176x Filetype XLSX File size 0.05 MB Source: csdpool.org
Business Income and Extra Expense Worksheet The Colorado Special Districts Property and Liability Pool (CSD Pool) provides a $250,000 Business Income and Extra Expense limit Per Occurrence to all members with scheduled property; however, higher limits are available. Completing a worksheet can help determine the appropriate limit for your district. What we are looking to determine through this process is a premises that: 1) generates income that would cease if there was no longer access to that location 2) generates income that would cease if it was destroyed 3) continuing expenses the district would incur even though no revenue was being generated 4) extra expenses the district would incur in trying to resume operations through another means. Named Member: Location(s): Address: Estimated Values Projected Values 2021 2022 Revenue Gross Operating Revenue minus Revenue Deductions Returns and Allowances Discounts Bad Debts Contractual Allowances Provider Fee Charity Donation Other minus continuing revenue such as: Tax Revenue Grants Tap Fees and Contributions Interest Other Covered Revenue (Covered) $ - $ - Expenses Gross Operating Expenses minus non-continuing expenses such as: Utilities (if no longer needed) Supplies Purchased Services and other Repairs & Maintenance Capital Outlay / Expenditures Operational Debt Service Other TOTAL Continuing Expenses $ - $ - Business Income Limit $ - $ - Business Income and Extra Expense Worksheet Estimated Values Projected Values Estimated Extra Expenses 2021 2022 Relocating Equipment and Property Emergency Services Rent for a Temporary Premises Property Coverage Utilities Equipment Rentals Computer Rentals Travel Expenses Overtime and/or Additional Staf Other Extra Expenses Limit $ - $ - Business Income and Extra Expense Limit $ - $ - The total Business Income and Extra Expense limit calculated above represents the worst possible loss of income the district foresees. This is the limit the CSD Pool will use for the 2022 coverage term unless you wish to cover your exposure at a lower level than calculated above. You can elect to do so by entering a revised limit below. REVISED BUSINESS INCOME AND EXTRA EXPENSE LIMIT REQUESTED: Signed Dated Once completed, please sign, date and e-mail it to pc@csdpool.org. Forms must be e-mailed from an official address (no personal email accounts). *If you prefer to sign this "electronically" please send the auto-filled form back with the signature line above empty from your work email address. By sending this form electronically, you agree to the electronic transmission of this form. Further, you acknowledge that the CSD Pool will retain records related to this business income worksheet electronically.
no reviews yet
Please Login to review.