12. YourPPO Network is: Blue Cross Blue Shield
13. Your Utilization Review Provider is: Anthem
14. Eligible for coverage:
Retirees: Yes [X] No[ ] Late Entrants: Yes [ ] No [X] Other - Retirees Pre-65 Only: Yes[X]No[ ]
15. Estimated Covered Units:
Covered Unit Description Units
Composite 2050
16, Initial premium deposit accompanying this Application:
$154,693.00
17. COVERAGES
QBE QBE INSURANCE CORPORATION
STATE OF DOMICILE: PENNSYLVANIA
APPLICATION FOR EXCESS LOSS INSURANCE POLICY
Policy Number: LGS02732-22
1,
10.
11.
Full legal name of Policyholder: Tax ID Number:
City of Nashua 02-6000581
(as it will appear in the Policy)
Principal Office Address:
229 Main Street Nashua, NH _ 03060
(street) icity) (state) (zip)
Contact Person: Kim Kleiner Email: kleinerki@nashuanh.gov
Nature of Business: 9111 Executive Offices
Also enclosed is the Premium & Enrollment statement. Premiurn is due on the first ofevery month. Please note that
premium must be remitted directly to the PO BOX address listed on the Premium & Enrollment statement. A
completed copy of this statementshould be remitted with each payment,
QGE A&H
123 Pleasant Street. 3‘ Floor
Marblehead M401945
Toll Free 800 742 9279
qbeah com
June 8. 2022
Beth Cutliffe
HUB International Limited
1667 Elm Street, Suite 3
Manchester, NH 03101
Dear Beth
Re: Policy Issuance
Policyholder: City of Nashua, July 01, 2022
Policy Number: LGS02732-22
Thank you for selecting QBE Insurance Corporation for City of Nashuas Excess Loss Policy We are pleased to have
the opportunily lo service your cllentand hope to exceed yaur expectal ons.
we
Stop Loss Comparison for:
City of Nashua
City of Nashua
Administrative Services Division (603) 589-3020
229 Main Street - Nashua, NH 03060
Ta: Mayor Donchess
Finance Committee
Date: June 27, 2022
Re: Stop Loss Coverage FY23
This request is approval of a contract with QBE Insurance Corporation for the City of Nashua’s Excess
Loss Policy, otherwise known as Stop Loss.
Funding: Benefits Fund 13.6600.890- 59615 Stop Loss Coverage $1,905,516.
City of Nashua
Purchasing Department
Administrative Services Division (603) 589-3330
229 Main Street - Nashua, NH 03060 Fax (603) 594-3233
June 29, 2022
Memo #23-304
TO: Mayor Donchess
Finance Committee
SUBJECT: Excess Loss Insurance in the amount not to exceed $1,905,516 funded from 59165 Stop
Loss Coverage/Benefits Internal Service Fund
Jim Donchess
Mayor e City of Nashua
To: Board of Aldermen
From: Mayor Jim Donchess
Date: June 29, 2022
Re: Contract Award in Excess of $1M-— Excess Loss Insurance Coverage
Pursuant to NRO: § 5-74/B: E. Approval by the Finance Committee of a contract award in excess of
$1,000,000 shall be submitted to the full Board of Aldermen at its next regularly scheduled meeting
for final approval prior to award of the contract.
T FE LVU E Dan Joworisak <djoworisak@telvue.com>
6 o\\
Johnson, Pete <johnson.peta@nashuanh.gov> Mon, Jun 20, 2022 at 4:08 PM
To: Dan Joworisak <djoworisak@telvue.com>
RE: Nashua TelVue Care
1 message
Hi Dan,
The city has decided to go with the 2 Year TelVue care extension discussed below for $15,500
21505 Invoice 16011
TelVue Corporation Date 6/17/2022
16000 HORIZON WAY JUN 2 4 2022 Page 1
SUITE 100
MT, LAUREL NJ 08054
Bill To: Ship To:
City of Nashua City of Nashua
Accounts Payable, PO Box 2019 Accounts Payable, PO Box 2019
229 Main Street 229 Main Street
NashuaNH 03061-2019 Nashua NH 03061-2019
Purchage Order No. | Customer ID Salesperson ID Shipping Method nt Terms Ship Oste __| Master No.
Won (o!2Alzg. | T08778 Net 30 6/17/2022 16,181
