 2-AJ-D230H DVC-Pro Recorders in Oakland Schools Office &Professional Development Center at 2111 Pontiac Lake Road, Waterford $11,033.36

Mixed Misc Instructional Equip in SW Campus at 1000 Beck Road, Wixom $106,090.00Data Various in Oakland Schools Visions Unlimited at 22915 Commerce Drive,Farmington Hills $25,597.40

Mixed Various 4-Satellite Dishes in Oakland Schools Office & ProfessionalDevelopment Center at 2111 Pontiac Lake Road, Waterford $35,306.75

Data Various in SE Campus at 5055 Delemere Street, Royal Oak $1,614,401.24Voice Various in OTC SW Garage at 1000 Beck Road, Wixom $47,740.50Data Various in NE Campus at 1371 Perry Street, Pontiac $1,172,294.50Mixed Avid MCXpress 1 & 2 in Oakland Schools Office & ProfessionalDevelopment Center at 2111 Pontiac Lake Road, Waterford $68,186.16

Mixed Avid Xpress System 1 & 2 in Oakland Schools Office & ProfessionalDevelopment Center at 2111 Pontiac Lake Road, Waterford $136,372.33

Voice Various in JobLink Program at 1820-1856 N Perry, Pontiac $63,654.00Data Various in JobLink Program at 1820-1856 N Perry, Pontiac $286,977.69

Limit of Coverage for Data/Voice Technology: $11,242,837.36

Total: $12,820,719.76

Page 23: Member Coverage Contribution Summary Sheetinternet.oakland.k12.mi.us/CIP/FY 2012 SetSeg... · Waterford, MI 48328-2736 63000 PC-00428-201107 as of 7/1/2011 12:01 A.M. on the dates

MASB-SEG Property/Casualty Pool

Member's Name:Member's Address: Account Number:Coverage Reference:Coverage Period:

Oakland Schools2111 Pontiac Lake RdWaterford, MI 48328-273663000PC-00428-201107 as of 7/1/201112:01 A.M. on the dates of 7/1/2011 - 7/1/2012

The Declarations are an integral part of your coverage, and, along with the Coverage Forms, CommonConditions and any applicable Endorsement(s), complete the coverage identified by the Coverage Referenceabove.

415 W. Kalamazoo St. Lansing, MI 48933-2079 517-482-0871

Toll-Free 800-292-5421 Fax 517-482-0800