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<br />City of Santa Ana <br />Excess Workers' Compensation <br />Carrier Information Proposed <br />Policy Term 7/1/2025 - 7/1/2026 <br />Carrier Response Indemnity Company of California <br />A.M. Best Rating <br />Admitted/Non-Admitted <br />Payment Plan <br />Payment Method <br />A- X <br />Admitted <br />In Full <br />Agency Bill <br />Premium & Exposures <br />Premium <br />Proposed <br />$327,547.00 <br />Exposure / TIV <br />Rate <br />$142,743,924 - Total Payroll <br />0.2295 <br />TRIA Included <br />Minimum Type <br />Minimum Amount / Description <br />Estimated Cost <br />Minimum And Deposit Premium <br />$327,547 <br />$327,547.00 <br />States <br />States Covered: CA <br />States Excluded: OH, ND, WA, WY <br />Extraterritorial Jurisdictions: <br />Standard Coverages Proposed <br />Coverage A - Workers' Compensation Statutory <br />Per Occurrence, Each Accident: Per Person, <br />Each Occupational Disease or Cumulative <br />Trauma <br />$500,000 <br />Optional Coverages Proposed <br />$750,000 xs $1,250,000 <br />$1,000,000 xs $1,000,000 <br />Premium : $475,721 <br />Premium : $735,719 <br />Deductibles/SIR Proposed <br />Retention - Workers Compensation - Limit & <br />Retention per occurrence, each Accident: per <br />person, each Occupational Disease or <br />Cumulative Trauma <br />$1,500,000 <br />Endorsements (including but not limited to) <br />Policy form - FSIR 00 01 02 17 <br />Subject to Audit: At Expiration <br />16 <br />  <br />  <br />City Council 15 – 20 8/5/2025