HomeMy WebLinkAboutAgr 2019-01-01 (California Housing Workers Compensation Authority) 4V
1750 Creekside Oaks Drive,Suite 200,Sacramento,California 9"383 3
(916) 244-1100 FAX(916) 2.14-1199
Memorandum of Coverage
Declaration of Workers' Compensation and Employer's Liability Coverage
Coverage Number CHWCA 2019-1 WC
Named Covered Party: California Housing Workers'
Compensation Authority, et. al., as
per Endorsement No.l
1750 Creekside Oaks Drive, Suite
200
Sacramento, CA 95833
Coverage Period: From 1/]/2019 to 1/1/2020
12:01 a.m.Pacific Time
Limit of Liability: $750,000 Each Occurrence
Form and Endorsements: Form No. CHWCA 2019-IWC,
Endorsement No.l
Approved by the CHWCA Executive Committee on August 16, 2018
ON BEHALF OF
CALIFORNIA HOUSING WORKERS' COMPENSATION AUTHORITY
Countersigned:
Date: _ January 1 2019 ' ' ' °
By:
Authorized Signature
Approved by the CHWCA Executive Committee on August 16, 2018
Commercial Liability Declarations
Policy No: HARRG-145-192830-2019
Named Insured/Mailing Address: Company Name:
Marin County Housing Authority Housing Authority Risk Retention Group
4020 Civic Center Drive 189 Commerce Court
San Rafael, CA 94903 Cheshire, CT 06410
ALL COVERAGES: General Aggregate: $2,000,000 each Policy Year
Policy Effective: 6/30/2019
Policy Expiration: 6/30/2020
AT 12:01 A.M. STANDARD TIME AT YOUR MAILING ADDRESS SHOWN ABOVE
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS
POLICY, WE AGREE TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
NOTICE:
THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP. YOUR RISK RETENTION GROUP
MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE
STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK
RETENTION GROUP.
COVERAGE SECTIONS:
Coverage Section A: Bodily Injury and Property Damage Liability
Limits of Coverage
Per Occurrence: $2,000,000
Fire Damage Liability Sub-Limit: $50,000
Athletic Sports Injury Liability Sub-Limits:
Per Occurrence.- $250,000
Aggregate: $250,000
Deductible -- Per Occurrence: $25,000
Coverage Section B: Personal and Advertising Injury Liability
Limits of Coverage
Personal and Advertising Injury Limit: $2,000,000
Deductible -- Per Occurrence: $25,000
Coverage Section C: Law Enforcement Liability- Claims Made
Limits of Coverage
Per Wrongful Act: NOT COVERED
Aggregate: NOT COVERED
Retroactive Date:
Deductible -- Per Wrongful Act: NONE
ID: 145 Marin County Housing Authority, CA (Portions Copyright Insurance Services Office, Inc.)
Policy:HARRG-145-192830-2019 HACL 506 0617
Coverage Section D: Public Officials Liability- Claims Made
Limits of Coverage
Per Wrongful Act: NOT COVERED
Aggregate: NOT COVERED
Retroactive Date:
Deductible -- Per Wrongful Act: NONE
Coverage Section E: Mold, Other Fungi or Bacteria Liability- Claims Made
Limits of Coverage
Limit of Coverage: $250,000
Retroactive Date: 6/30/2011
Deductible -- Per Year: $25,000
Coverage Section F: Non-Owned and Hired Auto Liability
units of Coverage
Per Accident: NOT COVERED
Deductible -- Per Accident: NONE
Coverage Section G: Employee Benefits Administration Liability- Claims Made
Limits of Coverage
Each Employee: $1,000,000
Aggregate: $1,000,000
Retroactive Date: 6/20/2011
Deductible -- Each Employee: $1,000
Coverage Section H: Lead-Based Paint Liability- Claims Made
Limits of Coverage
Limit of Coverage: NOT COVERED
Retroactive Date:
Deductible -- Per Year: NONE
ID: 145 Marin County Housing Authority, CA (Portions Copyright Insurance Services Office, Inc.)
Policy:HARRG-145-192830-2019 HACL 506 0617
Coverage Section I:Third Party Discrimination - Claims Made
Limits of Coverage
Per Wrongful Act: $500,000
Aggregate: $500,000
Retroactive Date: 06/30/2018
Deductible -- Per Wrongful Act: $25,000
These Declarations, together with the Coverage Form and Endorsement(s) complete the above
numbered policy.
June 21, 2019
Housing Authority Risk Retention Group, Inc. Date
PREMIUM: $52,595
ID: 145 Marin County Housing Authority, CA (Portions Copyright Insurance Services Office, Inc.)
Policy: HARRG-145-192830-2019 HACL 506 0617