HomeMy WebLinkAboutRes 17-10 WA Approving WA Insurance Bid with Box Insurance WESTLAKE ACADEMY
RESOLUTION NO. 17-10
A RESOLUTION OF THE WESTLAKE ACADEMY BOARD OF TRUSTEES
AWARDING THE BID FOR PROPERTY/CASUALTY INSURANCE PRODUCTS AND
SERVICES TO BOX INSURANCE AGENCY FOR FY 2017-2018.
WHEREAS, Westlake Academy desires to maintain a comprehensive risk management
program for the protection of its property, students, employees, elected officials, and stakeholders;
and,
WHEREAS, the leaders of Westlake Academy desire to exercise exceptional levels of
stewardship with all financial resources; and,
WHEREAS, the Board of Trustees finds that the passage of this Resolution is in the best
interest of the citizens of Westlake as well as the students, their parents, and faculty of Westlake
Academy,
NOW, THEREFORE, BE IT RESOLVED BY THE BOARD OF TRUSTEES OF
WESTLAKE ACADEMY:
SECTION 1: that the Board of Trustees of Westlake Academy does hereby award the
recommended bid for property/casualty insurance products and services to Box Insurance Agency
for FY 17-18,attached hereto as Exhibit "A'; and further authorize the Superintendent or designee
to execute this agreement.
SECTION 2: that, all matters stated in the Recitals hereinabove are found to be true and
correct and are incorporated herein by reference as if copied in their entirety.
SECTION 3: If any portion of this Resolution shall, for any reason, be declared invalid
by any court of competent jurisdiction, such invalidity shall not affect the remaining provisions
hereof and the Council hereby determines that it would have adopted this Resolution without the
invalid provision.
Resolution WA 17-10
Page 1 of 3
SECTION 4: That this resolution shall become effective from and after its date of
passage.
PASSED AND APPROVED ON THIS 7TH DAY OF AUGUST 2017.
� .
ATTEST: Laura` heat, President
4'aila,
Kelfy. Ed ads, Town Secretary Thomas E. Brymer, erintendent
APPROVED AS TO FORM:
Janet . Bubert or L. tanton Lowry,
Schoo Attorney
Resolution WA 17-10
Page 2 of 3
Exhibit "A"
Recommended Bid — Box Insurance
Coverage Expiring Premium Renewal Premium
Commercial Property-Travelers $ 75,499 $ 79,545
General Liability—Utica $ 11,665.00 $ 12,062.00
Business Auto - Utica $ 2,954.00 $ 2,498.00
Crime -Utica $ 2,670.00 $ 2,670.00
Umbrella($5,000,000)—Utica $ 8,574.00 $ 8,578.00
Workers Compensation -Travelers $ 19,004.00 $23,679.00
Student Accident Policy—QBE $ 4,282.00 $ 4,480.00
International Travel—CHUBB $2,000.00 $2,000.00
Total $1269668.00 $1339790.00
Optional Recommended Coverage Premium
Cyber Liability- Travelers $ 1,670.00
Total Premium $ 1359460.00
Resolution WA 17-10
Page 3 of 3
CERTIFICATE OF INTERESTED PARTIES
(� FORM 1295
(deg I� -10 1of
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2019-524573
Box Insurance Agency
Grapevine,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 08/01/2019
being filed.
Westlake Academy Date Acknowledged:
08/02/2019
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
RFP 17-001
Property&Casualty Insurance
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling Intermediary
Westlake Academy Westlake,TX United States X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is , and my date of birth is
My address is
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in County, State of ,on the day of ,20
(month) (year)
Signature of authorized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.39f8039c
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business. 2019-524573
Westlake Academy
Westlake,TX United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 08/01/2019
being filed.
Box Insurance Agnecy Date Acknowledged:
08/02/2019
3 Provide the identification number used by the governmental entity or state agency to track or identify the contract,and provide a
description of the services,goods,or other property to be provided under the contract.
RFP 17-001
Property&Casualty Insurance
Nature of interest
4
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Westlake Academy Westlake,TX United States X
5 Check only if there is NO Interested Party. ❑
6 UNSWORN DECLARATION
My name is Adam Syswerda and my date of birth is
My address is 1200 S. Main St. Suite 1600 Grapevine TX 76051 USA
(street) (city) (state) (zip code) (country)
I declare under penalty of perjury that the foregoing is true and correct.
Executed in Tarrant County, State of Texas ,on the 5 day of August 20 19
(month) (year)
Signatu�orized agent of contracting business entity
(Declarant)
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.1.39f8039c