HomeMy WebLinkAboutCertificate of InsuranceCERTIFICATE OF COVERAGE—RATE
—(MM/DD/YYYY)
TYPE OF COVERAGE
12/15/2020
PRODUCER
Alliant Insurance Services, Inc,
100 Pine Street, 11th FloorTHIS
San Francisco CA 94111 JAN j 2020
THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERS NO RIGHTS
UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR
NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
MEMORANDUM(S) OF COVERAGE BELOW,
CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
ISSUING COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE
CERTIFICATE HOLDER.
I
(��p�A� /� LOS
TOWN 01 LOS ALTOS HIL
IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDITIONAL COVERED PARTY, THE
MEMORANDUMCATE
HIS CEOFIFISUCH
DOES CONFER VERIGHTS RAGE UTO ST BTHE ND CERTIFICATORSED. A E HOLDER NT OIN TLIEU
ENDORSEMENT(S).
NAMED COVERED PARTY
West Bay Sanitary District
500 Laurel St
Menlo Park CA 94025
IMPORTANT: IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE
MEMORANDUM(S) OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON
THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH
ENDORSEMENT(S).
PROGRAM AFFORDING COVERAGE
EACH OCCURRENCE
$ 2,000,000
A: CSRMA - California Sanitation
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [z] OCCUR
B:
C:
COVERAGES
THIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUM(S) OF COVERAGE, FOR THE PERIOD SHOWN BELOW, NOT WITHSTANDING 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 AFFORDED BY THE PROGRAM
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUM(S) OF COVERAGE. THE FOLLOWING COVERAGE IS IN EFFECT.
JPA
LTR
TYPE OF COVERAGE
MEMORANDUM NUMBER
COVERAGE EFFECTIVE
DATE (MM/DD/YY)
COVERAGE EXPIRATION
DATE (MMIDD/YY)
LIMITS
A
GENERAL LIABILITY
CSL WBSD 2021 1
12/31/2020
12/31/2021
EACH OCCURRENCE
$ 2,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE [z] OCCUR
FIRE DAMAGE (Any one fire)
$ 2,000,000
MED EXPENSE (Any one person)
$ 2,000,000
X Ded: $25,000
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ N/A
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$ N/A
X MEMOPROJECT LOC
ANDUMA
AUTOMOBILE LIABILITY
CSL WBSD 2021 1
12/31/2020
12/31/2021
COMBINED SINGLE LIMIT
$ 2,000,000
ANY AUTO
(Ea accident)
$
X ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X I NON -OWNED AUTOS
WORKERS' COMPENSATION ANDWC
EMPLOYERS LIABILITY
OTHER
STATUTORY
LIMITS
ANY PROPRIETOR/PARTNER/
E.L. EACH ACCIDENT
$
EXECUTIVE/OFFICER/MEMBER
EXCLUDED?
E.L. DISEASE – EA EMPLOYEE
$
IF YES, DESCRIBED UNDER SPECIAL
PROVISION BELOW
E.L. DISEASE–POLICY LIMIT
$
OTHER
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONStVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIALIPROVISIONS
Town of Los Altos Hills is named as an Additional Covered Party per the Memorandum of Coverage with respect to Maintenance Services Agreement
between the Town of Los Altos Hills and West Bay Sanitary District. Copies of the Memorandum of Coverage are available upon request.
Town of Los Altos Hills
Public Works Director
26379 Fremont Road
Los Altos Hills CA 94022
NGtLLAIIUN
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE
BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE
PROVISIONS.
AUTHORIZED REPRESENTATIVE
CALIFORNIA SANITATION RISK MANAGEMENT
AUTHORITY
ADDITIONAL COVERED PARTY ENDORSEMENT
This Endorsement forms a part of the Memorandum of Coverage issued by the
CALIFORNIA SANITATION RISK MANAGEMENT AUTHORITY.
ADDITIONAL COVERED PARTY: Town of Los Altos Hills
CSRMA MEMBER ENTITY: West Bay Sanitary District
DESCRIPTION OF ACTIVITY: Maintenance Services Agreement between the Town of
Los Altos Hills and West Bay Sanitary District
DATE(S) OF ACTIVITY: 12/31/2020 - 12/31/2021
LOCATION OF ACTIVITY: Town of Los Altos Hills
MAXIMUM COVERAGE LIMIT: $2,000,000
DEDUCTIBLE: $25,000
The person or organization first named above is added as an ADDITIONAL COVERED
PARTY pursuant to Section III(A), "Definitions" and Section VII, "Covered Parties."
Coverage is provided through participation in a risk sharing joint powers authority, for
general and automobile liability as defined in the Memorandum of Coverage.
The coverage being provided by this Endorsement is limited to "occurrences" arising out
of the activity or location described, and the time period indicated herein, and is subject to
all the terms, conditions and exclusions of the Memorandum of Coverage. Pursuant to
Section III (A), the person or entity named above is only an Additional Covered Party with
respect to operations performed by or on behalf of the CSRMA MEMBER ENTITY, or
facilities owned or used by the CSRMA MEMBER ENTITY.
Coverage is in effect for the DATE(S) OF ACTIVITY indicated above and will not be
cancelled or allowed to expire at a date other than the last date indicated except upon 30
days' written notice to the Additional Covered Party.
Date issued: 12/15/2020
Authorized Representative