2018/07/01 Valley-Wide Recreation and Park District Certificate of Liability InsuranceCERTIFICATE NO.
ISSUE DATE (MM/DD/YYYY)
CAPRI-149
CER pG p C>, TE OF COVERAGE
06/27/2017
Primary Insurance Provided by
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
CALIFORNIA ASSOCIATION FOR PARK AND
CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND
OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF COVERAGE DOES NOT
RECREATION INDEMNITY (CAPRI)
CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
ATTN: PAT CABULAGAN
PRODUCER, AND THE CERTIFICATE HOLDER.
6341 AUBURN BLVD, SUITE A
CITRUS HEIGHTS, CA 95621-5203
IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the
Memorandums of Coverage/Policies must be endorsed. A statement on this certificate does not
confer rights to the certificate holder in lieu of such endorsement(s).
COVERAGE A - CALIFORNIA ASSOCIATION FOR PARK
AFFORDED BY: RECREATION INDEMNITY
CAPRI MEMBER:
COVERAGE B
VALLEY -WIDE RECREATION AND PARK DISTRICT
AFFORDED BY:
COVERAGE
AFFORDED BY: C
Coverages
THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE
FOR THE PERIOD INDICATED, 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 MEMORANDUMS
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS.
CO
LTR
TYPE OF COVERAGE
MEMORANDUM
COVERAGE EFFECTIVE
COVERAGE EXPIRATION
LIABILITY LIMITS
NUMBER
DATE (MM/DD/YYYY)
DATE (MM/DD/YYYY)
A
OTHER
CAPRI 2018-2019 WC
07/01/2018
07/01/2019
WORKERS'
PERMISSIBLY SELF-
COMPENSATION:
INSURED
$350,000
- WORKERS' COMPENSATION
EMPLOYERS' LIABILITY:
- EMPLOYERS' LIABILITY
of N
City City
eniree
erk
$350,000
u'
2018
Rece
ed
Description of Operations/Locations/Vehicles/Special Items:
AS RESPECTS EVIDENCE OF COVERAGE FOR PROFESSIONAL SERVICES AGREEMENT BETWEEN VALLEY -WIDE
RECREATION AND PARK DISTRICT AND CITY OF MENIFEE TO PROVIDE LANDSCAPE MAINTENANCE SERVICES FOR PARKS,
STREET MEDIANS, RIGHT-OF-WAYS AND RETENTION BASINS.
THE AUTHORITY WAIVES ITS RIGHTS OF SUBROGATION AGAINST ADDITIONAL COVERED PARTIES PURSUANT TO
ENDORSEMENT NUMBER U-4.
Certificate Holder
Cancellation
CITY OF MENIFEE
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF
29714 HAUN ROAD
COVERAGE/POLICIES BE CANCELLED BEFORE EXPIRATION THEREOF,
MENIFEE, CA 92586
NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUMS
OF COVERAGE/POLICIES PROVISIONS
AUTHORIZED REPRESENTATIVE
PAGE 1 of 3
CERTIFICATE NO.
ICCI IF nATF (hAhA/nnlvvvv)
EIA PE-WC-149
C rERT(R C A [ OF COVE o A GE
06/27/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
SAC Excess Insurance
RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
//��
Authority OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS
d1�:CERTIFICATE OF COVERAGE DOES NOT CONSTITUE A CONTRACT BETWEEN THE ISSUING
INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THIS CERTIFICATE
C/O ALLIANT INSURANCE SERVICES, INC. HOLDER.
P.O. BOX 6450 IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the
NEWPORT BEACH, CA 92658-6450 Memorandum of Coverage/Polices must be endorsed. A statment on this certificate does not
confer rights to the certificate holder in lieu of such endorsement(s).
PHONE (949) 756-0271 / FAX (619) 699-0901 COVERAGE
LICENSE #OC36861 AFFORDED BY: A - See attached Schedule of Insurers
MEMBER: COVERAGE
CALIFORNIA ASSOCIATION FOR PARK AND AFFORDED BY: B
RECREATION INDEMNITY (CAPRI)
ATTN: PAT CABULAGAN COVERAGE
6341 AUBURN BLVD, SUITE A AFFORDED BY: C
CAPRI MEMBER:
VALLEY -WIDE RECREATION AND PARK DISTRICT COVERAGE D
AFFORDED BY:
Coverages
THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE
FOR THE PERIOD INDICATED, 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
MEMORANDUMS DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS.
CO
LTR
TYPE OF COVERAGE
MEMORANDUM
NUMBER
COVERAGE EFFECTIVE
COVERAGE EXPIRATION
DATE (MM/DD/YYYY)
DATE (MM/DD/YYYY)
LIABILITY LIMITS
A
EXCESS WORKERS'
See attached
07/01/2018
07/01/2019
WORKERS' COMPENSATION:
COMPENSATION &
Schedule of
Difference between
EMPLOYERS' LIABILITY
Insurers for policy
Statutory and Members
numbers
$350,000 Retention
EMPLOYERS' LIABILITY:
Difference between
$5,000,000 and Members
$350,000 Retention
"LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED.
Description of Operations/Locations/Vehicles/Special Items:
AS RESPECTS EVIDENCE OF COVERAGE FOR PROFESSIONAL SERVICES AGREEMENT BETWEEN VALLEY -WIDE
RECREATION AND PARK DISTRICT AND CITY OF MENIFEE TO PROVIDE LANDSCAPE MAINTENANCE SERVICES FOR
PARKS, STREET MEDIANS, RIGHT-OF-WAYS AND RETENTION BASINS.
THE AUTHORITY WAIVES ITS RIGHTS OF SUBROGATION AGAINST ADDITIONAL COVERED PARTIES PURSUANT TO
ENDORSEMENT NUMBER U-4.
Certificate Holder
Cancellation
CITY OF MENIFEE
SHOULD ANY OF THE ABOVE MEMORANDUMS OF COVERAGE/POLICIES BE
29714 HAUN ROAD
CANCELED BEFORE THE EXPIRATION THEREOF, NOTICE WILL BE
MENIFEE, CA 92586
DELIVERED IN ACCORDANCE WITH THE MEMORANDUMS OF
COVERAGE/POLICIES PROVISIONS
AUTHORIZED REPRESENTATIVE
CSAC EXCESS INSURANCE AUTHORITY
PAGE 2 of 3
CSAC EXCESS INSURANCE AUTHORITY
EXCESS WORKERS' COMPENSATION PROGRAM
2018/2019 SCHEDULE OF INSURERS
CAPRI
PROVIDER
MEMORANDUM/POLICY
NUMBER
LIMIT
CSAC Excess Insurance Authority
EIA-PE 18 EWC-15
Workers' Compensation:
$50,000,000 each accident/each employee
for disease
(Difference between $50,000,000 and the
individual member's retention)
Employers' Liability:
$5,000,000 each accident/each employee
for disease
(Difference between $5,000,000 and the
individual member's retention)
Liberty Insurance Corporation
EW7-64N-444785-018
Statutory each accident/ each employee
for disease excess of
$50,000,000
EWC PAGE 2 of 2
E 11,C�1''SE
CSAC EXCESS INSURANCE AUTHORITY
EXCESS WORKERS' COMPENSATION
WAIVER OF SUBROGATION ENDORSEMENT
It is understood and agreed that Section VIII. SUBROGATION of the CONDITIONS section
of the Memorandum of Coverage is deleted in its entirety and replaced by the following:
VIII. SUBROGATION: In the event of any payment under this Memorandum, the Authority
shall be subrogated, to the extent of such payment, to all the Covered Party's rights of
recovery therefore, and the Covered Party shall execute all papers required and shall do
everything that may be necessary to secure such rights. Any amount recovered as a result
of such proceedings, together with all expenses necessary to the recovery of any such
amount shall be apportioned as follows: The Authority shall first be reimbursed to the extent
of its actual payment hereunder. If any balance then remains, said balance shall be applied
to reimburse the Covered Party. The expenses of all proceedings necessary to the
recovery of such amount shall be apportioned between the Covered Party and the
Authority in the ratio of their respective recoveries as finally settled. If there should be no
recovery in proceedings instituted solely on the initiative of the Authority, the expenses
thereof shall be borne by the Authority.
However, in the event of any loss payment under this Memorandum for which you have
waived the right of recovery in a written contract entered into prior to the loss, we hereby
agree to also waive our right of recovery but only with respect to such loss.
It is further agreed that nothing herein shall act to increase the Authority's limit of indemnity.
This endorsement is part of the Memorandum of Coverage and takes effect on the effective
date of the Memorandum of Coverage unless another effective date is shown below. All
other terms and conditions remain unchanged.
Effective Date:
Issued to: ALL MEMBERS
Issue Date: June 25, 2018
Authorized Repres ntative
CSAC Excess Insura thority
Memorandum No.:
EIA 18 EWC-00