Insuance - Workers' Compensation - 2004-07-01 MODEM
SPEICAL DISTRICT RISK
MANAGEMENT AUTHORITY
A Properly,Liability rid Worke Compen atto Program for Public Age
WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY
CERTIFICATE OF COVERAGE
COVERED PARTY Costa Mesa Sanitary District
ADDRESS OF COVERED PARTY Post Office Box 1200
Costa Mesa, CA 92628-1200
COVERAGE EFFECTIVE: 7/1/2004
COVERAGE TERMINATES: 6/30/2005
COVERAGE LIMITS. $100,000,000 Per Occurrence for Workers' Compensation
$5,000,000 for Employer's Liability
COVERAGE PROVIDED BY Self Insured: Special District Risk Management
Authority Workers' Compensation Program
COVERAGE AGREEMENT Memorandum of Coverage
COVERAGE AMENDMENTS. None
CANCELLATION NOTICE Insurer will endeavor to mail 30 days of written notice to certificate
holder Failure to do so shall not impose any obligation or liability to self-insurer agents, or
representatives
Special District Risk Management Authority
Workers' Compensation Program
Dated: July 1 2004 By
Authorized Signature
Workers Compensation Program
Manual Rates for Fiscal Year 2004-05 and Comparison to Manual Rates for Fiscal Year 2003-04
15%increase 19% increase
of WCIRB Pure of WCIRB Pure
Premium 1/1/03 Premium 1/1/04
Manual Rate Manual Rate
Code Principal Work for FY 03-04 for FY 04-05
0005 Nurseryman 10.03 9.19
0050 Orchard Spraying 14.36 12.88
0251 Irrigation,Drainage or Reclamation Works 9.67 8.98
3724 Mechanic Supervisor;Electrical Repair 11.66 12.88
4511 Analytical or Testing Laboratories(o/s&i/s) 3.66 3.70
6220 Heavy Equipment Operator 7 19 6.96
7332 Ambulance 10.80 7.85
7382 Drivers 18.63 21.88
7429 Airport Operations 9.40 9.41
7520 Waterworks Operation 11 42 11.69
7539 Electric Light or Power Company 4.14 4.76
7580 Sanitation District Operation 5.30 5.64
7706 Firemen 13.35 13.52
7707* Volunteer Firemen $559.61 $510.06
7720 Police/Sheriff 13.90 12.60
7721 Patrolmen,Watchmen or Guards 10.68 9.38
7722' Volunteer Police/Sheriff $357.66 $424.37
8389 Heavy Equipment/Truck Mechanic 10.09 10.95
8392 Automobiles Storage Garages/Parking Lots 14.82 14.72
8601 Engineers Consulting(„otengaged actual construction oroperation) 2.24 1.90
8720 Weighmasters 8.50 6.69
8742 Salesmen Outside 1.61 142
8742* Directors $17.31 $20.60
8810 Clerical 1.38 1.24
9015 Building Operations including Janitorial 13.21 11.55
9016 Boat Anchorage and Rentals; Marinas 10.47 10.63
9031 Pest Control 8.96 9.51
9048 Camps Recreational 13.48 15.76
9053 Lifeguards 5.04 4.90
9066 Homeowners'Association Patrol Officers manned) 8.91 10.06
9220 Cemetery Operations 14 15 16.62
9402 Street or Sewer Cleaning 8.33 7.88
9403 Garbage.Refuse Collection 19.24 18.64
9410 Municipal/County,Non-Manual 8.21 8.65
9420 Municipal/County,Manual 15.65 13.58
9422 Roads;Maintenance and Repair 10.91 11.60
9424 Garbage. Refuse Dump Operations 14.24 13.86
*Per Capita Rate
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