Municipal Program Application Municipal Program Application Step 1 of 9 11% Entity NameAddress Street or Mailing Address City ZIP / Postal Code Type of Municipality City Borough Other PopulationFEINCity Manager or Similar Official First Name Last Name TitlePhoneEmail Who should APRA contact to discuss your coverage? First Name Last Name TitlePhoneEmail Will you be working with a broker? Yes No If so, First Name Last Name Name of FirmAddress Street Address City State ZIP / Postal Code PhoneEmail Member will compensate Broker in the form of: A flat fee to be paid directly to broker by the member Commission If paying commission, what percentage of gross contribution?If the broker's compensation is in the form of a percentage commission, would you like APRA to include it in the quoted premium contribution? Yes No Members working with a broker will receive a discount of 5% or $50,000, whichever is less, on their premium contribution. If you have questions on how to complete this questionnaire or the materials needed to be submitted, please contact your broker, or one of the APRA underwriting staff at *protected email* or 907-523-9400 or 907-258-2625. Municipal Attorney Name Firm Other InsuranceDoes your municipality have any insurance policies issued by an insurer other than APRA that apply to property or liability exposures? This includes coverage for property (including flood or earthquake), liability, workers’ compensation, aviation, and marine, but not health insurance. Yes No If yes, describe the policies and insurers:Employment Practices and Legal ConsultationsAPRA’s employment practices coverage for wrongful termination is contingent upon conferring with an attorney before terminating or non-retaining an employee and then following the advice given by the attorney.(Required) By checking this box, I acknowledge an understanding of this requirement.Scheduled Buildings or Other StructuresAPRA’s property coverage requires that buildings and other structures be scheduled (insured) for their full replacement value. Members may schedule particular buildings for an amount less than their full replacement value if those buildings are listed on an Agreed Value Endorsement, which limits the coverage in the event of a loss to the scheduled value. Do you wish to cover any of your buildings or other structures for an Agreed Value less than their full replacement cost? Yes No If yes, list the buildings and the desired values.You may also upload the list as a separate document here:Max. file size: 50 MB.Are all buildings or other structures on the schedule, other than the ones listed above, scheduled for their full replacement cost? Yes No In no, explain: Exposure Questions1) AircraftDoes your municipality permit employees to pilot any aircraft when travelling on municipal business? Yes No Does your municipality own or lease any aircraft? Yes No Note: The APRA General Liability Policy does not extend to any aircraft operation. 2) AirportsDoes your municipality operate or maintain an airport? Yes No If yes, who owns the airport? Municipality State Other 3) Alcoholic Beverages and Liquor StoresDoes your municipality own or operate liquor stores or other establishments for the distribution or sale of alcohol? Yes No If yes, please complete and submit the Liquor Liability Questionnaire. Note: the APRA General Liability Policy does not cover liability related to the sale of alcohol. This coverage may be added for specific operations, upon submission of the Liquor Liability Questionnaire and approval by APRA.4) Dams and ReservoirsDoes your municipality own or operate a Dam or Reservoir? Yes No If yes, please complete the Dam and Reservoir Exposure Addendum separately for each Dam or Reservoir that you own or operate.5) DaycareDoes your municipality operate a Daycare center for children or adults? Yes No If yes, describe the center, the age group for which you offer care, and staffing.6) DriversDescribe the procedures your municipality follows to verify that employees and volunteers who drive vehicles for work have valid driver’s licenses. How frequently are licenses re-verified to ensure they are still valid? 7) Drones Does your municipality use any drones? Yes No If yes, please describe how they are used, for what purpose, and who operates the drone(s):8) Electric Utilities Does your municipality operate an electrical utility? Yes No If yes, describe the electrical distribution services provided, including your customers, outsourced services, and contingency plans.9) ErosionIs any property currently under imminent threat of damage due to erosion? Yes No If yes, describe:APRA property coverage does not include loss due to erosion 10) Events Centers / Public Events Does your municipality operate any facility that is available for rent to the public? Yes No Does your municipality require Usage Agreements for its rentals? Yes No Does your municipality require Lessees to show evidence of liability insurance for large events? Yes No 11) Fire Department / Rescue / Ambulance Services Does your municipality operate a Fire Department, Rescue, or Ambulance Service? Yes No If yes, has your municipality submitted the 2025 Fire Department Registration Form required to be submitted to the State of Alaska, Department of Public Safety by January 31, 2025 Yes No If yes, please upload a copy of the Registration FormMax. file size: 50 MB.Note: APRA needs the registration form submitted to the Department of Public Safety, not the certificate sent in return. For more information about the 2025 Fire Department Registration Form: Go to: https://dps.alaska.gov/Fire/FDRegistration Expand “Fire Department Registration” Click on the “FD Registration Summary Report and Membership Roster” hyperlink to download the 2025 Fire Department Registration Form. If no, please explain your anticipated timeline for making the submission.12) Fireworks Does your municipality hold, or issue permits for others to hold, fireworks displays? Yes No Note that the APRA liability policy does not regularly cover losses due to fireworks. This can be added upon request for specific events. If you have any specific fireworks events that you would like to have coverage for, please list them here:13) Hospital, Clinic, or Nursing Home Does your municipality own or operate a hospital, clinic, or nursing home? Yes No If yes, describe the facility, including the types of services provided:Is this facility operated by a third party. If so, name of 3rd Party:14) Law Enforcement and/or Jail or Detention Facility Does your municipality employ or contract with Law Enforcement Personnel of any kind? Yes No If no, who is responsible for law enforcement in your area?Does your municipality operate a Jail or Detention Facility? Yes No The APRA policy provides $1 million of liability coverage for law enforcement activities. Higher limits are available upon request, subject to APRA approval. To request higher policy limits, please complete the separate Law Enforcement Questionnaire. 15) MarijuanaDoes your municipality have any involvement in the growing, selling, testing or distribution of marijuana? This includes the use of member-owned facilities by a private party for this purpose. Yes No If yes, explain:16) PermafrostIs any property currently under imminent threat of damage due to thawing permafrost? Yes No If yes, describe:APRA property coverage does NOT include loss due to the thawing of permafrost. 17) Ports or MarinasDoes your municipality own or operate any active port facility or marina? Yes No If yes, describe the port facility or marina:Are boat hauling, storage, or repairs performed? Yes No If yes, describe the hauling, storage, and repair and who performs the activities:18) Public Transportation / Para-Transit ProgramDoes your municipality own or operate Public Transportation or a Para-Transit Program? Yes No 19) Seward UtilityDoes your municipality maintain a sewage disposal plant? Yes No If no, describe the current disposal methods and who is responsible for the maintenance:If yes, describe the services provided:20) Ski Facilities Does your municipality own or operate a downhill ski facility? Yes No 21) Swimming PoolsDoes your municipality own or operate a Swimming Pool? Yes No If yes, describe pool(s), including any sharing of pool management or operations with another party:22) Telecommuting Do any employees live and work from outside Alaska? Yes No If yes, provide the number of employees and the state(s) they reside in:Note: The APRA Workers’ Compensation coverage does NOT extend to employees whose primary workplace is outside of Alaska. APRA can help you obtain appropriate coverage for these employees through another carrier. 23) Underwater Divers Does your organization have employees performing underwater diving? Yes No If yes, describe the nature and frequency of dive operations: 24) Waste Disposal / Garbage CollectionDoes your organization own or operate any waste disposal facilities? Yes No If yes, describe the facilities and services:Does your organization own or operate a water utility? Yes No If yes, describe the services provided:26) WatercraftDoes your municipality own or lease any Watercraft that are over 27 ft. long? Yes No Note: APRA liability and property coverage does NOT extend to powered owned or leased watercraft over 27 feet long. CERTIFICATION The person submitting this form is authorized to act for the member in the application for insurance coverage. They have read and understand this application and confirm that all statements, schedules, and documents provided are true, complete, and accurate. If any event occurs before July 1, 2025, that makes any statement here untrue or incomplete, the member representative will report it in writing to APRA immediately. Submitting this application does not obligate the member to buy insurance from APRA, nor does reviewing it require APRA to issue a policy. This application will form the basis of the contract if a policy is issued. This must be submitted by the City Manager, Mayor, or similarly authorized individual. Name of person submitting this form First Last Title PhoneEmail Δ
