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Regional Government Services - Insurance Certificate (2019)Municipal Insurance Cooperative CERTIFICATE OF COVERAGE Issue Date Great American E&S Insurance Co 7/2/2018 ADMINISTRATOR: LICENSE # 0451271 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Keenan & Associates 2868 Prospect Park Drive, #600 Rancho Cordova, CA 95670 916-859-7160 www.keenan.com COVERED PARTY: Municipal Services Authority P.O. Box 1350 Carmel Valley CA 93924 AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE COVERAGE DOCUMENTS BELOW. ENTITIES AFFORDING COVERAGE: ENTITY A: Municipal Insurance Cooperative ENTITY B: Great American E&S Insurance Co ENTITYc: Arch Insurance Group 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. ENT COVERAGE EFFECTIVE/ LTR I TYPE OF COVERAGE I DOCUMENTS I EXPIRATION DATE A GENERAL LIABILITY [ ,�GENERAL LIABILITY MIC 18190001 7/1/2018 [ ] CLAIMS MADE (�j OCCURRENCE 7/1 /2019 [ jGOVERNMENTCODES [ ,//L ERRORS & OMISSIONS [ PO Liability A AUTOMOBILE LIABILITY [ � ANY AUTO MIC 18190001 7/1/2018 [ ] HIRED AUTO 7/1/2019 [ ] NON -OWNED AUTO [ ] GARAGE LIABILITY [ ] AUTO PHYSICAL DAMAGE PROPERTY [ ] ALL RISK [ ] EXCLUDES EARTHQUAKE & FLOOD [ ] BUILDER'S RISK STUDENT PROFESSIONAL LIABILITY WORKERS COMPENSATION [ ] EMPLOYERS' LIABILITY EXCESS WORKERS COMPENSATION C [ EMPLOYERS' LIABILITY WCX 0057220 04 7/1/2018 7/1/2019 B OTHER Occupational Accident BL 4659049-05 7/1/2018 Buffer Layer 7/1/2019 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL PROVISIONS: MEMBER RETAINED LIMIT / DEDUCTIBLE LIMITS COMBINED SINGLE LIMIT EACH OCCURRENCE $ 50,000 $ 2,000,000 COMBINED SINGLE LIMIT EACH OCCURRENCE $ 50,000 $ 2,000,000 EACH OCCURRENCE EACH OCCURRENCE [,/I WC STATUTORY LIMITS [ ] OTHER $ 1,000,000 E.L. EACH ACCIDENT $ 1,000,000 $ 1,000,000 E.L. DISEASE- EACH EMPLOYEE $ 1,000,000 E.L. DISEASE- POLICY LIMITS $ 100,000 1,000,000 $ 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 ENTITYMPA City of Gilroy WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE Y y HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL Attn: Kristi Abrams IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE ENTITY/JPA, ITS 7351 Rosanna Street AGENTS OR REPRESENTATIVES. Gilroy CA 95020 William Poland AUTHORIZED REPRESENTATIVE _" eCuU0nline.c ' 42963841 1 MUNI CSER 1 18-19 P&L Master Higher Limits I Danielle Clayson 1 7/2/2018 3:56:43 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. eCutsOnNmc- 42963841 1 MUNICSER 1 18-19 P&L Master Higher Limits I Danielle Clayson 1 7/2/2018 3:56:43 PM (PDT) I Page 2 of 4 GRE GREAT AMERICAN E&S INSURANCE A"AmmcAN, COMPANY INSURANCE GROUP OCCUPATIONAL ACCIDENT BUFFER LAYER INSURANCE — POLICY AMENDMENT Named Insured: Municipal Services Authority Policy No.: BL04659049 Policy Amendment No. 1 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. President Secretary AES4360 (4/11) 42963841 1 MUNICSER 1 18-19 P&L Master Higher Limits I Danielle Clayson 1 7/2/2018 1:56:43 PM (PDT) I Page 3 of 4 Page 1 of 1 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 Nvith 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 t1-tis 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 tapes 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 Issued to: Municipal Services Authority Leslie Delozier MIC JPA Manager Authorized Representative Memorandum No.: MIC-18190001 Issue Date: 07/02/2018 © 2017 Iseenan & Associates. All Rights Reserved. 42563841 1 MUNICSER 1 18-19 P&L Master Higher Limits I Danielle Clayson 1 7/2/2018 3:56:43 PM (PDT) I Page 4 of 4