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Regional Government Services - Insurance Certificate (2018)Municipal Insurance Cooperative CERTIFICATE OF COVERAGE Issue Date 3/27/2018 Great American E &S Insurance Co ADMINISTRATOR: LICENSE # 0451271 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Keenan & Associates AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 2868 Prospect Park Drive, #600 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE Rancho Cordova, CA 95670 AFFORDED BY THE COVERAGE DOCUMENTS BELOW. ENTITIES AFFORDING COVERAGE: 916 - 859 -7160 www.keenan.com ENTITYA: Municipal Insurance Cooperative ENTITY B: Great American E &S Insurance Co COVERED PARTY: Municipal Services Authority P.O. Box 1350 ENTITY C: Arch Insurance Group p Carmel Valley CA 93924 ENTITY D: ENTITY E: THIS IS TO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED PARTY NAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED HEREIN IS SUBJECT TO ALL THE TERMS AND CONDITIONS OF SUCH COVERAGE DOCUMENTS. MEMBER ENT COVERAGE EFFECTIVE/ RETAINED LIMIT LTR TYPE OF COVERAGE DOCUMENTS EXPIRATION DATE I DEDUCTIBLE LIMITS A GENERAL LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE I ✓GENERAL LIABILITY CLAIMS MADE (OCCURRENCE MIC 17180001 7/1/2017 $ 50,000 $ 2,000,000 [ ] [ GOVERNMENT CODES 7/1/2018 [ ERRORS & OMISSIONS [ PO Liability A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE ( 4 ANY AUTO MIC 17180001 7/1/2017 $ 50,000 $ 2,000,000 [ ]HIREDAUTO 7/1/2018 [ ] NON -OWNED AUTO [ ] GARAGE LIABILITY [ ] AUTO PHYSICAL DAMAGE PROPERTY $ $ [ ] ALL RISK EACH OCCURRENCE [ ] EXCLUDES EARTHQUAKE & FLOOD [ ] BUILDER'S RISK STUDENT PROFESSIONAL LIABILITY $ $ EACH OCCURRENCE WORKERS COMPENSATION [ WC STATUTORY LIMITS [ ] OTHER [ ] EMPLOYERS' LIABILITY $ $ 1,000,000 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EACH EMPLOYEE C EXCESS WORKERS COMPENSATION [ 4 EMPLOYERS' LIABILITY WCX 0057220 02 7/1/2017 $ 1,000,000 7/1/2018 $ 1,000,000 E.L. DISEASE - POLICY LIMITS B OTHER Occupational Accident BL04659049 -04 7/1/2017 $ 100,000 1,000,000 Buffer La er 7/1/2018 $ DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES /RESTRICTIONS /SPECIAL PROVISIONS: * *THIS CERTIFICATE SUPERSEDES AND REPLACES CERTIFICATE #36199062 DATED 06/16/17 ** As respects to staffing as specified in the client agreement between Regional Government Services (RGS) and the City of Gilroy. Municipal Services Authority is a Joint Powers Authority representing its member agencies, Regional Government Services and Local Government Services Authorities. CERTIFICATE HOLDER: CANCELLATION ...... SHOULD ANY OF THE ABOVE DESCRIBED COVERAGES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING ENTITY /JPA Clt of Gilroy, Its officers, officials and y Y, WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE volunteers HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL Attn: LeeAnn McPhillips IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ENTITY /JPA, ITS AGENTS OR REPRESENTATIVES. 7351 Rosanna Street Gilroy CA 95020 William Poland AUTHORIZED REPRESENTATIVE 41033237 MUNICSER 111 -19 11L Master Higher Limits I Danielle Clayson 1 3/27/2018 4:06:19 PM (PDT) I Page 1 of 4 DISCLAIMER The Certificate of Coverage on the reverse side of this form does not constitute a contract between the issuing entity(ies), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the coverage documents listed thereon. rCW.01'1,—.m 41033237 1 MUNICSER 117 -18 P &L Master Higher Limits I Danielle Clayson 1 3/27/2019 4:06:19 PM (PDT) I Page 2 of 4 MUNICIPAL INSURANCE COOPERATIVE ADDITIONAL COVERED PARTY ENDORSEMENT It is agreed that the person or organization named on the Certificate of Coverage is included as an Additional Covered Party, but only with respect to liability arising out operations performed by or on behalf of the coverage agency or facilities owned or used by the covered agency. The coverage afforded by this memorandum to additional covered parties shall be no broader and for no higher limit of liability than that which is required by the contract between a covered agency and the additional covered party Pursuant to the contract between the covered agency and the Additional Covered Party, coverage under this Memorandum shall be primary to coverage maintained by the Additional Covered Party in the event of a covered claim that occurs subsequent to the execution of the aforementioned contract. Additional Covered Party: City of Gilroy, its officers, officials and volunteers Attn: LeeAnn McPhillips 7351 Rosanna Street Gilroy, CA 95020 As Respects: As respects to staffing as specified in the client agreement between Regional Government Services (RGS) and the City of Gilroy. Municipal Services Authority is a Joint Powers Authority representing its member agencies, Regional Government Services and Local Government Services Authorities. It is further agreed that nothing herein shall act to increase the Cooperative's limit of liability. This endorsement is part of the Memorandum and takes effect on the effective date of the Memorandum unless another effective date is shown below. All other terms and conditions remain unchanged. Effective Date: 06/14/2017 Memorandum No.: MIC- 17180001 Issued to: Municipal Services Authority Issue Date: 03/27/2018 Leslie Delozier iVIIC JPA Manager Authorized Representative © 2017 Keenan & Associates. All Rights Reserved. 41033237 1 MUNICSER 1 17 -19 P&L Master Higher Limits I Danielle Clayson 1 3/27/2019 4:06:19 PM (PDT) I Page 3 of 4 GREAT AMERICAN E &S INSURANCE GmATAmERICAN COMPANY INSURANCE GROUP OCCUPATIONAL ACCIDENT BUFFER LAYER INSURANCE - POLICY AMENDMENT Named Insured: Municipal Services Authority Policy No.: BLO4659049 Policy Amendment No. This Policy Amendment is attached to and made part of the Policy effective July 1, 2013 at 12:01 AM, Standard Time at the address of the Named Insured. Any changes in coverage apply only with respect to Occupational accidents that occur on or after that date. Any changes in premium apply as of the first premium due date on or after the effective date of this Amendment. Effective July 1, 2013, ITEM 5., Benefits, of the Policy DECLARATIONS, is extended to include: Waiver of Subrogation This Policy Amendment expires concurrently with the Policy and is subject to all of the provisions, limitations and conditions of the Policy except as they.are specifically modified by this Policy Amendment. In Witness Whereof, the Company has caused this Policy to be signed by its President and Secretary and signed on the Declarations Page by a duly authorized representative of the Company. " <b , ?1*4 --- President AES4360 (4/11) Secretary 41033237 1 MUNICSER I 17 -18 P&L Master Higher Limits I Danielle Clayson 1 3/27/2018 4:06:19 PM (PDT) I Page 4 of 4 Page 1 of 1