324246 04/18/18 1 ur.C4Ab
v . CITY OF CARMEL, INDIANA VENDOR: 00352999
j ONE CIVIC SQUARE HYLANT GROUP CHECK AMOUNT: $*****6,106.00*
CARMEL, INDIANA 46032 PO BOX 638720 CHECK NUMBER: 324246
9y_roN- CINCINNATI;OH 45263-8720 CHECK DATE: 04/18/18
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1205 4347500 179016 6,106.00 GENERAL INSURANCE
VOUCHER NO. WARRANT NO. Prescribed by State Board of Accounts City Form No.201(Rev.1995)
Vendor# 00352999 ALLOWED 20 ACCOUNTS PAYABLE VOUCHER
HYLANT GROUP IN SUM OF$ CITY OF CARMEL
PO BOX 638720 An invoice or bill to be properly itemized must show:kind of service,where performed,dates service
rendered,by whom,rates per day,number of hours,rate per hour,number of units,price per unit,etc.
CINCINNATI, OH 45263-8720
Payee
$6,106.00
ON ACCOUNT OF APPROPRIATION FOR Purchase Order#
General Administration Terms
Date Due
PO# ACCT# DATE INVOICE# DESCRIPTION
DEPT# INVOICE# Fund# AMOUNT Board Members DEPT# FUND# (or note attached invoice(s)or bill(s)) AMOUNT
179016 43-475.00 $6,106.00 1 hereby certify that the attached invoice(s),or 4/16/18 179016 $6,106.00
1205 101 1205 101
bill(s)is(are)true and correct and that the
materials or services itemized thereon for
which charge is made were ordered and
received except
Tuesday,April 17,2018
Crider,James
Administration
I hereby certify that the attached invoice(s),or bill(s),is(are)true and correct and I have
audited same in accordance with IC 5-11-10-1.6
120
Cost distribution ledger classification if claim paid motor vehicle highway fund. Clerk-Treasurer
Please Return Top with Remittance To: PO Box 638720,Cincinnati,OH 45263-8720
rem V---f iii-sEff-Date µ Due Date Trans Description Amount
Cyber Liability Policy# G29520963 Effective: 4/10/18 - 1/1/19
Issuing Company Federal Insurance Company
1390597 4/10/2018 4/23/2018 NEWS 18/19 Cyber Liability 10,633.00
4/10/2018 4/16/2018 APCR Batch 1778-COA (2,425.00)
4/10/2018 4/16/2018 APCR Batch 1790-COA (50.00)
4/10/2018 4/16/2018 APCR Delete 37 W.Main Street (35.00)
4/10/2018 4/16/2018 APCR Batch 1894-COA (365.25)
4/10/2018 4/16/2018 APCR Batch 1894-COA (365.25)
4/10/2018 4/16/2018 APCR Batch 1883-COA (365.25)
4/10/2018 4/16/2018 APCR Batch 1872-COA (365.25)
4/10/2018 4/16/2018 APCR Correct 18/19 GLIA Premium (556.00)
Total Invoice Balance: $6,106.00
Subnn�'-ted ToC
APR 17 2018
HYLANT Hylant-Indianapolis 10401 North Meridian St,Ste 200 Indianapolis IN 46290
4/16/2018 City of Carmel Loan# Invoice#179016 FARWEI Page 1 of 1
CHUB
Cyber Enterprise Risk.Management
Binder of Insurance
Contact Information
To: Phone:
Michael Wells 317-817-5107
Company: Email Address:
Hylant Group Mike.wells@hylant.com .
From: .. Date:
Ania Boyko 04/13/2018
Company: Phone:
Chubb 312-889753717.
Pages: Email:
12 Ania.boyko@chubb.com
Ucensed.Producers Hylant Group;Inc.
Account Information
Insured Name:. City of Carmel
Insured Address: : . One Civic Square
Carmel,,IN 46032:
Line of Coverage: Chubb Cyber Enterprise Risk Management Policy .
.Insurance Company:. ACE American InsuranceCompanX
Policy Number:. G2952o963 001
.Policy Form: PF=48168.(i /16)/PF-48169(10/16)
Policy Number: 00/2618.-1/oi/2o19
Dear Michael,
I am pleased.to offer the attached binder for City of Carmel.
Please review thus binder for accuracy and contact Chubb,prior to the effective date of policy coverage in the event'of any
inaccuracies to this binder.. If Chubb does not hear from youprior to the effective date,.it will be assumed that this binder
has been accepted a3 an accurate description of our agreed upon terms of coverage.
Thank you for binding coverage with Chubb:..If you should have any questions,please feelfree to contact me. .
Sincerely, .
pp
lam-
Ania Boyko
Underwriter
Chubb-I Financial Lines
Chubb. Insured.
Chubb Cyber Enterprise Risk Management Policy,Binder of Insurance i
Insured of 1 1 'r: G2952o963 /•
Subjectivities',
The Insurer hereby,confirms the coverage described below with an inception date of 04%10/2o18ob1igations the Insurer
may have tinder this coverage confirmation are conditioned upon each of the following conditions having first:been met:
i. The Applicant has submitted to the Insurer the-following documents;and the Insurer has received such
documents no later than close of business N/A:
2. The Applicant has remitted the:preimium specified below to the Insurer.so that:the Insurer receive's the.
premium no later than close of business on the Both day from the date of this Confirmation of Coverage or
-the Effective Date of this policy,.whichever is later.
PolicyMaximum of Insurance
Maximum Single-Limit of Insurances $3,000,000"
Maximum"Policy Aggregate;Limit of.Insurance: :. $30001000
First Party Insuring Agreements
Limit of Insurance: Reteiition/Waiting O ber-Incident.
:Check if _ Each Period Response Coach `
Included- Insuring"Agreement Incident/Aggregate Each"Incident : RetentionJ. '
_.
.'Data Breach Team. .
® Cyber Incident Reponse Fund (Inside the Limit)*
StandarCyber Incident Response.
Team $3000,000/$3,000,000 $50;000 $0.
Non-Panel Response Provider: $500,000/$500,000 $50,000
Business Interruption.Loss and
® $3;000,000/$3,000,000; ,.$50,000/8.Hours.: : N/A: .
Extra Expenses
Contingent Business Interruption ..
® Loss and Extra Expenses
Unscheduled Providers $250,000/$250,000 $50,000/8 Hours N/A
Scheduled:Providers : Not Covered - N/A
® Digital Data Recovery": $3,000,000/$3,000,000. $50,000" N/A
Network.Extortion $3,000,000%$3,000,000 . $50,000. N/A .
ThirdOther Party Liability
Cheek if. -' - ` I unit.of Insurance Retention, Retroactive ,-,Pending_or Prior
f Included Insu.nng'Agreement : : :Each Claim/Aggregate.' `Each Clain °Date- :Proceedings Date
-
Z. Cyber,Privacy And Network $30.00 000/$3,000,000 $50,000: Full Prior. 4/10/2018 . .
Security Liability . Acts
ull Prior
$50,000 F
Payment Card Loss $1;000,000/$1,0001000 4/10/2oi8
Acts
Regulatory Proceedings $3000,000/$3,000,000 $50,000 FuAPS or 4/10/2018
Electronic;Social And Printed $3,000,000/$3,000,000 $50,000 Full.Prior
Media-Liability Acts 4/10/2o18.
Chubb. Insured."
Chubb Cyber Enterprise Risk Management Policy,Binder of Insurance 2
Additional Information
Extended Reporting Period:12 months for i00%of last.annual premium
Retroactive Date(only applicable to Third Party Liability Insuring.Agreements): Full Prior Acts
Pending or Prior Date(only appliable-to Third Party Insuring Agreements):4/io/i8
Total Annual- Premium: $io,633.
The Following Notice(s) basic
-
Title : Form Number
i Chubb Producer Compensation Practices&Policies ALL-20887a(63/16) Y.
2. Cyber Services for.Incident Response Notice to Policyholders. PF-48259(io/.16)
3. Cyber Services for Loss:Mitigation PF.-4826o (io/i6).
4: U.S.Treasury Department's.Office of Foreign Assets.Control("OFAC") PF-17914a(o.4/i6)
Advisory Notice to Policyholders
5. IN Notice to Policyholders
. . ALL-2Y81 -.
The Following Endorsement(s) added basic
Title Form Number
i. Forms Schedule PF-48152(o.g/i6).
2. Signature Endorsement CC-iKiii(o2%i8)
3. Cap on Losses From Certified Acts of Terrorism 'PF-45354(01/15)
4. Trade or Economic Sanctions Eiidorseni ent PF-46422 (07/15)
5. Policyholder Disclosure Notice of Terrorism Insurance Coverage TRIAiid(63/16)
6.. IN Cyber Amendato
�' �' . . PF 48297(ii/i6) : -
7.. Representations Amended Waiver of App Reliance.Upon Other Carrier.App .- PF748279.(io/16).
Chubb. Insured."
Chubb Cyber Enterprise Risk Management Policy,Binder of Insurance 3
Conditions of this Binder
This binder is.valid forgo days from the Effective_Date.
When signed by the Insurer,.the coverage described above is in effect from 12:oi AM (local time at the address shown. .
above) of the.Effective Date listed above to 12:oi AM (local;time at the address-shown above).of the Expiration Date
listed above pursuant to:the terms; conditions and exclusions of the policy form.listed above and .any policy
endorsements described_above. Unless' otherwise indicated, this binder maybe:cancelled by-the-Insured, or by the
Broker on behalf of the Insured;-by written notice to.the Insurer.or by thesurrender of this binder stating when such
cancellation.shall be effective. Unless-otherwise indicated,.this.binder may be.cancelled by the Insurer prior, .to the.
Effective Date by sending.Written notice to the Insured at the address shown above stating when such cancellationshall.
be effective: .Unless' otherwise indicated,this_binder may be.cancelled by the Insurer on.or-after the Effective Date in the
same manner and upon the same terms.and conditions-applicable to cancellation-of the-policy.form listed above.. If. .
cancellation of the binder,by or on behalf of either the Insured or-the Insurer,is-effective after the Effective Date;.then
the Insurer shall be entitled tuthe earned.premium,on a pro=rata basis,for the covered period: Issuance by the Insurer
and acceptance by,or on behalf of the Insured of the policy shall render this binder void except as indicated below.
Conditions precedent.to coverage afforded:.by this binder are: (i) receipt,..review:and acceptance of-the information
required herein-within the stated timeframe;:and (2) that no:material change in the risk occurs-and no submission is
made to:the.Insurer of a:claim or_circumstances that might give rise to a claim between the date of this binder indicated
above andthe Effective.Date. 'If:such.required information,is not received,'reviewed and accepted within the stated
timeframe, or such material change.in the risk is discovered or submission of a claim or circumstance is made,then the_
proposed insurance coverage will be.void ab initio("from,the beginning").
Note: If the Insuring Company noted above is either Westchester-Surplus Lines-Insurance-Company.or Illinois,Union
Insurance Company;then this insurance is issued pursuant to the state Surplus Lines laws that the insured is domiciled..
Persons insured by Surplus.Lines carriers do not have the protection of the above.captioned,state's Guaranty Act to:the
extent.of any.right of recovery for the obligation of an insolvent unlicensed insurer.
Any applicable.taxes,surcharges or countersignature fees,etc:,are in-addition to the above bound
figures. Your.office'is responsible for malting State Surplus Lines Filings-and complying,with all
applicable laws:
Sincerely,
pQ
Ania Boyko
Underwriter
Chubb I Financial Lines:
Chubb. Insured.
Chubb Cyber Enterprise Risk Management Policy,Binder of Insurance 4
CHUBB"
Premium Surcharges
If the issuing company indicated on the indication/quotation/binder is either ACE American
Insurance Company or Westchester Fire Insurance Company, the following surcharges will
apply in addition to the premium. Some exemptions apply. Premium surcharges are subject
to change at the anniversary dates of multiyear policies paid in annual installments.
Collection and remittance of premium surcharges for surplus lines policies, if applicable, are
the responsibility of the surplus lines broker.
Kentucky Insureds
➢ Premium Surcharge 1.8%
➢ Local Government Premium Tax Varies by municipality
New Jersey Insureds
➢ NJ Property-Liability Insurance Guaranty Association o.6%
West Virginia Insureds
➢ Premium Surcharge 0.55%
All Other Insureds
There are currently no premium surcharges in your state for this line of business. This is
subject to change at the anniversary dates of multiyear policies paid in annual installments
Ed.10/01/2016 Page 1 of i
TERMS OF TRADE
**PAYMENT DUE 3o DAYS FROM EFFECTIVE DATE**
Payment is due, in full, within 3o days from the date of this Binder or
the Effective Date of this policy, whichever is later.
Failure to pay premium will result in cancellation of this policy.
j Please make sure to include your Chubb Policy Number in any
correspondence and on any checks.
Please remit premium payment to:
Genius Payments
Regular Mail
CHUBB
Dept CH 1o678
Palatine, IL 60055-0678
Genius Overnight Address
ACE American Insurance Co.
Genius-1o678
5505 N. Cumberland Ave Suite 307
Chicago, IL 60656-1471
Attn: Box 1o678
Wire Payment
Mellon Bank West, NA
3 Mellon Bank Center
Pittsburgh, PA 15259
ABA# 043000261
Account # 093-8373
DISCLOSURE PURSUANT TO TERRORISM RISK
INSURANCE ACT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Disclosure Of Premium
In accordance with the federal Terrorism Risk Insurance Act,we are required to provide you with a notice disclosing the
portion of your premium, if any, attributable to coverage for terrorist acts certified under the Terrorism Risk Insurance
Act. The portion of your premium attributable to such coverage is shown in this endorsement or in the policy
Declarations.
Disclosure Of Federal Participation In Payment Of Terrorism Losses
The United States Government,Department of the Treasury,will pay a share of terrorism losses insured under the federal
program.The federal share equals 85%for year 2015,84%beginning on January 2o16; 83%beginning on January:L 2017,
82% beginning on January 1, 2o18; 81% beginning on January 1, 2019 and 8o%beginning on January 1, 2020 of that
portion of the amount of such insured losses that exceeds the applicable insurer retention. However,if aggregate insured
losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed$loo billion in a calendar year
the Treasury shall not make any payment for any portion of the amount of such losses that exceeds$loo billion.
Cap On Insurer Participation In Payment Of Terrorism Losses
If aggregate insured losses attributable to terrorist acts certified under the Terrorism Risk Insurance Act exceed $loo
billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance Act,we shall not be
liable for the payment of any portion of the amount of such losses that exceeds $loo billion, and in such case insured
losses up to that amount are subject to pro rata allocation in accordance with procedures established by the Secretary of
the Treasury.
COVERAGE OF"ACTS OF TERRORISM"AS DEFINED BY THE REAUTHORIZATION ACT WILL BE PROVIDED FOR
THE PERIOD FROM THE EFFECTIVE DATE OF YOUR NEW OR RENEWAL POLICY THROUGH THE EARLIER OF
THE POLICY EXPIRATION DATE OR DECEMBER 31, 2020. EFFECTIVE DECEMBER 31, 202o THE TERRORISM
RISK INSURANCE PROGRAM REAUTHORIZATION ACT EXPIRES.
Terrorism Risk Insurance Act premium: $
Authorized Representative
TRIAnd(03/16) Includes copyrighted material of Insurance Services office,Inc.,with its permission.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Cap On Losses From Certified Acts Of Terrorism
A. If aggregate insured losses attributable to terrorist acts certified under the federal Terrorism Risk Insurance Act
exceed$ioo billion in a calendar year and we have met our insurer deductible under the Terrorism Risk Insurance
Act,we shall not be liable for the payment of any portion of the amount of such losses that exceeds$ioo billion,and
in such case insured losses up to that amount are subject to pro rata allocation in accordance with procedures
established by the Secretary of the Treasury.
"Certified act of terrorism"means an act that is certified by the Secretary of the Treasury,in accordance with the
provisions of the federal Terrorism Risk Insurance Act,to be an act of terrorism pursuant to such Act. The criteria
contained in the Terrorism Risk Insurance Act for a"certified act of terrorism"include the following:
1. The act resulted in insured losses in excess of$5 million in the aggregate,attributable to all types of insurance
subject to the Terrorism Risk Insurance Act;and
2. The act is a violent act or an act that is dangerous to human life,property or infrastructure and is committed by
an individual or individuals as part of an effort to coerce the civilian population of the United States or to
influence the policy or affect the conduct of the United States Government by coercion.
B. The terms and limitations of any terrorism exclusion,or the inapplicability or omission of a terrorism exclusion,do
not serve to create coverage for any"loss"that is otherwise excluded under this Policy.
All other terms and conditions of this Policy remain unchanged.
Authorized Representative
PF-45354(01/15) Page 1 of 1
Includes copyrighted material of Insurance Services Office,Inc.,with its permission.
TRADE OR ECONOMIC SANCTIONS ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY.
This insurance does not apply to the extent that trade or economic sanctions or similar laws or regulations prohibit
us from providing insurance,including,but not limited to,the payment of claims. All other terms and conditions of
policy remain unchanged.
Authorized Representative
PF-46422 (07/15) Page 1 of 1
C H u S Be U.S. Treasury Department's
Office
Of Foreign Assets Control
("OFAC")
Advisory Notice to Policyholders
This Policyholder Notice shall not be construed as part of your policy and no coverage is provided by this
Policyholder Notice nor can it be construed to replace any provisions of your policy. You should read your
policy and review your Declarations page for complete information on the coverages you are provided.
This Notice provides information concerning possible impact on your insurance coverage due to directives
issued by OFAC.Please read this Notice carefully.
The Office of Foreign Assets Control(OFAC) administers and enforces sanctions policy,based on Presidential
declarations of"national emergency".OFAC has identified and listed numerous:
• Foreign agents;
• Front organizations;
• Terrorists;
• Terrorist organizations;and
• Narcotics traffickers;
as "Specially Designated Nationals and Blocked Persons". This list can be located on the United States
Treasury's web site—http//www.treas.gov/ofac.
In accordance with OFAC regulations,if it is determined that you or any other insured,or any person or entity
claiming the benefits of this insurance has violated U.S.sanctions law or is a Specially Designated National and
Blocked Person, as identified by OFAC,this insurance will be considered a blocked or frozen contract and all
provisions of this insurance are immediately subject to OFAC. When an insurance policy is considered to be
such a blocked or frozen contract,no payments nor premium refunds may be made without authorization from
OFAC:Other limitations on the premiums and payments also apply.
PF-17914a(o4/16) Reprinted,in part,with permission of Page i of i
ISO Properties,Inc.
CHUBS°
Chubb Producer Compensation
Practices&Policies
Chubb believes that policyholders should have access to information about Chubb's practices and policies related
to the payment of compensation to brokers and independent agents. You can obtain that information by accessing
our website at h=://www.aceproducercompensation.com or by calling the following toll-free telephone number:
1-866-512-2862.
ALL-20887a(03/16)
CHUBB®
U.S. FOREIGN ACCOUNT
TAX COMPLIANCE ACT ("FATCA")
The U.S.Foreign Account Tax Compliance Act,commonly known as"FATCA',became the law in the U.S.in March of
20io and becomes effective July 1,2014. Pursuant to FATCA,brokers,producers,agents and/or clients may need to
obtain withholding certificates from insurance companies. For information on how to obtain the applicable withholding
certificate from Chubb U.S.insurance companies,please go to the following web site:
http://www2.chubb.com/us-en/u-s-foreign-account-tax-compliance-act-fatca.gVx
ALL-4249ob(07/i6)