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BK:00028 PG:0328
<br />NO' R T H C A R O L I N A NCACC Risk Management Pools
<br />ASSOCIATION OF COUNTY COMMISSIONERS Liability and Property
<br />Please return this form with your confirmation indicating your deductible choices. If we do not receive the
<br />completed form, we will process your renewal using the standard deductibles (shown in bold, italics type).
<br />LEE COUNTY
<br />LIAellt TV Amn PRnPFRTv ncnurTIMI C noT�nuc
<br />COVERAGE
<br />X DEDUCTIBLE
<br />COVERAGE
<br />X DEDUCTIBLE�V
<br />Property
<br />$1,000
<br />Inland Marine
<br />X$1,000
<br />These factors are applicable only
<br />to non -coastal counties.
<br />$2,500
<br />These factors are
<br />applicable only to
<br />non -coastal counties.
<br />$2,500
<br />$5,000
<br />$5,000
<br />$10,000
<br />$10,000
<br />$25,000
<br />$25,000
<br />$50,000
<br />$50,000
<br />$75,000
<br />$75,000
<br />$100,000
<br />$100,000
<br />Coastal county members only --
<br />You may select a 2% Wind Deduct.
<br />Your proposal includes the standard deductible for wind coverage for all
<br />property exposures. To accept a 2% wind deductible for the savings
<br />shown in your proposal, check the block at the left.
<br />Crime
<br />>< $1,000
<br />General Liability
<br />$0
<br />$2,500
<br />$500
<br />$5,000
<br />X$1,000
<br />$10,000
<br />$2,500
<br />$25,000
<br />$5,000
<br />$50,000
<br />$10,000
<br />$75,000
<br />$25,000
<br />$100,000
<br />$50,000
<br />Automobile Liability
<br />$0
<br />Auto Phy. Damage
<br />$1,000
<br />$500
<br />$2,500
<br />$1,000
<br />$5,000
<br />$2,500
<br />$10,000
<br />$5,000
<br />$25,000
<br />$10,000
<br />$50,000
<br />$25,000
<br />$75,000
<br />$50,000
<br />$100,000
<br />Law Enforcement
<br />$5,000
<br />Public Officials
<br />$5,000
<br />$10,000
<br />$10,000
<br />$25,000
<br />$25,000
<br />$50,000
<br />$50,000
<br />$75,000
<br />$75,000
<br />$100,000
<br />$100,000
<br />Employment Practices
<br />$5,000
<br />Boiler and Machinery Coverage
<br />$10,000
<br />' The deductible for Boiler and Machinery is $1,000 for
<br />Direct Damage and 24 hours for Indirect Damage at the
<br />request of the reinsurer. Other options are not available
<br />for Boiler & Machinery.
<br />$25,000
<br />$50,000
<br />$75,000
<br />$100,000
<br />NCACC
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