HomeMy WebLinkAboutWest Bay Sanitary District, CSRMA WC Program Member 06.24.2024CERTIFICATE O COVERAGE
DATE (MM/DD/YYYY)
6/24/2024
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERS NO RIGHTS
TYPE OF COVERAGE
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.
EACH OCCURRENCE
IMPORTANT: IF THE CERTIFICATE. HOLDER IS AN ADDITIONAL COVERED PARTY, THE
MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE
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
CSRMA WC Program Member:
Y Sanitary
West Ba Sanity 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
B:
MED EXPENSE (Any one person)
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, 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
GENERAL LIABILITY
Los Altos Hills CA 94022
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
FIRE DAMAGE (Any one fire)
$
CLAIMS MADE ® OCCUR
MED EXPENSE (Any one person)
$
PERSONAL & ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG
$
MEMOR-
ANDUM []PROJECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
$
ANY AUTO
(Ea accident)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
A
WORKERS' COMPENSATION AND
EMPLOYERS LIABILITY
CSWC WBSD 2425 1
7/1/2024
7/1/2025
WC I X OTHER
STATUTORY
LIMITS
$750,000
ANY PROPRIETOR/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/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS
This certificate is issued for evidence only.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE
Town of Los Altos Hills
BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
Attn: Public Works Director
DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE
PROVISIONS.
26379 Fremont Road
AUTHORIZED REPRESENTATIVE
Los Altos Hills CA 94022