2019/07/01 Valley-Wide Recreation and Park District Certificate of Liability InsuranceCERTIFICATE NO.
ISSUE DATE (MM/DD/YYYY)
CAPRI-167
CERTIFICATE OF COVERAGE
06/24/2019
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: MATTHEW DUARTE
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
TYPE OF COVERAGE
MEMORANDUM
COVERAGE EFFECTIVE
COVERAGE EXPIRATION
LIABILITY LIMITS
LTR
NUMBER
DATE (MM/DD/YYYY)
DATE (MM/DD/YYYY)
A
OTHER
CAPRI 2019-2020 WC
07/01/2019
07/01/2020
WORKERS'
PERMISSIBLY SELF-
COMPENSATION.
INSURED
$350,000
- WORKERS' COMPENSATION
EMPLOYERS' LIABILITY:
- EMPLOYERS' LIABILITY
$350,000
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.
Certificate Holder
Cancellation
City of Me n ifee
CITY OF MENIFEE
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF
29714 HAUN RD. City Clerk
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
}^.�,� yj pp. y
/,.
PAGE 1 of 3
CERTIFICATE NO.
ISSUE DATE (MM/DD/YYYY)
EIA PE-WC-167
CERTIFICATE OF COVERAGE
06/24/2019
CSAC Excess Insurance
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
Authority
OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS
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.
IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the
P.O. BOX 6450
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).
COVERAGE A - See attached Schedule of Insurers
PHONE (949) 756-0271 / FAX (619) 699-0901
LICENSE #OC36861
AFFORDED BY:
MEMBER:
COVERAGE
B
CALIFORNIA ASSOCIATION FOR PARK AND
AFFORDED BY:
RECREATION INDEMNITY (CAPRI)
COVERAGE
ATTN: MATTHEW DUARTE
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
DATE (MM/DD/YYYY)
COVERAGE EXPIRATION
DATE (MM/DD/YYYY)
LIABILITY LIMITS
A
EXCESS WORKERS'
See attached
07/01/2019
07/01/2020
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 Member's
$350,000 Retention
*LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED.
Description of Operations/LocationsNehicles/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 CITY OF MENIFEE PURSUANT TO ENDORSEMENT NUMBER U-4.
VALLEY -WIDE RECREATION AND PARK DISTRICT IS A MEMBER OF CALIFORNIA ASSOCIATION FOR PARK AND RECREATION INDEMNITY
(CAPRI)
Certificate Holder
Cancellation
CITY OF MENIFEE
SHOULD ANY OF THE ABOVE MEMORANDUMS OF COVERAGE/POLICIES BE
29714 HAUN RD.
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
2019/2020 SCHEDULE OF INSURERS
CALIFORNIA ASSOCIATION FOR PARKS AND RECREATION INDEMNITY (CAPRI)
PROVIDER
MEMORANDUM /
POLICY NUMBER
LIMIT
CSAC Excess Insurance Authority
EIA PE 19 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-444785-019
Statutory each accident/each employee
for disease excess of
$50,000,000
ENDORSEMENT NO. U-4
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:
Issue Date:
Authorized Represen live
CSAC Excess Insurance
ALL MEMBERS
June 28, 2019
Memorandum No.: EIA 19 EWC-00