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Regional Government Services - Insurance Certificate (2019) Municipal Insurance Cooperative 7/2/2018 Great American E&S Insurance Co 0451271 Keenan & Associates 2868 Prospect Park Drive, #600 Rancho Cordova, CA 95670 916-859-7160 www.keenan.com Municipal Insurance Cooperative Great American E&S Insurance Co Municipal Services Authority Arch Insurance Group P.O. Box 1350 Carmel Valley CA 93924 A 3 50,0002,000,000 7/1/2018 MIC 18190001 3 7/1/2019 3 3 PO Liability A 2,000,000 3 7/1/2018 MIC 18190001 50,000 7/1/2019 3 1,000,000 1,000,000 1,000,000 3 C7/1/2018 WCX 0057220 04 7/1/20191,000,000 B 100,000 1,000,000 Occupational Accident7/1/2018 BL 4659049-05 Buffer Layer7/1/2019 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. 30 City of Gilroy Attn: Kristi Abrams 7351 Rosanna Street Gilroy CA 95020 William Poland 42963841 | MUNICSER | 18-19 P&L Master Higher Limits | Danielle Clayson | 7/2/2018 3:56:43 PM (PDT) | Page 1 of 4 42963841 | MUNICSER | 18-19 P&L Master Higher Limits | Danielle Clayson | 7/2/2018 3:56:43 PM (PDT) | Page 2 of 4 GREAT AMERICAN E&S INSURANCE COMPANY OCCUPATIONAL ACCIDENT BUFFER LAYER INSURANCE – POLICY AMENDMENT Named Insured: Municipal Services Authority Policy No.: BLO4659049 Policy Amendment No. 1 ThisPolicy 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 PolicyDECLARATIONS,is extended to include: Waiver of Subrogation ThisPolicy Amendment expires concurrently with the Policyand 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 theDeclarations Page by a duly authorized representative of the Company. President Secretary AES4360 (4/11) Page 1 of 1 42963841 | MUNICSER | 18-19 P&L Master Higher Limits | Danielle Clayson | 7/2/2018 3:56:43 PM (PDT) | Page 3 of 4 MUNICIPAL INSURANCE COOPERATIVE ENDORSEMENT NO. 13 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 Attn: Kristi Abrams 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: 07/01/2018 Memorandum No.: MIC-18190001 Issued to: Municipal Services Authority Issue Date: 07/02/2018 Leslie Delozier MIC JPA Manager Authorized Representative © 2017 Keenan & Associates. All Rights Reserved. 42963841 | MUNICSER | 18-19 P&L Master Higher Limits | Danielle Clayson | 7/2/2018 3:56:43 PM (PDT) | Page 4 of 4