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INSURANCE - CMSDIssue Date MEMBER'S CERTIFICATE OF COVERAGE 07/012014 1 02 This is to cerafy Nat 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 ^T r 4 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,L \l�fV�Y��L -1� described herein is subject to all the terms, exclusions, and conditions of the specific coverage document. 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.sd"a.or Type of Coverage Policy Number Effective Date Expiration Date Limits QGeneral Liability LCA- SDRMA- 201415 07/01/2014 07/0112015 Personal Injury and Property Damage Per Occurrence $10,000,000 x Public Officials and Employees Errors ❑ LCA - SDRMA- 201415 07/01/2014 07/01/2015 Per Occurrence $10,000,000 Occurrence Form General Aggregate $10,000,000 X Personal Liability Coverage for Board LCA - SDRMA- 201415 07/01/2014 07/0112015 Members Per Occurrence $500,000 Occurrence Form I General Aggregate $500,000 Ex Employment Practices Liability LCA- SDRMA - 201415 07/01/2014 07101/2015 Per Occurrence $10,000,000 Occurrence Form General Aggregate $10,000,000 [j]Employee Benefits Liability LCA - SDRMA - 201415 07/01/2014 07101/2015 Per Occurrence $10,000,000 Occurrence Form General Aggregate $10,000,000 QEmpioyee Dishonesty Coverage EDC- SDRMA- 201415 07101/2014 07/01/2015 Per Occurrence $400,000 Qz Auto Liability LCA - SDRMA- 201415 07/01/2014 0710112015 Personal Injury and Property Damage Per Occurrence $10,000,000 QAuto Physical Damage LCA - SDRMA - 201415 07101/2014 07/0112015 Limits on File OUmnsured i Underinsured Motorists UMI- SDRMA- 201415 07/01/2014 07/01/2015 Each Accident $750,000 Trailer Coverage x�Properly, Coverage PPC- SDRMA- 201415 07/01/2014 07/0112015 Includes Fire, Theft and Flood Per Occurrence $1,000,000,000 Replacement cost for Scheduled Property Qx Boiler and Machinery Coverage SMC- SDRMA- 201415 07/01/2014 07/0112015 Each Occurrence $100,000,000 Replacement cost for Scheduled Property QWorkers'Comp. WCP- SDRMA- 201415 07/0112014 07/01/2015 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. HAII - Chief Executive Officer Issue Date NON - MEMBER'S CERTIFICATE OF COVERAGE 0701 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 ikA sI policy or an agreement of coverage and does not amend, extend or alter the coverage afforded by the agreements listed herein. Notwithstanding any ^�T , requirement, farm, or condition of any contract or other document with respect to which this certificate may be issued or may pertain, the coverage J described herein is subject to all the terms, exclusions, and conditions of the spedfic coverage document. l��(AVn�--Ln This certificate of coverage evidences the limits of liability In effect at the inception of me 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 Policy Number Effective Date Expiration Date Limits QCrime /Fidelity Coverage EDC- SDRMA- 201415 07/01/2014 07/01/2015 Per Occurrence $400,000 RECEIVED 11W bu41AlntJASM11ARXW� r�, Description; NI listed coverage is in effect only for the time period specified. Proof of Coverage: Coverage induces Designated Agent as Employee- Marcus Davis As Independent Treasurer for the Costa Mesa Sanitary District. Cancellation: Should any of the above - described policies be cancelled before the expiration dates thereof, the issuing company will endeavor to mail 30 days written notice to the above -named certificate holder, but failure to mail such notice shall impose no obli ation or Iiij of any kind upon the com an . Certificate Dates: Effective Date Expiration Date Certcate Type: ❑ Adtli6onal Covered Party ❑Loss Payee 07/01/2014 07/01/2015 x❑Evidence of Coverage CERTIFICATE HOLDER Costa Mesa Sanitary District� 628 West 19th Street - Costa Mesa, CA 92627 -2716 Grill! ory S. Hall - Chief Executive Officer