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Page 1 of 2 <br /> <br /> <br /> <br />CSAC EXCESS INSURANCE AUTHORITY <br />EXCESS WORKERS' COMPENSATION PROGRAM <br />MEMORANDUM OF COVERAGE <br />DECLARATIONS <br /> <br />ITEM 1: COVERED PARTY: City of Redwood City <br />ITEM 2: MEMORANDUM PERIOD: From July 1, 2015 to July 1, 2016, 12:01 a.m. local time of the <br />Covered Party as stated herein <br />ITEM 3: STATE: California <br />ITEM 4: RETENTION AND INDEMNITY: <br />A. COVERED PARTY’S RETENTION: <br /> $ 500,000 each occurrence <br />B. LIMIT OF INDEMNITY: <br />Statutory (See attached Schedule of Limits and Coverage Providers) <br />The Authority’s limit of indemnity, as set forth in ITEM 4 B includes pooled limits that apply to <br />all Members and all Covered Parties combined for all losses as a result of any one <br />occurrence. <br />ITEM 5: MEMORANDUM NUMBER: EIA-PE 15 EWC-100 <br />ITEM 6: ESTIMATED PAYROLL: $ 65,978,771 <br />ITEM 7: DEPOSIT PREMIUM: $ 538,693 (inclusive of all layers & fees) <br /> This premium is auditable based on final audited payroll <br />ITEM 8: FORMS AND ENDORSEMENTS ATTACHED AT INCEPTION: EWC MOC 7/1/2012, <br />Endorsement No. U-1, U-2, U-3, U-4, U-5, 1 <br />Notice: The limits of indemnity shown below include various reinsurance and excess placements with <br />specific limits which are inclusive and not excess of the limits stated above in Item 4.B. The limits of <br />indemnity shown in Item 4.B. apply to all Members and all Covered Parties combined for all losses <br />as a result of any one occurrence. Each Coverage Provider listed on the Schedule of Limits and <br />Coverage Providers provides coverage on its own form so there may be some coverage variances as <br />a result of different policy language. Please carefully review all coverage forms. <br /> <br /> <br />Countersigned by: Issue Date: June 26, 2015 <br />Authorized Representative <br />CSAC Excess Insurance Authority <br />6.1.C. - Page 48