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.