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Insurance - CMSD - 1984-05-15 Pchcy.No. PO 4 • PUBLIC OFFICIALS LIABILITY POLICY 5 Renewal of PO 22371 FOPUM INSURANCE COMPANY PROVIDENCE, RHODE ISLAND EXECUTIVE OFFICES. 140 S. STATE ST CHICAGO ILLINOIS 60603 DECLARATIONS Item A. NAMED INSURED- COSTA MESA SANITARY DISTRICT Producer Code: ADDRESS. P 0 BOX 1200 COSTA MESA, CA 92628-1200 Item B. Policy Period: From 12:01 A.M. MAY 15 1984 to 12:01 A.M. MAY 15, 1987 standard time at the address of the Insured as stated herein Thi Dacia ati page issued conju ction ith nd forms part of the Public Offic als Liability Policy. Item C. Limits of Liability $ 5 000 000 00 Each Loss (Including 'Loss Expenses ) $ 5 000 000 00 Maximum Annual Aggregate Item D. Deductible $ 1 000 00 Each Loss Item E. Premium $ 11 861 00 $ At Inception On On Item F Designee of Public Entity to report claims as provided paragraph VI. FINANCE DIRECTOR Item G. otice o claim shall given to: Forum Insurance Company 140 South State Street Chicago, Illinoi 60603 Atten: Claims Manager Item H. Form Numbers of Endorsements attached at issuance: ENDORSEMENT #1 //////)) �/�/J� COUNTERSIGN ED• `_0i#64 horized Representative MW IC 404 ORIGINAL ,5 ENDORSEMENT Effective Date MAY 15, 1984 GENERAL AMENDATORY ENDORSMENT In consideration of the premium charged for this policy, it is understood and agreed that 1 The word "Hospital" as used in Paragraph III (b) (3) of the policy wording is defined to include all Hospitals, Clinics, Nursing Homes, Rehabilitation Facilities and other similar health care operations. 2 Paragraph IV Exclusions (a) (9) is amended to read as follows Arising out of the Insured's acting in a fiduciary capacity as respects any employee benefit plan or as Trustee of any employee benefit plan. 3 Paragraph IV Exclusions (a) (10) is deleted in its entirety and Exclusion (a) (11) is amended to (a) (10) ALL OTHER TERMS, CONDITIONS AND LIMITATIONS OF THIS POLICY REMAIN UNCHANGED Attached to and made a part of Policy No. pr) 75746 of FORUM INSURANCE COMPANY issued to COSTA MESA SANITARY DISTRICT Countersigned• At: Date C eoed Gerald E. Dennis, Secretary Howard President By Authorized Representative 301 — 105 3YR FORjJM INSURANCE COMPANY PROVIDENCE,RHODE ISLAND EXECUTIVE OFFICES: CHICAGO, ILLINOIS 1taci ;,7 N g .+•e W tit , t;7" .''.:: ..Y- v*C?'!W- r, t I1C- S ib Ce THI S IS A PROPOSAL FOR A CLAIMS MADE POLICY 1 Name and Address of Public Entity. COSTA MESA SANITARY DISTRICT P O Box 1200 , Costa Mesa, CA 92628-1200 Present Population Unknown (approx 90 , 000 +) Current Policy Number PO 22371 (Forum Insur Co ) Expiration Date May 15, 1984 2. Names and Official Titles of Governing Board Members NAME TITLE JAMES A WARNER President ORMA 0 CRANK Vice President ROBERT HANSON Secretary HARRY S . GREEN Director STEVEN R. SMITH Director 3. (a) The last completed fiscal year ended on June 30 , 1983 Actual income for fiscal year S 1, 892 , 726 Actual expenditures for fiscal year$ 1, 985, 104 (b) Total Budget Current Fiscal Year s3 , 301 , 052 Surplus or (Deficit) Si None - Balanced Estimated IUD-Budget next Fiscal Year $ 3'400, 000 Surplus or (Deficit) $ None — Balanced MWIC 370 Id) Does the Public Entity anticipate any special projects which will result in a substantial budget increase in the next three r4 years? No If yes please detail: 4. Does the authority of the Governing Board here listed cover the operation and allocated budget of: (a) an airport Yes— Nom Current Budget S (b) hospital,clinic, nursing home or other health care operation Yes_ No X...._ Current Budget S (c) gas or electric utility Yes_ No X Current Budget S (dl 'chool Yes_ No_X Current Budget S 5. It is agreed that this renewal Proposal is a supplement to the original Proposal dated 4/16/81 and that no oche'cubstantial changes in the original Proposal information have occurred except as herewith indicated.This renewal Proposal together with the original Proposal shall form the basis of contract and the undersigned declare to the best of their knowledge that the statements set forth herein are true. Signing of this Proposal does not bind the undersigned to complete the insurance. TWO SIGNATURES ARE REQUIRED Signed -e!' II /✓�- Date 29 (Chief Executiv- Official) (Title) ,/ e Signed r� Date 4.44184- C2 ir or) ;Title! Submitted by (Name of Agent; A1WIC 370 �L�✓�/\ AGENT Attach a copy of bid specifications,,iif am. c �/ PLEASE RETURN TO YOUR NEAREST r CM-iit Srrinh OFFICE. .�sa,k lJm it : S.+:v- 171.. K bCS ;.L 'rtSin• iL �ff . iglar 1 m ♦ rt 5muh hne a.m.lo[_ :,.Stewart Smith co M�rLyn IQ. LM}311J.1 5r S:Wacker r Dives Inc IL ,K�t°anSrn a i l& .ert 7doSTr4lrSti'A:jj X13`.o Waslme swd ar .Gtr National Rw1x 6 4 325 5 Made Drove_max_,�x .d )af1.1(In k Awe � Y ;,,.,"P.-;;;;C:4:;,:.791))1asMRles icw 1 . (313).�.aiaS4 - mlr infr•inho6 `'s'*i T'VlxsIID51 r+ l0.620.l 1 (MI 963-7061 ' r ;. 'i3IDZ367m < "?r# "•' ^•z-,yufaleea�os3-cf Y}'"s __a r t.� . . - .. w x.r�v _.... . ..'• �(c- rit SAN FRANCISCO _' • _t^� IL'�@l tMli t NEW YORK 3300 WILSHIRE BLVD. SEATTLE LOS ANGELES 90010 CHICAGO 'J 194900 7369600 INVOICE NUMBER 7 7 5 3 6 0 CHARGE TO COSTA MESA SANITARY DISTRICT PO BOX 1200 DATE MAY 23 84 COSTA MESA, CA 92626-1200 ORDER NUMBER B 94526 Please Indicate Our Invoice ASSURED Number When Remitting IF DIFFERENT for Ready Identification- 15-87 POLICY 5-15-84 — COMMENCES EXPIRES POLICY NUMBER COMPANY COVERAGE LOCATION AMOUNT PREMIUM P025746 FORUM INS PUBLIC OFFICIALS LIABILITY 11 861 00 cq { 6C AVL 11 861 00 ZONE 32 R qi VS3 t ( A.! I 1k3H_2 7,, 4'Uill MAKE ALL PAYMENTS TO BAYLY MARTIN & FAY INC. ORIGINAL 'THIS IS A CLAIMS MADE POLICY---PLEASE READ CAREFULLY' - STOCK COMPANY ii . FORUM INSURANCE COMPANY PROVIDENCE, RHODE ISLAND EXECUTIVE OFFICES: L i' 1 ,../ 140 S. STATE ST CHICAGO, ILLINOIS 60603 ( i3 �iJr`� + ! ��L VIi • PUBLIC OFFICIALS LIABILITY POLICY IN CONSIDERATION of the payment of the premium and subject to all of the terms, conditions and limitations of this policy the Forum Insurance Company hereinafter called the Company agrees: I. Insuring Clause: claim or claims which may be first made against (a) With the Insureds that if during the policy period the Insureds during the period of twelve calendar any claim or claims are first made against the months after the date of such cancellation or non- Insureds, individually or collectively for a renewal but only in respect of any Wrongful Act Wrongful Act the Company will pay on behalf of committed before the date of such cancellation or in accordance with the terms of this policy the non-renewal. Such twelve month period is Insureds. or any of them their Executors. hereinafter referred to as extended discovery Administrators or Assigns for all loss which the period' This right of extension shall terminate said Insureds, or any of them shall become legally unless written notice is given to the Company obligated to pay as damages, within thirty (30) days after the effective date of (b) With the Public Entity that if during the policy cancellation or non-renewal period, any claim or claims are first made against III. Definitions: the Insureds. individually or collectively for a Wrongful Act the Company will pay on behalf of (a) •Public Entity shall mean the City Town Village. in accordance with the terms of this policy the Governmental Body or Administrative Department Public Entity for all loss for which the Public Entity or Agency named and defined in Item A of the may be required or permitted by law to indemnify Declarations as legally constituted at the inception such Insureds, of the policy (c) With the Public Entity that if during the policy (b) 'Insured' shall mean the Public Entity named in period any claim or claims are first made against it Item A of the Declarations and those persons who as a result of any Wrongful Act the Company will were, now or shall be duly elected or appointed pay on behalf of in accordance with the terms of officials or members or full-time employees of the this policy all loss which the Public Entity shall governing body of such commissions, boards or become legally obligated to pay as damages, and, other units operating by and under the jurisdiction as respects I. (a) (b) (c) the Company of such governing body and within an ap- shall have the right.and duty to defend any suit portionment of the total operating budget in- against the Insured seeking damages on account dicated in the proposal form. 'Full-time employee of such Wronful Act even if any of the allegations shall not include any person hired by the Public of the suit are groundless, false or fraudulent and Entity working less than 20 hours per week. 'Full- may make such investigation and settlement of any time employee shall not include any person claim or suit as it deems expedient but the working on a retainer or contractual agreement. Company shall not be obligated to pay any claim or 'Insured' shall not include any of the following to defend any suit after the limits of the Company s boards, commissions. authorities, units or ad- liability have been .exhausted by payment of ministrative departments or agencies unless claims. judgements, and/or settlements. specifically endorsed hereon: I School 2. airport, 3. hospital 4. municipally II. Extensions: owned gas or electric utility (a) This policy shall cover loss arising from any claim (c) 'Wrongful Act shall mean any actual or alleged first made during the policy period against error or misstatement or act or omission or neglect the estates, heirs legal representatives or assigns or breach of duty including misfeasance, of deceased persons, who were Insured at the time malfeasance, and non-feasance by the Insureds in of the Wrongful Act upon which such claims are the discharge of their duties with the Public Entity based. individually or collectively or any matter claimed (b) If the Company shall cancel or refuse to renew this against them solely by reason of their being or policy the Insureds shall have the right upon having been Insureds. payment of an additional premium of 25% of the (d) 'Loss shall mean any amount which the Insureds three year premium hereunder to an extension of are legally obligated to pay including, but not the coverage granted by this policy in respect of a limited to any amounts which the Public Entity MWIC 405 may be required or permitted to pay as indemnity such discharge, dispersal, release or escape is to an Insured, for a claim or claims made against sudden and accidental' an Insured fora Wrongful Act and shall include but (8) for which the Insureds are entitled to in- not be limited to damages, judgements, set- demnity and/or payment by reason of having tlements and costs, cost of investigation and given notice of any circumstances which might defense of legal actions (excluding salaries of give rise to a claim under any policy or policies officers or employees of the Public Entity or any the term of which has expired prior to the other governmental body) claims or proceedings inception date of this policy and appeals therefrom, premiums on bonds to (g) for any claims arising out of the Insured's release attachments or similar bonds but without acting in a fiduciary capacity or as trustee or in any obligation to apply for or furnish any such any similar capacity' bonds, provided always, however such subject of (10) for any claim against any attorney architect, loss shall not include fines and penalties imposed engineer or accountant while acting in the by law and any amounts due or payable under the scope of his professional duties, terms of any contractual obligation. (11) for any damages arising from inverse con- (e) 'Policy Year' shall mean the period of one year demnation, adverse possession or dedication commencing on the effective date and hour of this by adverse use. policy or any anniversary thereof or if the time between the effective date or any anniversary and V Limits of Liability' the termination of the policy is less than one year (a) The Company will be liable to pay each and every such lesser period. loss hereunder which shall include all costs, charges and expenses in excess of the deductible IV Exclusions: shown in Item D of the Declarations and up to the (a) The Company shall not be liable to make any limits of liability as shown under Item C of the payment in connection with any claim made Declarations. The deductible set out in Item D of against the Insureds: the Declarations shall remain uninsured. The Company may pay all or any part of the deductible (1) fact any upon profit it or advantage to their they were amount to effect settlement of any claim or suit or fact deg profit ti aed, including remuneration to defend such claim or suit and upon notification paid in violation of law as determined by of the action taken the Insured shall promptly the Courts; reimburse the Company for such amount of the (2) brought about or contributed to by fraud or deductible amount as has been paid by the dishonesty of an Insured; however not- Company withstanding the foregoing, the Insureds shall (b) Losses based on or of one or more of the of the same nsureds be protected under the terms of this policy as to any claims upon which suit may be brought shall be considered a single loss and only one against them by reason of any alleged fraud or deductible shall be applicable to such single dishonesty on the part of any Insureds, unless loss. a judgement or other final adjudication thereof (c) Subject to the foregoing, in no event shall the adverse to such insureds shall establish that Company's total limit of liability in any one policy acts of active or deliberate dishonesty or fraud year exceed the maximum annual aggregate stated committed by such Insureds was material to in Item C of the Declarations. However maximum the cause of action so adjudicated; liability in the last policy year shall not be in- (3) which is insured by another valid policy or creased for any discovery period. policies or which shall be deemed uninsurable under the law pursuant to which this policy VI. Notice of Claim: shall be construed; (4) for any damages arising from bodily injury, (a) If during the policy period or the extended sickness, mental anguish, disease or death of discovery period the Public Entity or any Insureds any person or for damage to or destruction of shall receive written or oral notice from any party any tangible property including loss of use that it is the intention of such party to hold the Insureds responsible for a Wrongful Act they shall thereof' give written notice to the Company of the receipt of (5) for false arrest libel, slander defamation of such written notice or oral notice as soon as character invasion of privacy wrongful practicable, but in no event exceeding one year eviction, assault or battery' then any claim which may subsequently be made (6) based upon or attributable to the rendering or against the Insureds arising out of such Wrongful failure to render any opinion, treatment, Act shall, for the purpose of this policy be treated consultation or service if such opinion, as a claim made during the policy year in which treatment consultation or service was ren- such notice was given or if given during the ex dered or failed to have been rendered while tended discovery period, as a claim made during such Insureds were engaged in any activity for the last policy year which they received compensation from any (b) The Public Entity or any Insureds, or the named source other than the Public Entity named in designee shall, as a condition precedent to their Item A of the Declarations or were gratuitously rights under this policy give the Company notice engaged other than by specific direction of the in writing as soon as practicable of any claim made Public Entity named in Item A of the and shall give the Company such information and Declarations; cooperation as it may reasonably require. (7) arising out of the discharge, dispersal release (c) For the purpose of the above clauses notice to the or escape of smoke, vapors, soot, fumes, designee named under Item F of the Declarations acids, alkalis, toxic chemicals, liquids or shall constitute notice to the Public Entity or to gases, waste materials or other irritants, con- any Insureds. taminants or pollutants into or upon land, the (dl In the event of any claim occurring hereunder atmosphere or any watercourse or body of notice to the Company shall be given to the person water' but this exclusion does not apply if or firm(s) shown under Item G of the Declarations. prepaid mail properly addressed. payment to all rights of recovery therefore, and the Insureds shall execute all papers required and shall VII. GENERAL CONDITIONS: do everything that may be necessary to secure and (a) Warranty and Seyerability Clause preserve such rights including the execution of it is warranted that the particulars and statements such documents necessary to enable the Company contained in the written proposal copy of which is nsu edely to bring suit in the name of the Insureds.hereto and the Declarations are the basis nsureds. of this policy and are to be considered as in- (d) Public Entity Authorization Clause corporated in and constituting part of the policy By acceptance of this policy the Public Entity As respects the particulars and statements con- named in Item A of the Declarations agrees to act tained in the written proposal and the Exclusions on behalf of all Insureds with respect to the giving set forth herein this policy shall be construed as a and receiving of notice of claim or cancellation the separate agreement with each Insured Nothing in payment of premiums and the receiving of any this paragraph shall be construed to increase the return premiums, that may become due under this Company's maximum liability as set forth in policy and the Insureds agree that the Public Entity Section V of this policy shall act on their behalf (b) Cancellation Clause (e) Conformity Clause This policy may be canceled by the Insureds at any Terms of this policy which are in conflict with the time by written notice or by surrender of this statutes of those states wherein certain provisions policy This policy may also be canceled by or on and coverages included under this policy are not behalf of the Company by delivery to the Insureds or by mailing to the Insureds by registered, cer permitted are hereby ges as amended to cover only rm to tilled •or other first class mail at the Insured's provisions and coverages as apply and conform to address shown in this policy written notice stating such statutes when, not less than thirty (30) days thereafter the (f) Action Against Company cancellation shall become effective.The mailing of No action shall lie against the Company unless as such notice as aforesaid shall be sufficient proof of a condition precedent thereto the Insureds shall notice and this policy shall terminate at the date have fully complied with all terms of this policy In and hour specified in such notice. the event of the bankruptcy or insolvency of the If this policy shall be canceled by the Insureds, the Insureds. the Company shall not be relieved of the Company shall retain the customary short rate payment of such indemnity hereunder as would proportion of the premium hereon have been payable but for such bankruptcy or If this policy shall be canceled by or on behalf of insolvency the Company the Company shall retain the pro- (g) Changes rata proportion of the premium hereon. Payment or Notice to any agent or knowledge possessed by tender of any unearned premium by the Company any agent or by any other person shall not effect a shall not be a condition precedent to the el- waiver or a in any a fectiveness of cancellation but such payment shall 9 Y errt of this policy or estop the Company from asserting any right under be made as soon as practicable If the period of the terms of this policy nor shall the terms of this limitation relating to the giving of notice is policy be waived or changed except by en- prohibited or made void by any law controlling the dorsement issued to form part of this policy construction thereof such period shall be deemed to be amended so as to be equal to the minimum (h) Assignment period of limitation by such law Assignment of interest under this policy shall not (c) Subrogation Clause bind the Company until its consent is endorsed In the event of any payment under this policy the hereon IN WITNESS WHEREOF the Company has caused this policy to be executed and attested out this policy shall not be valid unless countersigned by a dui),Authorized Representative of the Company /Leaf I Zr-afeeaff>- lit /irprfti Gerald E. Dennis,Secretary Howard H. Lamb,President NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) This endorsement modifies the provisions of this policy. It is agreed that II As used in this endorsement I. This policy does not apply: 'hazardous properties' include radioactive, toxic or explosive properties; A. Under any Liability Coverage. to bodily injury or property damage 'nuclear material' means source material, special nuclear material or by- III with respect to which an insured under this policy is also an insured product material, under a nuclear energy liability policy issued by Nuclear Energy liability Insurance Association, Mutual Atomic Energy Liability Underwriters or 'source material' 'special nuclear material' and 'byproduct material' have Nuclear Insurance Association of Canada. or would be an insured under the meanings given them in the Atomic Energy Act of 1954 or in any law any such policy but for its termination upon exhaustion of its limit of amendatory thereof, liability;or means any fuel element orfuel component, solid or liquid,which (2) resulting from the hazardous properties of nuclear material and with 'spent fuel' respect lo which (a) any person or organization is required to maintain has been used or exposed to radiation in a nuclear reactor; financial protection pursuant to the Atomic Energy Act of 1954. or any 'waste means any waste material (1) containing byproduct material and been issued would thereof,e or lbl to the is,oor the United States of '21 resulting from the operation by any person or organization of any nuclear y tfacility included within the definition of nuclear facility under paragraph America,eiss or d any dgbe, titled) under any agreement entered into by fa)or thereof; the United States of America, or any agency thereof, with any person or organization. 'nuclear facility' means B Under any Medical Payments Coverage, or under any Supplementary Pay (al any nuclear reactor ments provision relating to first aid, to expenses incurred with respect to bodily injury resulting from the hazardous properties of nuclear material 161 any equipment or dente designed or used for Ill separating the isotopes and arising out of the operation of a nuclear facility by any person or of uranium or plutonr pa (2) processing or ublumg,spent fuel, or 131 handling,processing or packaging waste, organization. C. Under any Liability Coverage, to bodily injury or property damage resulting lc) any equipment or device used for the processing, fabricating or alloying from the hazardous properties of nuclear material, if of special nuclear material if at any time the total amount of such ma (1) the nuclear material (a) is at any nuclear facility owned by, or operated terial in the custody of the insured at the premises where such equipment by or on behalf of, an insured or lb) has been discharged or dispersed or device is uranium consists any of or inations eree than or grams of therefrom; plutonium or uranium 233 or any Combination thereof, or more than 250 grams of uranium 235, (2) the nuclear material is contained in spent fuel or waste at any time id) any structure, basin, excavation, premises or place prepared or used for possessed, handled, used, processed, stored, transported or disposed the storage or disposal of waste, of by or on behalf of an insured,or 131 the bodily injury or property damage arises out of the furnishing by an and includes the site on which any of the foregoing is located,all operations insured at services, materials, parts or equipment in connection with conducted on such site and all premises used for such operations, the planning. construction. maintenance, operation or use of any nuclear 'nuclear reactor' means any apparatus designed facility, but if such facility is located within the United States of H eo co contain to sustain nuclear America, its territories or possessions or Canada, this exclusion (3) fission in a self-supporting chain reaction or to contain a critical mass of applies only to property damage to such nuclear facility and any fissionable material; property thereat. 'property damage' includes all forms of radioactive contamination of property.