Insurance - CBIZ Accounting - 2006-07-10 0 'O V'V/ F V/ / V 4 -V V I U 4 O , V-V 1 v n , v, ry n L. 1/4.1/4011
0061154
FILE COPY CR 10 24
( Ed . 10 90 )
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THIS ENDORSEMENT CHANGES THE POLICY . PLEASE READ IT CAREFULLY.
INCLUDE DESIGNATED AGENTS AS EMPLOYEES
COVERED FOR "EMPLOYEE DISHONESTY" ONLY
This endorsement applies to the CRIME GENERAL PROVISIONS FORM and all Crime
Coverage 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
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COSTA MESA SANITARY DISTRICT. $400 , 000
B . PROVISIONS
1 . "Employee" also includes each natural person , partnership or corpora -
tion you appoint in writing to act as your agent in the capacity shown
in the Schedule while 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 Policy for loss caused by an agent in -
cluded as an "employee" by this endorsement is the Limit of Insurance
• shown in the Schedule . That Limit of Insurance is part of , not in ad -
dition to , the Limit of Insurance shown in the Declarations as appli -
cable to the Employee Dishonesty Coverage Form.
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REcuvED
JUL 1 3 2006 SDRMA
INVOICE COSTA cASANIIARYDISTRICT
July 10, 2006
Costa Mesa Sanitary District
628 West 19' Street
Costa Mesa, CA 92627
Special Crime Coverage -Wendy Davis& Marcus D. Davis - $500.00
"Employee Dishonesty" coverage
2006-07 program year
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Please Remit Payment to-
SDRMA
1112 "I" Street, Suite 300, Sacramento, California 95814
For questions or assistance, please call 916.231.4141