Insurance - SDRMA - 2003-07-01 Exhibit F-Employee
COMMERCIAL CRIME COVERAGE Dishonesty
INSURANCE SUMMARY
GREAT AMERICAN INSURANCE COMPANY POLICY #GVT 554-3930
This declaration page is a summary of the attached policy Please refer to the attached policy for a complete listing
of the terms, conditions and exclusions.
NAMED INSURED- Special District Risk Management Authority and its named members
ADDRESS. 1481 River Park Drive, Suite 110, Sacramento, CA 95815
POLICY TERM: July 1, 2003 to July 1 2004
AM BEST RATING. A, Excellent,Financial Size Category X111 ($1.25 Billion to $1.5 Billion)
STANDARD & POORS
RATING. A
COVERAGE/LIMIT $400,000 FORM O' Employee Dishonesty with Faithful Performance
$500.000 Livermore Amador Valley Water Management Agency
$400,000 FORM B: Forgery or Alteration
$400,000 FORM C. Theft, Disappearance &Destruction
$400,000 FORM F Computer Fraud
DEDUCTIBLE. 525.000 All Members EXCEPT
$100,000 Donner Summit PUD
Please refer to your policy for a complete listing of your terms, exclusions and conditions.
California Government Code Section 990, et seq. Annotated authorizes local government entities to jointly self-
insure risks, jointly purchase insurance or reinsurance, and to contract for risk management, and claims
administrative services. Nothing herein contained shall be held to vary alter waive or extend any of the terms.
conditions provisions, agreements or limitations of the above mentioned Policy other than as above stated.
In witness whereof. Special District Risk Management Authority has caused this declaration be signed by a duly
authorized representative of Special District Risk Management Authority
Signed At. Sacramento. CA Signed By / -r' June 30. 2003
Program Administrator Date
G`DOCUMENTS\Covenge Docs\2003.0a'Cnme summary master I�.pd
Sent By SDRMA 916 641 0160 Sep 23-04 B 244M, Page 1 /1
0061154
CR 10 24
( Ed 10 901
THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY
INCLUDE DESIGNATED AGENTS AS EMPLOYEES
COVERED FOR EMPLOYEE DISHONESTY ONLY
Th s endorsement applies to the CRIME GENERAL PROVISIONS FORM and all Crime
Cove age Forms forming part of the Policy
A SCHEDULE
Capacity of Agent Limit of Insurance
WENDY H DAVIS AND MARCUS D DAVIS
AS INDEPENDENT TREASURERS FOR THE
COSTA MESA SANITARY DISTRICT 4400 000
B PROVISIONS
1 Employee also includes each natural pe son partnership or corpora
Lion you appoint in writing to act as your agent in the capacity shown
in the Schedule wh Is acting on your behalf or while in possession of
Covered Property These natural persons partnerships or corporations
are not covered for faithful performance of duty even in the event
that this Policy may have been amended by endorsement to provide such
coverage on employees as they are defined in the Crime General Pro
visions The only covered cause of loss for the Agents scheduled above
is employee dishonesty as defined in the Employee Dishonesty Coverage
Form
Each such agent and the partners officers and employees of that agent
are considered to be collectively one employee for the purposes of
this insurance However the Cancellation As To Any Employee Additional
Condition in the Employee Dishonesty Coverage Form applies individually
to each of them
2 The most we will pay under this Pol cy for loss caused by an agent in
cluded as an employee by this endorsement is the Limit of Insurance
shown n the Schedule That Limit of Insurance is part of not in ad
dition to the Limit of Insurance shown in the Declarations as applt
cable to the Employee Dishonesty Coverage Form
CR 10 24 ( Ed 10 /901 PRO (Page 1 of 11
SEP-23-2004 08 32 916 641 0160 954 P 01
Page 1 of 3
FAUTH, TOM
From: Jim Towns[JTowns@sdrma.org]
Sent: Thursday July 01 2004 8:51 AM
To: TomFauth @ci.costa-mesa.ca.us
Subject: Treasurer's crime and fidelity endorsement
Tom,
This is to provide you with verification of crime and fidelity coverage for Wendy Davis for the treasurer's position appointment.
Wendy asked that we forward this binder notification to you. Paperwork for the endorsement will be forwarded as we receive it.
Please give me a call if you have any questions.
James W. Towns,ARM
Chief Executive Officer
Special District Risk Management Authority
1481 River Park Drive, Suite 110
Sacramento, CA 95815-4501
Toll-Free: 800.537 7790
Direct 916.537 7790
jtowns @sdrma.org
-Original Message--
From: DWozniak @driveralliant.com [mailto:DWozniak@driveralliant.com]
Sent:Thursday,July 01, 2004 8:32 AM
To: Edgar, Nancy
Cc: srrnaquilan @driveralliant.com
Subject: RE: SDRMA endorsement request
Hi Nancy
Thank you for your quick response. I will inform SDRMA of the additional premium.
Also,these individuals have no prior acts of employee dishonesty
Please bind this coverage and move forward with the endorsement.
Thank youl
Doug Wozniak,Vice President,Ml
Driver Alliant Insurance Services, Inc.
1301 Dove Street, Suite 200
Newport Beach, CA 92660-2436
(800)821-9283 Main/(949) 756-2713 Fax/(949)660-8166 Direct
License#0C36861
'Edgar,Nancy'<nedgar@GAtC.COM>
To: <DW,zn k@ddriveralllant.com>
07/01/0406:38 AM cc: csrmaquilan @driveralliantcom>
Subject RE:SDRMA endorsement request
08/31/2004
Page 2 of 3
Hi Doug this endorsement can be added for the 2 independent treasurers for$250 per person.
be $75 (flat) Whenever one of the districts wants to add a 'non
employee/agent to the policy they should verify the person has not been
involved in any prior employee dishonesty loss I am assuming these
individuals have no prior acts of employee dishonesty
Thank you,
Nancy Edgar
-Original Message----
From: DWnzniak @driveralliant com (mailto DWozniak @driveralliant.com)
Sent Wednesday June 30, 2004 8.20 PM
To. Edgar Nancy
Cc: srmaquilan @dr veralli nt.com
Subject SDRMA endor ement request
Hi Nancy
We have rece ved a request from SDRMA thi afternoon regarding
"De ignated Agent Endo ement" from their member' Costa Mesa Sanitary
Dist The district would like to nclude Wendy H. Day and Marcus D.
Da as Designated Agents on the crime coverage for the SDRMA pool
Both Wendy and Marcu are ndependent treasurer for the Costa Mesa
Sanitary District
Thi goes to ote at the district board meeting tomorrow mo ng I
would appreciate your response email approv ng thi request so I can
let SDRMA know it' a go the morning when I arrive at the office
We appreciate your help with thi late request We als understand if
an additional premium needs to be charged for thi endor ement
Thanks
I look forward to hearing from you in the mor ng
Doug Woz iak, Vice President, AAI
Dr Alliant In urance Service Inc.
1301 Do Street Suite 200
Newport Beach, CA 92660-2436
(800) 821-9283 Mai / (949) 756-2713 Fax / (949) 660-8166 Direct License
# 0C36861
-- Forwarded by Doug Woz iak on 06/30/04 05 10 PM
Sheila R Maquilan
To Doug
Wo iak/RFDri r @RFDriver
06/30/04 05 06 PM cc
Subject
08/31/2004
Page 3 of 3
"Edgar Nancy" <nedgar @GAIC.COM>
Regards,
Sheila
Sheila R. Maquilan
Account Manager
Dr er Alliant Ins ance Services Inc
1301 Dov St Suite 200, Newport Beach, CA 92660-2436
Di ect (949) 809-1404 Toll free (800) 821-9283
Fax (949) 756-2713
Li #0036861
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08/31/2004