FLORIDA LEAGUE OF CITIES SPONSORED INSURANCE PROGRAMS DECLARATIONS

Transcription

1 FLORIDA LEAGUE OF CITIES SPONSORED INSURANCE PROGRAMS DECLARATIONS I. DESIGNATED MEMBER: Address: City of Plant City P.O. Box C Plant City, FL II. COVERAGE PERIOD From October 1, 2010 to October 1, :01 A.M. Standard Time at the address of the Designated Member. III. AGREEMENT NUMBER Florida Municipal Insurance Trust (FMIT) FMIT #0691 IV. COVERAGES INCLUDED General Liability Automobile Property Workers' Compensation V. ESTIMATED ANNUAL PREMIUM Normal Premium Expense Constant Incentive Credit Net Premium $825,379 $200 $(40,808) $784,771 October 1, 2010 Signature of Authorized Representative Date

2 FLORIDA MUNICIPAL INSURANCE TRUST AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE DECLARATIONS I. II. DESIGNATED MEMBER: Agreement No.: FMIT #0691 City of Plant City GOVERNMENT DESCRIPTION Municipality III. COVERAGE PERIOD From 10/01/2010 to 10/01/ :01 A.M. Standard Time at the address of the Designated Member IV. AUTOMOBILE Premium Basis Deductible/ Type Limit Net Premium 1. Automobile Liability Per Schedule $25,000 DSL $1,000,000 $146,281 Number of Vehicles: Uninsured Motorists Protection N/A N/A 3. Personal Injury Protection $10,000 Included 4. Automobile Medical Payments N/A N/A 5. Automobile Physical Damage Per Schedule Per Schedule N/A $46,094 V. This Agreement includes these endorsements and schedules: See Schedule B VI. ESTIMATED ANNUAL PREMIUM Florida Municipal Insurance Trust (FMIT) Normal Premium $204,093 Incentive Credit $(11,718) Net Premium $192,375 Florida League of Cities Sponsored Insurance Programs Since 1977 THIS DECLARATIONS AND THE SUPPLEMENTAL DECLARATIONS, TOGETHER WITH THE COMMON CONDITIONS, COVERAGE FORM(S) AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED AGREEMENT. FMIT AUTO DEC 1010 Page 1 of 2

3 FMIT AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE COVERAGES October 1, October 1, 2011 Scheduled Coverage Forms List City of Plant City, FMIT #0691 Schedule B Form # FMIT AUTO SCH 1002 FMIT TRAG 1010 FMIT CA 1010 FMIT AL 1010 FMIT PIP 1007 FMIT APD 1009 FMIT ARR 1009 FMIT SE AL 1007 FMIT DSL 1010 FMIT AE 1008 Description Automobile Schedule Trust Agreement Coverage Agreement Automobile Liability Personal Injury Protection Automobile Physical Damage Coverage Form Rental Reimbursement Coverage Specific Excess Endorsement - Automobile Liability Deductible StopLoss Endorsement Employer - Provided Vehicles - Automobile Liability FMIT AUTO DEC 1010 Page 2 of 2

4 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem NON OWNED AUTOS $ $42 $0 $0 $0 n/a n/a n/a $0 $42 HIRED AUTOS $ $42 $0 $0 $0 n/a n/a n/a $0 $ FORD F $10, $497 $20 $0 $0 $250 n/a $500 $72 $ INT'L RECYCLING TRUCK 147 $51, $646 $20 $0 $0 $250 n/a $500 $145 $ LAFRANCE FIRE TRUCK 5986 $5, $410 $18 $0 $0 $250 n/a $500 $16 $ GMC VAN 3848 $6, $497 $20 $0 $0 $250 n/a $500 $40 $ GMC VAN 3157 $13, $497 $20 $0 $0 $250 n/a $500 $72 $ GMC VAN 7169 $13, $497 $20 $0 $0 $250 n/a $500 $72 $ FORD 6276 $15, $328 $29 $0 $0 $250 n/a $500 $105 $ FORD F350 DIESEL 1514 $22, $497 $20 $0 $0 $250 n/a $500 $92 $ A 1995 FORD F800 DIESEL 8881 $47, $593 $20 $0 $0 $250 n/a $500 $101 $ DODGE CARGO VAN 2400 $6, $497 $20 $0 $0 $250 n/a $500 $48 $ A 1997 FORD TRUCK 4236 $16, $497 $20 $0 $0 $250 n/a $500 $83 $ FORD TRUCK 4716 $15, $497 $20 $0 $0 $250 n/a $500 $83 $ FACTORY 0485 $ $0 $0 $0 $0 $250 n/a $500 $13 $ FORD PICK UP 8056 $15, $497 $20 $0 $0 $250 n/a $500 $83 $ A 1995 HOMEMADE N/A $2, $0 $0 $0 $0 $250 n/a $500 $13 $13 040A 1996 HOMEMADE 4030 $10, $50 $2 $0 $0 $250 n/a $500 $47 $ HOMEMADE N/A $1, $0 $0 $0 $0 $250 n/a $500 $13 $ FORD PICK UP 2968 $16, $497 $20 $0 $0 $250 n/a $500 $83 $ $2, $0 $0 $0 $0 $250 n/a $500 $13 $ PIERCE FIRE PUMPER 0330 $242, $410 $18 $0 $0 $250 n/a $500 $161 $ TIMBER CARGO 0675 $4, $50 $2 $0 $0 $250 n/a $500 $20 $ FORD 1413 $22, $328 $29 $0 $0 $250 n/a $500 $115 $472 Page 1 of 15

5 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem FORD 1419 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 1420 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 1421 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 1422 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 3554 $20, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD EXPLORER 7444 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 3555 $20, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 3556 $20, $328 $29 $0 $0 $250 n/a $500 $115 $ B 1998 FORD F $14, $497 $20 $0 $0 $250 n/a $500 $72 $ A 2000 STERLING TRASH TRUCK 0497 $75, $727 $20 $0 $0 $250 n/a $500 $173 $ FORD 3/4 TON PU 1916 $23, $497 $20 $0 $0 $250 n/a $500 $92 $ FORD 3/4 TON PU 8086 $23, $497 $20 $0 $0 $250 n/a $500 $92 $ A 2000 DODGE RAM 3216 $20, $497 $20 $0 $0 $250 n/a $500 $83 $ OPEN ROAD 4088 $3, $50 $2 $0 $0 $250 n/a $500 $16 $ CHEVROLET PICKUP 6869 $15, $497 $20 $0 $0 $250 n/a $500 $83 $ CARGO 2353 $5, $50 $2 $0 $0 $250 n/a $500 $20 $ FORD RANGER 0078 $12, $497 $20 $0 $0 $250 n/a $500 $72 $ GMC DUMP 6798 $26, $422 $20 $0 $0 $250 n/a $500 $69 $ CHEVROLET UPDATE NEEDED 4043 $17, $497 $20 $0 $0 $250 n/a $500 $83 $ CHEVROLET 1/2 TON PU 3644 $17, $497 $20 $0 $0 $250 n/a $500 $83 $ FORD 5491 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 5490 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 5489 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 5488 $22, $328 $29 $0 $0 $250 n/a $500 $115 $472 Page 2 of 15

6 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem DODGE RAM PU 4640 $19, $497 $20 $0 $0 $250 n/a $500 $83 $ DODGE RAM PU 3241 $18, $497 $20 $0 $0 $250 n/a $500 $83 $ HOMEMADE 5825 $3, $50 $2 $0 $0 $250 n/a $500 $16 $ DODGE RAM 4333 $32, $522 $20 $0 $0 $250 n/a $500 $81 $ FORD DUMP 1504 $36, $422 $20 $0 $0 $250 n/a $500 $69 $ A 1988 CHEVROLET UPDATE NEEDED 1575 $9, $497 $20 $0 $0 $250 n/a $500 $59 $ FORD 9423 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 9422 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 9427 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 9421 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 9426 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ FORD 9424 $22, $328 $29 $0 $0 $250 n/a $500 $115 $ OPEN ROAD 4109 $2, $50 $2 $0 $0 $250 n/a $500 $18 $ JOHNSON STREET SWEEPER 9479 $131, $1,278 $20 $0 $0 $250 n/a $500 $292 $1, STERLING DUMP TRUCK 8727 $55, $1,156 $20 $0 $0 $250 n/a $500 $164 $1, DODGE RAM 7806 $21, $497 $20 $0 $0 $250 n/a $500 $108 $ DODGE TRUCK 1305 $20, $497 $20 $0 $0 $250 n/a $500 $108 $ DODGE TRUCK 1494 $23, $497 $20 $0 $0 $250 n/a $500 $108 $ DODGE TRUCK 2307 $22, $497 $20 $0 $0 $250 n/a $500 $108 $ DODGE QUAD CAB 2621 $18, $497 $20 $0 $0 $250 n/a $500 $99 $ HOMEMADE 1297 $3, $50 $2 $0 $0 $250 n/a $500 $18 $ FORD F250 PK 3531 $22, $497 $20 $0 $0 $250 n/a $500 $108 $ CHEVROLET SILVERADO 9684 $14, $497 $20 $0 $0 $250 n/a $500 $87 $ PIERCE FIRE TRUCK 0565 $242, $410 $18 $0 $0 $250 n/a $500 $161 $589 Page 3 of 15

7 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem US CARGO 0739 $2, $0 $0 $0 $0 $250 n/a $500 $13 $ L & J SERVICES 0786 $3, $50 $2 $0 $0 $250 n/a $500 $16 $ OPEN ROAD 4101 $4, $50 $2 $0 $0 $250 n/a $500 $16 $ CUSTOM 0 $2, $50 $2 $0 $0 $250 n/a $500 $16 $ MOTORCYCLE 0203 $1, $50 $2 $0 $0 $250 n/a $500 $16 $ CHEVROLET PICKUP 6477 $19, $497 $20 $0 $0 $250 n/a $500 $99 $ A 1973 FORD BOX VAN 6738 $2, $497 $20 $0 $0 $250 n/a $500 $33 $ SMART 8773 $2, $50 $2 $0 $0 $250 n/a $500 $16 $ JEEP CHEROKEE 0253 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ MACK REL 8938 $120, $1,278 $20 $0 $0 $250 n/a $500 $273 $1, FORD AMBULANCE 6822 $84, $797 $34 $0 $0 $250 n/a $500 $132 $ INT'L RECYCLE TRUCK 7043 $36, $727 $20 $0 $0 $250 n/a $500 $122 $ FORD 4958 $20, $328 $29 $0 $0 $250 n/a $500 $115 $ CHEVROLET IMPALA 9546 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ CHEVROLET IMPALA 7284 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ CHEVROLET IMPALA 5779 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ CHEVROLET IMPALA 5990 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ CHEVROLET IMPALA 4339 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ CHEVROLET IMPALA 4230 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ CHEVROLET IMPALA 5353 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ CHEVROLET IMPALA 5739 $18, $328 $29 $0 $0 $250 n/a $500 $105 $ INT'L LIFT TRUCK 0133 $88, $593 $20 $0 $0 $250 n/a $500 $152 $ MADVAC MADVAC 2954 $33, $522 $20 $0 $0 $250 n/a $500 $95 $ FORD PICKUP 8605 $18, $497 $20 $0 $0 $250 n/a $500 $99 $616 Page 4 of 15

8 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem DUMP 6770 $5, $50 $2 $0 $0 $250 n/a $500 $24 $ GMC SIERRA TRUCK 2517 $14, $497 $20 $0 $0 $250 n/a $500 $87 $ WDHC TRUCK 8992 $148, $1,278 $20 $0 $0 $250 n/a $500 $323 $1, FORD F550 BUCKET TRUCK 0233 $65, $522 $20 $0 $0 $250 n/a $500 $163 $ MACK REAR END LOADER 2577 $121, $1,431 $20 $0 $0 $250 n/a $500 $345 $1, MACK FRONT END LOADER 9376 $132, $1,431 $20 $0 $0 $250 n/a $500 $370 $1, CHEVROLET IMPALA 0744 $17, $328 $29 $0 $0 $250 n/a $500 $114 $ CHEVROLET IMPALA 6461 $17, $328 $29 $0 $0 $250 n/a $500 $114 $ CHEVROLET IMPALA 6411 $17, $328 $29 $0 $0 $250 n/a $500 $114 $ CHEVROLET IMPALA 4730 $17, $328 $29 $0 $0 $250 n/a $500 $114 $ FORD F350 PICKUP 7248 $22, $497 $20 $0 $0 $250 n/a $500 $108 $ PACE 9764 $5, $50 $2 $0 $0 $250 n/a $500 $24 $ PACE 1107 $5, $50 $2 $0 $0 $250 n/a $500 $24 $ FORD F $23, $497 $20 $0 $0 $250 n/a $500 $108 $ FREIGHTLINER GRABBER TRUCK 8783 $78, $727 $20 $0 $0 $250 n/a $500 $207 $ ISUZU RECYCLING TRUCK 0760 $55, $646 $20 $0 $0 $250 n/a $500 $186 $ PACE CARGO 6142 $3, $50 $0 $0 $0 $250 n/a $500 $18 $ ANDERSON 8495 $10, $50 $0 $0 $0 $250 n/a $500 $43 $ CHEVROLET IMPALA 0488 $16, $328 $29 $0 $0 $250 n/a $500 $114 $ FORD F-150 TRUCK 9018 $16, $497 $20 $0 $0 $250 n/a $500 $107 $ STERLING ACTERRA 6707 $59, $621 $20 $0 $0 $250 n/a $500 $232 $ CHEVROLET IMPALA 3776 $16, $328 $29 $0 $0 $250 n/a $500 $114 $ CHEVROLET IMPALA 0890 $16, $328 $29 $0 $0 $250 n/a $500 $114 $ CHEVROLET IMPALA 0365 $16, $328 $29 $0 $0 $250 n/a $500 $114 $471 Page 5 of 15

9 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem CHEVROLET IMPALA 3174 $16, $328 $29 $0 $0 $250 n/a $500 $114 $ FORD F-350 W/CRANE 5294 $37, $497 $20 $0 $0 $250 n/a $500 $128 $ FORD F $23, $497 $20 $0 $0 $250 n/a $500 $108 $ FORD SEDAN 8041 $22, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD RANGER 5059 $12, $497 $20 $0 $0 $250 n/a $500 $94 $ FORD SEDAN 8046 $22, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD SEDAN 8047 $22, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD EXPLORER 8135 $24, $328 $29 $0 $0 $250 n/a $500 $124 $ MACK REAR END LOADER 4881 $132, $1,431 $20 $0 $0 $250 n/a $500 $398 $1, MACK REAR END LOADER 4880 $132, $1,431 $20 $0 $0 $250 n/a $500 $398 $1, FORD F $19, $497 $20 $0 $0 $250 n/a $500 $107 $ FORD F $19, $497 $20 $0 $0 $250 n/a $500 $107 $ G 2004 FORD F $19, $497 $20 $0 $0 $250 n/a $500 $107 $ B 2004 FORD F $19, $497 $20 $0 $0 $250 n/a $500 $107 $ FORD F $19, $497 $20 $0 $0 $250 n/a $500 $107 $ FORD F $19, $497 $20 $0 $0 $250 n/a $500 $107 $ FORD F $13, $497 $20 $0 $0 $250 n/a $500 $94 $ FORD RANGER 3619 $9, $497 $20 $0 $0 $250 n/a $500 $59 $ VACTOR JET VAC 6475 $25, $522 $20 $0 $0 $250 n/a $500 $103 $ HARLEY DAVIDSON ROAD KING 2674 $16, $279 $0 $0 $0 n/a 250 $500 $189 $ HARLEY DAVIDSON ROAD KING 2396 $16, $279 $0 $0 $0 n/a 250 $500 $189 $ HARLEY DAVIDSON ROAD KING 2688 $16, $279 $0 $0 $0 n/a 250 $500 $189 $ HARLEY DAVIDSON ROAD KING 3104 $16, $279 $0 $0 $0 n/a 250 $500 $189 $ HARLEY DAVIDSON ROAD KING 2436 $16, $279 $0 $0 $0 n/a 250 $500 $189 $468 Page 6 of 15

10 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem ISUZU DUMP TRUCK 2048 $20, $522 $20 $0 $0 $250 n/a $500 $73 $ MACK FRONT END LOADER 6544 $158, $727 $20 $0 $0 $250 n/a $500 $379 $1, FORD 8040 $22, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD RANGER PICKUP 2598 $11, $497 $20 $0 $0 $250 n/a $500 $100 $ FORD RANGER PICKUP 2599 $11, $497 $20 $0 $0 $250 n/a $500 $100 $ FORD RANGER PICKUP 2600 $11, $497 $20 $0 $0 $250 n/a $500 $100 $ FORD 138 ECONOLINE VAN 0671 $14, $497 $20 $0 $0 $250 n/a $500 $100 $ BRAY UTILITY 4891 $4, $50 $2 $0 $0 $250 n/a $500 $27 $ CHEVROLET IMPALA 0772 $16, $328 $29 $0 $0 $250 n/a $500 $124 $ CHEVROLET EXPRESS VAN 1576 $16, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD PICKUP 7448 $20, $497 $20 $0 $0 $250 n/a $500 $126 $ G 2005 FORD PICKUP 7447 $20, $497 $20 $0 $0 $250 n/a $500 $126 $ FORD PICKUP 7449 $20, $497 $20 $0 $0 $250 n/a $500 $126 $ FORD EXT CAB DUMP TRUCK 7445 $28, $422 $20 $0 $0 $250 n/a $500 $95 $ FORD 4X4CREW CAB DUMP TRK 7446 $28, $422 $20 $0 $0 $250 n/a $500 $95 $ FORD 4X4CREW CAB DUMP TRK 7444 $28, $422 $20 $0 $0 $250 n/a $500 $95 $ FORD 5239 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD 5240 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD 5241 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD 5242 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD 5243 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD 5244 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD 5245 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD 5246 $20, $328 $29 $0 $0 $250 n/a $500 $134 $491 Page 7 of 15

11 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem FORD 5247 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD E350 VAN 6158 $26, $497 $20 $0 $0 $250 n/a $500 $149 $ KING 0420 $11, $50 $2 $0 $0 $250 n/a $500 $47 $ FORD F750 DUMP TRUCK 9507 $44, $422 $20 $0 $0 $250 n/a $500 $130 $ YAMAHA MOTORCYCLE 0219 $2, $96 $0 $0 $0 n/a 0 $500 $39 $ LIPPERT DUMP 5802 $5, $50 $2 $0 $0 $250 n/a $500 $27 $ FORD 8577 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD RANGER 5416 $12, $497 $20 $0 $0 $250 n/a $500 $100 $ FORD F-250 TRUCK 4826 $22, $497 $20 $0 $0 $250 n/a $500 $126 $ FORD F-250 TRUCK 3582 $18, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD F-250 TRUCK 3581 $18, $497 $20 $0 $0 $250 n/a $500 $114 $ CHEVROLET IMPALA 8027 $5, $377 $34 $0 $0 $250 n/a $500 $59 $ CHEVROLET SILVERADO 2487 $20, $497 $20 $0 $0 $250 n/a $500 $126 $ CHEVROLET IMPALA 9762 $16, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1676 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1677 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1678 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1679 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1681 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1682 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1674 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 1675 $19, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD DUMP TRUCK 4280 $51, $727 $20 $0 $0 $250 n/a $500 $226 $ FORD DUMP TRUCK 4281 $51, $727 $20 $0 $0 $250 n/a $500 $226 $973 Page 8 of 15

12 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem FORD F $27, $497 $20 $0 $0 $250 n/a $500 $149 $ FORD 1 TON TRUCK 2233 $25, $497 $20 $0 $0 $250 n/a $500 $149 $ FORD AMBULANCE 0326 $112, $797 $34 $0 $0 $250 n/a $500 $183 $1, FORD PICKUP 2156 $14, $497 $20 $0 $0 $250 n/a $500 $100 $ FREIGHTLINER DUMP TRUCK 3821 $73, $485 $20 $0 $0 $250 n/a $500 $171 $ FORD TRUCK 2157 $14, $497 $20 $0 $0 $250 n/a $500 $100 $ FORD F550 TRUCK 0297 $46, $522 $20 $0 $0 $250 n/a $500 $170 $ FORD GRABBER TRUCK 8766 $86, $593 $20 $0 $0 $250 n/a $500 $201 $ ACTION CONSTRUCTION 8495 $10, $50 $2 $0 $0 $250 n/a $500 $50 $ FORD RANGER PICKUP 6194 $13, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD RANGER PICKUP 6196 $13, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD RANGER PICKUP 6195 $13, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD RANGER PICKUP 6200 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ FORD RANGER PICKUP 6198 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ FORD RANGER PICKUP 6199 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ FORD RANGER PICKUP 6197 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ FORD RANGER PICKUP 6201 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ GMC DUMP TRUCK 1782 $76, $422 $20 $0 $0 $250 n/a $500 $188 $ FORD 1006 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 1003 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 1008 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 0998 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 1007 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 0999 $19, $377 $34 $0 $0 $250 n/a $500 $151 $562 Page 9 of 15

13 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem FORD 1000 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 1002 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 0997 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 0996 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 1004 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 1001 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD 1005 $19, $377 $34 $0 $0 $250 n/a $500 $151 $ FORD RANGER PICKUP 2585 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ FORD RANGER PICKUP 2583 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ INTERNATIONAL VAC TRUCK 9319 $286, $1,278 $20 $0 $0 $250 n/a $500 $764 $2, CHEVROLET PICKUP 4948 $18, $497 $20 $0 $0 $250 n/a $500 $99 $ TENNANT LITTER VAC 2730 $30, $497 $20 $0 $0 $250 n/a $500 $168 $ FORD RANGER SUPER CAB 5507 $13, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD RANGER SUPER CAB 5506 $13, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD RANGER SUPER CAB 5505 $13, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD DUMP TRUCK 8169 $32, $398 $20 $0 $0 $250 n/a $500 $168 $ FORD EXPLORER 4936 $20, $328 $29 $0 $0 $250 n/a $500 $168 $ FORD RANGER PICKUP 5508 $12, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD EXPLORER 5509 $12, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD F $18, $497 $20 $0 $0 $250 n/a $500 $130 $ FORD F $14, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD 5247 $19, $328 $29 $0 $0 $250 n/a $500 $154 $ FORD 5248 $19, $328 $29 $0 $0 $250 n/a $500 $154 $ BELSHE 3152 $5, $50 $2 $0 $0 $250 n/a $500 $32 $84 Page 10 of 15

14 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem FORD MUSTANG 8605 $18, $377 $34 $0 $0 $250 n/a $500 $102 $ CHEVY IMPALA 7067 $17, $328 $29 $0 $0 $250 n/a $500 $114 $ UTILITY CABLE 76 $1, $50 $2 $0 $0 $250 n/a $500 $18 $ YAMAHA VINO 312 $2, $96 $9 $0 $0 n/a 250 $500 $57 $ GATOR TRACKHOE 369 $10, $50 $2 $0 $0 $250 n/a $500 $47 $ CHEVY 15 PASSENGER VAN 872 $20, $739 $46 $0 $0 $250 n/a $500 $79 $ VACTOR JET VAC 1131 $25, $522 $20 $0 $0 $250 n/a $500 $69 $ VACTOR JET VAC 1168 $25, $522 $20 $0 $0 $250 n/a $500 $69 $ CURRAHEE DUMP 1304 $ $0 $0 $0 $0 $250 n/a $500 $14 $ YAMAHA VINO 1671 $2, $96 $9 $0 $0 n/a 250 $500 $39 $ YAMAHA VINO 1903 $2, $96 $9 $0 $0 n/a 250 $500 $39 $ WARER 2080 $1, $50 $2 $0 $0 $250 n/a $500 $23 $ TBA 4X6 GARDEN 2148 $16, $50 $2 $0 $0 $250 n/a $500 $49 $ FORD RANGER PICKUP 2584 $16, $497 $20 $0 $0 $250 n/a $500 $130 $ CHEVY BLAZER 3797 $25, $328 $29 $0 $0 $250 n/a $500 $128 $ FORD VAN 3707 $16, $497 $20 $0 $0 $250 n/a $500 $114 $ CHEVY MALIBU 3763 $17, $410 $18 $0 $0 $250 n/a $500 $52 $ FORD DUMP TRUCK 4093 $40, $422 $20 $0 $0 $250 n/a $500 $113 $ OPEN ROAD 4126 $2, $50 $2 $0 $0 $250 n/a $500 $18 $ OPEN ROAD 4127 $2, $50 $2 $0 $0 $250 n/a $500 $18 $ OPEN ROAD 4136 $2, $50 $2 $0 $0 $250 n/a $500 $18 $ G 2003 PACE COVERED 5202 $5, $50 $2 $0 $0 $250 n/a $500 $24 $ FORD 5238 $20, $328 $29 $0 $0 $250 n/a $500 $134 $ CUSTOM FLAT BED 5322 $7, $50 $2 $0 $0 $250 n/a $500 $24 $76 Page 11 of 15

15 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem OPEN ROAD 7086 $2, $50 $2 $0 $0 $250 n/a $500 $16 $ FORD EXPLORER 7449 $25, $328 $29 $0 $0 $250 n/a $500 $134 $ FORD EXPEDITION 7608 $23, $542 $48 $0 $0 $250 n/a $500 $276 $ INTERNATIONAL BUCKET TRUCK 7647 $126, $1,673 $20 $0 $0 $250 n/a $500 $662 $2, CARRY-ON 7981 $1, $0 $0 $0 $0 $250 n/a $500 $16 $ KUSTOM SPEED 8033 $1, $0 $0 $0 $0 $250 n/a $500 $16 $ FORD 8043 $22, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 8044 $22, $328 $29 $0 $0 $250 n/a $500 $124 $ FORD 8045 $22, $328 $29 $0 $0 $250 n/a $500 $124 $ MACK REL 8463 $160, $1,278 $20 $0 $0 $250 n/a $500 $402 $1, MACK REL 8655 $158, $1,673 $20 $0 $0 $250 n/a $500 $658 $2, PACE COVERED 8731 $2, $50 $2 $0 $0 $250 n/a $500 $18 $ OPEN ROAD 4152 $2, $0 $0 $0 $0 $250 n/a $500 $18 $ AUTOCAR FRONT LOADER 3593 $154, $727 $20 $0 $0 $250 n/a $500 $371 $1, AUTOCAR FRONT LOADER 3761 $179, $727 $20 $0 $0 $250 n/a $500 $480 $1, FORD F250 PICKUP 2544 $33, $497 $20 $0 $0 $250 n/a $500 $179 $ FORD F250 PICKUP 2547 $29, $497 $20 $0 $0 $250 n/a $500 $179 $ FORD F350 PICKUP 2584 $29, $497 $20 $0 $0 $250 n/a $500 $179 $ VESPA SCOOTER 0449 $3, $279 $0 $0 $0 n/a 0 $500 $75 $ VESPA SCOOTER 3191 $4, $279 $0 $0 $0 n/a 0 $500 $92 $ CHRYSLER TV VAN 3129 $133, $1,278 $20 $0 $0 $250 n/a $500 $417 $1, FORD DUMP TRUCK 5569 $58, $485 $20 $0 $0 $250 n/a $500 $165 $ FORD F $35, $522 $20 $0 $0 $250 n/a $500 $135 $ FORD F $20, $497 $20 $0 $0 $250 n/a $500 $151 $668 Page 12 of 15

16 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem FORD F $24, $497 $20 $0 $0 $250 n/a $500 $151 $ FORD F $30, $497 $20 $0 $0 $250 n/a $500 $179 $ FORD F $35, $522 $20 $0 $0 $250 n/a $500 $135 $ FORD F $35, $522 $20 $0 $0 $250 n/a $500 $135 $ FORD 2483 $20, $377 $34 $0 $0 $250 n/a $500 $188 $ FORD 2484 $20, $377 $34 $0 $0 $250 n/a $500 $188 $ FORD 2485 $20, $377 $34 $0 $0 $250 n/a $500 $188 $ FORD 2486 $20, $377 $34 $0 $0 $250 n/a $500 $188 $ AUTO CAR GARBAGE TRUCK 6670 $168, $1,431 $20 $0 $0 $250 n/a $500 $636 $2, FORD 2482 $20, $377 $34 $0 $0 $250 n/a $500 $188 $ PIERCE CONTENDER PUMPER 7604 $318, $410 $18 $0 $0 $250 n/a $500 $324 $ HINO GARBAGE TRUCK 1687 $103, $1,431 $20 $0 $0 $250 n/a $500 $424 $1, FORD PICKUP 9105 $26, $497 $20 $0 $0 $250 n/a $500 $179 $ AUTO CAR GARBAGE TRUCK 6662 $145, $727 $20 $0 $0 $250 n/a $500 $426 $1, DODGE AMBULANCE 5682 $100, $797 $34 $0 $0 $250 n/a $500 $202 $1, DODGE TRUCK 8659 $18, $377 $34 $0 $0 $250 n/a $500 $102 $ LOWE BOAT J809 $1, $50 $2 $0 $0 $250 n/a $500 $30 $ BUELL MOTORCYCLE 0092 $12, $279 $0 $0 $0 n/a 0 $500 $193 $ FORD F250 PU 4902 $21, $497 $20 $0 $0 $250 n/a $500 $108 $ FORD RANGER 5414 $11, $497 $20 $0 $0 $250 n/a $500 $114 $ FORD RANGER 866 $12, $497 $20 $0 $0 $250 n/a $500 $122 $ FORD F $19, $497 $20 $0 $0 $250 n/a $500 $139 $ HOOPER 3351 $1, $50 $2 $0 $0 $250 n/a $500 $16 $ FORD F $26, $497 $20 $0 $0 $250 n/a $500 $179 $696 Page 13 of 15

17 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem FORD CARGO VAN 672 $16, $497 $20 $0 $0 $250 n/a $500 $114 $ MACK FRONTLOADER 3619 $38, $593 $20 $0 $0 $250 n/a $500 $96 $ CHEVY MALIBU 5465 $17, $328 $29 $0 $0 $250 n/a $500 $154 $ GATOR 1530 $9, $0 $0 $0 $0 $250 n/a $500 $37 $ KING 6006 $6, $50 $2 $0 $0 $250 n/a $500 $34 $ CUB CADET UTILITY 0009 $1, $0 $0 $0 $0 $250 n/a $500 $20 $ DOWN TO EARTH 6159 $8, $50 $2 $0 $0 $250 n/a $500 $48 $ FORD VAN 7071 $14, $410 $18 $0 $0 $250 n/a $500 $41 $ SURREY 7478 $35, $410 $18 $0 $0 $250 n/a $500 $51 $ FORD EXPEDITION 3700 $27, $263 $23 $0 $0 $250 n/a $500 $61 $ FORD TRUCK 8086 $28, $522 $20 $0 $0 $250 n/a $500 $81 $ FORD FLAT DUMP TRK 7200 $14, $522 $20 $0 $0 $250 n/a $500 $54 $ FORD F $14, $497 $20 $0 $0 $250 n/a $500 $122 $ TRANSHAUL CARGO TRLR 9190 $4, $50 $2 $0 $0 $250 n/a $500 $37 $ DODGE TRUCK 1344 $22, $497 $20 $0 $0 $250 n/a $500 $108 $ NATIONS 3797 $6, $50 $2 $0 $0 $250 n/a $500 $24 $ $1, $0 $0 $0 $0 $250 n/a $500 $15 $15 908A 2000 STERLING TRUCK 496 $74, $593 $20 $0 $0 $250 n/a $500 $128 $ DODGE 1/2 TON PU 0733 $18, $497 $20 $0 $0 $250 n/a $500 $99 $ FORD F $26, $497 $20 $0 $0 $250 n/a $500 $128 $ DODGE 1/2 TON TRUCK 7073 $18, $497 $20 $0 $0 $250 n/a $500 $99 $ FREIGHTLINER DUMP TRK 0373 $42, $422 $20 $0 $0 $250 n/a $500 $94 $ B 1995 FORD DUMP TRK 2581 $35, $422 $20 $0 $0 $250 n/a $500 $69 $ AUTOCAR GARBARGE TRK FRONTEN 5755 $179, $1,431 $20 $0 $0 $250 n/a $500 $671 $2,122 Page 14 of 15

18 Automobile Schedule City of Plant City, FMIT # /01/ /01/2011 Veh # Eff Date Exp Date City # Year Make Description ID # Cost New Code Liab PIP Med Pay UM Comp Ded SP Ded Coll Ded Phy Dmg Total Prem AUTOCAR GARBAGE TRK REAREND 5754 $155, $1,431 $20 $0 $0 $250 n/a $500 $595 $2, FREIGHTLINER GRABBER TRUCK 8627 $100, $727 $20 $0 $0 $250 n/a $500 $362 $1, ARROW BOAT 5063 $4, $50 $2 $0 $0 $250 n/a $500 $16 $ INT'L TRUCK $100, $1,278 $20 $0 $0 $250 n/a $500 $198 $1, HINO RECYCLE TRUCK 1441 $126, $1,431 $20 $0 $0 $250 n/a $500 $576 $2, GATA UTILITY VEHICLE 0004 $13, $328 $29 $0 $0 $250 n/a $500 $162 $ TRADEWINDS TRL W/ MOUNTED GENER 9020 $32, $50 $2 $0 $0 $250 n/a $500 $90 $ TRADEWINDS TRL 9019 $34, $50 $2 $0 $0 $250 n/a $500 $90 $ CHEVROLET SLO TRUCK 4687 $8, $497 $20 $0 $0 $250 n/a $500 $48 $ DODGE TRUCK 1037 $8, $497 $20 $0 $0 $250 n/a $500 $48 $ FORD EXPEDITION 0320 $26, $328 $29 $0 $0 $250 n/a $500 $216 $ INTERNATIONAL AMBULANCE 4259 $16, $410 $18 $0 $0 $250 n/a $500 $46 $ HME FIRE TRUCK 1851 $599, $410 $18 $0 $0 $250 n/a $500 $715 $1, FORD F-250 TRUCK $18, $497 $20 $0 $0 $250 n/a $500 $114 $ CHEVROLET IMPALA 8268 $18, $377 $34 $0 $0 $250 n/a $500 $174 $ CHEVROLET IMPALA 8486 $18, $377 $34 $0 $0 $250 n/a $500 $174 $ CHEVROLET IMPALA 9211 $18, $377 $34 $0 $0 $250 n/a $500 $174 $ CHEVROLET IMPALA 7324 $18, $377 $34 $0 $0 $250 n/a $500 $174 $ CHEVROLET IMPALA 6811 $18, $377 $34 $0 $0 $250 n/a $500 $174 $585 Total Normal Premiums $151,014 $6,985 $0 $0 $46,094 $204,093 Normal Premium Incentive Credit Net Premium $204,093 $-11,718 $192,375 Page 15 of 15

19 FMIT TRAG 1010 Page 1 of 5

20 FMIT TRAG 1010 Page 2 of 5

21 FMIT TRAG 1010 Page 3 of 5

22 FMIT TRAG 1010 Page 4 of 5

23 FMIT TRAG 1010 Page 5 of 5

24 FMIT CA 1010 Page 1 of 17

25 FMIT CA 1010 Page 2 of 17

26 FMIT CA 1010 Page 3 of 17

27 FMIT CA 1010 Page 4 of 17

28 FMIT CA 1010 Page 5 of 17

29 FMIT CA 1010 Page 6 of 17

30 FMIT CA 1010 Page 7 of 17

31 FMIT CA 1010 Page 8 of 17

32 FMIT CA 1010 Page 9 of 17

33 FMIT CA 1010 Page 10 of 17

34 FMIT CA 1010 Page 11 of 17

35 FMIT CA 1010 Page 12 of 17

36 FMIT CA 1010 Page 13 of 17

37 FMIT CA 1010 Page 14 of 17

38 FMIT CA 1010 Page 15 of 17

39 FMIT CA 1010 Page 16 of 17

40 FMIT CA 1010 Page 17 of 17

41 FMIT AL 1010 Page 1 of 4

42 FMIT AL 1010 Page 2 of 4

43 FMIT AL 1010 Page 3 of 4

44 FMIT AL 1010 Page 4 of 4

45 FMIT PIP 1007 Page 1 of 4

46 FMIT PIP 1007 Page 2 of 4

47 FMIT PIP 1007 Page 3 of 4

48 FMIT PIP 1007 Page 4 of 4

49 FMIT APD 1009 Page 1 of 4

50 FMIT APD 1009 Page 2 of 4

51 FMIT APD 1009 Page 3 of 4

52 FMIT APD 1009 Page 4 of 4

53 FMIT ARR 1009 Page 1 of 1

54 1,000,000 1,000,000 FMIT SE AL 1007 Page 1 of 1

55 City of Plant City X 25, ,519 FMIT DSL 1010 Page 1 of 3

56 FMIT DSL 1010 Page 2 of 3

57 FMIT DSL 1010 Page 3 of 3

58 FMIT AE 1008 Page 1 of 1