Insurance - SDRMA - 2012-07-01Issue Date
— -
MEMBER'S CERTIFICATE OF COVERAGE
07/01/2012
1.02
This is to certify that coverages listed below have been issued to the Member named below for the period indicated. This certificate is not an insurance
policy or an agreement of coverage and does not amend, extend or alter the coverage afforded by the agreements listed herein. Notwithstanding any ^�]E�; , ,
requirement, term, or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the coverage J
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described herein is subject to all the terms, exclusions, and conditions of the specific coverage document. �A`//�
This certificate of coverage evidences the limits of liability in effect at the inception of the agreements shown; limits shown may have been reduced by paid
claims. This certificate is issued as a matter of information only and confers no rights upon the certificate holder.
Participating Member: Member Number:
Entity Affording Coverage:
Costa Mesa Sanitary District BOP -6819
Special District Risk Management Authority
628 West 19th Street
1112 'I' Street, Suite 300
Costa Mesa, CA 92627 -2716
Sacramento, California 95814
800.537.7790 www.sdrma.or
Type of Coverage
I Policy Number
Effective Date
Expiration Date
I Limits
Qx General Liability
LCA- SDRMA- 201213
0710112012
07/01/2013
Personal Injury and Property Damage
Per Occurrence $10,000,000
Public Officials and Employees Errors
LCA - SDRMA- 201213
f 0710112012
0710112013
Per Occurrence $10,000,000
Occurrence Form
i
General Aggregate $10,000,000
Rx Personal Liability Coverage for Board
LCA - SDRMA- 201213
07/01/2012
j 07/01/2013
I _
Members
Per Occurrence $500,000
Occurrence Form
General Aggregate $500,000
❑x Employment Practices Liability
LCA - SDRMA- 201213
07/01/2012
07101/2013
Per Occurrence $10,000,000
Occurrence Form
General Aggregate $10,000,000
❑x Employee Benefits Liability
LCA - SDRMA- 201213
07/0112012
07101/2013
Per Occurrence $10,000,000
Occurrence Form
General Aggregate $10,000,000
Qx Employee Dishonesty Coverage
EDC- SDRMA- 201213
07/01/2012
07/01/2013
Per Occurrence $400,000
Qx Auto Liability
I LCA - SDRMA- 201213
07/01/2012
07/0112013
Personal Injury and Property Damage
Per Occurrence $10,000,000
❑x Auto Physical Damage
LCA - SDRMA - 201213
07/01/2012
07/01/2013
Limits on File
Uninsured / Underinsured Motorists
UMI- SDRMA- 201213
07/0112012
07/01/2013
Each Accident $750,000
Trailer Coverage
I
i
I
Qx Property Coverage
PPC- SDRMA- 201213
07/01/2012
07/01/2013
Includes Fire, Theft and Flood
Per Occurrence $1,000,000,000
Replacement cost for
Scheduled Property
Rx Boiler and Machinery Coverage
BMC- SDRMA- 201213
07/01/2012
07/01/2013
I
Each Occurrence $100,000,000
Replacement cost for
Scheduled Property
❑x Workers' Comp.
WCP- SDRMA- 201213
07/01/2012
07/01/2013
A. Statutory Workers' Comp.
Each Occurrence Statutory
B. Employers' Liability Coverage
Each Occurrence $5,000,000
Description; All listed coverage is in effect only for the time period specified.
G ory S. Hdfl - Chief Executive Officer
Special District Risk
Management Authority
Maximizing Protection.
Minimizing Risk.
June 26, 2012
1112 I Street, Suite 300
Sacramento, California 95814 -2865
T 916.231.4141
T 800.537.7790
F 916.231.4111
www.sdrma.org
Ms. Anna Sanchez
Admin Manager
Costa Mesa Sanitary District
628 West 19th Street
Costa Mesa, California 92627 -2716
Re: 2012 -13 Coverage Documents
Dear Ms. Sanchez,
PErEIVIFr_1
JUN 2 9 2012
CUSIA int,� �tiN11AIPYpW�r�,,,,
SDRMA
On behalf of the Special District Risk Management Authority ( SDRMA) Board of Directors and our entire risk
management team, it is my pleasure to take this opportunity to extend our sincere appreciation for your participation
in our Property /Liability and Workers' Compensation Programs. The new program year begins July 1 and complete
coverage documents will be available by August 1 in the SDRMA MemberPlus Online TM portal. The following
coverage documents will be available July 1 in the portal:
Property /Liability and Workers' Compensation Programs
• Member's Certificate of Coverage (a copy is attached)
• California Vehicle Identification Cards (if applicable — available in MemberPlus Online TM portal to print out
and place in vehicles)
To access the SDRMA MemberPlus Online TIM portal, go to www.sdrma.org — on the Home page click on Member
Login. The above listed items will be available in the left navigation window under Quick Links. Your current
coverage documents will be archived as in past years and will also be available in the portal under Coverage
Documents.
Property /Liability contribution invoices for 2012 -13 were mailed in mid -May. SDRMA offers limits of liability of $2.5
million, $5.0 million and $10.0 million. As explained in the Property /Liability Program renewal invoice, if SDRMA did
not receive written notice from your Agency of an election to change its present limit of liability by June 15, 2012,
the same limit of liability that your Agency has presently will remain in force for the new program year. If you did
submit written notice to change your limit of liability before June 15, then upon receipt of your payment, a final
revised Member's Certificate of Coverage reflecting your elected limit of liability will be updated in the MemberPlus
Onlinelm portal and available for access.
If you have any questions regarding the coverage documents listed above please contact Ellen Doughty at
800.537.7790 or 916.231.4141 or edoughty @sdrma.org.
Thank you for your continued loss prevention and safety efforts. SDRMA's Board of Directors is looking forward to
another successful year in our programs!
Sincerely,
Special District Risk Management Authority
44
Gregor` Ha , ARM
Chief Executive Officer
A proud California Special Districts California Special Districts Association CSDA Finance Corporation
Alliance partner. 1112 1 Street, Suite 200 1112 1 Street, Suite 200
Sacramento, California 95814 -2865 Sacramento, California 95814 -2865
T 877.924.CSDA (2732) T 877.924.CSDA (2732)
F 916.442.7889 F 916.442.7889
C, c' ?
SDfiMP.