Employee - Public Official Dishonesty Certificate of CoverageNON-MEMBER'S CERTIFICATE OF COVERAGE Issue Date
7/1/2021
Special District Risk Management Authority
1112 'I' Street, Suite 300
Sacramento, California 95814800.537.7790 www.sdrma.org
Provider
Costa Mesa Sanitary District
290 Paularino Avenue
Costa Mesa, California 92626
Member Number: 6819Member
Certfcate Number: 7
This is to certfy that coverages listed below have been issued to the Member named above for the period indicated. This certfcate is not an insurance
policy or an agreement of coverage and does not amend, extend or alter the coverage aforded by the agreements listed herein. Notwithstanding any
requirement, term, or conditon of any contract or other document with respect to which this certfcate may be issued or may pertain, the coverage
described herein is subject to all the terms, exclusions, and conditons of the specifc coverage document. This certfcate of coverage evidences the limits
of liability in efect at the incepton of the agreements shown; limits shown may have been reduced by paid claims. This certfcate is issued as a mater of
informaton only and confers no rights upon the certfcate holder.
Type of Coverage LimitsExpiraton DateEfectve DatePolicy Number
7/1/20227/1/2021LCA-SDRMA-202122General Liability
Per OccurrenceEmployee/Public Ofcials Dishonesty (Crime)$1,000,000
Proof of Coverage: Coverage includes Designated Agent as Employee - Marcus Davis As Independent Treasurer for the Costa Mesa Sanitary District.
Cancellaton: Should any of the above-described policies be cancelled before the expiraton dates thereof, the issuing company will mail 30 days
writen notce to the above-named certfcate holder, but failure to mail such notce shall impose no obligaton or liability of any kind upon the company.
Laura S. Gill - Chief Executve Ofcer
endeaver to
Certfcate Dates:Additonal Covered Party
X Evidence of Coverage
Loss Payee
Certfcate Holder
Certfcate Type:Efectve Date
7/1/2021
Expiraton Date
7/1/2022
Costa Mesa Sanitary District
290 Paularino Ave
Costa Mesa, CA 92626