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SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY INDEMNITY POLICY EMPLOYERS REINSURANCE CORPORATION No. 0553087 SCHEDULE I. Insured: City of Redwood City 2. Mailing address: 1017 Middlefield Road Redwood City, California 94063 .\. Named states: California 4, Excluded states: None ~, Policy Period: (a) From: July 1, 2002 (b) To: July 1,2003 Both days at 12:01 A.M. standard time at the Insured's address shown in Item 2 of this Schedule fl, Retention: (a) Each accident: (b) Each employee for disease: $500,000 $500,000 Limit each accident: (a) Policy Part One, Workers Compensation: (b) Policy Part Two, Employers Liability: $25,000,000 $ 1,000,000 Ii. Limit each employee for disease: (a) Policy Part One, Workers Compensation: (b) Policy Part Two, Employers Liability: $25,000,000 $ 1,000,000 I). Premium: (a) Payroll divided by $100 multiplied by: (b) Minimum: $llO,400.00 (c) Deposit: $122,734.00 .2664 UK'-2120 I '-r-"~' rt~~ :tll: ;'..;.~~,"~..~.' '1..1,.,.. :~, ,,' :1 'i ; :7' , j I"~ !1 ! i ¡r, , « \' 1->, ¡ II ;111 t~1 It, ~....'.'"' :r I; :",~ i :,. t , .i: ¡t~¡ ;."'.~'.I':" ,~ 1!;!, "~~ ~~I ,¡"iir.. .~~ 1:1 );;j ',:;,