Agmt25 City of Belmont Range Contract FY 2025-2028

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CERTIFICATE NO. ISSUE DATE WC -4238 CERTIFICATE OF COVERAGE 1 11/19/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO PUBLIC RISK INNOVATION, RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY SOLUTIONS, AND MANAGEMENT OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE DED BELOW. CERTIFICATE OFCOVERAGE DOES NOT CONSTITTUUEACON RACOTBETWEEN HE HIS ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE C/O ALLIANT INSURANCE SERVICES, INC. CERTIFICATE HOLDER 18100 VON KARMAN AVENUE, 10TH FLOOR IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the IRVINE, CA 92612 Memorandums of Coverage must be endorsed. A statement on this certificate does not confer PHONE (949) 756-0271 / FAX (619) 699-0901 rights to the certificate holder in lieu of such endorsement(s). COVERAGE LICENSE #OC36861 AFFORDED BY: A See Attached Schedule of Insurers Member: COVERAGE CITY OF BELMONT AFFORDED BY: B ATTN: MS. NAWEL VOELKER COVERAGE ONE TWIN PINES LANE, SUITE 320 BELMONT. CA 94002 AFFORDED BY: C COVERAGE AFFORDED BY: D Coverages THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE AND POLICIES 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 AND POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS AND POLICIES. CO TYPE OF COVERAGE MEMORANDUM/ COVERAGE EFFECTIVE COVERAGE EXPIRATION LIABILITY LIMITS LTR POLICY NUMBER DATE DATE A WORKERS' PRISM -PE 25 EWC-91 07/01/2025 07/01/2026 WORKERS' COMPENSATION: COMPENSATION & Statutory EMPLOYERS' LIABILITY EMPLOYERS' LIABILITY: $5,000,000 LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED. Description of Operations/Locations/Vehicles/Special Items: AS RESPECTS EVIDENCE OF COVERAGE FOR AGREEMENT BETWEEN CITY OF BELMONT AND CITY OF REDWOOD CITY FOR USE OF REDWOOD CITY POLICE DEPARTMENT FIRING RANGE LOCATED AT 1301 MAPLE STREET, REDWOOD CITY, CA FOR TRAINING PURPOSES. THE AUTHORITY WAIVES ITS RIGHTS OF SUBROGATION AGAINST CITY OF REDWOOD CITY, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS PURSUANT TO ENDORSEMENT NUMBER U-2. Cancellation Certificate Holder SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF COVERAGE/POLICIES BE CANCELLED BEFORE THE EXPIRATION THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUMS OF COVERAGE/POLICIES PROVISIONS. CITY OF REDWOOD CITY AUTHORIZED REPRESENTATIVE 1017 MIDDLEFIELD ROAD REDWOOD CITY, CA 94063 Public Risk Innovation, Solutions, and Management