Insurance - SDRMA - 2011-07-01 7/I
/1/2011 12 00'00 AM „ .. . >a . ; MEMBER'S CERTIFICATE OF'CO ERAGE`' e r.t
This is to certify that coverages selected below have been issued to the Member named below for the period indicated. This certificate is not an SD1�Jr`") A ,� A
insurance policy or an agreement of coverage and does not amend,extend or alter the coverage afforded by the agreements listed herein. �v�
Notwithstanding any requirement,term,or condition of any contract or other document with respect to which this certificate may be issued or
may pertain,the coverage described herein is subject to all the terms,exclusions,and conditions of the specific coverage document. This
certificate of coverage evidences the limits of coverage 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
Toll-Free 800.537.7790 www.sdrma.org
Type of Coverage Policy Number Effective Date Expiration Date Limits
® General Liability LCA-SDRMA-201112 07/01/2011 07/01/2012
Personal Injury and Property Damage Per Occurrence $5,000,000
Occurrence Form Property Damage $500
Deductible
® Public Officials and Employees Errors LCA-SDRMA-201112 07/01/2011 07/01/2012
Per Occurrence $5,000,000
Occurrence Form General Aggregate $5,000,000
Personal Liability Coverage for Board LCA-SDRMA-201112 07/01/2011 07/01/2012
Members
Per Occurrence _ $500,000
Occurrence Form General Aggregate $500,000
Deductible $500
lid Employment Practices Liability LCA-SDRMA-201112 07/01/2011 07/01/2012
Per Occurrence $5,000,000
Occurrence Form General Aggregate $5,000,000
® Employee Benefits Liability LCA-SDRMA-201112 07/01/2011 07/01/2012
Per Occurrence $5,000,000
Occurrence Form General Aggregate $5,000,000
® Employee Dishonesty Coverage EDC-SDRMA-201112 07/01/2011 07/01/2012
Per Occurrence $400,000
k Auto Liability LCA-SDRMA-201112 . 07/01/2011 07/01/2012
Personal Injury and Property Damage Per Occurrence $5,000,000
Property Damage $1,000
Deductible
® Auto Physical Damage LCA-SDRMA-201112 07/01/2011 07/01/2012
Limits on File
® Uninsured 1 Underinsured Motorists UMI-SDRMA-201112 07/01/2011 07/01/2012
Each Accident $750,000
® Trailer Coverage LCA-SDRMA-201112 07/01/2011 07/01/2012
Limits on File
® Property Coverage PPC-SDRMA-201112 07/01/2011 07/01/2012
Includes Fire,Theft and Flood Each Occurrence $1,000,000,000
Property Damage Property Damage See Coverage
Deductible Documents
Replacement cost for
Scheduled Property
® Boiler and Machinery Coverage BMC-SDRMA-201112 07/0112011 07/01/2012 •
Each Occurrence $100,000,000
Deductible See Coverage
Documents
Replacement cost for
Scheduled Property
• Workers'Comp. WCP-SDRMA-201112 07/01/2011 07/01/2012
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.
Grego , all- hief Executive Officer