!iil-''
Insurance Agency
OF THE HILL COUNTRY, INC.
123 B Commerce Street
P. O. Box 291549
Kerrville, Texas 78029 - 1549
Phone: (830) 896 - 2400 Fax: (830) 257 - 2057
Online: www.firstinsagency.com Comfort Phone: (830) 995 - 2700
January 06, 2010
Kerr County
Attn: Auditor
700 Main St. Room 103
Kerrville, TX 78028
Re: Professional Liability Policy County Clerk
Dear Mindy Lou Williams,
Enclosed is your Professional Liability policy for the County
Clerk. Please take a few moments to review your policy and
should you have any questions or changes to be made, feel free
to contact us:
Sincerely,
. ~ . ~ ~-
~c:~1 L._.~,,~
Debbie L. Corbin
First Insurance Agency Of The Hill Country, Inc.
This Declaration Page is attached to and forms part of certificate provisions (Form SLC-3 USA).
Previous No. ELC40456 Authority Ref. No. C2800- 09 Certificate No. ELC40467
1
Name and address of the Assured
THE COUNTY CLERK OF KERR COUNTY, TEXAS
POLICY FEE FULLY EARNED
UPON ISSUANCE OF POLICY.
2
3
4
KERR COUNTY COURTHOUSE
KERRVILLE TX 78028
Effective from 01-01-10 TO 01-01-11 both days at 12:01 a.m. standard time
Insurance is effective with certain UNDERWRITERS AT LLOYD'S, LONDON.		Percentage: 100.00%
Amount	Coverage Rate	Premium	State/Rate
$500,000	COUNTY CLERK AND RECORDER	$1,709.00	PREMIUM
EACH AND EVERY	LIABILITY INSURANCE PER		
CLAIM & IN THE	FORM LSW070	$200.00	POLICY FEE
AGGREGATE		$92.58	TAX
INCLUDING CLAIMS	(TERRORISM COVERAGE NOT	$1.15	STAMPING FEE
EXPENSE/COSTS	APPLICABLE TO COVERAGE)		
$2,002.73 TOTAL
5 Special conditions: C2800-09, LSW 070, LSW 541, NMA 1477, NMA 1331, NMA 1256 [03-17-60], NMA 1998,
NMA 2340, NMA 2918 [10-08-01], CN-1, GFN 4-09, ASBESTOS
CLAIMS-MADE BASIS, RETROACTIVE DATE: 01/01/1982
DEDUCTIBLE: $1,000 EACH AND EVERY CLAIM, INCLUDING CLAIMS EXPENSE
PROPOSAL DATED: 10/26/09
6 Service of Suit may be made upon: PER ENDORSEMENT NMA 1998 ATTACHED
Dated QUIRK COMPANY
29-12-09 DRE
P O BOX 792030
SAN ANTONIO TEXAS 78279-2030
by
Correspondent
INSURED
LLOYD'S
One Lime Street London EC3M 7HA
SECURITY
100% UNDERWRITERS AT LLOYDS
PERCENTAGE SYNDICATE NO. SYND
50.00 570 ATR
50.00 958 GSC
czsooio9
(ELC Prefix)
THE SCHEDULE
Policy No.: ELC40467
Name of the Assured:
THE COUNTY CLERK OF KERB COUNTY, TEXAS
Address of the Assured:
KERB COUNTY COURTHOUSE
KERRVILLE, TX 78028
Period of Insurance:
From:
To:
O1/O1/10
O1/O1/11
Both days at 12:01 A.M. Standard Time at address of Assured stated above.
Limits of Liability:
Each Claim: $500,000
Aggregate: $500,000
EACH AND EVERY CLAIM AND 1N THE
AGGREGATE INCL CLAMIS EXPENSE/COSTS
Deductible:
$1,000 EACH AND EVERY CLAIM, INCLUDING CLAIMS EXPENSES/COSTS
Retroactive Date:
01/01/82
Date of Application:
10/26/09
Designee for Service of Suit:
WILSON, ELSER, MOSKOWITZ, EDELMAN & DICKER LLP
150 EAST 42ND STREET
NEW YORK, NEW YORK 10017
Premium: $1,709.00
ANNUAL
Dated in London: 12/29/09 QUIRK & COMPANY (DE)
COUNTY CLERKS AND RECORDERS
PROFESSIONAL INDEMNITY INSURANCE
NOTICE
THIS IS A CLAIMS MADE POLICY
EXCEPT TO SUCH EXTENT AS MAY BE PROVIDED OTHERWISE HEREIN, THIS POLICY IS LIMITED TO
INDEMNITY FOR ONLY THOSE CLAIMS THAT ARE FIRST MADE AGAINST THE ASSURED DURING THE POLICY
PERIOD. PLEASE REVIEW THE POLICY CAREFULLY.
Words which are capitalized in this Policy shall be deemed, where appropriate, to have those meanings as set forth in the
Definitions which are a part of this Policy.
In consideration of the payment of the premium, the undertaking of the ASSURED to pay the deductible as described herein, in
reliance upon the statements in the application attached hereto and made a part hereof, and subject to the Limits of Liability
shown in the Schedule, and subject to all terms of this Insurance, Underwriters agree to indemnify the ASSURED as follows:
INSURING AGREEMENTS
1. COVERAGE: CLAIMS MADE PROVISION:
The Underwriters will indemnify the insured COUNTY CLERK or RECORDER for all sums which the ASSURED
shall become legally obligated to pay as DAMAGES as the result of CLAIMS first made against the ASSURED during
the POLICY PERIOD by reason of any negligent act, error or omission committed or alleged to have been committed by the
ASSURED which arises solely out of the conduct of the ASSURED in his official capacity as a COUNTY CLERK or
RECORDER as hereinafter defined, provided always that:
(a) such CLAIM is not executed by reason of any RETROACTIVE DATE specified in the Schedule,
and,
(b) the ASSURED had no knowledge of any such negligent act, error or omission on or prior to the
effective date of this Policy and there is no prior policy or policies under which the ASSURED is
entitled to indemnify for such CLAIM or suit.
2. DISCOVERY CLAUSE:
If during the POLICY PERIOD, the ASSURED first becomes aware of a specific negligent act, error or
omission for which insurance is provided under the Policy and if the ASSURED shall during the
POLICY PERIOD give written notice to the Underwriters of:
(a) the specific negligent act, error or omission, and
(b) the damage which has resulted or may result therefrom, and
(c) the circumstances by which the ASSURED first became aware thereof,
then any CLAIM subsequently made against the ASSURED arising out of such negligent act, error or
omission shall be deemed for the purpose of this Insurance to have been made during the POLICY
PERIOD. The ASSURED shall cooperate fully with the Underwriters, and any investigation conducted
by the Underwriters or their representatives shall be subject to the terms set forth in this Policy.
3. LIMITS OF LIABILITY:
The liability of Underwriters for each CLAIM first made against the ASSURED during the POLICY
PERIOD, including CLAIM EXPENSES, shall not exceed the amount stated in the Schedule for "each
claim". Subject to that limit for each CLAIM, the total Limit of Underwriters' Liability for all
CLAIMS, including CLAIM EXPENSES, first made against the ASSURED during the POLICY
PERIOD shall never exceed the amount stated in the Schedule as "aggregate". The inclusion herein of
more than one ASSURED or the making of CLAIMS or the bringing of suits by more than one person
or organization shall not operate to increase the Limit of Underwriters' Liability for each CLAIM and
in the aggregate.
4. DEDUCTIBLE:
The deductible amount stated in the Schedule shall be paid by the NAMED ASSURED and shall be
applicable to each CLAIM and shall include CLAIM PAYMENTS and CLAIM EXPENSES, whether
or not CLAIM PAYMENT is made.
5. DEFENSE AND SETTLEMENT:
(a) The ASSURED shall not admit liability for or settle any CLAIM or incur any CLAIM EXPENSES
in connection therewith without the written consent of the Underwriters, who shall be entitled at
any time to take over and conduct in the name of the ASSURED, the defense of any CLAIM, and
the ASSURED shall continue to cooperate fully with the Underwriters in such defense. All CLAIM
EXPENSES shall be subject to the Limits of Liability available for such CLAIMS.
(b) The Underwriters' shall not settle any CLAIM without the consent of the ASSURED, If, however,
the ASSURED shall refuse to consent to any settlement recommended by the Underwriters and
shall elect to contest or continue any legal proceedings in connection with such CLAIM, then the
underwriters' liability for the CLAIM shall not exceed the amount for which the CLAIM could
have been settled plus the CLAIM EXPENSES incurred with their consent up to the date of such
refusal.
DEFINITIONS
1. THE ASSURED:
The unqualified word "ASSURED" whenever used in this Policy means:
(a) The NAMED ASSURED herein defined as the individual named in the Schedule;
(b) any salaried employee or assistant of the NAMED ASSURED while acting within the scope of his
official duties as stated in the Schedule;
(c) any predecessor(s) in office and/or any salaried employee or assistant thereof while formerly acting
within the scope of his official duties as stated in the Schedule;
(d) the county and/or any court of competent jurisdiction and/or any government or administrative
departments of the said county and/or courts within whose jurisdiction the NAMED ASSURED
performs his official duties, and by whom, for the purposes of this Insurance, the NAMED
ASSURED shall be considered to be employed, but solely by reason of those negligent acts, errors
or omissions committed or alleged to have been committed by the NAMED ASSURED in his
official capacity as insured hereunder.
2. POLICY PERIOD:
The term "POLICY PERIOD" whenever used in this Policy shall mean the period from the inception
date of this Policy to the expiration date as set forth in the Schedule or its earlier termination date, if any.
3. RETROACTIVE DATE:
The term "RETROACTIVE DATE" whenever used in this Policy shall mean the date, if any, stated in
the Schedule, and any CLAIM based upon or arising out of any act, error or omission committed or
alleged to have been committed prior to such date is not insured hereunder whether or not such CLAIM
is first made against the ASSURED during the POLICY PERIOD.
4. CLAIM:
The unqualified word "CLAIM" whenever used in this Policy shall mean a written demand received by
the ASSURED for money or services, including the service of suit upon the ASSURED or institution of
arbitration proceedings against the ASSURED.
5. CLAIM EXPENSE:
"CLAIM EXPENSES" means:
(a) fees charged by any attorney designated by Underwriters,
(b) all other fees, costs and expenses resulting from the investigation, adjustment, defense and appeal
of a CLAIM, incurred by Underwriters, and
(c) the reasonable fees charged by any attorney designated by the ASSURED with the written consent
of Underwriters.
6. CLAIM PAYMENTS:
The term "CLAIM PAYMENT" whenever used in this Policy shall mean the payment of DAMAGES
for any settlement or judgment in any CLAIM covered under this Policy.
7. COUNTY CLERK OR RECORDER:
The terms "COUNTY CLERK" or "RECORDER" mean that person or persons designated by
appropriate state or county statute to perform such ministerial, judicial or quasi judicial duties and
responsibilities as specifically delegated to a COUNTY CLERK or RECORDER.
8. DAMAGES:
The word "DAMAGES" whenever used in this Policy means compensatory damages only and does not
include fines, penalties, taxes, punitive, exemplary, multiplied or treble damages, matters uninsurable
under the law pursuant to which the policy is construed, or the return or withdrawal of fees.
EXCLUSIONS
The Insuring Agreements and all other provisions of this Policy shall not apply to, and no coverage shall be afforded under this
Policy for, any CLAIMS, CLAIM PAYMENTS and/or CLAIM EXPENSES for, based upon, relating to, or arising out of:
(a) any intentional, dishonest, fraudulent, criminal or malicious act or any act of infidelity, conversion or
misappropriation of funds, committed or alleged to have been committed by, or at the direction of the
ASSURED, his agents, servants and/or employees.
(b) punitive or exemplary damages, taxes, fines or penalties, except that if a suit is brought against the
ASSURED on a CLAIM falling within the coverage hereof, seeking both compensatory and punitive or
exemplary damages, taxes, fines, or penalties, then the Underwriters will, subject to all other provisions of
this Policy, indemnify for CLAIM EXPENSES incurred in such action, without liability, however, for such
punitive or exemplary damages, taxes, fines, or penalties.
(c) bodily injury to, or sickness, emotional distress, disease or death of any person.
(d) injury to or destruction of any tangible property, including the loss of use thereof.
(e) personal injury, including, but not limited to:
1. libel and slander,
2. invasion of privacy, discrimination, assault or battery.
3. malicious prosecution,
4. false arrest, false imprisonment or detention.
(f) any opinion or certification of title, or any opinion or certification of the marketability of any title, furnished
or rendered by the ASSURED unless otherwise endorsed hereon.
(g) federal or state securities laws, including but not limited to the Securities Act of 1933, the Securities Act of
1934, any amendments thereof or additions thereto, or any rules or regulations issued pursuant to any such
laws.
(h) the performance of professional services as an attorney-at-law.
(i) the handling or disbursement of funds unless otherwise endorsed hereon.
(j) the ownership, maintenance, operation or use of any aircraft, watercraft, automobiles or vehicles of any
kind.
(k) any obligation under any workers compensation law.
(1) the Employee Retirement Income Security Act of 1974 and any amendments thereto or rules or regulations
promulgated thereunder, or similar provisions of any federal, state or local statutory or common law.
(m) any actual or alleged violation of the Racketeer Influenced and Corrupt Organizations Act, 18 USC Section
1961 et seq., and any amendments thereto or rules or regulations promulgated thereunder.
(n) any assertions, allegations, causes or action, proceedings, or demands whatsoever by or on behalf of any
ASSURED or ASSUREDS under this Policy against any other ASSURED or ASSUREDS hereunder.
(o) any liability, loss or damage directly or indirectly occasioned by, happening through or in consequence of
war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion,
revolution, insurrection, military or usurped power or confiscation or nationalization or requisition or
destruction of or damage to property by or under the order of any government or public or local authority.
CONDITIONS
1. ASSURED'S DUTIES IN THE EVENT OF A CLAIM OR SUIT:
The ASSURED shall as a condition precedent to his right to be indemnified under this Insurance give
to Underwriters immediate notice in writing of any CLAIM first made against him, cooperate with
Underwriters and upon Underwriters' request, submit to examination and interrogation by a
representative, under oath if required, and shall attend hearings, depositions and trials, and shall assist
in effecting settlement, securing and giving evidence, obtaining the attendance of witnesses and
assisting in the conduct of suits, as well as in the giving of a written statement or statements to
Underwriters' representatives and meeting with such representatives for the purposes of investigation
and/or defense, and all without charge to the Underwriters.
2. SUBROGATION:
In the event of any payment under this Policy, Underwriters shall be subrogated to all the ASSURED'S
rights of recovery therefor against any person or organization and the ASSURED shall execute and
deliver instruments and papers and do whatever else is necessary to secure such rights. The ASSURED
shall do nothing after the CLAIM to prejudice such rights. Underwriters shall not exercise any such
rights against any persons or corporations included in the definition of ASSURED. Notwithstanding
the foregoing, however, Underwriters reserve the right to exercise any rights of subrogation against an
ASSURED in respect of any CLAIM brought about or contributed to by the intentional, dishonest,
fraudulent, criminal or malicious act or omission of such ASSURED.
3. ACTION AGAINST UNDERWRITERS:
No action shall lie against Underwriters unless, as a condition precedent thereto, the ASSURED shall
have fully complied with all the terms of this Policy, nor until the amount of the ASSURED'S obligation
to pay shall have been fully and finally determined, either by judgment against the ASSURED after actual
trial, or by written agreement of the ASSURED, the claimant and Underwriters.
Any person or organization or the legal representative thereof who has secured such judgment or
written agreement shall thereafter be entitled to recover under this Policy to the extent of the insurance
afforded by the policy, and the coverage available thereunder.
Nothing contained in this Policy shall give any person or organization any right to join Underwriters as
codefendant in any action against the ASSURED to determine the ASSURED'S liability. Bankruptcy
or insolvency of the ASSURED or of the ASSURED'S estate shall not relieve Underwriters of any of
their obligations hereunder.
4. FALSE OR FRAUDULENT CLAIMS:
If the ASSURED shall proffer any CLAIM knowing same to be false or fraudulent, as regards amount
or otherwise, this Insurance shall become null and void and all CLAIMS hereunder shall be forfeited.
5. APPLICATION:
By acceptance of this Policy the ASSURED agrees that the statements in the application are his
representations, that this Policy is issued in reliance upon the truth of such representations, that they shall
be deemed material, and that this Policy embodies all agreements existing between the ASSURED and
Underwriters, or any of their agents, relating to this Insurance.
6. OTHER INSURANCE:
Subject to the limitation of coverage as set forth in Insuring Agreement 1(b) regarding the application of
a prior policy or policies, this Insurance is in excess of the amount of applicable deductible of this
Policy and any other valid and collectible insurance available to the ASSURED whether such other
Insurance is stated to be primary, contributory, excess, contingent or otherwise.
7. CHANGES:
Notice to any agent or knowledge possessed by any agent or by any other persons acting on behalf of
Underwriters shall not effect a waiver or a change in any part of this Policy or estop Underwriters from
asserting any rights under this Policy, nor shall the terms of this Contract be waived or changed, except
by endorsement issued to form a part of this Policy.
8. ASSIGNMENT:
Assignment of interest under this Policy shall not bind Underwriters until their consent is endorsed
hereon. In the event of the death or incompetency of the ASSURED, this Policy shall cover the
Assured's legal representatives as an ASSURED as respects any liability previously incurred and
covered by this Policy.
9. CANCELLATION:
This Policy may be canceled by the NAMED ASSURED by a written notice stating when thereafter
such cancellation shall be effective. If canceled by the NAMED ASSURED, Underwriters shall retain
the short rate proportion of the premium as set out herein.
This Policy may be canceled by the Underwriters by mailing to the NAMED ASSURED written notice
stating when, not less than thirty (30) days thereafter, such cancellation shall be effective, but this
Policy may be canceled as aforesaid by not less than ten days notice when the cancellation is being
effected by reason of the ASSURED'S nonpayment of premium. The mailing of notice as aforementioned
shall be sufficient notice and the effective date of cancellation stated in the notice shall become the end
of the POLICY PERIOD. Delivery of such written notice by the NAMED ASSURED or Underwriters shall
be equivalent to mailing. If canceled by Underwriters, earned premium shall be computed pro rata.
Premium adjustment may be made at any time cancellation is effected or as soon as practicable thereafter.
The check of Underwriters or any of their representatives, mailed or delivered, shall be sufficient tender
of any refund due to the NAMED ASSURED.
10. SERVICE OF SUIT
It is agreed that in the event of the failure of Underwriters hereon to pay any amount claimed to be due
hereunder Underwriters hereon, at the request of the NAMED ASSURED, will submit to the jurisdiction of
a court of competent jurisdiction within the United States. Nothing in this clause constitutes or should be
understood to constitute a waiver of Underwriters' rights to commence an action in any court of competent
jurisdiction in the United States, to remove an action to a United States District Court, or to seek a transfer
of a case to another court as permitted by the laws of the United States or of any State in the United States.
It is further agreed that service of process in such suit against Underwriters maybe made upon the designee
named in the Schedule and that in any suit instituted against them upon this Policy, Underwriters will abide
by the final decision of such court or of any appellate court in the even of an appeal.
The designee so named in the Schedule is hereby authorized and directed to accept service of process
on behalf of Underwriters in any such suit, and/or upon the request of the NAMED ASSURED to give a
written undertaking to the NAMED ASSURED that they will enter a general appearance upon
Underwriters' behalf in the event such suit shall be instituted.
Further, pursuant to any statute of any state, territory or district of the United States which makes provision
therefor, Underwriters hereon hereby designate the Superintendent, Commissioner, or Director of Insurance
or other officer specified for that purpose in the statute, or his successors in office, as their true and lawful
attorney upon whom maybe served any lawful process in any action, suit or proceeding instituted by or on
behalf of the NAMED ASSURED or any beneficiary hereunder arising out of this Policy and hereby
designate the above named as the person to whom said officer is authorized to mail such process or a true
copy thereof.
11. CONFORMITY TO STATUTE:
Terms of this Policy which are in conflict with the statutes of the state wherein this Policy is issued are
hereby amended to conform to such statutes.
	SHORT RATE CANCELLATION TABLE	
Days Insurance in Force	% of One Year Premium	Days Insurance in Force % of One Year Premium
1 ..........................................	5	154 - 156	...................................	53
2 ...........................................	6	157 - 160	...................................	54
3-4 .......................................	7	161-164	...................................	55
5-6 .......................................	8	165-167	...................................	56
7-8 .......................................	9	168-171	...................................	57
9-10 .......................................	10	172 - 175	...................................	58
11 - 12 .................................	11	176 - 178	.....................................	59
13 - 14 ...................................	12	179 - 182	(6 months) ...............	60
15-16 ...................................	13	183-187	...................................	61
17-18 ...................................	14	188-191	...................................	62
19 - 20 ...................................	15	192 - 196	...................................	63
21 - 22 ...................................	16	197 - 200	...................................	64
23 - 25 ...................................	17	201 - 205	...................................	65
26 - 29 ...................................	18	206 - 209	...................................	66
30 - 32 (1 month) .................	19	210 - 214	(7 months) ...............	67
33-36 ...................................	20	215-218	...................................	68
37 - 40 ...................................	21	219 - 223	...................................	69
41 - 43 ...................................	22	224 - 228	...................................	70
44 - 47 ...................................	23	229 - 232	...................................	71
48 - 51 ...................................	24	233 - 237	...................................	72
52 - 54 ...................................	25	238 - 241	...................................	73
55 - 58 ...................................	26	242 - 246	(8 months) ...............	74
59 - 62 (2 months) ...............	27	247 - 250	...................................	75
63 - 65 ...................................	28	251 - 255	...................................	76
66 - 69 ...................................	29	256 - 260	...................................	77
70 - 73 ...................................	30	261 - 264	...................................	78
74 - 76 ...................................	31	265 - 269	...................................	79
77 - 80 ...................................	32	270 - 273	(9 months) ...............	80
81 - 83 ...................................	33	274 - 278	...................................	81
84 - 87 ...................................	34	279 - 282	...................................	82
88 - 91 (3 months) ...............	35	283 - 287	...................................	83
92 - 94 ...................................	36	288 - 291	...................................	84
95 - 98 ...................................	37	292 - 296	...................................	85
99 - 102 ...................................	38	297 - 301	...................................	86
103 - 105 .................................	39	302 - 305	(10 months) ............	87
106 - 109 .................................	40	306 - 310	...................................	88
110 - 113 .................................	41	311 - 314	...................................	89
114-116 .................................	42	315-319	...................................	90
117 - 120 .................................	43	320 - 323	...................................	91
121 - 124 (4 months) ......	44	324 - 328	...................................	92
125 - 127 .................................	45	329 - 332	...................................	93
128 - 131 .................................	46	333 - 337	(11 months) .............	94
132 - 135 .................................	47	338 - 342	...................................	95
136 - 138 .................................	48	343 - 346	...................................	96
139 - 142 .................................	49	347 - 351	...................................	97
143 - 146 .................................	50	352 - 355	..................................	98
147 - 149 .................................	51	356 - 360	..................................	99
150 - 153 (5 months) ......	52	361 - 365	(12 months) ............	100
Notwithstanding anything contained herein to the contrary, the following clause
shall apply:
R.I.CO. EXCLUSION
In consideration of the premium charged, it is hereby understood and agreed
that there shall be no liability hereunder in respect of any loss payments or
claims expenses directly or indirectly brought about by, arising out of, or
attributable to:
any actual or alleged violation of the Racketeer Influenced and Corrupt
Organisations Act, 18 USC Sections 1961 et seq., or any comparable
state law, and any amendments thereto, or any rules or regulations
promulgated thereunder.
01/94
LSW541
Page 1 of 1 INSURED LSW 1001
RADIOACTIVE CONTAMINATION EXCLUSION CLAUSE-LIABILITY-DIRECT (U.S.A.)
For attachment (in addition to the appropriate Nuclear Incident Exclusion Clause-Liability-Direct) to
liability insurances affording worldwide coverage.
In relation to liability arising outside the U.S.A., its Territories or Possessions, Puerto Rico or the Canal
Zone, this Policy does not cover any liability of whatsoever nature directly or indirectly caused by or
contributed to by or arising from ionising radiations or contamination by radioactivity from any nuclear
fuel or from any nuclear waste from the combustion of nuclear fuel.
13/2/64
NMA1477
CANCELLATION CLAUSE
NOTWITHSTANDING anything contained in this Insurance to the contrary this
Insurance may be cancelled by the Assured at any time by written notice or by
surrendering of this Contract of Insurance. This Insurance may also be
cancelled by or on behalf of the Underwriters by delivering to the Assured or by
mailing to the Assured, by registered, certified or other first class mail, at the
Assured's address as shown in this Insurance, written notice stating when, not
less than 30 days thereafter, the cancellation shall be effective. The mailing of
notice aforesaid shall be sufficient proof of notice and this Insurance shall
terminate at the date and hour specified in such notice.
If this Insurance shall be cancelled by the Assured the Underwriters shall retain
the customary short rate proportion of the premium hereon, except that if this
Insurance is on an adjustable basis the Underwriters shall receive the Earned
Premium hereon or the customary short rate proportion of any Minimum
Premium stipulated herein whichever is the greater.
If this Insurance shall be cancelled by or on behalf of the Underwriters the
Underwriters shall retain the pro rata proportion of the premium hereon, except
that if this Insurance is on an adjustable basis the Underwriters shall receive the
Earned Premium hereon or the pro rata proportion of any Minimum Premium
stipulated herein whichever is the greater.
Payment or tender of any Unearned Premium by the Underwriters shall not be a
condition precedent to the effectiveness of Cancellation but such payment shall
be made as soon as practicable.
If the period of limitation relating to the giving of notice is prohibited or made void
by any law controlling the construction thereof, such period shall be deemed to
be amended so as to be equal to the minimum period of limitation permitted by
such law.
20/4/61
NMA 1331 INSURED Page 1 of 1
NUCLEAR EXCLUSION CLAUSE-LIABILITY-DIRECT (BROAD) (U.S.A.)
For attachment to insurances of the following classifications in the U.S.A., its Territories and
Possessions, Puerto Rico and the Canal Zone:
Owners, Landlords and Tenants Liability, Contractual Liability, Elevator Liability, Owners or
Contractors (including railroad) Protective Liability, Manufacturers and Contractors Liability, Product
Liability, Professional and Malpractice Liability, Storekeepers Liability, Garage Liability, Automobile
Liability (including Massachusetts Motor Vehicle or Garage Liability),
not being insurances of the classifications to which the Nuclear Incident Exclusion Clause-Liability-Direct
(Limited) applies.
This Policy' does not apply:
Under any Liability Coverage, to injury, sickness, disease, death or destruction:
(a) with respect to which an insured under the Policy is also an insured under a nuclear energy
liability policy issued by Nuclear Energy Liability Insurance Association, Mutual Atomic
Energy Liability Underwriters or Nuclear Insurance Association of Canada, or would be an
insured under any such policy but for its termination upon exhaustion of its limit of liability;
or
(b) resulting from the hazardous properties of nuclear material and with respect to which (1) any
person or organization is required to maintain financial protection pursuant to the Atomic
Energy Act of 1954, or any law amendatory thereof, or (2) the insured is, or had this Policy
not been issued would be, entitled to indemnity from the United States of America, or any
agency thereof, under any agreement entered into by the United States of America, or any
agency thereof, with any person or organization.
11. Under any Medical Payments Coverage, or under any Supplementary Payments Provision
relating to immediate medical or surgical relief, to expenses incurred with respect to bodily injury,
sickness, disease or death resulting from the hazardous properties of nuclear material and arising
out of the operation of a nuclear facility by any person or organization.
III. Under any Liability Coverage, to injury, sickness, disease, death or destruction resulting from the
hazardous properties of nuclear material, if:
(a) the nuclear material (1) is at any nuclear facility owned by, or operated by or on behalf of, an
insured or (2) has been discharged or dispersed therefrom;
(b) the nuclear material is contained ion spent fuel or waste at any time possessed, handled,
used, processed, stored, transported or disposed of by or on behalf of an insured; or
(c) the injury, sickness, disease, death or destruction arises out of the furnishing by an insured of
services, materials, parts or equipment in connection with the planning, construction,
maintenance, operation or use of any nuclear facility, but if such facility is located within the
United States of America, its territories or possessions or Canada, this exclusion (c) applies
only to injury to or destruction or property at such nuclear facility.
IV. As used in this endorsement:
"hazardous properties" include radioactive, toxic or explosive properties; "nuclear material"
means source material, special nuclear material or by-product material; "source material",
"special nuclear material", and "by-product material" have the meanings given them in the Atomic
Energy Act of 1954 or in any law amendatory thereof; "spent fuel" means any fuel element or
fuel component, solid or liquid, which has been used or exposed to radiation in a nuclear reactor;
"waste" means any waste material (1) containing by-product material and (2) resulting from the
operation by any person or organization of any nuclear facility included within the definition of
nuclear facility under paragraph (a) or (b) thereof; "nuclear facility" means:
(a) any nuclear reactor,
(b) any equipment or device designed or used for (1) separating the isotopes of uranium or
plutonium, (2) processing or utilizing spent fuel, or (3) handling, processing or packaging
waste,
(c) any equipment or device used for the processing, fabricating or alloying of special nuclear
material if at any time the total amount of such material in the custody of the insured at the
premises where such equipment or device is located consists of or contains more than 25
grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of
uranium 235,
3/17/60
Page 1 of 2 INSURED NMA 1256
(d) any structure, basin, excavation, premises or place prepared or used for the storage or
disposal of waste,
and includes the site on which any of the foregoing is located, all operations conducted on such
site and all premises used for such operations; "nuclear reactor" means any apparatus
designed or used to sustain nuclear fission in aself-supporting chain reaction or to contain a
critical mass of fissionable material. With respect to injury to or destruction of property, the
word "injury" or "destruction" includes all forms of radioactive contamination of property.
It is understood and agreed that, except as specifically provided in the foregoing to the contrary, this
clause is subject to the terms, exclusions, conditions and limitations of the Policy to which it is attached.
*NOTE: As respects policies which afford liability coverages and other forms of coverage in addition, the
words underlined should be amended to designate the liability coverage to which this clause is td apply.
3/17/60
Page 2 of 2 INSURED NMA 1256
SERVICE OF SUIT CLAUSE (U.S.A.)
(Approved by Lloyd's Underwriters Non-Marine Association)
It is agreed that in the event of the failure of the Underwriters hereon to pay any
amount claimed to be due hereunder, the Underwriters hereon, at the request of
the Insured (or Reinsured), will submit to the jurisdiction of a Court of competent
jurisdiction within the United States. Nothing in this Clause constitutes or should
be understood to constitute a waiver of Underwriters' rights to commence an
action in any Court of competent jurisdiction in the United States, to remove an
action to a United States District Court, or to seek a transfer of a case to another
Court as permitted by the laws of the United States or of any State in the United
States. It is further agreed that service of process in such suit may be made upon
Wilson, Elser, Moskowitz, Edelman & Dicker, LLP, 150 East 42nd Street,
New York , NY 10017
and that in any suit instituted against any one of them upon this contract,
Underwriters will abide by the final decision of such Court or of any Appellate
Court in the event of an appeal.
The above-named are authorized and directed to accept service of process on
behalf of Underwriters in any such suit and/or upon the request of the Insured (or
Reinsured) to give a written undertaking to the Insured (or Reinsured) that they will
enter a general appearance upon Underwriters' behalf in the event such a suit
shall be instituted.
Further, pursuant to any statute of any state, territory or district of the United
States which makes provision therefore, Underwriters hereon hereby designate
the Superintendent, Commissioner or Director of Insurance or other officer
specified for that purpose in the statute, or his successor or successors in office,
as their true and lawful attorney upon whom may be served any lawful process in
any action, suit or proceeding instituted by or on behalf of the insured (or
Reinsured) or any beneficiary hereunder arising out of this contract of insurance
(or reinsurance), and hereby designate the above-named as the person to whom
the said officer is authorized to mail such process or a true copy thereof.
24/4/86
NMA 1998 INSURED Page 1 of 1
U.S.A. & CANADA
LAND, WATER AND AIR EXCLUSION
Notwithstanding any provision to the contrary within the Policy of which this
Endorsement forms part (or within any other Endorsement which forms part of this
Policy), this Policy does not insure land (including but not limited to land on which
the insured property is located), water or air, howsoever and wherever occurring,
or any interest or right therein.
SEEPAGE AND/OR POLLUTION AND/OR CONTAMINATION EXCLUSION
Notwithstanding any provision to the contrary within the Policy of which this
Endorsement forms part (or within any other Endorsement which forms part of this
Policy), this Policy does not insure:
(a) any loss, damage, cost or expense, or
(b) any increase in insured loss, damage, cost or expense, or
(c) any loss, damage, cost, expense, fine or penalty, which is incurred, sustained
or imposed by order, direction, instruction or request of, or by any agreement
with, any court, government agency or any public, civil or military authority, or
threat thereof, (and whether or not as a result of public or private litigation).
which arises from any kind of seepage or any kind of pollution and/or
contamination, or threat thereof, whether or not caused by or resulting from a peril
insured, or from steps or measures taken in connection with the avoidance,
prevention, abatement, mitigation, remediation, clean-up or removal of such
seepage or pollution and/or contamination or threat thereof.
The term "any kind of seepage or any kind of pollution and/or contamination" as
used in this Endorsement includes (but is not limited to):
(a) seepage of, or pollution and/or contamination by, anything, including but not
limited to, any material designated as a "hazardous substance" by the United
States Environmental Protection Agency or as a "hazardous material" by the
United States Department of Transportation, or defined as a "toxic
substance" by the Canadian Environmental Protection Act for the purposes of
Part II of that Act, or any substance designated or defined as toxic,
dangerous, hazardous or deleterious to persons or the environment under
any other Federal, State, Provincial, Municipal or other law, ordinance or
regulation; and
(b) the presence, existence, or release of anything which endangers or
threatens to endanger the health, safety or welfare of persons or the
environment.
24/11 /88
NMA 2340 INSURED Page 1 of 3
DEBRIS REMOVAL ENDORSEMENT
THIS ENDORSEMENT CONTAINS PROVISIONS WHICH MAY LIMIT OR
PREVENT RECOVERY UNDER THIS POLICY FOR LOSS WHERE COSTS OR
EXPENSES FOR DEBRIS REMOVAL ARE INCURRED.
Nothing contained in this Endorsement shall override any Seepage and/or
Pollution and/or Contamination Exclusion or any Radioactive Contamination
Exclusion or any other Exclusion applicable to this Policy.
Any provision within this Policy (or within any other Endorsement which forms part
of this Policy) which insures debris removal is cancelled and replaced by the
following:
In the event of direct physical damage to or destruction of property, for which
Underwriters hereon agree to pay, or which but for the application of a
deductible or underlying amount they would agree to pay (hereinafter
referred to as "Damage or Destruction"), this Policy also insures, within the
Sum Insured, subject to the limitations and method of calculation below, and
to all the other terms and conditions of the Policy, costs or expenses;
(a) which are reasonably and necessarily incurred by the Assured in the
removal, from the premises of the Assured at which the Damage or
Destruction occurred, of debris which results from the Damage or
Destruction; and
(b) of which the Assured becomes aware and advises the amount thereof
to Underwriters hereon within one year of the commencement of such
Damage or Destruction.
2. In calculation the amount, if any, payable under this Policy for loss where
costs or expenses for removal of debris are incurred by the Assured (subject
to the limitations in paragraph 1 above):
(a) the maximum amount of such costs or expenses that can be included
in the method of calculation set out in (b) below shall be the greater of
US$25,000 (twenty-five thousand dollars) or 10% (ten percent) of the
amount of the Damage or Destruction from which such costs or
expenses result; and
24/11 /88
NMA 2340 INSURED Page 2 of 3
(b) the amount of such costs or expenses as limited in (a) above shall be
added to:
(i) the amount of the Damage or Destruction; and
(ii) all other amounts of loss, which arise as a result of the same
occurrence, and for which Underwriters hereon also agree to pay,
or which but for the application of a deductible or underlying
amount they would agree to pay; and
the resulting sum shall be the amount to which any deductible or
underlying amount to which this Policy is subject and the limit (or
applicable sub-limit) of this Policy, shall be applied.
24/11 /88
NMA 2340 INSURED Page 3 of 3
WAR AND TERRORISM EXCLUSION ENDORSEMENT
Notwithstanding any provision to the contrary within this insurance or any endorsement thereto
it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature
directly or indirectly caused by, resulting from or in connection with any of the following
regardless of any other cause or event contributing concurrently or in any other sequence to the
loss;
1. war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be
declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the
proportions of or amounting to an uprising, military or usurped power; or
2. any act of terrorism.
For the purpose of this endorsement an act of terrorism means an act, including but not
limited to the use of force or violence and/or the threat thereof, of any person or
group(s) of persons, whether acting alone or on behalf of or in connection with any
organisation(s) or government(s), committed for political, religious, ideological or similar
purposes including the intention to influence any government and/or to put the public, or any
section of the public, in fear.
This endorsement also excludes loss, damage, cost or expense of whatsoever nature directly or
indirectly caused by, resulting from or in connection with any action taken in controlling,
preventing, suppressing or in any way relating to 1 and/or 2 above.
If the Underwriters allege that by reason of this exclusion, any loss, damage, cost or expense is
not covered by this insurance the burden of proving the contrary shall be upon the Assured.
In the event any portion of this endorsement is found to be invalid or unenforceable, the
remainder shall remain in full force and effect.
08/10/01
NMA2918
IMPORTANT NOTICE
To obtain information or make a complaint:
You may contact the Texas Department of
Insurance to obtain information on companies,
coverages, rights or complaints at:
1-800-252-3439
You may write the Texas Department of
Insurance:
P.O. Box 149104
Austin, TX 78714-9104
Fax (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: ConsumerProtection@tdi.state.tx.us
PREMIUM OR CLAIM DISPUTES:
Should you have a dispute concerning your
premium or about a claim you should contact the
agent first. If the dispute is not resolved, you may
contact the Texas Department of Insurance.
ATTACH THIS NOTICE TO YOUR POLICY:
This notice is for information only and does not
become a part or condition of the attached
document.
AVISO IMPORTANTE
Para obtener information o para someter una
queja:
Puede comunicarse con el Departamento de
Seguros de Texas para obtener information
acerca de companias, coberturas, derechos o
quejas al:
1-800-252-3439
Puede escribir al Departamento de Seguros de
Texas:
P. O. Box 149104
Austin, TX 78714-9104
Fax: (512) 475-1771
Web: http://www.tdi.state.tx.us
E-mail: ConsumerProtection@tdi.state.tx.us
DISPUTAS SOBRE PRIMAS O RECLAMOS:
Si tiene una disputa concerniente a su prima o a
un reclamo, debe comunicarse con el agente
primero. Si no se resuelve la disputa, Puede
entonces comunicarse con el departamento
(TDI).
UNA ESTE AVISO A SU POLIZA: Este aviso
es solo para proposito de information y no se
convierte en parte o condition det documento
adjunto.
Page 1 of 1 CN-1 (07/07)
Guaranty Fund Nonparticipation Notice
This insurance contract is with an insurer not licensed to transact insurance in this state
and is issued and delivered as surplus line coverage under the Texas insurance statutes.
The Texas Department of Insurance does not audit the finances or review the solvency
of the surplus lines insurer providing this coverage, and the insurer is not a member of
the property and casualty insurance guaranty association created under Chapter 462,
Insurance Code. Chapter 225, Insurance Code, requires payment of a 4.85 percent tax
on gross premium.
Page 1 of 1 INSURED GFN 4-09
ASBESTOS EXCLUSION:
This Policy shall not apply to CLAIMS or CLAIMS EXPENSES arising directly or
indirectly out of or resulting from or in consequence of, or in any way involving
Asbestos, or any materials containing asbestos in whatever form or quantity.
TOXIC MOLD EXCLUSION:
In consideration for the premium charged, it is hereby understood and agreed that
the coverage afforded by this Policy shall not apply to:
A. CLAIMS or CLAIMS EXPENSES which, either in whole or in part, directly or
indirectly, are for, based upon, relate to, or arise out of:
(1) The actual, potential, alleged or threatened formation, growth, presence,
release or dispersal of any fungi, molds, spores or mycotoxins of any kind; or
(2) Any action taken by any party in response to the actual, potential, alleged or
threatened formation, growth, presence, release or dispersal of fungi, molds,
spores or mycotoxins of any kind, such action to include investigating, testing for,
detection of, monitoring of, treating, remediating or removing such fungi, molds,
spores or mycotoxins;
B. Any governmental or regulatory order, requirement, directive, mandate or
decree that any party take action in response to the actual, potential, alleged or
threatened formation, growth, presence, release or dispersal of fungi, molds,
spores or mycotoxins of any kind, such action to include investigating, testing for,
detection of, monitoring of, treating, remediating or removing such fungi, molds,
spores or mycotoxins;
C. Underwriters will have no duty or obligation to defend any Insured with respect
to any CLAIM or governmental or regulatory order, requirement, directive, mandate
or decree which, either in whole or in part, directly or indirectly, is for, based upon,
relates to, or arises out of the actual, potential, alleged or threatened formation,
growth, presence, release or dispersal of any fungi, molds, spores or mycotoxins of
any kind.
P U R C H A S E O R_ D E h
Kerr County
FURC~IASE ORDER # 09-06172 11/05l?_009
SHIP TO: ISSUED TO:
KERR COUNTY VEND #: OI-2986 REQ #09-0617?
?00 MAIN FIRST INSURANCE AGENCY
KER,RVILLE TX 78028 P. O. BOX. 191599
(83U) 792-2235 KERRVILLE, TX ~l8C29-1543
I fig~3Y APFFY'3JE ~IHE I.~T.Y~E; OF `THIS I HEFiFBY CQ~IZFY TIC' TrIE 1~'LLJNI' OF THIS ~r
~t'~HASE; C;F2I~7~. IIAS H~Il~ ENIERID FL~II~F>I' THE i'-ESIQ~ID APPId~'RIF~TICN
PO~~TIS PI~ID Tf~' iHIS II~~ IS [~~i THE
C7-~ry~ `I~~~cgi PUIf~IZED AUF~I.AC~LE, H~Lr'YS~, OF S`1ID AE?FTdX~.TFul ~~.
CY(PF- iHS 5Hi DyY ~ I~PJJENffiZ 2009 C1~sy1 Trrsrpsca~i
(A~ ~2I:F'I'IQQ G/I, ~~]T TRICE PMXJNI'
O.0L #40427 E&O Ins 1/1/10-11 10 -403-206 ~ & II~JRhISE
0.00 2, 002. "74
*** ~g~L, *** 2,002,79
~'1r _i1~
~~
TI-IIS A~`~ IS APE~~IED FEZ PAYP~EIVI' iN Try
~SJNP II~I~ A~JE.
~: ~ ~~o
First Ins. Agency
123 B Commerce Street
POB 291549
Kerrville TX 78029-1549
(830) 896-2400
Kerr County
Attn: Auditor
700 Main St. Room 103
Kerrville
TX 78028-0000
INVOICE
Invoice Number: 40427
Date: 11!02/2009
AMOUNT REMITTED:
Please detatch and return with remittance
Description ~I Price !, Amount
#40427 ~ 2,002 74 2 002.74
COUNTY CLERK E&O
EFFECTIVE: 1/1/2010-2011 i
',
Notes
'. PLEASE REMIT UPON RECEIPT
''~, THANK YOU
----__
ASINVIA
Please Pay This Amount L,UUL./4
.._ _..
_ _ __
Q112003 1-34
.~~~'`
Insurance Agency
OF THE HILL COUNTRY, INC.
123 B Commerce Street
P. O. Box 291549
Kerrville, Texas 78029 - 1549
Phone: (830) 896 - 2400 Fax: (830) 257 - 2057
Online: www.firstinsagency.com Comfort Phone: (830) 995 - 2700
November 02, 2009
Kerr County
Attn: Auditor
700 Main St. Room 103
Kerrville, TX 78028
Re: County Clerk Errors & Omissions Insurance
Dear Mindy Lou Williams,
The County Clerk Errors & Omissions policy expires on 1/1/2010,
The renewal premium will be $2,002.74. I have enclosed an
invoice. Please remit premium to renew policy PRIOR to
effective date of 1/1/2010.
If you have any questions, please give me a call!
Sincerely,
~~~ ~ ~~~
Debbie L. Corbin
First Insurance Agency Of The Hill Country, Inc.
_-. x.;49 1::17 &M R E Q U I S i T I 0 N R E G i 5 T E R
.'~h'E 1 !. ~. x'13765-11•~`_~09-3 CTYCLK cat
hn0.#: 09-06172 VENDOR: 01-2536 PI P.ST INSURANCE AGENCY
S TATO: NEW APPR^VED BY: Cheryl ihnmpson
!)E PI'r 903 Oi?UERED BY: Cheryl Thompson
SHIP-T0: 000 KERR COUNTY
i~T'IN: i030i ,92-2235
-- _ .. ACCOONT NAME DESCRIPTION
. .. ,,~_ -_ BONDS s INSURANCE N90927 E6G Ins 1/1/10-i1
d4U42? Ea0 Ins i/1/10-1i
ISSUb'D: 11~OS/?009
EST DEL: 11/05/2009
__________= ORDERED =_
UNITS PRICE
TOTAL ORDERED
PAGE:
09-06P2
KELEAS E: FLF.~:;:
RE::EIVK F?,AG: ,~
AMOUNT
2, 002.?9
?,002."14
l. i~ ~`~+"'~ R E Q U I S I T I O N R E G 1~ T E k
..-~::"c.'7 N0: 1!3'65-ll15u9-; C'CYCLR cat
-~. TO'PALS BY MGNTA fVND MONTH ITEMS P.MOVNT
10 11 !2005 Z ~9
TOTALS ** ] i~?2. 79
. ..;. TC?AL: BY DEPARTMEN?' DEPARTMENT PO'S AMOCJNT
903 1 2, 002.7q
'IOTAL9 " 1 ?,002,74
.-, ,C ;'HL:~ P.Y STATUS PO'S AMOUNT
NF.W I _,~;~"~2.7q
OUTSTANDING 0 v.Gu
"' TOTALS •* 1 2,002.74
PAGE: 2
___. .. ~!S rF. [NEED FO'S PG'S AMOiJNT
s liS PF,N U~~L p0
.~-__-1009 ;i:i2 Ai9 R. E Q U I S I T I G N R E G I S T E R
~R::KET P:,i: ~1Vi6~-il!:509-.3 CTYCLK cat
P.O. TCTALS BY G1L ACCOUNT
FAGF:
		-° -._===	LINE ITEM= .-:.	- -==GR SOP BUCK ~
		ANNUAL	BUDGET OV&P.	ANNUAL. BGUGE. ,,9$p,
-_- ACCOUNT NAME	PO'S AMOUNT	BUDGET	AVAILABLE BUUG	BUGGF,T AVAIL.§BI, ~. BU DC;
'~ - °,+-: 06 BONUS 5 INSUW.NCE	1 2,00[.74	3,106	1,103.26	
" 09-IO YEAR TOTALS '*	2,002.74			
-..k EU~1~"-N ..
REQUISITION N P. %„ N MESSAGE OTHER INFC
NO WARNING(SI
N^. ERROR (5!

Insurance Agency
OF THE HILL COUNTRY, INC.
123 B Commerce Street
P. O. Box 291549
Kerrville, Texas 78029 - 1549
Phone: (830) 896 - 2400 Fax: (830) 257 - 2057
Online: www.firstinsagency.com Comfort Phone: (830) 995 - 2700
October 23, 2009
Kerr County
Attn: Auditor
700 Main St. Room 103
Kerrville, TX 78028
Re: PROFESSIONAL LIABILITY RENEWAL
INSURED: JANETTE PIEPER
Dear Mindy Lou Williams,
The professional liability policy for Janette Pieper renews on
01/01/2010. Please complete the enclosed application, sign and
date and return to me by 11/10/09. As soon as the quote is
received, I will send it to you.
Please contact me should you have any questions.
Sincerely,
Debbie L. Corbin
First Insurance Agency Of The Hill Country, Inc.
,~°t
;~
~~ ~
1
COUNTY CLERK $ RECORDER INDEMNITY INSURANCE
PROPOSAL FORM
(THIS APPLICATION IS FOR A CLAIMS MADE POLICY)
THROUGH: QUIRK ~ COMPANY -SAN ANTONIO, TEXAS
LPL.CC 12/73/60
1. Name of Proposer: (~) Clerk	'I. Jannett Pieper, County Clerk, Kerr Cou
(b) Recorder	Texas
(c) County	
2. Date of Elsction/Appointment to	
present County:	
{a) Clerk	2. Elected 11-3-1998
(b} Recorder	
3. Policy tern! desired: ~	3. 1 year 1/1/201.0
Commencing at	
4. Does the Proposer wish coverage on	4.
a retroactive basis? t.e. for any un-	
known, undiscovered errors or	Yes
omissions made during the named	
Proposer's previous brm in office in	
the County as state above.	
Date from which retroactive	1/1/1982
coverage is required?	
6. Does your County employ a County	5. Clerk only
Clerk only or in addition a County	
Recorder?	
6. Number of staff{including the	6. 14 Full Time
Proposer) in the County Clerk's	
Office?	
Number of staff (including the	
Proposer} in the Recorder's Office?	
	
nty,

7. (a) Previous Carrier:
(b) Policy Dates:
(c) Retro Date
(d) Has any application for this type
of Insurance ever been decUned
or has any similar Insurance
canceled?
7. Lloyd's of London
of/0l/201o to 0l/01/2011
01/01/1982
No
8. Have any claims been made against 8. No
the Proposer or to hb knowledge
against his predecessors in office?
If so, please give details.
9. Is the Proposer awaro of any 9. ,~' 0
circumstances which might result
in any claim being made against
him? If so, please give details.
10. Amount of Indemnity required? 10. $ 300 , o00
Amount of Deductible? s loo
IIWe hereby declare that the above statements and particulars are true and
INVe have not suppressed or mis-etat~d any mabrial facts and UWe agree
that this declaration shall be the basis of the contract betvwen me/us and
the Undorwrkors.
Date: /©- a~ - c~ 9
Signature of proposer:'`~~ >