HomeMy WebLinkAboutWest Bay Sanitary District (11)CERTIFICATE OF COVERAGE
DATE (MM/DD/YYYY)
12/18/2023
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERS NO RIGHTS
UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR
Alliant Insurance Services, Inc.
NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
MEMORANDUM(S) OF COVERAGE BELOW.
560 Mission Street, 6th Floor
THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE
San Francisco CA 94105
ISSUING COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE
CERTIFICATE HOLDER.
GENERAL LIABILITY
IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDITIONAL COVERED PARTY, THE
12/31/2023
MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE
EACH OCCURRENCE
DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH
ENDORSEMENT(S).
IMPORTANT: IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE
NAMED COVERED PARTY
West Bay Sanitary District
500 Laurel St
Menlo Park CA 94025
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
A: CSRMA - California Sanitation
FIRE DAMAGE (Any one fire)
B:
4X CLAIMS MADE [E]OCCURMED
C:
COVERAGES
THIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUMS) OF COVERAGE, FOR THE PERIOD SHOWN BELOW, 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 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 (MM/DD/YY)
LIMITS
A
GENERAL LIABILITY
CSL WBSD 2324 1
12/31/2023
12/31/2024
EACH OCCURRENCE
$2,000,000
COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one fire)
$ 2,000,000
4X CLAIMS MADE [E]OCCURMED
EXPENSE (Any one person)
$ 2,000,000
X Ded: $$100,000
PERSONAL & ADV INJURY
$ 2,000,000
GENERAL AGGREGATE
$ N/A
GEN'L AGGREGATE LIMITAPPLIES PER:
PRODUCTS-COMP/OP AGG
$ N/A
X ANDUM F1 PROJECT M LOC
A
AUTOMOBILE LIABILITY
CSL WBSD 2324 1
12/31/2023
12/31/2024
COMBINED SINGLE LIMIT
$2,000,000
$
ANY AUTO
(Ea accident)
X ALL OWNED AUTOS
SCHEDULED AUTOS
X HIRED AUTOS
X NON -OWNED AUTOS
WORKERS' COMPENSATION AND
EMPLOYERS LIABILITY
WC
STATUTORY OTHER
LIMITS
ANY PROP RIETOR/PARTNER/
EXECUTIVE/OFFICER/MEMBER
E.L. EACH ACCIDENT
$
EXCLUDED?
E.L. DISEASE — EA EMPLOYEE
$
IF YES, DESCRIBED UNDER SPECIAL
E.L. DISEASE—POLICY LIMIT
$
PROVISION BELOW
OTHER
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS
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.
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Town of Los Altos Hills
Public Works Director
26379 Fremont Road
Los Altos Hills CA 94022
M-119LMIR14W 1IM91
SHOULD ANY OF THE ABOVE
BE CANCELLED BEFORE THE
DELIVERED IN ACCORDANCE
PROVISIONS.
AUTHORIZED REPRESENTATIVE
DESCRIBED MEMORANDUM(S) OF COVERAGE
EXPIRATION DATE THEREOF, NOTICE WILL BE
WITH THE MEMORANDUM(S) OF COVERAGE
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: 12/31/2023 - 12/31/2024
LOCATION OF ACTIVITY: Town of Los Altos Hills
MAXIMUM COVERAGE LIMIT: $2,000,000
DEDUCTIBLE: $ X000
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: 12/18/2023
Authorized Representative