FAIRVIEW INSURANCE AGENCY ASSOCIATES, INC. November 30, 2018 Mr. Andrew J. Casais, RMC, QPA Borough Clerk/ Qualified Purchasing Agent Borough of Roselle Park 110 East Westfield Avenue Roselle Park, New Jersey 07204 Re: Request for Proposal: 2019 Risk Manager and Insurance Broker Dear Mr. Casais, Thank you for the opportunity to bid on the above referenced RFP. One (1) original proposal and one (1) electronic copy (PDF file on a CD) of the full submission are enclosed for your review and consideration. The complete evaluation criteria can be found under the tab marked ?Proposal?. All other required and illustrative information is located under the following tabs: Tab Letters of Recommendation Tab Firm License, Staff Licenses and Resumes Tab Examples of Risk Transfer Tab Required Paperwork Completed Checklist of Required Documents Completed Submission Form/Qualification Statement Statement of Ownership Disclosure Non-Collusion Affidavit Required EEO/Affirmative Action Evidence and Signed Compliance Notice Certificate of Employee Information Report Acknowledgment of Americans with Disabilities Act Language of 1990 Disclosure of Investment Activities in Iran Insurance Requirements Acknowledgment Form Certification Regarding Political Contributions New Jersey Business Registration Certificate W-9 Evidence of Professional Errors Omissions Insurance If you have any questions regarding this proposal, please do not hesitate to contact me. I can be reached at 973?857-0870 ext.151#, or via email at Igraham@fairviewinsurancecom. Thank you in advance for the consideration of our firm for this position. Sincerely, Lawrence K. Graham, CIC Vice President 25 Fairview Avenue 0 Verona, New Jersey 07044 Tel: 973.857.0870 - Toll Free: 800.372.2558 0 Fax: 973.857.9131 I 1930 E. Marlton Pike, Suite 0 Cherry Hill, New Jersey 08003 Tel: 856.424.8515 - Toll Free: 800.452.5376 . Fax: 856.424.7933 :1 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Proposal Fairview Insurance Agency Associates, Inc. FAIRVTEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Fairview Insurance Agency Associates, Inc. ("Fairview Insurance?) is pleased to have the opportunity to submit information regarding our firm and the superior Property, Casualty and Workers Compensation insurance services that we can provide to the Borough of Roselle Park. Our highly trained and professional staff has a deep understanding of the complex insurance needs of public entities in the State of New Jersey, and has decades of experience insuring clients in both the public and private sector. Our firm?s risk management division currently manages the insurance for client property valued at more than $6 Billion. In addition, our clients have over $1.2 Billion in payroll, and we manage workers compensation insurance for over 12,000 client employees. Fairview Insurance is a full?service independent insurance agency that provides customized insurance plans, broker services, risk management services, and employee benefits for individuals, companies and public entities. Our longevity, depth of experience and reputation for friendly, personal service has contributed to the position we hold today as one of the leading independent insurance agencies in the mid?Atlantic. The agency was founded in 1970 and has offices in Verona and Cherry Hill, New Jersey. With more than 30 licenses, we offer services to clients in New Jersey, and New York, as well as nationally through our specialty insurance programs for hard-to-place risks. Fairview Insurance is a family-owned and operated firm with the ability to deliver the services of a national-caliber company with the personality of a Main Street Business. One of our firm?s specialties includes Public Sector Property and Casualty insurance programs. Our risk management experience dates back more than thirty five years. We take pride in our extensive industry knowledge, and our ability to meet any client demands. Some recent notable achievements are listed below, and detailed information regarding our firm?s experience and success is documented throughout this presentation. RECENT NOTABLE ACHIEVEMENTS: 0 As Risk Manager for the Jersey City Board of Education, our staff conducted an extensive TPA/Managed Care Network review and negotiated a TPA/Managed Care solution that saved the District $2,428,409 in a single year. I As Broker of Record for the Township of Parsippany-Troy Hills, Fairview Insurance secured several competitive quotes and achieved a $412,000 premium savings for the Township. Fairview?s implementation of aggressive risk management safety and Fairview Insurance Agency Associates, Inc. Page 1 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker employee wellness programs have also resulted in additional workers compensation variable cost savings in excess of $950,000. 0 As Broker of Record for the Township of Bloomfield, our firm implemented a loss control/safety program with Anthony Nesto and Samantha DePalma that decreased the Township?s costs. Our program created a safety committee structure and implemented guidelines for in-house Township safety meetings auto fleet safety, defensive driving, etc.). In 2013, Fairview Insurance assisted the Township with the replacement of their Third Party Administrator and Managed Care Organization for Workers Compensation claims. The change resulted in a savings of $5,044,234 since 2012. - Upon being named Risk Manager for the Borough of Caldwell our staff initiated a competitive bidding process that resulted in a $50,000 annual savings, while significantly increasing the safety control and awareness for all departments and department heads. 0 After being named Broker of Record for the Borough of Roselle, we identified four Public Official claims that were originally denied due to late reporting. Through negotiations and leveraging our experience, we convinced the insurance company to rescind the claims declinations. This resulted in a savings of legal fees and settlement costs of over $150,000. a Fairview Insurance saved the Jersey City Board of Education $92,626 by reversing an insurance carrier flood claim denial that was based on an incorrect flood zone determination done by the carrier. An important part of our services includes financial analysis and advice regarding risk minimization. We evaluate risks by analyzing current portfolios to ensure that proper insurance limits and coverages are in place. Our risk evaluation capabilities make it possible for our firm to provide premium projections significantly faster than the average insurance agency. This reduces lead-time and facilitates your planning process. We also help our clients identify and reduce risk exposure. For example, our staff will review the Borough?s safety records and Borough compliance with PEOSHA regulations. Our extensive expertise will help you address any loss control issues and help reduce your insurance costs. Additional services we provide are as follows: 0 Claims and Loss Experience Analysis 0 Competitive Bid Obtainment Fairview Insurance Agency Associates, Inc. Page 2 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker - Strategic Cost Containment a Communication of Market Trends 0 Availability to attend any JIF or Insurance Carrier meetings on the Borough?s behalf Scope of Work: Fairview Insurance Agency Associates, Inc. confirms that we will perform all of the services as listed in the following scope of work, however, our services will not strictly be limited to the following and we will provide whatever level of service the Borough requires: 1. Work with department heads and management staff to identify insurable property, casualty, and other exposures of the Borough, 2. Recommend professional methods to reduce, assume or transfer the risk and loss, 3. Work in concert and coordination with Borough staff including but not limited to the Borough?s Joint Insurance Fund Commissioner and Department Heads, 4. Work in concert and coordination with the professional staff retained or contracted by the Borough?s Joint Insurance Fund, 5. Review and make professional recommendations relating to all applications for coverage by the Borough. Submission Formeualification Statement: 1. Names and roles of the individuals who will perform the services and description of their education and experience with projects similar to the services contained herein: Fairview Insurance Agency Associates, Inc. Main Office: 25 Fairview Avenue Branch Office: 1930 E. Marlton Pike, Ste C16 Verona, NJ 07044 Cherry Hill, NJ 08003 Tel: 800-372-2558 Tel: 800-452-5376 Fax: 973-857?9131 Fax: 856-424-7933 Key Contact Person: Lawrence Graham, CIC, Vice President Email: lgraharn@fairviewinsurance.com Phone: 800?372-2558 ext.151# Fairview Insurance Agency Associates, inc. Page 3 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Our service model is to provide exceptional service both quickly and accurately and our service is unparalleled in the industry. Fairview Insurance prides ourselves in managing all aspects of the Property Casualty Insurance. This includes all coverages that are within the Joint Insurance Fund and all related coverages that must be placed outside of the Joint Insurance Fund. Additionally, we are the primary point of contact for insurance inquiries, claims reviews, and safety trainings to reduce the frequency of workplace accidents and claims related to the Borough. While other agencies direct clients and members to contact the carrier first, we advise all to contact us first so that we may effectively resolve any issue before it becomes escalated to minimize the impact to the Borough. We provide a myriad of services to all our clients, and are as involved as our clients prefer. All of our staff that will be managing the Risk Management servicing needs is located at our Verona office. We structure our department, and agency as a whole, in a way that allows us to provide complete service and management for our clients? Property and Casualty programs. We provide a team of knowledgeable and capable staff, each with specific expertise. Lawrence Graham, CIC, (Supervising Risk Management Consultant) Vice President Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, NJ 07044 Tel: 973-857-0870 ext.151# Toll Free: 800-372-2558 Fax: 973-857-9131 Email: Igraham@fairviewinsurance.com Larry is responsible for risk management services for numerous public sector accounts. He also oversees Fairview?s risk management operations for public sector accounts on a daily basis. Larry coordinates each team that will be servicing Fairview Insurance?s public sector clientele. Larry will serve as the primary point of contact for the Borough and will assist with account renewal, risk management analysis, loss control coordination, and insurance carrier relations. Larry will also be the lead on any contract review desired by the Borough. Larry has over thirty five years of experience in the industry. Fairview Insurance Agency Associates, Inc. Page 4 FAIRVTEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Zach Edelman, CRM (Risk Management Consultant) Director of Risk Management Email: zedelman@fairviewinsurance.com Zach works with Larry on numerous public sector accounts. He is responsible for visits with the clients, loss control and claim management assistance to assure client profitability and appropriate insurance analysis. Zach will assist Larry. He will help coordinate the various servicing needs of the Borough. Zach will also assist Larry in contract review, if desired by the Borough. Tom FitzPatrick, (Risk Management Consultant) Executive Sales Email: Tom works with Larry and Zach on a number of public sector accounts. Tom is responsible for visits with clients, loss control and claims management assistance to assure client profitability and appropriate insurance analysis. Tom also specializes in workplace safety, claims management, and premium stabilization. Tom will assist Larry, and Zach as necessary to ensure the Borough?s insurance program is running smoothly. Tom will assist Larry and Zach with the contract review as well if desired by the Borough. Danielle Voda, CIC, CPIA, Account Executive Email: dvoda@fairviewinsurance.com Danielle is responsible for handling day-to-day account responsibilities such as coverage questions, endorsement processing, policy review, certificate analysis and general account management tasks. Danielle will serve as the main customer service representative for the Borough. Danielle?s hands-on approach to account management ensures that all clients receive the highest caliber of client service. Teresa Sulsona, CISR, CPSR, CPIA, Property Casualty Lines Manager Teresa is responsible for underwriting of new and renewal Public Sector business. Teresa is responsible for the oversight of all public sector accounts. She will make sure all needs are met by the CSR staff. Teresa will handle client?s inquiries regarding insurance coverage and will manage Fairview?s staff on a daily basis to assure that the customers? needs are met. Teresa has over thirty years of experience in the industry. Fairview Insurance Agency Associates, Inc. Page 5 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Anne Campagna, Account Manager Anne is responsible for providing high quality client service which includes marketing, assistance with routine coverage questions, endorsement processing, certificate of insurance coordination, problem solving, billing and policy review. Anne will serve as a secondary customer service representative for the Borough. Anne has over 20 years of experience in the insurance industry. Please refer to Tab #2 for staff licenses and resumes. 2. References and record of success of same or similar service: Fairview Insurance Agency Associates, Inc. brings a wealth of knowledge and over thirty five years of experience to the field of public sector Risk Management and Insurance Broker Services. The following are examples of some of our success throughout the years. 2002 Present: Township of Bloomfield - Risk Management Consultant Fairview Insurance has had the pleasure of working with the Township for a number of years now. In 2012, we were able to move the Township into the Garden State Municipal Joint Insurance Fund for a savings while providing better coverage. The GSMJIF Assessment for 2012 was $623,817 versus that of the Suburban Essex JIF renewal price of a minimum of $651,790 and a max of $728,000. This move also benefited the Township by lowering deductibles and self-insured retentions. The General Liability self-insured retention was lowered from $150,000 to $100,000 per claim. The Property insurance deductible was lowered from $2,500 to $1,000 per occurrence. The Auto Physical Damage, Comprehensive and Collision deductibles were all lowered from $2,500 to $1,000. In 2013, Fairview Insurance assisted the Township in replacing their Third Party Administrator and Managed Care Organization for Workers Compensation claims effective 1/1/2013. The result of this change for 2013 was a savings of $1,012,195 on claims paid by the Township?s funds. The positive results for the Township since the switch account for a cumulative savings over 2012 of $5,044,234. These are highly significant savings that have been generated by the recommendations of Fairview Insurance. Fairview Insurance Agency Associates, Inc. Page 6 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Additionally, Fairview Insurance established a Risk Management Safety Program coordinating with Anthony Nesto and Samantha DePalma with special emphasis on Workers? Compensation Safety. Patterns of claims were identified and trainings were recommended and implemented within the Township. Working closely with the department heads, Fairview and the Township of Bloomfield were able to reduce the Township?s Workers? Compensation claims which resulted in premium reductions. Fairview Insurance coordinates with the Township to take advantage of all of the safety and training programs that are available through the JlF/Insurance Carrier. An example is how the Township was able to receive a special Employee Liability training session arranged specifically for the Township at the expense of the JIF. Many other safety programs were provided at the Township?s locations for safety training of various departments. These safety training sessions saved employee travel time, prevented injuries, and ultimately reduced the Township?s claim payments. April 2012 - Current: Jersey City Board of Education Risk Manager/Insurance Broker Jersey City Board of Education - TPA/Managed Care Network Monitoring and Consulting for Workers Compensation Program: Through Fairview Insurance?s TPA/Managed Care Network Monitoring and Consulting services, we negotiated and recommended a TPA/Managed Care solution that saved the District $2,428,409 in a single year. We achieved this savings by implementing the following action plan: I Initiated the RFP process for TPA and Managed Care Services 0 Reviewed seven proposals and drafted a comparison spreadsheet that documented each respondent?s definition of percentage of savings and flat fees Redefined how respondents could receive fees based on percentage of savings 0 Further negotiated respondents? proposed percentage of savings fees. Risk Manager/Insurance Broker Services Provided: Fairview Insurance, upon being named broker of record for property and casualty insurance, immediately began to remarket all lines of insurance on behalf ofthe Board Fairview Insurance Agency Associates, Inc. Page 7 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker of Education. Fairview marketed the program to two different joint insurance funds and eighteen different private insurance carriers to explore all options available to the Board for the most cost effective and best coverage available. We significantly reduced the Board?s costs through our extensive marketing efforts. In addition, Fairview secured placement for multiple flood insurance policies at locations that would not have otherwise had coverage for flood damages. Fairview Insurance saved the Board of Education $92,626 by reversing a flood claim denial that was based on an insurance carrier?s incorrect flood zone determination. Further, Fairview identified potential gaps in coverage by uncovering several claims that the previous insurance broker failed to report to excess insurance carriers. Fairview immediately reported these claims. Fairview met with the Administration to review certificate of insurance procedures. We issued guidelines for certificates that the Board?s previous broker failed to provide, and these guidelines are now used in every Jersey City Board of Education RFQ. To date we have reviewed and approved 24 new certificates of insurance provided by vendors to the Board. Fairview Insurance replaced all Board of Education Bond needs for half the price of previous years. We have also provided end of year and mid?year quotes for different lines of insurance to keep the Board aware of current market trends. June 2015 Present: Toms River Regional Schools - Insurance Broker/Risk Manager Fairview Insurance is working closely with the District on their insurance program. Our office continues to provide numerous certificates of insurance, complete contract reviews for insurance compliance, review vendor contracts, assist in the claims process, and various other services to the District. Fairview's risk management team also attends regular safety committee meetings as well as insurance committee meetings with Board members that are held quarterly. We also worked with the business administrator on solicitations for actuarial and third party administrator services. We continue to work with the District on managing safety including training for employees that is focused on the loss history to prevent similar claims from occurring in the future. Fairview Insurance Agency Associates, Inc. Page 8 FAIRVIEW INSURANCEAGENCY ASSOCIATESWC- Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker 2014 - Present: Township of Union Board of Education Risk Manager In our time as Risk Manager with the District, we have worked closely with the District administration on a number of items; improving the overall insurance program. Fairview Insurance now reports all claims other than workers compensation to the appropriate insurance carriers to streamline the process for the District. This removes multiple steps for the District. Fairview Insurance set up standard vendor insurance requirements for the purchasing department to better protect the District. Our team also reviews certificates of insurance to ensure they match the required specifications. Fairview Insurance recommended changes to the Student Accident insurance carrier and the School Leaders Errors and Omissions insurance carrier. We also market the entire insurance program on a regular basis to ensure the best possible pricing and coverage for the District?s overall insurance program. 2015 Present: Brick Township Municipal Utilities Authority Risk Manager Fairview Insurance attends all JIF meetings to represent the interest of the Authority. We identified certain MUA properties that are in high hazard flood zones that do not have flood insurance. We are working with the MUA and the National Flood Insurance Program on obtaining quotes. We also identified inaccuracies in the property schedule on file with the Joint Insurance Fund. The MUA had given the previous risk manager changes to the property schedule to submit which was never done. Fairview Insurance input all of the property changes into the JIF website to ensure that the MUA's property is now insured accurately. Fairview Insurance has also obtained numerous certificates of insurance for the MUA, while reviewing and making recommendations on certificates the MUA has received from vendors. The Brick MUA received an increase in the dividend received by the JIF this past year due to improvements in the insurance program. 2007 Present: Western Monmouth Utilities Authority Risk Manager Fairview Insurance established guidelines for a Safety Program with the MUA. Fairview also reviews claims with administration to prevent reoccurrence. Coverages have been increased while costs have been stabilized. Fairview Insurance assists with contract and certificate of insurance review to ensure adequate protection of the MUA from vendors. Fairview Insurance assists in coordinating available safety programs from the New Jersey Municipal Utilities Authority JIF to further employee safety awareness. This safety training helps to reduce overall claims. During our tenure, the Western Monmouth Utilities Authority received a perfect 10 score for the NJMUA JIF Safety Fairview Insurance Agency Associates, Inc. Page 9 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Incentive Award. It is important to note that the Western Monmouth Utilities Authority was one of only eight authorities out of 96 to receive this distinct honor. Western Monmouth Utilities Authority was also honored as the first member of the JIF to become Sharp Certified. 2001 2012: North Jersey Water District Supply Commission Risk Manager During our time as Risk Manager, Fairview Insurance worked closely with the insurance carriers, including Travelers and other carriers still utilized today by North Jersey District Water Supply Commission to develop balanced insurance solutions and create effective plans tailored to the Commission?s unique insurance needs. Fairview Insurance consistently analyzed the Commission?s insurance policies to enhance their coverage and reduce cost. Fairview Insurance performed numerous contract reviews, organized multiple meetings with the insurance carriers to review exposures, developed a service plan to assist with reducing accidents and injuries, and provided risk control management services. Fairview Insurance also made sure the Commission was up to date and aware of all new insurance vehicles and coverage enhancements. Fairview Insurance made the Commission aware of Cyber Liability Coverage, which was a brand new type of coverage in the industry. We pointed out how important this type of coverage is for the Water Commission. The North Jersey District Water Supply Commission has unique exposures such as dams, and while Fairview Insurance was the Insurance Broker, we reviewed the Army Corps of Engineers reports on the condition ofthe dams in order to help place the appropriate insurance for them. This included coverage for the Monksville dam among others. Terrorism coverage is also important due to these unique exposures. We also set up the appropriate coverage for the Wanaque South Joint Venture. This required additional coverage separate from the coverage for North Jersey District Water Supply Commission. Fairview Insurance also made sure that the appropriate and necessary additional named insureds were on each insurance policy. 5/2013 Present: City of Passaic Risk Manager/Insurance Broker Fairview Insurance saved the City over $315,000 annually in insurance premium by recommending the City move insurance into a Joint Insurance Fund. The added benefit Fairview Insurance Agency Associates, Inc. Page 10 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker of this move is the significant addition of many more trainings and services that are offered by the Joint Insurance Fund. The City of Passaic has taken advantage of these safety trainings at no additional cost. Even with this reduction in premium there was an increase in limits of liability insurance from $11,000,000 to $15,000,000 to further protect the City. From a day to day standpoint, Fairview Insurance processes numerous certificates of insurance and recommends changes on vendor contracts to better protect the City. We continue to process numerous vehicle and property changes. Fairview Insurance also reviewed the insurance carried by the City of Passaic Public Library and determined based on the Library?s relationship with the City that the Library needed to purchase its own Workers Compensation policy. This limited any exposure for the City in the event ofany injury. The following are some of the services provided to the City by Fairview Insurance: 0 Deductible analysis with recommendations based on losses 0 Assist the City in keeping up to date with PEOSHA standards in the workplace 0 Facility with JIF representatives and the Fairview Insurance team 0 Reduce City liability through Contract Liability Transfer II Review Certificates of Insurance the City receives from outside vendors in Review all City owned property for flood zone indications 0 Review all insurance policies for any gaps in coverage I Placed Cyber Liability coverage for the City 9 Solicited multiple competitive quotes for the City?s insurance renewal - Clarified all named insured?s to be added to the City?s insurance policies I Placed general liability insurance for Passaic Alliance in the JIF while keeping the professional liability policy separate saving the City money 8/2011 Dec. 2017: Township of Parsippany-Troy Hills Risk Manager Fairview Insurance assisted the Township in collecting and formulating information for a RFP to obtain competitive insurance bids from the insurance market. Fairview Insurance secured several competitive quotes and was able to achieve an annual savings of $412,000 for the Township of Parsippany Troy Hills. 5 Fairview Insurance Agency Associates, Inc. Page 11 FAIRVIEW WSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Fairview Insurance performed a comprehensive review of all policies in place. Upon review, Fairview found multiple discrepancies within the policies. One major discrepancy was $1.4 million of mobile equipment being listed as automobiles on the policy. Fairview also reviewed all township buildings for flood zone status (Buildings wholly or partially in flood zones through require specific coverages from the National Flood Insurance Program). As a part of Fairview?s services, we reviewed Township loss experience and recommended implementation of certain safety measures to reduce claim frequency and severity. This led to significant reductions in the loss experience which will ultimately reduce the Township's premiums for years to come. Fairview?s implementation of aggressive risk management safety and employee wellness programs have resulted in additional workers compensation variable cost savings in excess of $950,000. 2008 2012: Bloomfield Board of Education - Risk Manager Fairview Insurance established guidelines and assisted in the implementation of a Safety Program to reduce claims which lead to premium reduction and stabilization. Fairview organized a routine review of claims with administration to increase safety and reduce frequency of accidents. We transferred the administrative insurance burden from the School District to Fairview Insurance. Fairview Insurance attended Joint Insurance Fund Meetings as the Board of Education?s representative. Fairview Insurance then advised the Board of Education of any updates and changes in the insurance industry and how they relate to the entity. 1999 2009: Clark Board of Education Risk Manager As Risk Manager, Fairview reduced premiums overall by $1 million. Fairview coordinated a Safety Program with the School Safety Department and the Insurance Carrier. We reviewed premium audits which saved an additional $42,000. As a part of the new Safety Program, Fairview also helped set up playground inspections. 2007-2010: Roselle Board of Education Risk Manager As Risk Manager, Fairview Insurance reduced premiums for three consecutive years for a savings of $122,000. This savings was achieved while significantly increasing coverages. The coverage increases were as follows: Fairview Insurance Agency Associates, Inc. Page 12 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker The property values were increased from $64 Million to $81 Million. 0 School Board Leaders Liability coverage increased from $5 Million to $16 Million. I General Liability coverage was increased from $1 Million to $16 Million. 0 Student Accident Liability coverage increased from $1 Million to $16 Million. Fairview Insurance reviewed premium audits for additional savings. Fairview also formalized safety programs in the district and set up playground safety inspections to meet state safety codes. 2004 Present: Livingston Township - Risk Management Consultant Fairview Insurance established a Risk Management Safety Program with emphasis on Automobile Liability. We coordinated a computer sign-up which allows the Township to check Motor Vehicle Reports free of charge with the State of New Jersey. We enabled the Township to leverage the Joint Insurance Fund?s outside Loss Control Division to inspect all premises for auto fleet maintenance, proper valuation, and loss prevention. Fairview also provided an outline for the Township Safety Committee to conduct bi- safety meetings. Fairview Insurance established a workers compensation claim reporting procedure to handle first reports for the Township which helps to mitigate fees and provide a prompt return to work program. We reviewed and updated Township entities, recommended loss control techniques, and analyzed exposures such as FEMA flood coverages. This enabled the Township to properly cover properties that are in high hazard flood zones. Fairview Insurance provides the Township with alternative insurance market quotations in order to ensure the most cost effective insurance program. January 2012 Present: Township of Old Bridge Risk Manager Fairview Insurance Agency completed a complex analysis of the Township?s insurance program, along with daily insurance maintenance and answers to inquiries. The following are services that we have provided to the Township throughout our tenure as Risk Management Consultant: In the past few years we stabilized the Township?s fixed insurance costs. Fairview Insurance helped the Township achieve a substantial savings by implementing a small workers compensation self?insured retention versus first dollar coverage. While making Fairview Insurance Agency Associates, Inc. Page 13 FAIRVTEW INSURANCE AGENCY ASSOCIATESJNC Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker this move, we have also been active with the Township?s safety committee to focus on keeping workers compensation claims to a minimum in order to maximize the savings to the Township. Fairview Insurance Agency has helped the Township of Old Bridge realize a significant savings in fixed costs and claims costs in the last two years. The savings we were able to help the Township achieve for 2015 and 2016 combined over the 2014 Fund year is $757,858. The Township?s move into a new Joint Insurance Fund was beneficial to coordinate all safety training to be completed in the Township of Old Bridge for all employees rather than sending employees to various locations throughout the State. 0 Over the past two years, Fairview Insurance Agency has been monitoring Workers Compensation claims closely to identify any patterns or issues that should be addressed to minimize the Township?s exposure to the SIR. I We attend Safety Committee meetings and review claims each month and ways to prevent or reduce specific types of claims. I During the 2016 renewal process, Fairview Insurance was able to obtain a competitive quote that saved the Township over $100,000 in fixed annual assessment costs. 0 During our review of Workers Compensation Self?Insured Retention billing from the third party administrator, Fairview Insurance Agency noticed a duplicate billing which saved the Township $15,000. 0 Fairview Insurance recommended for the 2015 term that the Township only renew with the Central Jersey JIF for one year, rather than a 3 year commitment. This gave the Township much more flexibility and choices in the year following year. Fairview identified a Gap in coverage and recommended Accident Insurance for Recreation Activities. A policy was placed with QBE Insurance Corporation for the volunteer participants. I Fairview identified that certain positions that are required to be bonded were not. As a result, Fairview Insurance facilitated a Bond for the Township?s Finance Director/CFO. Fairview Insurance Agency Associates, Inc. Page 14 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Fairview introduced CAIR (Customer Abstract Information Retrieval), a program offered by the Motor Vehicle Commission that provides driver history abstracts ownership history and registration/title inquiries. 0 Fairview provided guidance and recommendation of FEMA assistance Vendor to have Old Bridge reimbursed for Hurricane Sandy. . Fairview assisted in the set-up the MSI Learning Management System for the Township. Fairview entered 600 employees into the database, organized by department, to track all classes going forward so that a quick report will enable the Township to see which employees are trained in which areas. I Fairview reviewed and made recommendations of coverage for vendor Certificates of Insurance. I We recommended a review ofthe Property Schedule to confirm that all buildings were scheduled and that both Building Limits and Contents Limits were sufficient. I Fairview reviewed the Tort Claims Reporting Procedure and recommended the use of a revised Notice of Tort Claim Form. 2007 2010: Borough of Roselle Risk Manager Fairview Insurance achieved significant financial reductions for the Workers? Compensation line of insurance. Fairview Insurance did an overall analysis of areas relating to workers compensation including the legitimacy of workers compensation claims, employee workplace safety awareness, physician networks, and accident investigations. Fairview Insurance recommended a Workers? Compensation Project Plan that was approved and implemented. Annual savings of Workers? Compensation premiums of over $75,000 were achieved. Over $30,000 of past billing mistakes were uncovered and safety was at its highest level in years. Fairview Insurance identified four Public Official claims that were originally denied due to late reporting. Through negotiation and leverage of experience, we were able to have the insurance company rescind the declination of the claims. This resulted in a saving of legal fees and settlement costs of over $150,000. 2010: City of Atlantic City Consulting Services Fairview Insurance provided insurance consulting services in efforts to streamline administrative procedures and reduce premiums. A RFQ was conducted with a total Fairview Insurance Agency Associates, Inc. Page 15 FAIRVIEW INSURANCE AGENCY ASSOCIATESJNC. Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker evaluation of all insurance policies, insurance related vendors and services. Evaluation was based on the following criteria: 0 Risk Management and Loss Control Services: This analysis was used to eliminate/reduce claims by classifying exposures and designing training, such as the Return to Work Program. City Safety Committees implemented the trainings. Negotiation of Third Party Administration/Managed Care Services: 0 We implemented an effective use of medical network. 0 Fairview Insurance negotiated Medical Re-Pricing Discounts. 0 We also provided accurate claim information as well as reconciliation reports with the City finance department for claim payments. 0 Reduction of Fixed Administrative Costs: As a Consultant, Fairview reduced fixed administrative costs upfront by $247,000 with the possibility of up to an additional $1,000,000 of savings based on Risk Management Recommendations. 1994 2008: Cherry Hill Township - Risk Manager Fairview Insurance reduced premiums overall by $2.8 million. Fairview established a safety and risk management committee that led to favorable loss experience and increased employee safety which helped the Township finish 2nd among 42 municipalities for overall safety awards for 2006 2007. 2008 - Present: Borough of Caldwell Risk Manager Fairview Insurance went out to bid utilizing multiple insurance vehicles and obtained multiple quotes. This resulted in an annual savings of over $50,000 and significantly increased the safety services and controls for all departments. Previously, the annual assessments were increasing an average of 8% per year. After the change in Joint Insurance Funds, the average increase was reduced to After selecting Fairview Insurance, the Borough of Caldwell was paying less in 2010 than they were paying in 2006. Fairview recommended that the Borough police force become certified with an accredited Police Program to review, update, and implement policies and procedures within the police force. This program will allow the police force to be able to Fairview Insurance Agency Associates, Inc. Page 16 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker accomplish more with less and reduce both Workers? Compensation and General Liability claims, which leads to a decrease in premiums. 1998 Present: Township of West Orange Risk Management Consultant Fairview Insurance examined policies from a coverage and pricing standpoint. Gaps in coverage were identified and placement into a different Joint Insurance Fund was recommended. Negotiations on behalf of the Township were completed which resulted in an increase in coverage and a reduction in premiums. Quarterly safety committee meetings are now done on an ongoing basis to maintain a heightened level of workplace safety awareness. 2006 2009: Township of Pemberton Risk Manager Fairview Insurance attended Safety and JIF Meetings. We reviewed coverages and exposures and established formalized procedures for a Safety Committee. 2006 2011: Borough of Highland Park Risk Manager Fairview Insurance negotiated compliance of Loss Control recommendations, attended JIF meetings, and set up a Safety Program to comply with JIF regulations. January 2014 December 2016: City of Millville Risk Manager/Insurance Broker Fairview Insurance accomplished the following with the City: I Since Fairview Insurance Agency became the City?s Risk Management Consultant, the JIF assessment has had a net savings of $255,200 for the renewal years of 2016 and 2017 combined compared to the 2015 Fund year. These were the first reductions of the City?s Atlantic County Municipal Joint Insurance Fund assessment since 2009. I Fairview Insurance attended all scheduled Atlantic County Municipal Joint Insurance Fund meetings. I Fairview Insurance attended Safety Committee meetings at the City of Millville. Fairview Insurance reviewed all outside vendors certificates of insurance to verify that they comply with insurance requirements specified in the City contracts to transfer the risk of loss. Fairview Insurance Agency Associates, Inc. Page 17 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Fairview Insurance assisted in gathering all renewal application information (verifying and entering all data into the Atlantic County Municipal Joint Insurance Fund online system). 1997 2015: Borough of New Providence - Insurance Broker Fairview Insurance Agency accomplished the following with the Borough: 0 Stabilization of the Borough?s insurance costs. The Borough?s renewal pricing for 2016 was $527,428 compared to $516,687 in 2015. This total premium for 2016 includes coverage for the NPSM Consolidated Communications which will pay $34,996 of the overall assessment, which means that the assessment for the Borough of New Providence in 2016 is $492,432 representing a savings over the previous year. I Increased on-site safety training has resulted in achieving a more favorable claims experience for the Borough. Fairview Insurance Agency Associates, Inc. was the Insurance Broker for the Borough of New Providence for fifteen years. We consistently focused on safety claims management and reducing or keeping premium increases to a minimum. In the 2009-10 renewal process, we achieved an overall premium reduction. In the 2010-11 renewal process there were a number of workers compensation claims that would have led to almost doubling the premium, however thanks to Fairview remarketing the workers compensation to multiple markets; we obtained no increase in premium. We also attained a premium reduction on the rest of the package. In the 2011?12 renewal process Fairview again achieved an overall account savings. We continuously remarketed the account to ensure that the Borough had the most comprehensive program for the most advantageous cost. November 2011 -2014 2015- 2016: Hoboken Housing Authority Risk Manager Fairview Insurance Agency became Risk Manager for Hoboken Housing Authority shortly after Hurricane Irene. Fairview provided assistance by facilitating payment between both the Authority?s insurance carriers and FEMA. Hurricane Sandy?s effects on the Authority?s various complexes were severe. The Fairview staff visited the Authority during the aftermath of Sandy, again facilitating emergency and clean-up procedures. In addition to aiding in ground efforts, Fairview Fairview Insurance Agency Associates, Inc. Page 18 FAIRVIEW INSURANCE AGENCY ASSOCIATESWC- Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker ensured that the Authority received timely payments from both the insurance carriers and FEMA. Similar to Fairview?s efforts after Irene, Fairview gathered and classified all of the necessary documentation in order to get payment as quickly as possible from all possible opportunities (avenues included the Authority?s 28 Flood Insurance policies, their coverage package with a Joint Insurance Fund and FEMA funding). Considering the large impact that Sandy had on the Authority, it was most important that the Authority receive prompt payment in order to return to normalcy for its residents. January 2008 Present: Housing Authority of City of Passaic Fairview Insurance identified a strong need for specific trainings. Wrongful termination, harassment and other EPLI claims are on the rise and the best way to control frequency and severity is proactive trainings. Fairview Insurance recommended and coordinated an all-day 3 session Employment Practices training. This included Employee Conduct, Conflict Resolution Stress Management. Separate underlying flood policies were secured to eliminate gaps of insurance between flood carriers. Additionally with the FEMA Flood maps changes throughout the year, Fairview Insurance regularly looks for changes in flood zones to ensure coverage is current. September 2012 2015: Bergen County Housing Authority Fairview Insurance worked with the Housing Authority to ensure compliance of the Employee Handbook and Policies and Procedures Manual. This resulted in a reduction in deductibles of $15,000 per claim. Additionally Safety Trainings were established and implemented based on claims in the past 2 years. There was also damage from both Hurricane Irene and Hurricane Sandy in which Fairview was involved in expediting the claims reimbursement process. At the end of the contract Fairview Insurance we out to get competitive bids to keep insurance premiums down. As Risk Manager, Fairview Insurance attends JIF meetings as representative. We established guidelines for a Safety Program. Fairview also reviews claims with administration to prevent reoccurrence. Coverages have been increased while costs have been stabilized. Please refer to Tab #1 for Letters of Recommendation. Fairview Insurance Agency Associates, Inc. Page 19 FAIRVIEW INSURANCE AGENCY ASSOCIATES, INC. Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Pronertv 8c Casualtv Contact Phone Client/Address Lines of Coverage Contact Number Property Borou of Ke ort Ste hen Gallo yp Casualty? 2015- 732?739-5122 75 West Front Street, Keyport, NJ Busmess Administrator Current Property Borough of Red Bank Zlad Shehady Cas alt - 2017- 732-530?2740 90 Monmouth Street, Red Bank, NJ Business Administrator Current City of Passaic Rick Fernandez 973 365 6330 330 Passaic Street, Passaic, NJ Business Administrator Current Passaic Valle Sewera eCommission Property& Gre or A Tramontozzi Casualty? 2015 973-466-2915 600 Wilson Avenue, Newark, NJ Executive Director Current . Property Ct Ed ersey I oar uca-ion Casualty 2012_ Hegina linson 201-915-6279 346 Claremont Ave, Jersey City, NJ Busmess Administrator Current Property range Casualty - 2014- ,Oomon fall 'g 973-266-5310 44 City Hall Plaza, East Orange, NJ Busmess Administrator Current Property To fU Shols a ip 0- mon IC- Casualty? 2014_ anue . ieir 908-851?6419 2369 Morris Avenue, Union, NJ Busmess Administrator Current . Property Brian Dellabella City of Bayonne Casualty 2017- Insurance Committee 201-858-6034 630 Avenue C, Bayonne, NJ Current Secretary Woodland Park Board of Education Property Thomas DiFluri 853 McBride Avenue, Woodland Casualty 2013? . . . 973?317-7720 Busmess Administrator Park, NJ Current ert Gar Vaccaro Brick Municipal Utilities Authority . 1551 Hi hwa 88 West Brick NJ Casualty 2015- Director Compliance, 732?701-4256 Current Safety GIS . Property Township of Old Bridge Himanshu Shah It ?2012- 732-721?5600 One Old Bridge Plaza, Old Bridge, NJ asugurllrent Finance Director Fairview Insurance Agency Associates, Inc. Page 20 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Township of West Orange Property Jack Sayers Ca alt ?1998- 973-325-4050 66 Main Street, West Orange, NJ su Business Administrator Current Property Toms River Regional Schools William Doering Casualt ?2015- 732-505-5549 1144 Hooper Ave, Toms River, NJ Business Administrator Current Pro ert 8L City of Bayonne Board of Education Leo Smith Casualty 2017- 201-858-5560 669 Avenue A, Bayonne, NJ Ret. Busmess Administrator Current Townshi of Livin ston Property RUSS Jones Casualty - 2004- Asst. Business 973-535-7973 357 S. Ave, LIVIngston, NJ Current Administrator Property Borough of Caldwell Casualt 2008 Paul Carelli 973 466 4634 One Provost Square, Caldwell, NJ Business Administrator Current . Property Township of Bloomfield Matthew Watkins Casualt ?2002? 973-680-4004 1 Municipal Plaza, Bloomfield, NJ Curyrent Business Administrator 3. Description of ability to provide the services in a timely fashion (including staffing, familiarity and location of key staff): Our service model is to provide exceptional service both quickly and accurately and our service is unparalleled in the industry. Fairview Insurance prides ourselves on managing all aspects of the Property Casualty Insurance. This includes all coverages that are within a Joint Insurance Fund and all related coverages that must be placed outside of a Joint Insurance Fund. Additionally, we are the primary point of contact for insurance inquiries, claims reviews, and safety trainings to reduce the frequency of workplace accidents and claims related to the Borough. While other agencies direct clients and members to contact the carrier first, we advise all to contact us first so that we may effectively resolve any issue before it becomes escalated to minimize the impact to the Borough. We provide a myriad of services to all our clients, and are as involved as our clients prefer. All of our staff that will be managing the Risk Management servicing needs is located at our Verona, NJ office. Fairview Insurance Agency understands that our clients may have needs outside of normal business hours. In order for Fairview to be able to service our clients as Fairview Insurance Agency Associates, Inc. Page 21 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker efficiently and effectively as possible, all Fairview staff have 24/7 access to email and voicemail. Fairview also uses a computer system known as The Agency Manager to keep track and diary all contact that we have with all of our clients. Using this system allows us to keep detailed records of all client interaction and needs. The Fairview staff also has secure remote access to this system as necessary. All Fairview staff members checks email and voicemail regularly after business hours to ensure that client needs are met diligently. Additionally, appropriate staff members have smartphones to always be connected to the office and our clients. The Risk Managers give all of our clients our direct cellular telephone numbers in case of an emergency or after hours need. If a client has a special need after business hours, or on a weekend, Fairview has the capabilities to fulfill those needs. Additionally, our staff is more than happy to take care of any of these special requirements whenever necessary for our clients. We structure our department, and agency as a whole, in a way that allows us to provide complete service and management for our clients? Property and Casualty programs. We provide a team of knowledgeable and capable staff, each with specific expertise. Lawrence Graham, CIC, Vice President Larry is responsible for risk management services for numerous public sector accounts. He also oversees Fairview?s risk management operations for public sector accounts on a daily basis. Larry coordinates each team that will be servicing Fairview Insurance?s public sector clientele. Larry will serve as the primary point of contact for the Borough and will assist with account renewal, risk management analysis, loss control coordination, and insurance carrier relations. Larry will also be the lead on any contract review desired by the Borough. Larry has over thirty five years of experience in the industry. Zach Edelman, CRM, Director of Risk Management Zach works with Larry on numerous public sector accounts. He is responsible for visits with the clients, loss control and claim management assistance to assure client profitability and appropriate insurance analysis. Zach will assist Larry. He will help coordinate the various servicing needs of the Borough. Zach will also assist Larry in contract review, if desired by the Borough. Tom FitzPatrick, Executive Sales, Risk Manager Tom works with Larry and Zach on a number of public sector accounts. Tom is responsible for visits with clients, loss control and claims management assistance to assure client profitability and appropriate insurance analysis. Tom also specializes in Fairview Insurance Agency Associates, Inc. Page 22 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker workplace safety, claims management, and premium stabilization. Tom will assist Larry, and Zach as necessary to ensure the Borough?s insurance program is running smoothly. Tom will assist Larry and Zach with the contract review as well if desired by the Borough. Danielle Voda, CIC, CPIA, Account Executive Danielle is responsible for handling day-to-day account responsibilities such as coverage questions, endorsement processing, policy review, certificate analysis and general account management tasks. Danielle will serve as the main customer service representative for the Borough. Danielle?s hands-on approach to account management ensures that all clients receive the highest caliber of client service. Teresa Sulsona, CISR, CPSR, CPIA, Property Casualty Lines Manager Teresa is responsible for underwriting of new and renewal Public Sector business. Teresa is responsible for the oversight of all public sector accounts. She will make sure all needs are met by the CSR staff. Teresa will handle client?s inquiries regarding insurance coverage and will manage Fairview?s staff on a daily basis to assure that the customers? needs are met. Teresa has over thirty years of experience in the industry. Anne Campagna, Account Manager Anne is responsible for providing high quality client service which includes marketing, assistance with routine coverage questions, endorsement processing, certificate of insurance coordination, problem solving, billing and policy review. Anne will serve as a secondary customer service representative for the Borough. Anne has over 20 years of experience in the insurance industry. Over the years, Fairview Insurance has developed a specialized set of services that we provide to our public entity clients. We believe that this set of services is the best resource that we provide to our clients. This service overview describes our ability to provide the services desired in a timely fashion. Below is essentially an outline of everything that we do for our clients on a day to day basis. The service overview is as follows: FAIRVIEW INSURANCE SERVICE OVERVIEW At Fairview Insurance, we pride ourselves on our Risk Management Services and our abilities to properly insure the Public Entity. Through a series Risk Management controls we work proactively to ensure that the entity is properly covered; working as safely as possible and costs are kept to a minimum. Fairview Insurance is available to accommodate any required meetings. Below is a description of some of the relevant Fairview Insurance Agency Associates, Inc. Page 23 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker services performed routinely on Public Sector Accounts. Additional Risk Management Services are provided on an as needed basis. It is important to note that all of Fairview Insurance Agency?s services are tailored to fit each of our client?s needs. The following is a sample of all the services that Fairview can provide, however, Fairview will provide whatever level of service the Borough of Roselle Park desires. Immediately Upon Being Appointed as Risk Manager Fairview Insurance Associates will review all lines of insurance to insure that proper coverage is in place. This ensures that there are no gaps in coverage and the public entity is fully covered. If we find that there are gaps in coverage we make the necessary recommendations to the Business Administrator. Examples of this review are: 0 Review and ensure all Public Entity buildings appear on the statement of values. a Review and ensure all vehicles are listed on the policy 0 Review all Workers' Compensation class codes and payrolls to ensure accuracy I Ensure all key positions have surety bonds protecting against theft 0 Review and ensure all equipment appears on equipment schedule 0 Review all current insurance policies, prepare an analysis and provide recommendations Claims Management Although there is no way to predict the severity of a claim or eliminate claims entirely, there are a number of action items that the entity and risk manager can work on jointly to keep these claims to a minimum. Some examples are: 0 Promoting - As Public Sector employees are present and on facilities full time an effective approach is self-inspections. Quarterly safety checklists are completed by department heads and reviewed to eliminate hazards. Proactive Hazard Identification Walk Through - Fairview Insurance will do a periodic walk through of the facilities to identify the issues and make the necessary recommendations. Fairview Insurance Agency Associates, Inc. Page 24 FAIRVIEW INSURANCE AGENCY ASSOCIATES, INC. Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Streamline Claims Reporting Process - Fairview Insurance reviews current Public Entity's Claims handling process. By helping to identify and documenting which department(s) or contacts are specifically assigned to report claims. The benefits are: Minimize employee loss work time Reduce overall claim totals Avoid Claim Denials based on late or failure to report Employees back to work sooner reducing the unnecessary exposure of overtime and soft dollar savings of having to train new part-time workers Claim Review and Interdepartmental Meetings Claims can be minimized through the above actions, but accidents and injuries do occur. The purposes of Claims Meetings are geared to promote communication and reduce the frequency of the claims. The following are services and benefits that are provided, but our services are not limited to the following: Review Title 59 Guidelines and the spirit of Sovereign Immunity Meet with department heads to review prior month?s claims. Identify claim trends and specify what department the claims are coming from Based on these trends recommend a safety program to provide training where needed These trainings review PEOSHA trainings facilitated through insurance carriers such as - Blood Borne Pathogens, Confined Space Entry, Excavation, Fire Safety, Flagger/Work Zone Safety, Ladder Safety, Lock Out/Tag Out, Personal Protective, Equipment, Powered Industrial Trucks/Forklifts, Respiratory Protection, Hazcom, Spill Prevention, and Defensive Driving, etc. Administrative Assistance Fairview Insurance works to reduce the insurance related administrative burden from Business Administrators. Our services include but are limited to the following: Fairview Insurance Agency Associates, Inc. Page 25 FAIRVIEW INSURANCE AGENCY ASSOCIATES, INC. Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Continuous assistance to the Public Entity in identifying its insurable Property Casualty exposures and to recommend professional methods to reduce, assume or transfer the risk of loss. Assist the Public Entity in the preparation of applications, statements of values, and similar documents requested by the Insurance Company of record. Review Certificates of Insurance from contractors, vendors and professionals, when requested by the Public Entity. Review the Public Entity premiums in the preparation of its annual insurance budget. Assist where needed in the settlement of claims, with the understanding that the scope of Fairview Insurance?s involvement does not include the work normally done by a public adjuster. Contract Review: We will review, from a risk management standpoint, construction documents, lease agreements and other contracts which you provide us and we will offer our recommendations. This review will concentrate on insurance requirements; however, all contracts should be reviewed by legal counsel. Endorsements: Policy changes are handled on a special endorsement request form which is sent to the company and copied to you. It lets you know what changes have been ordered and on what basis. Please review the form to make certain the information is correct. When the endorsement is received, it is checked for accuracy and the premium is checked for correctness. Location Visits: The staff at Fairview Insurance Agency Associates, Inc., in conjunction with the insurance company, will visit job sites on an ?as needed? basis to evaluate unique loss exposures which may result from your operations. Renewal Policies Renewal Meeting: We will conduct a renewal meeting to determine your exposures for the coming policy year with approximately 120 days prior to expiration date. Some of the renewal topics discussed would include updating vehicles, payrolls, inland marine equipment, list of certificate holders, classifications, lease review, property values, driver information and audit review. We will prepare an annual report on such items as: Fairview Insurance Agency Associates, Inc. Page 26 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker - Summary of Agency service activities during the past year 0 Brief review of major outstanding claims 0 Summary of premiums and loss experience 0 Our views of the marketplace and how it relates to you 0 Renewal Checklist: We feel renewals are just as important as producing new business. Much time is spent reviewing renewal policies, reviewing all coverages, and making sure our insured receives the best coverages for what they are paying. 0 Renewal Policies: We endeavor to have renewal policies to our clients prior to the renewal date. If this cannot be done for some reason, detailed binders of insurance are prepared confirming renewal coverage in effect. We do not take our clients for granted. 0 Renewal Marketing: We will facilitate the remarketing of your insurance coverages to various markets available to guarantee that the most comprehensive and competitive program is in place. Communication We will communicate on a frequent basis to discuss any particular issue not previously addressed within the service agreement. We are also available on request to provide assistance and consultation on risk management issues which are of concern. Transfer of Liability Fairview Insurance understands the crucial element of transferring liabilities away from the Borough, specifically with contractors. We will recommend and apply the necessary Risk Management principles (referenced below) in order to secure proper levels of insurance, with the ultimate goal of transferring risk away and onto the contractors' insurance policies. Contractors must provide evidence of their own Workers? Compensation coverage, covering any injuries resulting from work done on behalf of the Borough. This will ensure that the Borough?s Workers Compensation policy and specifically its claims experience is not negatively affected. Contractors must also provide evidence of General Liability, Auto Liability and Umbrella coverage. Any injuries that arise in the area of Liability, Completed Operations and Fairview Insurance Agency Associates, Inc. Page 27 EAHGHENV INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Property Damage, will be applied to the contractor?s insurance carrier. Similar to the above mentioned Workers? Compensation requirement, this added precaution will ensure that the Borough?s Liability claims history is not affected. As an added layer of security, the Borough should be named as an additional insured on the contractor?s insurance policy and a hold harmless agreement must also be secured. Please refer to Tab #3 for examples of Risk Transfer. In addition to the attached Risk Manager/Broker Services, Fairview Insurance provides oversight into the insurance related vendors. This added benefit will not only ensure that these insurance related vendors offer competitive pricing, but also make sure that the vendors in place are top professionals in their fields. Evaluation Criteria TPA (Third Party Administrator): I Taking initial claim reports, validating and directing medical care to the proper network of physicians/hospitals I Ratio of claim adjusters to cases I Providing accurate claim information as well as reconciliation reports with the finance department for claim payments I Price per claim (medical only and indemnity) I Cost for run?out claims (if not on a life of claim basis) I Contract subject to a cap MCO (Managed Care Organization): I Effective use of medical network I Medical re-pricing discounts I Flat fee I What is the percentage of savings that is retained by the managed care organization (MCO) I Contract subject to a cap Workers Compensation/Liability Law Firms: I Fairview Insurance can assist in the RFQ process Fairview Insurance Agency Associates, Inc. Page 28 FAIRVIEW INSURANCEAGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker I Cost per claim/hour I Expertise in the industry Review of Costs: 0 Total Policy Cost Analysis 0 Insurance premiums 1' Self-Insured Retentions Deductibles 0 Loss Fund out of pocket claims costs Customized Cost Solution We understand that every risk is unique. We keep this in mind when re-marketing your insurance coverages to various markets. This guarantees that the most comprehensive and competitive programs are in place. I Utilizing all available insurance options in the marketplace we compare and contrast to see which is the best fit and create a customized solution. - Constant changing market trends and varying characteristics require an analysis that includes up to date information. - This underwriting information is sent to specialty programs, Joint Insurance Programs, Self-Insurance Options and Private Insurance Companies. Some of the insurance carriers that Fairview has the capability of working with are Ace Insurance, Admiral Insurance Company, Alteris, American Alternative, American Surplus Lines Insurance Company, American Safety, Beazly, Brit, Chartis Insurance, Chubb Insurance, Crum and Forster Group, Darwin Insurance, Essex Insurance Company, Evanston Insurance Company, Foremost Insurance, Franklin Mutual Insurance, Freberg Environmental Insurance, General Star Indemnity, Genesis, Glatfelter, Greater New York Mutual, Hartford Insurance, Hermitage Insurance Company, Hiscox, Insurance Company of PA, Interstate Fire and Casualty, Investors Underwriting Managers, Lexington Insurance, Liberty International, Markel International Insurance Company, McGowan, Mount Vernon Fire Insurance Company, Munich, National Union Fire Insurance Company, Nautilus Insurance Company, Northfield Insurance Company, NY Marine, Pacific Insurance Company, Philadelphia Insurance Company, Safety National, Selective Insurance Company, Scottsdale Insurance Company, Torus, Travelers Insurance, Tudor Insurance Company, US. Specialty, Lloyds of London, United States Liability Insurance Fairview Insurance Agency Associates, Inc. Page 29 FAIRVIEW INSURANCE AGENCY ASSOCIATESJNC. Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Company, Utica Mutual, W.R. Berkley, Western World Insurance Company, Wilshire Insurance Company, XL Insurance, Zurich Insurance. Fairview Insurance also has the capability and experience to work with numerous Joint Insurance Funds around the State. Once all of the above are combined with different levels of deductibles and self-insured retentions, you have a completely customized solution. 4. Cost details, including the annual fee for primary duties and the hourly rates of each of the individuals who will perform the services, and all expenses for any work that is not included in the primary duties: Insurance carriers and Joint Insurance Funds recognize the most effective way for their products to enter into the marketplace is through the insurance broker/consultant community. Therefore, insurance carriers have commissions automatically imputed into the rates. Joint Insurance Funds pay ?Risk Management Fees" based upon premium assessment promulgated by the Fund. Fairview Insurance would be paid by the private insurance carrier or the Joint Insurance Fund, not directly by the Borough of Roselle Park. Additionally Fairview Insurance does not impose any additional consulting fees or charges and accepts the standard commissions paid by either the Joint Insurance Fund or private insurance company as payment in full. All of the services discussed throughout this RFP would be provided for the standard commission or "risk management fee?, there would be no additional billing or fees. Fairview Insurance Agency agrees to accept five percent of the Borough?s annual joint insurance fund assessment as total payment for services as stated in the RFP. Fairview Insurance Agency Associates, Inc. Page 30 FAIRVIEW INSURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Tab Letters of Recommendation a Fairview Insurance Agency Associates, Inc. TOMS RIVER REGIONAL SCHOOLS WILLIAM DOERING, C.P.A. BUSINESS ADMINISTRATOR 1 144 I-Iooper Avenue, Toms River, NJ 08753 (732) 505?5549 - Fax: (732) 9144607 E?mail: October 20- 20l 7 John RX. Graham, CEO Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, New Jersey 07044 RE: Letter of Recommendation Mr. Graham, I am writing you to acknowledge the exemplary work that Fairview Insurance Agency has done for the Toms River Regional Schools; specifically the work of Larry Graham, Danielle Voda, Tom FitzPatrick, and Zach Edelman. Fairview Insurance Agency stat?fhas always dealt with our district and employees with the utmost professionalism and have done an outstandingjob with your close oversight and expertise regarding District?s property and casualty insurance program. Fairview?s communication with the Board of Education?s Insurance Committee on claim updates, insurance trends and recommendations is always very thorough and allows the administrative staff and all departments to stay informed. Your assistance with the coordination of safety services and the monitoring of insurance related vendors ensures that our insurance program remains as current and competitive as possible. Speci?cally, your assistance in reviewing multiple bids secured from top industry firms for Third Party Administrator, Actuarial services, and Workers? Compensation Attorney were helpful to the District. The result for the District was reduced costs while maintaining a comprehensive insurance program. We look forward to working with you in the future. Sincerely, Wt]. Z- William .I. Doering. CPA. Business Administrator Toms River Regional Schools THE JERSEY CITY PUBLIC SCHOOLS 346 CLAHEHONT RVEHUE JERSEY crrY. NEYY JERSEY 07305 (201)915-3274 (201) ass-1142 FAX Lures: c. Carat-ANA Business Administrator I Board Secretary October 21, 2013 EMAIL: leampanaGicbooma Mr. John Graham CEO Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, New Jersey 07044 Dear Mr. Graham, I wanted to take the time to acknowledge the professional work of, your sta?? on the Jersey City Board of Education?s Property Casualty Insurance program. Your ?rm marketed all lines of insurance to ensure that our program was as competitive as possible in both coverage and premium. Additionally, your staff is very responsive to our day to day inquiries and requests. We especially want to point out that through Fairview Insurance?s auditing and consulting services this year you analyzed, negotiated and recommended a TPA solution that was able to help save the District an estimated $1,067,000 annually on Third Party Administrative costs and Managed Care Services. There was no disruption in service and the process was completely seamless. We appreciate the detailed analysis that your ?rm provided and look forward to working with Fairview Insurance in the years to come. Sincerely, Luiggi C. Carnpana Business Administrator Board Secretary TI-IE JERSEY CITY Puauc SCHOOLS - AN EQUAL EIIPLOYER 'T?mms?iy cf?Unicm Tu??'c Schools Manuel E. Vieira Business Administrator March 10, 2015 John F.X. Graham, CEO, President Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, NJ 07044 Dear Mr. Graham, I wanted to take this opportunity to thank Fairview Insurance and your staff for the excellent Risk Management services that your team has provided to the District. Speci?cally I would like to point out the outstanding level of service received from Larry Graham, Zach Edelman, Tom FitzPatrick, and Danielle Voda. I appreciate that there is an entire team devoted to the success of our Property Casualty insurance program. All requests that we have are processed immediately with professionalism. Your team is quick to respond to all correspondence. It is evident that your staff has an immense knowledge and expertise in their ?eld. I look forward to a continued professional relationship with your ?rm. Sincerely, . Manuel E. Vieira, CPA Business Administrator Union Township Board of Education 2369 Morris Avenue, Union, New Jersey 07083-5712 Tel: 851-6419 Fax: (908) 964-1462 e?mail: mvieira@twpunionschools.org WOODLAND PARK BOARD OF EDUCATION BUSINESS OFFICE. 855 McBride Avenue Woodland Park, New Jersey 07494 Telephone: 975~517~7790 Fax: 975?511-7795 Thomas Dimitri, RSBA Email: tdi?und?ioolsmg July 1, 2014 Mr. John Graham CEO Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, NJ 07044 Dear Mr. Graham, i wanted to take the time to let you know about the outstanding service that the Woodland Park Board of Education has? received from your firm over the past year. All of your staff members, speci?cally Zach Edeiman, Torn and Danielle Voda, are always professional and responsive to the District?s insurance needs. All insurance matters are handled quickly, and the District is consistently updated on any pending matters. You have a knowledgeable and friendly staff that works quickly and ef?ciently for the District. 1 would like to speci?cally point out one case of your team?s persistence and excellent service. The District had a Boiler and Machinery claim that was initially denied by the insurance carrier. Your team at Fairview was able to get the insurance carrier to rescind the claim denial and the District received a check for $35,802 shortly after. This is a great example of the hard work that Fairview consistently provides to the District. Additionally, the insurance renewal process this year was seamless. I enjoy working with the Fairview Insurance team and look forward to working with your ?rm for years to come. Sincerely, Tom DiFluri Business Administrator Woodland Park Board of Education R. Smut Dlltacroa or FINANCE MIDDLESEX COUHW, NJ. April 2nd, 2012 Mr. John Graham Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, NJ 07044 Dear Mr. Graham, On behalf of the Township of Old Bridge, I would like to thank you and. your staff for the exceptional Risk Management services that Fairview Insurance has provided. Speci?cally we appreciate the efforts of Zach Edelman, Torn FitzPatrick and Danielle Voda. It is evident that Fairview Insurance has a full team of professionals available to address all the Township?s needs. As our Risk Manager, your analysis and review of our insurances have made us con?dent that our" liabilities are overseen properly. Through your hands-on approach, you have offered our internal staff much guidance regarding the Township?s insurance matters. We especially appreciate your attention to our ?nances and consideration of our bottom line. We are pleased with your services and look forward to working with you and Fairview Insurance in the future. Sincerely, . R. Shah Finance Director/CFO ONE OLD BRIDGE PLAZA OLD BRIDGE, NJ. 08851 i (732) 721-5600 EXT. 2905 . FAX (132) 607-1900 email: - website: Michael J. Venezia Telephone MAYOR (973) 680-4030 Fax (973) 680-4040 or Broom? One trump: Plaza armament Newjemey omen? mmedawbiaom?eldm?mm October 16, 2014 Mr. John Graham CEO Fairv'iew Insurance Agency Associates, Inc. 25 Fairview Avenue . Verona, New Jersey 07044 Dear Mr. Graham, The Township of Bloom?eld has been using Fairview Insurance?s Risk Management services for over 10 years. The Township has always received the highest level of service ?-om your staff. We are especially thrilled with the recent changes to the Township?s Workers Compensation program. Fairview Insurance facilitated the transition to a new Third Party Administrator and a new Managed Care Organization to handle workers compensation claims e?'ective 1/1/2013. Since the transition. the Township was able to save $1,043,036 in workers compensation costs in 2013 and the Township is projected to save almost $1,600,000 in 2014. We are grateful for the results. The Township looks forward to continuing to receive this high level of services for years to come. Sincerely, ?lfagl Venezia Mayor TOWNSHIP OF Parsippany-Troy Hills Fl? Tin? ?1 Depa rtment of Administration Jasmine L. Lim 1001 Boulevard Business Administrator Parmpparn), New Jersey 07054 0 973-263-4391 June 4, 2010 To Whom It May Concern: I am herein providing a reference for the Fairview Insurance Agency. Fairview has served as co- brolter for the 'l?ownship of Parsippany - Troy Hills? employee health bene?ts For almost four years. During that time Fairview has negotiated renewals for the Township. provided assistance to employees to resolve health insurance issues and provided valuable advice and guidance regarding negotiations with collective bargaining units. During the ?rst year that Fairview worked on the medical renewal, the Township was able to realize a $600,000 savings by contracting directly with Horizon rather than staying in the State Health Bene?ts Plan. For the 2010 calendar year, Fairview negotiated a contract with CIGNA that provided a $668,000 savings over the renewal quote provided by Horizon. Fairview?s large portfolio of, and years of experience with, public sector clients has provided Fairview staff with a wealth of experience and knowledge on public sector employee benclits trends and contract negotiations. Over the years. several cost savings changes in medical, prescription and dental bene?ts were effectuatetl. have found Fairview to be very responsive to the Township and pro-active in sharing infOrmation with the Township on the Health Care Reform Act, Medicare and other human resources employee bene?t issues. Fairview seems to enjoy a good relationship with most 01" the insurance carriers and the Township has benefited from these good relations. If you have any questions, please feel free to contact me at the above number or email address. Sincerely'Hr-rl?w Jasmine L. Lim Business Administrator QEity at, Iamherthille 18 York Street Lambertville, NJ 08530 Phone: 609-397-0110 Fax: 609-397-2203 David M. DelVecchio Beth Asaro Mayor Councilwoman Steven M. Stegman Wardel] Sanders Council President Councilman Elaine Warner Councilwoman October 2, 2014 Mr. John Graham CEO Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, New Jersey 07044 Dear Mr. Graham, The City of Lambertville has been using Fairview Insurance?s Risk Management services for approximately 2 years. I wanted to take the time to acknowledge the professional work of your staff. The Risk Management services that have been provided are always timely and very professional. We are especially happy with the recent renewal period where your agency was able to negotiate a ?at renewal with no increase. The good news came at a critical time while budgeting and we appreciate the results. I am looking forward to continuing to receive this high level of service. Sincerely, L. Ege, CMR, RMC City Clerk Registrar JUN-04-2010 16:05 GB 2} CD (I) IONIIRU ORECHID CHAIRMAN NUMT. NJ LOUIB A VICE CHAIRMAN ?Leo-en. NJ CHARLEJI P. anam??atrl FRANKLIN LAKES. NJ 1. ain?rlmao DEPUTY FJEGUTIVC DIE annNOA c. 5:9.an ANGELO M. erav. commission. seem-m MICHAEL T. CRICGO NJ ONE FA ONECHIO DRIVE JR, WMUH, NJ CALDWELL. NJ 5711354701 unam- Mina-a BATERGON NJ June 4, 2010 Mr. Ryan Graham Faiiview Associates 25 Fairview Avenue Verona, NJ 07044 Dear Mr. Graham: i wanted to take this opportunity to thank you for all the help and excellent service Fairview has provided in assisting the Commission with its employee insurance needs. including most recently assisting us in reducing our claims experience and thus saving the Commisswn considerable money in its premiums. i also wanted to thank you for your help in educating and convincing our employees to voluntarily move to the less expensive Direct Access option of our hospitalization and major medical insurance as well as working with our prescription provider to offer an incentive to our employees to choose less expensive generics. Both of these measures saved the Commission considerable expense without forcing a reduction in bene?ts. Finally. i will thank you for providing special service for some of the unique circumstances our employees encountered in dealing with some of their illnesses. We very much appreciate the assistance you provided and the fact that you went the extra mile for the Commission and its employees. 1 would recommend Fairview to anyone. Deputy Executive Director Bloam?aid Board 01? Of?ce of the Business Adlnim' gug?nm 155 Blind Strut I In? 2. 2010 corn?eld. NJ 07003 Edwiw hummer: Agency Associates, Inc. 25 Fn?rvicw Avenue: Verona. NJ 07044 Dear Mr. Graham: The Bloom?eld Board ofEduca?on is 1 school district with 6.0 Operating budget of II as with gm! pleasure to idm?fy wing: company. Michael Derden?an Business Administrator Telephone 9?73 - 680 - 4080 Fax 973 . 680 4040 RAYMOND J. MAYOR E-mail: . mccartliy TOWNSHIP OF BLOOMFIELD New JERSEY 07003-3487 June 2, 2010 Mr. Ryan Graham Fairview Insurance Agency Associates, Inc. 25 Fairview Avenue Verona, NJ 07044 Dear Mr. Graham: On behalf of the Township of Bloom?eld, we greatly appreciate the work accomplished by your agency. In 2006, your agency was responsible for saving our Township over $600,000 in medical and prescription premiums. In addition, your assistance in our collective bargaining negotiations has enabled us to achieve an additional significant savings. On top of the savings, the administrative staff, employees and dependents have received superb service that has exceeded our expectations. We are pleased with your performance and look forward to the continued high level of service. Ver sincerely, FAIRVIEW INSURANCE AGENCY Assocms?mc- Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Tab Firm License, Staff Licenses Resumes Fairview Insurance Agency Associates, Inc. State of New Jersey Department of Banking and Insurance 20 West State Street Trenton, NJ 08625?0327 THIS CERTIFIES THAT FAIRVIEW INSURANCE AGENCY ASSOCIATES INC AT BUSINESS ADDRESS 25 FAIRVIEW AVE VERONA, NJ 07044 PERSONAL LINES: SURPLUS LINES INSURANCE LICENSE NUMBER 8038220 This insurance license is valid and shall remain in effect unless revoked or suspended provided that the fee set forth in A 11:17-2 12 is paid and renewal requirements set forth in J.A 11:17-25. including continuing education requirements for resident individuals. are met by the license expiration date A renewal notice will be mailed to the licensee mailing address approximately 30 days prlor to the license expiration date. IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES 0F EFFECTIVE DATE EXPIRATION DATE Insurance Producer LIFE ACCIDENT. OR OBID1I2018 05I31I2020 ?1 22m. i. Acting Commissioner of printed: 0412312018 Banking and Insurance The Department maintains an informative website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact Information web site; phone: (609) 292-4337 ,rax: (609) 984~5263 The request for any change of license information must be sent to the Department within 30 days of the change. Make any checks and/or money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing Address:Department of Banking and Insurance 20 West State Street PO. Box 327 Trenton. NJ. 08625-0327 State of New Jersey Department of Banking and Insurance 20 West State Street Trenton, NJ 08625-0327 THIS CERTIFIES THAT LAWRENCE K. GRAHAM AT BUSINESS ADDRESS 25 FAIRVIEW AVE VERONA, NJ 07044-1341 LICENSE NUMBER 8017861 This Insurance license is valid and shall remain In effect unless revdked or suspended provided that the fee set forth in N.J.A.C. ls paid and renewal requirements set forth in N.J.A.C. 11:17-15, including continuing education requirements for resident individuals. are met by the license expiration date. A renewal notice will be mailed to the licensee mailing address approximately 30 days prior to the license expiration date. IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES OF AUTHORITY EFFECTIVE DATE EXPIRATION DATE Insurance Producer printed: 09/18/2018 LIFE ACCIDENT, HEALTH OR SICKNES PERS ONAL CASUALTY 1110112018 10131I2020 560 (Ioi'?niissioner of Banking and Insurance The Department maintains an informative website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact information web site: phone: (609) 292-4337 fax: (609) 984-5263 The request for any change of license information must be sent to the Department within 30 days of the change. Make any checks and/or money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing AddresszDepartment of Banking and Insurance 20 West State Street PO. Box 327 Trenton, NJ. 08625?0327 LAWRENCE K. GRAHAM PROFESSIONAL OUALIFIOATIONS I-?airview Insurance Agency Associates, Inc. Verona, NJ Vice President 1976 Present Risk Management for Municipalities, School Districts, Utility Authorities, Equipment Dealerships, Automobile Dealerships, Manufacturing, Construction Dealerships, and general commercial accounts Account renewal review including quarterly visits with clients, loss control, and claim management assistance to assure profitability and appropriate exposures Risk Management services for Public Sector accounts include attendance at IF meetings, recommendation compliance, claim reviews, contract reviews, and safety coordination RISK MANAGEMENT HISTORY 1994 2008 1999 2009 2001 2012 2006 2012 2002 Present 2004 - Present 2005 - 2007 2004 2008 2004 Present 2006 Present 2007 2009 2009 Present 2011 Present 2012 Present 2013 Present 2014 Present 2014 Present 2014 Present AFFILIALTIONS Cherry Hill Township Clark Board of Education North Jersey Water District Roselle Board of Education Township of West Orange Township of Bloomfield Township of Pemberton Borough of Highland Park Western Monmouth Utilities Authority Borough of New Providence Township of Riverside Township of Parsippany Township of Mine Hill Jersey City Board of Education City of Passaic City of Bayonne City of East Orange Aberdeen Township I Professional Insurance Agents Association since 1976 I Independent Insurance Agents Association since 1996 I Harleysville Insurance Agents Council, from 1978 to 1983 I Crum 8 Forster Insurance Agents Council, from 1984 to 1986 I Transamerica Agency Council, from 1987 to 1990 I American Rental Association Preferred Agent since 2003 I MHEDA Preferred Agent since 2000 I AmeriHealth Casualty Specialty Agent since 2004 OONTAOT 25 Fairview Avenue Verona, NJ 07044 856-424-8515 85644244933 609-760-3655 EDUCATION Bachelor of Science, Education 1972, Temple University, Philadelphia, PA LIOENSES I Certified Insurance Counselor since 1978 New Jersey . Preperty I Casualty I Life and Health I Property I Casualty I Life and Health Maryland I Property I Casualty I Life and Health State of New Jersey LICENSE NUMBER 1 037065 Department of Banking and Insurance 20 West State Street This insurance license is Trenton, NJ 08625-03 27 suspended provided that the fee set forth in A THIS CERTIFIES THAT ZACH W. EDELMAN 32523; forth in A 11117-2 5, including continuing education requirements for resident individuals, AT BUSINESS ADDRESS FAIRVIEW INSURANCE AGENCY I 25 FAIRVIEW AVE $31122 biriai??lii??e 0 BOX 324 VERONA, NJ 07044 to the license expiration date IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES OF AUTHORITY EFFECTIVE DATE EXPIRATION DATE PRODUCER CASUALTY 02/01/2017 01/31/2019 Q-ea??eqa printed: 03/21/2017 Commis'sion?r oFBanking and Insurance The Department maintains an informative website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact Information web site: phone: (609) 292-4337 fax: (609) 984-5263 The request for any change of license information must be sent to the Department within 30 days of the change. Make any checks and/or money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing AddresszDepartment of Banking and Insurance 20 West State Street PO. Box 327 Trenton, NJ. 08625-0327 ZAOHARY W. EOELMAN PROFESSIONAL QUALIFICATIONS Fairview Insurance Agency Associates, Inc. Verona, NJ Director of Busin ess De velopm en t; 2005' Presen 2? Client responsibilities include best practices of procurement, placement, and account management of public entity and private sector programs Special focus on reduction in workplace injuries Ensures content premiums are competitive and coverage comprehensive by bidding out insurance policies when necessary Makes necessary recommendations to ensure coverages are current and in-line with municipality infrastructure and budgets Facilitates PEOSHA and OSHA training to ensure regulatory compliance Attends Joint Insurance Fund meetings to keep municipalities compliant within IF guidelines Risk Maria gem en 1? History 2007 Present 2007 Present 2.011 Present 2012 Present Borough of Caldwell Bloomfield Board of Education Jersey City Board of Education City of Passaic EPIX Professional Employer Organization Manhattan, NY Accoun Executive," 2003? 2005 Responsible for consulting Human Resources Solutions unique to each company Consultative Selling approach Worked in a team environment for setting up and running payroll, insurance benefits, 401K accounts, and other benefit services Responsible for accurately forecasting renewal rates and new business forecasts Thomson NewsEdge Real Time News Internet Source Iselin, NJ Global Account Manager; 2000 2003 2001 Circle of Excellence for Outstanding Account Management Achievement Managed news solutions onto Corporate Intranets and Portals Responsible for a renewal base of 3.1 million dollars annually Managed relationships with executive administrative OONTAOT 2.5 Fairview Avenue Verona, NJ 07044 973-857?0870 x127 973-857-7935 Bachelor of Arts. Business Communications Minor, Philosophy 1997, University of Pittsburgh, Pittsburgh, PA - Semester at Sea: A Shipboard education in international marketing and business LICENSES NJ State Property Er Casualty, 2005 State of New Jersey LICENSE NUMBER 1 223086 Department of Banking and Insurance 20 West State Street This insurance license is Trenton, NJ 08625-03 27 Eifiitafri??fler3$2if?l suspended provided that the fee set forth in A THIS CERTIFIES THAT THOMAS J. FITZPATRICK I?iltitli?t?eiif?eil?fset forth in A 11217?2 5, including continuing education requirements for resident individuals, AT BUSINESS ADDRESS 25 FAIRVIEW AVE I VERONA, NJ 07044 licensee mailing address approximately 30 days prior to the license expiration date IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES OF AUTHORITY EFFECTIVE DATE EXPIRATION DATE PRODUCER LIFE ACCIDENT, HEALTH OR 01I01I2017 12/31/2018 CASUALTY printed: 12/20/2016 Commissioner ol'Bt-lnking and Insurance The Department maintains an informative website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact Information web site: phone: (609) 292?4337 fax: (609) 984-5263 The request for any change of license information must be sent to the Department within 30 days of the change. Make any checks and/or money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing AddresszDepartment of Banking and Insurance 20 West State Street PO. Box 327 Trenton, NJ. 08625-0327 THOMAS J. FITZPATRICK PROFESSIONAL QUALIFICATIONS Fairview Insurance Agency Associates, Inc. Verona, NJ Executive Sales; 200.9 - Present Responsible for all aspects of placement and account management of public entity and private sector insurance programs Underwriting, rating, marketing, and binding of commercial and personal lines of insurance with numerous insurance companies Design and implement target market campaigns for insurance prospects Aiding clients with claims management Account review with clients on a pre-set schedule based on client preferences Renewal review of accounts with clients including remarketing and pricing review when necessary Recommendations on loss control procedures to reduce claims occurrences Loss Control and Claims Management assistance to ensure client profitability Specialization in workplace safety and methods/best practices to reduce the risk of loss Ability to organize and set up safety committee meetings Coordination of health and wellness program for clients who choose to utilize this service Risk Managem en 1? History 2012 Present Jersey City Board of Education 2012 Present Township of Old Bridge 2013 Present City of Passaic 2013 Present Woodland Park Board of Education 2014 Present City of Bayonne 2014 - Present City of East Orange 2014 Present Town of Secaucus Enterprise Rent-A-Car Philadelphia, PA Management Assistan 2006-2009 Promoted to Management Assistant after qualifying for and passing management qualification test Required to set marketing goals and meet them each month Responsible for training new employees Responsible for managing and maintain a ?eet of over 175 vehicles Managed daily customer service calls Managed accounts receivable Management Tra1hee;2006?2009 Part of Enterprise Best Person Program at Philadelphia Airport after being with company for only two months Responsible for maintaining a high level of personal sales to stay in program Required to reach a marketing goal each month Learned to run daily operations of an office CONTACT 25 Fairview Avenue Verona, NJ 07044 973-857-0870 x124 973?857-7935 EDUCATION Bachelor of Science, Business Administration with a concentration in Management 2006, Albright College, Reading, PA LICENSES New Jersey - Property 8 Casualty . Life Insurance - Accident, Health, or Sickness Currently pursuing Certified Insurance Counsellor designation Member of - Professional Insurance Agents Association - Young Insurance Professionals of New Jersey State of New Jersey LICENSE NUMBER 1 301 146 Department of Banking and Insurance 2'0 West State 311-361 This in?ra'r?lc: license is valid a 3 remain 'n Trenton, NJ 08 625-03 27 effect unless revoked suspended provided that lhe fee set forlh in THIS CERTIFIES THAT DANIELLE M. VODA E?l?il??f?tf??rfe?tdet form In N.J.A.C. 11:17-25. rdiuiiggn??u?g?enls for resident individuals. AT BUSINESS ADDRESS FAIRVIEW INSURANCE AGENCY I 25 FAIRVIEW AVE 333?} bg?sn??'i??f?e VERONA. NJ 07044 to the license expiration date. IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES 0F AUTHORITY EFFECTIVE DATE EXPIRATION DATE PRODUCER LIFE ACCIDENT, HEA LTH OR 09IO1I201 7 08I31 I201 9 CASUALTY (?ea/9M printed: 08/17/2017 Cemmi?siea?r of Banking and Insurance The Department maintains an infen'native website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact Information web site: phone: (609) 292-4337 fax: (609) 984-5263 The request for any change of license information must be sent to the Department within 30 days of the change. Make any checks andlor money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing Address:Department of Banking and Insurance 20 West State Street PO. Box 327 Trenton, NJ. 08625-0327 DANIELLE VUDA CPIA PROFESSIONAL QUALIFICATIONS Fairview Insurance Agency Associates, Inc. - Verona, NJ Account Executive; 2011 Present Responsible for daily account management tasks for the Commercial Lines division, focusing on Public Sector accounts Markets and facilitates new business and renewal policies Expedites account management tasks such as endorsements, billing inquiries, certi?cate requests, and coverage questions Prepares marketing campaigns and presentations for prospective and current clients Assistan 2005' 2010 Assisted Account Managers in both the Property 6* Casualty and Benefits divisions Processed endorsement and certificate requests Responsible for clerical tasks Burson-Marstellar New York, NY Public Rela tions In fem, Corpora te Affairs Division; 201 0 - 2011 Participated in the Harold Burson Internship Program Planned events for key clients Created presentations for new business pitches and presentations Aided in the creation and implementation of strategic development plans for clients CUNTACT 25 Fairview Avenue Verona, NJ 07044 973-857-0870 x117 973-857-9131 dvodacafairviewinsurance.com Bachelor of Science, Business Administration with concentration in International Business Cum Laude 2010, Montclair State University, Montclair, NJ LICENSES New Jersey - Property Er Casualty - Life - Accident, Health, or Sickness State of New Jersey LICENSE NUMBER 8623909 Department Of Banking and Insurance 20 West State Street This insurance license is Trenton, NJ 08625-0327 2215331333933233 THIS CERTIFIES THAT TERESA M. SULSONA forth in N.J.A.C. 11:17?25. including continuing education requirements for resident individuals. AT BUSINESS ADDRESS FARIVIEW INSURANCE INC 25 FAIRVIEW AVE {rm bin-mailed to me VERONA, NJ 07044-1341 licenses mailing address approximately 30 days prior to the license expiration date. IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES OF AUTHORITY EFFECTIVE DATE EXPIRATION DATE PRODUCER ACCIDENT, HEALTH OR PERSONAL 0901/2017 0413012019 CASUALTY .r printed: 04/11/2017 Commis?sion?r of Bank ing and Insurance The Department maintains an informative website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact Information web Site: phone: (609) 292-4337 fax: (609) 984-5263 The request for any change of license information must be sent to the Department within 30 days Of the change. Make any checks and/or money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing Address:Department of Banking and Insurance 20 West State Street P.O. Box 327 Trenton, NJ. 08625-0327 TERESA M. SULSCNA CISH, CPSR, CPIA PROFESSIONALGUALIFIBATIDNS I-?airview Insurance Agency Associates, Inc. Verona, NJ General Manager, Personal 6* Commercial Divisions; 1.981 -Present Manages custom program business Services book of approximately $4 million in premiums Handles various risks including National Equipment Dealer Program, WholesaleE: retail Manufacturers, and Municipalities All aspects of customer service and client management Underwriting, rating, marketing, and binding of commercial book business Input/ update of client information on Agency Automation System (TAM) Assists Commercial Lines Manager in overseeing the daily operations of the Commercial Lines department and its? staff Assists Personal Lines/ Small Business Manager in overseeing the daily operations of the Personal/ Small Commercial Lines department and its' staff Monitors the processing of new business submissions Monitors the client base loss experience for the agency, interceding when necessary Acts as liaison between staff and upper management Maintains operation of Agency computer network, including updates Trains and assists new and current staff with all computer related operations Develops, analyzes, and maintains all work?ow and procedure manuals Assists management in program development and monitoring with carriers CONTACT 2.5 Fairview Avenue Verona, NJ 07044 973-857-0870 x120 973?857?9131 EDUCATION Advanced One-Year Course Honors 1981, Katharine Gibbs University, Montclair, NJ LICENSES New Jersey - Property 8 Casualty . Life - Health State of New Jersey LICENSE NUMBER 8623902 Department of Banking and Insurance 20 West State Street This insurance license is Trenton, NJ 08625-0327 suspended provided that the fee set forth in A C. THIS CERTIFIES THAT ANNE CAM PAG NA Qilt??lii?i?fii?eiifset forth in N.J.A.C. 11:17-25. including continuing education requirements for resident Individuals, AT BUSINESS ADDRESS FAIRVIEW INSURANCE AGENCY ASSOCIATES INC. . "zense 25 FAIRVIEW AVE 22525331?. VERONA, NJ 07044-1341 to the license expiration date. IS DULY LICENSED WITH THE FOLLOWING LICENSE AND AUTHORITIES LICENSE TYPE LINES OF AUTHORITY EFFECTIVE DATE EXPIRATION DATE Insurance Producer ACCIDENT, HEALTH OR PERSONAL 0413012020 CASUALTY 4, - T?f%c 525.241, I. Acting Commissioner of pn'nted: 03/23/2013 Banking and Insurance The Department maintains an informative website at Please visit this web page for valuable information and forms necessary to maintain compliance with licensing requirements. Department Contact Information web site: phone: (609) 292?4337 fax: (609) 984-5263 The request for any change of license information must be sent to the Department within 30 days of the change. Make any Checks and/or money orders payable to: STATE OF NEW JERSEY, GENERAL TREASURY Mailing AddresszDepartment of Banking and Insurance 20 West State Street P.0. Box 327 Trenton, NJ. 08625-0327 ANNE CAMPACNA PROFESSIONAL QUALIFICATICNS Fairview Insurance Agency Associates, Inc. Verona, NJ Commercial Lines Account Executive; 2008 - Present Manages custom program business Services a book of approximately $4.4 million in premiums Handles broad spectrum of risks including Municipalities, Construction 8 Forklift Equipment Dealers, Wholesale 8 Retail, Manufacturing, and Contractors All facets of customer service/client management Underwriting rating, marketing, binding, and billing of commercial book SelectAccoun t/Persona! Lines Manager," 1982-2006 Managed sales and service of small commercial and personal lines accounts Handled all facets of customer service/ client management Quoting and placing of small commercial lines and personal lines coverages Updated carrier rating and underwriting procedures for small commercial and personal lines accounts Cross-training customer service representatives and sales producers in underwriting and rating procedures Bollinger Insurance Company Short Hills, NJ Comm ercjal Lin es A cco um? Executive; 2006 ?2008 Managed custom program business in Medical Malpractice Serviced a book of approximately $5-7 million in premium Handled broad spectrum of risks including Wholesale 8 Retail Distributors Manufacturing, Contractors, Medical Facilities, Large Property Management Companies, and Large Hotel Chains All facets of customer service/ client management Underwriting, rating, marketing, binding, and billing of commercial book CCNTACT 25 Fairview Avenue Verona, NJ 07044 973-857-0870 x113 973-857-9131 EDUCATION Graduate Program in Paralegal Studies ABA Approved Program 2005, Montclair State University, Montclair, NJ Bachelor of Science, Social! Behavioral Science Minor, 2001, Seton Hall University, South Orange, NJ Insurance Programing and Licensing Course, 1982 LICENSES New Jersey . Property 8 Casualty - Life . Health FAIRVIEW INSURANCEAGENCY ASSOCIATESJNC. Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Tab Examples of Risk Transfer Fairview insurance Agency Associates, Inc. SAM PLE OP ID: AC . CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERISI. AUTHORIZED REPRESENTATIVE OR PRODUCER. AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcyIiesI must be endorsed. If SUBROGATION IS WNVED. subject to the terms and conditions of the policy. certain policies may require an endorsement A statement on this certi?cate does not confer rights to the certi?cate holder In lieu Of such PRODUCER 53:3? WHE- . wt: Hg: NAME AND ADDRESS OF PRODUCER 1 I, REFORDIHB COVERAGE NAIC I INSLIIERA :Nama of Insurance Carrier ee TESS City, NJ ZIP "'st INSURER INSURER INSWER E: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE mm an POLICY I EFF LINTIS GENERAL EACH OCCURRENCE 5 2.000.000 WEN A camacm GENERAL mum POLICY NUMBER 01mm 2 01:01:13 3 300,000 CLAIMS-MADE OCCUR NED EXP my on. puma) 10.000 PERSON-IL ADV INJURY 3 2,000,000 A mm magma 5 4,000,000 AGGREGATE LIMIT APPLIES PER: PRODUCTS . AGO 5 4.0001000 TI POLICVI Ifggf I ILOC 5 EOMDBILE LIABILITY 5 1,000,000 1! 2 I A i ANY AUTO POLICY NUMBER 0110 1 01 01113 BODILY ALL OWNED AUTOS INJURY (Pu mm SCHEDULED AUTOS PROPERTY was i HIRED AUTOS (Persona-m: 5 A NON-OWNEDAUTOS i UMBRELLA ma occua EACH OCCURRENCE I 1.000.000 excess LUIS 1,000,000 A cw? POLICY NUMBER 01mm: 01101113 RETENTION 5 10,000 5 WORKERS COMPENSATION WC STATU- AND LuaIerv A ANY POLICY NUMBER 01I01I12 E.L. EACH ACCIDENT .: 1,000,000 OFFICERIMEMBER A - Irma! EL. DISEASE. EAEMPLOYEE a 1.000.000 DESERWON 9319.? DISEASE - POLICY LIMIT 3 1,000,000 DESCRIPTION OF I LOCATIONS II VEHICLES ACCRD 101, Adult!? II mt In!? II I'IquIrId] (NAME OF thiir Officers officials, Jig-111:5, and consultants Dru named a: an itional Inaurucl as Di: interests may app": with rump-eta to work perform-cl by th- amid in?ux-cl as pl: uritt-n contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Name of EntIty Address of Entity AUTHORIZED REPRESENTATIVE ?1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD Sample Hold Harmless Agreement Additional Requirements as follows: 1. Certified copies ofall insurance policies provided above or certificates thereof satisfactory to the Borough of Roselle Park shall be furnished forthwith. Each such policy or certificate shall contain a provision that it is not subject to change, cancellation or non- renewal unless 30 days prior written notice via certified mail /return receipt shall have been given to the Borough of Roselle Park by the Contractor?s Insurer. These must be received 30 days prior to commencement of work. 2. The Contractor agrees that it will defend, indemnify and save harmless the Borough of Roselle Park, its officers, agents and employees from all liability, suits, actions, and demands and all damages, costs or fees on account of injuries to persons or property, including accidental death, arising out of or in connection with the work, or by reason of the operations under this agreement. 3. All insurance purchased and maintained by the Centre designate the Borough of Roselle Park, their officers, officials, agents, empl ees, co ants as additional insureds. SAMPLE CONTRACT CONTRACT #981 GENERAL CONDITIONS Article VII INSURANCE REQUIREMENTS: A. General Insurance Requirements: The Contractor shall not commence work under this contract until he has obtained all insurance coverages as required herein. Such insurance must be provided by a company or insurance business in the State of New Jersey and approved by the Borough of Roselle Park. The Contractor shall not allow any Subcontractor to commence work until all similar insurance requirements of the Subcontractor have been obtained and approved. The Contractor, prior to commencement of any work, shall is th Borough of Roselle Park with current certificates of insurance for all coverages required and ificates shall contain a provision stating that no policy will be canceled or modified for rea ept after thirty (30) days written notice to the Borough of Roselle Park, 110 East iel Roselle Park, New Jersey 07204. The Contractor, prior to making any deliveri ,5 rnish the Borough of Roselle Park with current certificates of insurance for all coverages re a uch certificates shall contain the following provision: "Should any of the abov olicies be canceled before the expiration date thereof, the issuing compan ma 0 ays prior written notice to the Certificate Holder named.? B. Indemnification: The Cont or all indemnify and hold harmless the Borough of Roselle Park, its officers, directors, agents and vants from and against any and all claims, demands, suits, damages, recoveries, settlements, actions, costs, counsel fees, expenses, judgments or decrees arising from or caused by, in whole or part, directly or indirectly, the Contractor, his agents, servants, independent contractors or subcontractors, in any manner, whether by negligence, willful misconduct or otherwise, or any failure to adhere to the specifications contained herein and/or any applicable building codes with respect to the matters contained herein. C. Worker's Compensation Insurance: The Contractor shall secure and maintain during the life of this contract Worker?s Compensation Insurance for all of its employees and, in case any work is sublet, the Contractor shall require the Subcontractor similarly to provide Worker's Compensation Insurance for all of the latter?s employees. Said policy or policies shall include Employer?s Liability Protection with a limit of not less than $1,000,000. CONTRACT #981 GENERAL CONDITIONS D. Public Liability and Property Damage Insurance: The Contractor shall secure and maintain during the life of the Contract Comprehensive General Liability Insurance as will protect him, the Borough of Roselle Park and his agents from claims for damages of bodily injury, including accidental death, as well as for claims of property damage which may arise from any act, omission or operations under this Contract, whether by the Contractor, or his Subcontractors. The limits of liability shall not be less than one million ($1,000,000) dollars per occurrence for bodily injury liability and one million ($1,000,000) dollars per occurrence for property damage liability. E. Comprehensive Automobile Liability: This insurance shall be written in a comprehensive form and shall comply with- N.J.S.A. and all local regulations and case law with regard to the scope and effect of the New Jersey Compulsory Motor Vehicle Insurance Statute; and shall provide coverage for protection against all claims for injury to any and rsons and damage to property arising from the maintenance, use or operation ofany own - ned vehicle used in, or in connection with, the performance ofthis contract. The limits of liability shall not be less than one mil do 5 ,000,000) for bodily injury and five hundred thousand dollars ($500,000) for prOp age. F. The following risks are considered ?exce ti to above requirements and where applicable the following coverages must be included i lic 1. Special Hazards: a. Blastingan exp '0 *Applicable co act: b. Collapse of, or structural injury to, any structure, due to excavation or pumping, shoring or demolition of any structure, or the removal or rebuilding of any structural support thereof. *Applicable to contract: YES c. Damage to underground structures or conduits. *Applicable to contract: (I. The term ?Caused by Accident" in the standard policy shall be broadened by the inclusion of the term ?Occurrence?. *Applicable to contract: YES The limits of liability shall not be less than one million dollars ($1,000,000) per occurrence for bodily injury and one million dollars ($1,000,000) per occurrence for property damage liability. 2. CONTRACT #981 GENERAL CONDITIONS Product Liability: Where applicable the Contractor should provide Product Liability coverage or a certificate of Product Liability Insurance from the Contractor. *Applicable to contract: YES Builders Risk Insurance: The Contractor shall secure and maintain during the life ofthis contract Builder?s Risk Insurance written in the completed value form and shall protect the Contractor and Owner against all risk of damage to the buildings, structures, materials and equipment not otherwise covered under an Installation Floater. The amount of insurance shall be not less than one hundred percent (100%) of the insurable value of the work at completion of this contract. The policy shall provide for losses to be payable to the Contractor and Owner as their interests may appear. *Applicable to contract: YES Installation Floater: The Contractor shall secur and equipment not otherwise covered or storage areas, during installation, accepted by the Borough of Rosell sha I be of the ?all risks? type, with coverages ?ch ccor in the particular work included in this contract and shall be for th . . cf the contract. The policy shall also cover any Owner-furnished equin materials or Subcontractor-furnished equipment and materials which are a .: a or installed under this contract. The insurance shall be in an amount suffi to -r the value of all equipment and materials for which the Contractor is Installation Floater surance shall provide for losses to be payable to the Contractor and the Owner as their interests may appear. Certificate of Insurance covering Installation Floater Insurance shall quote the insuring agreement and all exclusions as they appear in the policy, or in lieu of certificates, copies of the complete policy may be submitted. *Applicable to contract: YES Umbrella Policy: The Contractor (or Supplier) shall secure and maintain during the life of this contract Umbrella Liability Insurance as will protect him, the Borough of Roselle Park, and his agents from claims for damages of bodily injury, including accidental death, as well as for claims of property damage which may arise from any act, omission or operations under this Contract, whether by the Contractor, or his Subcontractors. The limits of liability shall not be less than five million ($5,000,000) dollars per occurrence for bodily injury liability and five million ($5,000,000) dollars per occurrence for property damage liability in excess of the limits of the other liability policies. *Applicable to contract: Article - LAWS, REGULATIONS AND PERMITS: A. The Contractor shall keep itself fully informed of all laws, ordinances and regulations or decrees which in any manner would affect persons or materials in any way used, engaged or employed in the work or which affect the conduct of the work. If any discrepancy or inconsistency should be discovered in this contract, or in the drawings or specifications herein referred to, in relation to any such law, ordinance, regulation, order of decree, the Contractor shall forthwith report the same in writing to the Borough of Roselle Park. B. The Contractor shall at all times observe and comply with and shall cause all its agents and employees to observe orders and decrees, and shall protect, indemnify a harmless the Borough of Roselle Park and its officers and agents against any claim or liability i or based on the violation of any such law, ordinance, regulation, order or decree, wheth by the ractor, its employees or agents. C. Permits and/or licenses of a temporary nature wh' ry for the prosecution ofthe work shall be secured and paid for by the Contractor prio om encement of such work as would require permits and/or licenses. Article IX Assignment: A. The Contractor shall not assign, . ey, sublet or otherwise dispose of this Contract, as a whole; or his right, title or i to the same or any part of thereof, without the previous consent in writing ofthe selle Park endorsed herein or hereto attached; and it shall not assign, by power of attorney 0 rwise, any of the monies to become due and payable under his Contract, unless by and with the like consent signified in like manner. B. If the Contractor shall, without such previous written consent, assign, transfer, convey, sublet, or otherwise dispose of this Contract, or of its right, title or interest therein, or any of the monies to become due hereunder, this Contract may, at the option ofthe Borough of Roselle Park, be revoked and annulled, and the Borough of Roselle Park shall thereupon be relieved and discharged from any and all liability and obligations growing out of the same to the Contractor and to its assignee or transferee,- and the Borough of Roselle Park shall be in no way deprived of or restricted in its right to sue for and recover damages for any breach of this Contract. FAIRVIEW DNISURANCE AGENCY Borough of Roselle Park Request For Proposal: 2019 Risk Manager Insurance Broker Tab Required Documents 2 Fairview Insurance Agency Associates, Inc. BOROUGH OF ROSELLE PARK SUBMISSION CHECKLIST THE FOLLOWING ITEMS, AS INDICATED BELOW IE, SHALL BE PROVIDED Initial WITH THE RECEIPT OF SEALED SUBMISSIONS Here Completed RF Checklist . Completed Submission Form Quali?cation Statement Statement of Ownership Disclosure Non-Collusion Af?davit Required EEO/Af?rmative Action Evidence Signed Compliance Notice Acknowledgement of Americans with Disabilities Act Language of 1990 Disclosure of Investment Activities in Iran m2: Insurance Requirement Acknowledgement Form Certi?cation Regarding Political Contributions New Jersey Business Registration Certi?cate of Vendor W-9 of Vendor This checklist is provided for vendor?s use in assuring compliance with required documentation; however, it does not include all submission requirements and does not relieve the vendor of the need to read and comply with the RFP. Name OfVendor: ml {Vial/L} ?0311mm 6 30110400] Date: ll! kl g/ hsfoamt?, [nc- Signature: PrintName: Ml Chara Title: Page 7 of 26 BOROUGH OF ROSELLE PARK SUBMISSION FORM QUALIFICATION STATENIENT (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 1. Names and roles of the individuals who will perform the services and description of their education and experience with projects similar to the services contained herein: Hearse- [2915(2/ 7256- Page 8 of 26 SUBNIISSION QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 2. References and record of success of same or similar service: P/Fage: raFe/ fm page] 7:16- Page 9 of 26 SUBMISSION FORM I QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 3. Description of ability to provide the services in a timely fashion (including staf?ng, familiarity and location of key staff): Home, (?43.59; {OP/gall 72:6. Page 10 on6 SUBMISSION FORM QUALIFICATION STATEMENT (CONTINUED) (ATTACH ADDITIONAL SHEETS AS NECESSARY, BUT DO NOT SIMPLY ATTACH VENDOR MATERIALS AND 4. Cost details, including the annual fee for primary duties and the hourly rates of each of the individuals who will perform services, and all expenses for any work that is not included in the primary duties: F/mge- 72' ffo?Dwsaj 73$. CERTIFICATION OF PROPOSAL (Sign Below) Firm: Ea t? has ULFQOCC A H330 gout 655, c. Date: ll 3 i? Signature: Authorized Rep?n'tativc Print): ?i (MOLCI 6m 610?] Title: 0-0-0. Telephone No; Fax No.: 07727-%Qj-%qg Page 11 of 26 BOROUGH OF ROSELLE PARK STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. (P.L. 1977, c.33, as amended by P.L. 2016, c.43) THIS STATEMENT SHALL BE COMPLETED, CERTIFIED TO, AND INCLUDED WITH ALL BID AND PROPOSAL SUBMISSIONS. FAILURE TO SUBMIT THE REQUIRED INFORMATION IS CAUSE FOR AUTOMATIC REJECTION OF THE BID OR PROPOSAL. - i inc. Organization Md 010,44 Part I Check the box that represents the type of business organization: Name of Organization: Sole Proprietorship (skip Parts II and execute certi?cation in Part IV) DNon-Pro?t Corporation (skip Parts 11 and execute certi?cation in Part IV) EFor-Pro?t Corporation (any type) nLimited Liability Company (LLC) Partnership Limited Partnership Limited Liability Partnership (LLP) Other (be speci?c): Part II The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST ON THE NEXT PAGE IN THIS SECTION) OR No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) Page 12 of 26 STATEMENT OF OWNERSHIP DISCLOSURE (Continued) [Please attach additional sheets if more space is needed): Name of Individual or Business Entity Home Address (for Individuals) or Business Address dorm x. amt/1am MWAB Mesa Lawrence Karol/101m ?(r/min? Nd cams at, 9? mm Egaliiatimaiior?i 0 most Part DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MENIBERS LISTED IN PART II If a bidder has a direct or indirect parent entity which 1s publicly traded, and any person holds a 10 percent or greater bene?cial interest' in the publicly traded parent entity as of the last annual fed cry/?2 Security and Exchange Commission (SEC) or foreign equivalent ?ling, ownership disclosure n? be met by providing links to the website(s) containing the last annual ?ling(s) with the federal See i?es and Exchange Commission (or foreign equivalent) that contain the name and address of each a?:Im?lholding a 10% or greater bene?cial interest in the publicly traded parent entity, along with the role I page numbers of the ?ling(s) that contain the information on each such person. Attach adWH?e?s if more space is needed. Website (URL) containing the last annual SEC (Weign equjx?lent) filing Page xii-ll r, partner or member owning a 10 percent or greater ip and/ or limited liability company (LLC) listed in Part II other than for any publicly traded rent entities referenced above. The disclosure shall be continued until names and addresse every noncorporate stockholder, and individual partner, and member exceeding the 10 pereen nership criteria established pursuant to N.J.S.A. 5225?242 has been listed. Attach additional sh if more space is needed. Please list the names and addresses of each stockho interest in any corresponding corporation, partn Stockholder! rtnerfM ember and Home Address (for Individuals) or Business Address CorreSpo Entityr Listed in Part II .1 Page 13 of 26 Part IV Certi?cation STATEMENT OF OWNERSHIP DISCLOSURE (Continued) 1, being duly sworn upon my oath, hereby represent that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I acknowledge: that I am authorized to execute this certi?cation on behalf of the bidder/proposer; that the Borough of Roselle Park is relying on the information contained herein and that I am under a continuing obligation from the date of this certi?cation through the completion of any contracts with the Borough of Roselle Park to notify the Borough of Roselle Park in writing of any changes to the information contained herein; that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certi?cationsubject to criminal prosecution under the law and that it will constitute a material breach of my agreement(s) with the, permitting the Borough of Roselle Park to declare any contract(s) resulting ?om this certi?cation void and unenforceable. Full Name (Print): Mill/WI troll/am Title: 00.0. Signature: ?at/{M Date: It 5/ It? . Page 14 of 26 BOROUGH OF ROSELLE PARK NON-COLLUSION AFFIDAVIT State of County of 35: 1, Hill lane] 11m 51 ofthe City of mac?! ly in the County of 5,55 5 and State of NW cl run age, being duly sworn according to law on my oath depose and say that: want: 6 1am 05-O- ofthe?rmof Jag. (Title or Position) (Name of Finn) the bidder making this Proposal for the above named project, and that I executed the said proposal with full authority so to do; that said bidder has not, directly or indirectly entered into any agreement, participated in any collusion, or otherwise taken any action in restraint of free, competitive bidding in connection with the above named project; and that all statements contained in said proposal and in this af?davit are true and correct, and made with full knowledge that the Borough of Roselle Park relies upon the truth of the statements contained in said proposal and in the statements contained in this af?davit in awarding the contract for the said project. I further warrant that no person or selling agency has been employed or retained to solicit or secure such contract upon an agreement or understanding for a commission, percentage, brokerage, or contingent fee, except bona ?de employees or bona ?de employees or bona ?de established commercial or selling agencies I Vt hSl/rat?] cc, maintained by Exam (5?0 0'1 Cup 69? m5 (name of contractor) Subscribed and sworn to before me this day WM or Meta/?tit, e/ 90 if Signature Mb Michael mam, can Dial/h 0 \ij O'gkm (Type 01? print name of af?ant under signature) Notary public of My ?Pitta; MWQM a. HOWES Expires 121112022 Page 15 of 26 BOROUGH OF ROSELLE PARK AFFIRMATIVE ACTION COMPLIANCE NOTICE N.J.S.A. 10:5-31 and N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS This form is a summary of the successful bidder?s requirement to comply with the requirements 10:5-3 and N.J.AC. 17227?1 et seq. The successful bidder shall submit to the public agency, after noti?cation of award but prior to execution of this contract, one of the following three documents as forms of evidence: a) A photocopy of a valid letter that the contractor is operating under an existing Federally approved or sanctioned af?rmative action program (good for one year from the date of the letter); OR A photocopy of a Certi?cate of Employee Information Report approval, issued in accordance with N.J.AC. 17:27-4; OR c) A photocopy of an Employee Information Report (Form AA302) provided by the Division and distributed to the public agency to be completed by the contractor in accordance with N.J.A.C. 17:27-4. The successful vendor may obtain the Af?rmative Action Employee Information Report (M302) from the contracting unit during normal business hours. The successful vendor(s) must submit the copies of the AA302 Report to the Division of Contract Compliance and Equal Employment Opportunity in Public Contracts (Division). The Public Agency copy is submitted to the public agency, and the vendor copy is retained by the vendor. The undersigned vendor certi?es that he/she is aware of the commitment to comply with the requirements of NJ .S.A. 1025?31 and N.J.AC. 17:27.1 et seq. and agrees to furnish the required forms of evidence. The undersigned vendor further understands that his/her bid shall be rejected as non-responsive if said contractor fails to comply with the requirements 10:5?31 and N.J.A.C. 1727?] et seq. COMPANY: {?it inc. SIGNATURE: . PRINT NAME: liliQhQ?i TITLE: DATE: ?4?th Page 16 on6 BOROUGH OF ROSELLE PARK EXHIBIT A MANDATORY EOUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5-31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS During the performance of this contract, the contractor agrees as follows: The contractor or subcontractor, where applicable, will not discriminate against any employee or applicant for employment because of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Except with respect to affectional or sexual orientation and gender identity or expression, the contractor will ensure that equal employment opportunity is afforded to such applicants in recruitment and employment, and that employees are treated during employment, without regard to their age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. Such equal employment opportunity shall include, but not be limited to the following: employment, upgrading, demotion, or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to be provided by the Public Agency Compliance Of?cer setting forth provisions of this nondiscrimination clause. The contractor or subcontractor, where applicable will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all quali?ed applicants will receive consideration for employment without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex. The contractor or subcontractor will send to each labor union, with which it has a collective bargaining agreement, a notice, to be provided by the agency contracting of?cer, advising the labor union of the contractor's commitments under this chapter and shall post copies of the notice in conspicuous places available to employees and applicants for employment. The contractor or subcontractor, where applicable, agrees to comply with any regulations promulgated by the Treasurer pursuant to N.J.S.A. 1015-31 et seq., as amended and supplemented from time to time and the Americans with Disabilities Act. The contractor or subcontractor agrees to make good faith efforts to meet targeted Borough employment goals established in accordance with N.J.A.C. 17:27-52. The contractor or subcontractor agrees to inform in writing its appropriate recruitment agencies including, but not limited to, employment agencies, placement bureaus, colleges, universities, and labor unions, that it does not discriminate on the basis of age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, and that it will discontinue the use of any recruitment agency which engages in direct or indirect discriminatory practices. The contractor or subcontractor agrees to revise any of its testing procedures, if necessary, to assure that all personnel testing conforms with the principles of job-related testing, as established by the statutes and court decisions of the State of New Jersey and as established by applicable Federal law and applicable Federal court decisions. In conforming with the targeted employment goals, the contractor or subcontractor agrees to review all procedures relating to transfer, upgrading, downgrading and layoff to ensure that all such actions are taken Page 17 of 26 EQUAL EMPLOYMENT OPPORTUNITY LANGUAGE N.J.S.A. 10:5?31 et seq. (P.L. 1975, C. 127) N.J.A.C. 17:27 GOODS, PROFESSIONAL SERVICE AND GENERAL SERVICE CONTRACTS (Continued) without regard to age, race, creed, color, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, nationality or sex, consistent with the statutes and court decisions of the State of New Jersey, and applicable Federal law and applicable Federal court decisions. The contractor shall submit to the public agency, after noti?cation of award but prior to execution of a goods and services contract, one of the following three documents: Letter of Federal Af?rmative Action Plan Approval Certi?cate of Employee Information Report Employee Information Report Form AA3 02 (electronically provided by the Division and distributed to the public agency through the Division?s website at The contractor and its subcontractors shall furnish such reports or other documents to the Division of Purchase Property, CCAU, EEO Monitoring Program as may be requested by the of?ce from time to time in order to carry out the purposes of these regulations, and public agencies shall furnish such information as may be requested by the Division of Purchase Property, CCAU, EEO Monitoring Program for conducting a compliance investigation pursuant to Subchapter 10 of the Administrative Code at N.J.A.C. 17:27. Page 18 of26 Certification 3 1 3 9 CERTIFICATE OF EMPLOYEE INFORMATION REPORT RENEWAL This is to certify that the contractor - N.J.A.C. et. seq. and the effect for the period of 25 FAIRVIEW AVENUE ..J A venom NJ 070- - r" WW 974%" Andrew P. Sidamon?Eristoff State Treasurer BOROUGH OF ROSELLE PARK AMERICANS WITH DISABILITIES ACT OF 1990 Equal Opportunity for Individuals with Disability The Contractor and the Owner, do hereby agree that the provisions of Title 11 of the Americans with Disabilities Act of 1990 (the ?Act") (42 US. C. 8121 01 et seq.), which prohibits discrimination on the basis of disability by public entities in all services, programs, and activities provided or made available by public entities, and the rules and regulations promulgated pursuant there unto, are made a part of this contract. In providing any aid, bene?t, or service on behalf of the owner pursuant to this contract, the contractor agrees that the performance shall be in strict compliance with the Act. In the event that the contractor, its agents, servants, employees, or subcontractors violate or are alleged to have violated the Act during the performance of this contract, the contractor shall defend the owner in any action or administrative proceeding commenced pursuant to this Act. The contractor shall indemnify, protect, and save harmless the owner, its agents, servants, and employees from and against any and all suits, claims, losses, demands, or damages, of whatever kind or nature arising out of or claimed to arise out of the alleged violation. The contractor shall, at its own expense, appear, defend, and pay any and all charges for legal services and any and all costs and other expenses arising from such action or administrative proceeding or incurred in connection therewith. In any and all complaints brought pursuant to the owner?s grievance procedure, the contractor agrees to abide by any decision of the owner which is rendered pursuant to said grievance procedure. If any action or administrative proceeding results in an award of damages against the owner, or if the owner incurs any expense to cure a violation of the ADA which has been brought pursuant to its grievance procedure, the contractor shall satisfy and discharge the same at its own expense. The owner shall, as soon as practicable after a claim has been made against it, give written notice thereof to the contractor along with full and complete particulars of the claim, If any action or administrative proceeding is brought against the owner or any of its agents, servants, and employees, the owner shall expeditiously forward or have forwarded to the contractor every demand, complaint, notice, summons, pleading, or other process received by the owner or its representatives. It is expressly agreed and understood that any approval by the owner of the services provided by the contractor pursuant to this contract will not relieve the contractor of the obligation to comply with the Act and to defend, indemnify, protect, and save harmless the owner pursuant to this paragraph. It is further agreed and understood that the owner assumes no obligation to indemnify or save harmless the contractor, its agents, servants, employees and subcontractors for any claim which may arise out of their performance of this Agreement. Furthermore, the contractor expressly understands and agrees that the provisions of this indemnification clause shall in no way limit the contractor?s obligations assumed in this Agreement, nor shall they be construed to relieve the contractor from any liability, nor preclude the owner from taking any other actions available to it under any other provisions of the Agreement or otherwise at law. The undersigned vendor consents to the full understanding of the forgoing Americans with Disabilities Act Language of 1990: I9 ,cwgmiqnssouarojnc. Bidder/ Vendor: Signature; Full Name (Print): Mid/moi 60mm Title: . Date refill) Page 19 of 26 BOROUGH OF ROSELLE PARK DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN PART 1: CERTIFICATION BIDDERS MUST COMPLETE PART 1 BY CHECKING EITHER BOX. Pursuant to Public Law 2012, c. 25, any person or entity that submits a bid or proposal or otherwise proposes to enter into or renew a contract must complete the certi?cation below to attest, under penalty of perjury, that neither the person or entity, nor any of its parents, subsidiaries, or af?liates, is identi?ed on the Department of Treasury?s Chapter 25 list as a person or entity engaging in investment activities in Iran. The Chapter 25 list is found on the Division?s website at Bidders must review this list prior to completing the below certi?cation. Failure to comnlete the ce?i?cm PLEASE CHECK EITHER BOX: certify, pursuant to Public Law 2012, c. 25, that neither the person/entity listed above nor any of the ntity?s parents, subsidiaries, or af?liates is listed on the NJ. Department of the Treasmy?s list of entities determined to be engaged in prohibited activities in Iran pursuant to PL. 20l2, c. 25 (?Chapter 25 List?). I further certify that I am the person listed above, or I am an of?cer or representative of the entity listed above and am authorized to make this certi?cation on its behalf. I will skip Part 2 and sign and complete the Certi?cation below. OR El I am unable to certify as above because I or the bidding entity and] or one or more of its parents, subsidiaries, or af?liates is listed on the Department?s Chapter 25 list. I will provide a detailed, accurate and precise description of the activities in Part 2 below and sign and complete the Certi?cation below. Failure to provide such will result in the proposal being rendered as non-responsive and appropriate penalties, ?nes and/or sanctions will be assessed as provided by law. PART 2 PROVIDE FURTHER INFORMATION RELATED TO INVESTMENT ACTIVITIES IN IRAN You must provide a detailed, accurate and precise description of the activities of the bidding personientity, or one of its parents, subsidiaries or af?liates, engaging in the investment activities in Iran cutlhied'above by completing the form below. (PROVIDE INFORMATION RELATIVE TO THE PLEASE THOROUGH ANSWERS TO CH QUESTION. IEXOU NEED TO MAKE ADDITIONAL ENTRIES, USE ADDITIONASY . r? Name: v/ Relationship to Bidder/Vendor: 1/ Description of Activities: Duration of EngW Anticipated Cessation Date: Bidder/Vendor: Contact e: Contact Phone Number: Page 20 of 26 DISCLOSURE OF INVESTMENT ACTIVITIES IN IRAN (Continued) CERTIFICATION I, being duly sworn upon my oath, hereby represent and state that the foregoing information and any attachments thereto to the best of my knowledge are true and complete. I attest that I am authorized to execute this certi?cation on behalf of the below?referenced person or entity. I acknowledge that the Borough of Roselle Park is relying on the information contained herein and thereby acknowledge that I am under a continuing obligation from the date of this certi?cation through the completion of contracts with the Borough of Roselle Park to notify the Borough of Roselle Park in writing of any changes to the answers or information contained herein. I acknowledge that I am aware that it is a criminal offense to make a false statement or misrepresentation in this certi?cationrecognize that I am subject to criminal prosecution under the law and that it will also constitute a material breach of my agreements(s) with the Borough of Roselle Park and that the Borough of Roselle Park at its option may declare any contract(s) resulting from this certi?cation void and unenforceable. Full Name (Prin [(4/1le Signature' I Title: .060 - Date ?6 l5 Bidder/Vendor: Farm 6A3 RWM 0140189 1. MG Page 21 of 26 BOROUGH OF ROSELLE PARK INSURANCE REQUIREMENTS AND ACKNOWLEDGEMENT FORM Certi?cate(s) of Insurance shall be ?led with the Borough Clerk's Of?ce upon award of contract by the governing body The minimum amount of insurance to be carried by the Professional Service Entity shall be as follows: PROFESSIONAL LIABILITY INSURANCE Limits shall be a minimum of $1,000,000.00 for each claim and $1,000,000.00 aggregate each policy period. Acknowledgement of Insurance Requirement: SIGNATURE: WAR DATE: Madame; Graham/1.0.0.0. (Printed Name 85 Title) Page 22 of 26 BOROUGH OF ROSELLE PARK CERTIFICATION REGARDING POLITICAL CONTRIBUTIONS STATE OF NEW JERSEY l, MiChC?i'ei 8'YOLham . of the mg of (3pr if in the County of and the State ofNew Jersey, of_ full age, being duly sworn SS. according to law on my oath depose and say that: I am the _p "wing of the ?rm of fajima? - ?the Professional Service Entity making the submissions for the above named ice, a that I executed the said submission with full authority to do so; that said Professional Service Entity acknowledges that it is aware that the Borough of Roselle Park pursuant to Section 2-4 of the Borough Code prohibits the awarding of any public contract to any Professional Service Entity that has contributed in excess of two hundred ($200.00) dollars to a campaign committee of any Borough of Roselle Park candidate or holder of the public of?ce having ultimate responsibility for the award of the contract, or to any Borough of Roselle Park or Union County Party Committee, or to any political action committee (PAC) that is organized for the primary purpose of promoting or supporting Borough of Roselle Park municipal candidates or municipal of?ceholders, within one (1) calendar year immediately preceding the date of the contract or agreement. I further warrant that pursuant to Roselle Park Borough Section 2-4, a ?professional service provider? seeking a public contract means: an individual, including the individual?s spouse, if any, and any child living at home; person; ?rm; corporation; professional corporation; partnership; organization; or association. The de?nition of a service provider includes all principals who own one percent or more of the equity in the corporation or business trust, partners, and of?cers in the aggregate employed by the provider as well as any subsidiaries directly controlled by the service provider. I further warrant that I have reviewed Borough Code Section 2-4. I hereby certify that the foregoing statements made by me are true. I am aware that if any of the foregoing statements made by me are false, I am subject to prurishment for contempt of Court. Subscribe and sworn to fo me this day of def {rig-r", (Sanaurre of Professional) i Misha $3335 Owens/mam (Signature of Notary) (Af?x Seal) ?t attire? ?we or amt My Commission Explres 1211M Page 23 of 26 if: II .- '1;er 1-93-VKVIN. STATE OF new JERSEY BUSINESS REGISTRATION CERTIFICATE PO BOX 252 TRENTON 08646-0252 TAXPAYER NAME: TRADE NAME: FAERVIEW ENSURANCE AGENCY ASSOCIATES, IN FAIRVIEH ASSOC IATES . i ADDRESS: SEQUENCE NUMBER: 25 AVENUE 1113731 igg-g venom NJ 01044-1341 :3 EFFECTIVE DATE: DATE: .. ii 1 mom if; 3552 gig} ?3 Dim 5% FQRM- 01) This Cerilficale is NOT assmnable or transferahi ll must be diam-awn at above address BOROUGH OF ROSELLE PARK EXAMPLE FORM Wm w-9 Request for Taxpayer a" pm m, In?, "mm mm Identi?cation Number and Certi?cation mquealer. Do not hm; . land In the 1 Namuf?smm mammal: mill-n]. amino: mum n3 63210169 ULC- Eltlilm?l-ll mm "3 a 1. Cnocls mun-Irma Hmnugmm ganglia mem 3mm mnnxuu'u nn 5:993: 5 El tl'r??dumuub GCWIM Barnumm map mm 3 [inlaid mu,- cunm. 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Sue What I: backup whaling. mum 1mm rmW-quw. man WESTFORT INSURANCE CORPORATION I Policy Number: WED4NJ005012013 Renewal of Policy: WED4NJ005012012 INSURANCE INDUSTRY PROFESSIONAL LIABILITY COVERAGE FOR INSURANCE AGENCIES DECLARATIONS THIS IS A CLAIMS MADE POLICY. PLEASE READ CAREFULLY. A. NAMED INSURED: FAIRVIEW INSURANCE AGENCY ASSOCIATES, INC. Address: 25 FAIRVIEW AVENUE VERONA, NJ 07044 B. POLICY PERIOD: From 12:01 AM. September 20, 2018 To 12:01 AM.September 20, 2019 Local time at the address stated herein C. POLICY Limits of Liability: 3 3,000,000 Per CLAIM 6,000,000 Aggregate for the POLICY PERIOD Sublimit of Liability for BREACH OF PERSONAL DATA: $1,000,000 Per CLAIM $1,000,000 Aggregate for the POLICY PERIOD D. DEDUCTIBLE: 10,000 Per CLAIM 30,000 Aggregate for the POLICY PERIOD E. Premium: *Experience Credit Applied *Loss Control Credit Applied F. RETROACTIVE DATE: Full Prior Acts Total Premium: NJPLIGA ASSESSMENT Total Premium Inc. Tax! 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