Note X – Risk Management (for participating member of pool)
Note 1 – General (for public entity risk pool)
The (city/county/district) is a member of the (pool) (Pool). Chapter 48.62 RCW authorizes the governing body of any one or more governmental entities to form together into or join a pool or organization for the joint purchasing of insurance, and/or joint self-insuring, and/or joint hiring or contracting for risk management services to the same extent that they may individually purchase insurance, self-insure, or hire or contract for risk management services. An agreement to form a pooling arrangement was made pursuant to the provisions of Chapter 39.34 RCW, the Interlocal Cooperation Act. The Pool was formed on (date) when (city/county/district) in the state of Washington joined together by signing an Interlocal Governmental Agreement to pool their self-insured losses and jointly purchase insurance and administrative services. (Number of participating members) (city/county/district) have joined the Pool.
The Pool allows members to (state purposes: i.e., jointly purchase insurance coverage, establish a plan of self-insurance, and provide related services, such as risk management, etc.). (State type of policy coverage: i.e., coverage for public official liability is on a “claims made basis.” All other coverages are on an “occurrence” basis.) The Pool provides the following forms of group purchased insurance coverage for its members: list by type of policy: i.e., property, liability, vehicle, other mobile equipment, electronic data processing equipment, bonds of various types, excess liability, public official liability, and machinery breakdown, etc.
Members make an annual contribution to fund the Pool. The Pool acquires insurance from unrelated underwriters that are subject to a per-occurrence deductible of $__________. Members are responsible for the first $__________ of the deductible amount of each claim, while the Pool is responsible for the remaining $__________. Insurance carriers cover all losses over $__________ to the maximum limits of each policy. Since the Pool is a cooperative program, there is a joint liability among the participating members.
Each new member pays the Pool an admittance fee. This amount covers the member’s share of organizational expenses and the cost of analyzing their loss data and risk profile. Members contract to remain in the Pool for a minimum of (number) year(s), and must give notice (number) year(s) before terminating participation. The Interlocal Governmental Agreement is renewed automatically each year after the initial (number) year period. Even after termination, a member is still responsible for contributions to the Pool for any unresolved, unreported, and in-process claims for the period they were a signatory to the interlocal governmental agreement.
The Pool is fully funded by its member participants. Claims are filed by members with (name of third party administrator, if appropriate) which has been contracted to perform claims adjustment, loss prevention, and property appraisal services for the Pool. Fees paid to the third party administrator under this arrangement for the year ended _______________, 20___ were $__________, which included fees for appraisal services. For ____ , the Pool has contracted with the third party administrator to perform claims adjustment and loss prevention services for $__________.
The Pool is governed by a board of directors which is comprised of one designated representative from each participating member. An executive committee is elected at the annual meeting, and is responsible for conducting the business affairs of the Pool.
Instructions to preparer:
 Insert next reporting year.