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CERTIF ICATE NO. ISSUE DATE (MM /DD/YYYY) <br /> WC -726 CERTIFICATE OF COVERAGE 06/24/2014 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO <br /> RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY <br /> CSAC Excess Insurance OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS <br /> Authority CERTIFICATE OF COVERAGE DOES NOT CONSTITITUE A CONTRACT BETWEEN THE <br /> ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE <br /> CERTIFICATE HOLDER <br /> CIO ALLIANT INSURANCE SERVICES, INC. <br /> PO BOX 6450 IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the <br /> NEWPORT BEACH, CA 92658 -6450 Memorandums of Coverage must be endorsed. A statement on this certificate does not confer <br /> s rights to the certificate holder in lieu of such endorsement(s). <br /> PHONE (949) 756 -0271 / FAX (619) 699 -0901 COVERAGE <br /> LICENSE #0C36861 AFFORDED BY: A - See attached schedule of insurers <br /> Member: COVERAGE <br /> CITY OF REDWOOD CITY AFFORDED BY: B <br /> ATTN: LAUREL BLAEMIRE <br /> 1017 MIDDLEFIELD RD. COVERAGE <br /> REDWOOD CITY, CA 94063 AFFORDED BY: C <br /> COVERAGE <br /> AFFORDED BY: D <br /> Coverages <br /> THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE AND POLICIES LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER <br /> NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR <br /> OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE COVERAGE AFFORDED <br /> BY THE MEMORANDUMS AND POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF <br /> SUCH MEMORANDUMS AND POLICIES. <br /> CO TYPE OF COVERAGE MEMORANDUM/ COVERAGE EFFECTIVE COVERAGE EXPIRATION LIABILITY LIMITS <br /> LTR POLICY NUMBER DATE (MM /DD/YYYY) DATE (MM /DD/YYYY) <br /> A EXCESS WORKERS' See attached 07/01/2014 07/01/2015 WORKERS' COMPENSATION: <br /> COMPENSATION & Schedule of Difference between <br /> EMPLOYER'S LIABILITY Insurers for policy Statutory and Member's <br /> numbers $350,000 Retention <br /> EMPLOYERS' LIABILITY: <br /> Difference between <br /> $5,000,000 and Member's <br /> $350,000 Retention <br /> LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED. <br /> Description of Operations /LocationsNehicles /Special Items: <br /> AS RESPECTS EVIDENCE OF COVERAGE FOR PERMIT AGREEMENT NUMBER 5331 BETWEEN THE CITY OF REDWOOD AND SAN MATEO <br /> COUNTY FOR THE USE OF COURTHOUSE SQUARE STORAGE SPACE. <br /> Certificate Holder Cancellation <br /> SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF COVERAGE /POLICIES <br /> SAN MATEO COUNTY BE CANCELLED BEFORE THE EXPIRATION THEREOF, NOTICE WILL BE DELIVERED IN <br /> COUNTY MANAGER'S OFFICE, REAL PROPERTY DIVISION ACCORDANCE WITH THE MEMORANDUMS OF COVERAGE /POLICIES PROVISIONS. <br /> 555 COUNTY CENTER, 5TH FLOOR <br /> REDWOOD CITY, CA 94063 AUTHORIZED REPRESENTATIVE <br /> CSAC EXCESS INSURANCE AUTHORITY <br /> Page 1 of 2 <br />