Insurance Certificates 2018/19 DRD Fritz Burns (Pool Management & Operations)CALIFORNIAF’I‘AJune11,2019(REVISEDJune13,2019)RobertAmbrizJr.rambrizj@laquintaca.govCityOfLaQuinta78495CalleTampicoLaQuinta,CA92253MemberName:DesertRecreationDistrictAdditionalProtectedParty:CityofLaQuintaActivity:Useofbuilding&poollocatedatthecornerofAvenue52&AvenidaBermudasLQ,CA922053formanagementandoperationsagreementforFritzBurnsPoolCoveragePeriod:From12:01AMon6/15/2019to11:59PMon5/31/2020TheDesertRecreationDistrict(Member)alongwithotherCaliforniapublicagencies,isamemberoftheCaliforniaJointPowersInsuranceAuthority(CaliforniaJPIA),andparticipatesinthefollowingself-insuranceandcommercialinsuranceprogramthatisadministeredbytheCaliforniaJPIAforitsmembers:PrimaryLiabilityProgram,IncludingAutomobileLiabilityCoverageLimit:$5,000,000peroccurrenceAnnualAggregateLimit:$6,000,000OnbehalfoftheMember,theCaliforniaJPIAagreestoincludetheabove-namedadditionalProtectedPartyasaProtectedPartyundertheMemorandumofCoverage-PrimaryLiabilityProgram,subjecttotheabove-statedlimits,butonlyfor‘Occurrencesarisingoutofthedescribedactivity,duringthedescribedCoveragePeriod,andwhererequiredunderthetermsofawrittenagreementbetweentheMemberandtheadditionalProtectedParty.TheCaliforniaJPIAwillendeavortoprovideatleastthirty(30)daysnoticeofanychangeintheforegoinginformation.Ifthewrittenagreementrequires,coverageshallbeprimary.Coverageissubjecttoalltheterms,Definitions,Exclusions,ConditionsandResponsibilitiesoftheMemorandumofCoverage-PrimaryLiabilityProgramandtheLimitsofCoveragestatedabove.AnyinjuryordamagecausedbythesolenegligenceoftheadditionalProtectedPartynamedaboveisnotcovered.Sincerely,JimThydenInsuranceProgramsManagercc:MaureenArchuleta,DesertRec,marchuleta@drd.us.comCALIFORNIAJOiNTPOWERSINSURANCEAUTHORITY808]MOODYSTREET.LAPALMA,CA90623TEL(562467-8700FAX(562)860-4992
ISSUE DATE (MM/DD/YYYY)
06/18/2019CERTIFICATE OF COVERAGE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE
CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND
OR ALTER THE COVERAGE AFFORDED BELOW. THIS CERTIFICATE OF COVERAGE DOES NOT
CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR
PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the
Memorandums of Coverage/Policies must be endorsed. A statement on this certificate does not
confer rights to the certificate holder in lieu of such endorsement(s).
Coverages
THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE 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
DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS.
CO
LTR TYPE OF COVERAGE MEMORANDUM
NUMBER
COVERAGE EFFECTIVE
DATE (MM/DD/YYYY)
COVERAGE EXPIRATION
DATE (MM/DD/YYYY)LIABILITY LIMITS
OTHER
CancellationCertificate Holder
COVERAGE
AFFORDED BY:
COVERAGE
AFFORDED BY:
COVERAGE
AFFORDED BY:
B
C
CALIFORNIA ASSOCIATION FOR PARK AND
RECREATION INDEMNITY (CAPRI)
ATTN: MATTHEW DUARTE
6341 AUBURN BLVD, SUITE A
CITRUS HEIGHTS, CA 95621-5203
CITY OF LA QUINTA
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
07/01/2018 07/01/2019
CAPRI-205
CERTIFICATE NO.
AS RESPECTS EVIDENCE OF COVERAGE FOR AGREEMENT BETWEEN DESERT RECREATION DISTRICT AND CITY OF LA QUINTA FOR POOL
MANAGEMENT AND OPERATIONS FOR FRITZ BURNS POOL LOCATED AT 78060 FRANCES HACK lANE
THE AUTHORITY WAIVES ITS RIGHTS OF SUBROGATION AGAINST CITY OF LA QUINTA, ITS OFFICERS AND EMPLOYEES PURSUANT TO
ENDORSEMENT NUMBER U-4.
Primary Insurance Provided by
DESERT RECREATION DISTRICT
A
PERMISSIBLY SELF-
INSURED
- WORKERS' COMPENSATION
- EMPLOYERS' LIABILITY
CAPRI 2018-2019 WC WORKERS'
COMPENSATION:
EMPLOYERS' LIABILITY:
$350,000
$350,000
CAPRI MEMBER:
AUTHORIZED REPRESENTATIVE
A - CALIFORNIA ASSOCIATION FOR PARK
RECREATION INDEMNITY
Description of Operations/Locations/Vehicles/Special Items:
CITY OF LA QUINTA
PAGE 1 of 3
SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF
COVERAGE/POLICIES BE CANCELLED BEFORE EXPIRATION THEREOF,
NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUMS
OF COVERAGE/POLICIES PROVISIONS
DESERT RECREATION DISTRICT Lchaudhry@laquintaca.gov
ISSUE DATE (MM/DD/YYYY)
06/18/2019CERTIFICATE OF COVERAGE
CSAC Excess Insurance
Authority
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO
RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY
OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS
CERTIFICATE OF COVERAGE DOES NOT CONSTITUE A CONTRACT BETWEEN THE ISSUING
INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THIS CERTIFICATE
HOLDER.C/O ALLIANT INSURANCE SERVICES, INC.
P.O. BOX 6450
NEWPORT BEACH, CA 92658-6450
PHONE (949) 756-0271 / FAX (619) 699-0901
IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the
Memorandum of Coverage/Polices must be endorsed. A statment on this certificate does not
confer rights to the certificate holder in lieu of such endorsement(s).
Coverages
THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE 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 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS.
CO
LTR TYPE OF COVERAGE MEMORANDUM
NUMBER COVERAGE EFFECTIVE
DATE (MM/DD/YYYY)
COVERAGE EXPIRATION
DATE (MM/DD/YYYY)LIABILITY LIMITS
Cancellation
AUTHORIZED REPRESENTATIVE
CSAC EXCESS INSURANCE AUTHORITY
MEMBER:
Certificate Holder
COVERAGE
AFFORDED BY:
COVERAGE
AFFORDED BY:
COVERAGE
AFFORDED BY:
COVERAGE
AFFORDED BY:
A - See attached Schedule of Insurers
B
C
D
CALIFORNIA ASSOCIATION FOR PARK AND
RECREATION INDEMNITY (CAPRI)
ATTN: MATTHEW DUARTE
6341 AUBURN BLVD, SUITE A
CITY OF LA QUINTA
78-495 CALLE TAMPICO
LA QUINTA, CA 92253
LICENSE #0C36861
07/01/2018 07/01/2019 WORKERS' COMPENSATION:
EMPLOYERS' LIABILITY:
A EXCESS WORKERS'
COMPENSATION &
EMPLOYERS' LIABILITY
EIA PE-WC-205
CERTIFICATE NO.
Difference between
Statutory and Member's
$350,000 Retention
Difference between
$5,000,000 and Member's
$350,000 Retention
AS RESPECTS EVIDENCE OF COVERAGE FOR AGREEMENT BETWEEN DESERT RECREATION DISTRICT AND CITY OF LA QUINTA FOR
POOL MANAGEMENT AND OPERATIONS FOR FRITZ BURNS POOL LOCATED AT 78060 FRANCES HACK lANE
THE AUTHORITY WAIVES ITS RIGHTS OF SUBROGATION AGAINST CITY OF LA QUINTA, ITS OFFICERS AND EMPLOYEES PURSUANT TO
ENDORSEMENT NUMBER U-4.
Description of Operations/Locations/Vehicles/Special Items:
DESERT RECREATION DISTRICT
CAPRI MEMBER:
*LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED.
PAGE 2 of 3
SHOULD ANY OF THE ABOVE MEMORANDUMS OF COVERAGE/POLICIES BE
CANCELED BEFORE THE EXPIRATION THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE MEMORANDUMS OF
COVERAGE/POLICIES PROVISIONS
See attached
Schedule of
Insurers for policy
numbers
Lchaudhry@laquint
CSAC EXCESS INSURANCE AUTHORITY
EXCESS WORKERS' COMPENSATION PROGRAM
CALIFORNIA ASSOCIATION FOR PARKS AND RECREATION INDEMNITY (CAPRI)
CSAC Excess Insurance Authority
PROVIDER MEMORANDUM /
POLICY NUMBER
LIMIT
EIA-PE 18 EWC-15
EW7-64N-444785-018Liberty Insurance Corporation
Workers’ Compensation:
$50,000,000
(Difference between $50,000,000 and the
individual member’s retention)
Employers’ Liability:
(Difference between $5,000,000 and the
individual member’s retention)
each accident/each employee
for disease
$5,000,000 each accident/each employee
for disease
Statutory each accident/each employee
for disease excess of
$50,000,000
2018/2019 SCHEDULE OF INSURERS
ENDORSEMENT NO. U-4
CSAC EXCESS INSURANCE AUTHORITY
EXCESS WORKERS’ COMPENSATION
June 25, 2018
It is understood and agreed that Section VIII. SUBROGATION of the CONDITIONS section of the
Memorandum of Coverage is deleted in its entirety and replaced by the following:
VIII. SUBROGATION: In the event of any payment under this Memorandum, the Authority shall be
subrogated, to the extent of such payment, to all the Covered Party’s rights of recovery therefore, and the
Covered Party shall execute all papers required and shall do everything that may be necessary to secure
such rights. Any amount recovered as a result of such proceedings, together with all expenses necessary
to the recovery of any such amount shall be apportioned as follows: The Authority shall first be reimbursed
to the extent of its actual payment hereunder. If any balance then remains, said balance shall be applied
to reimburse the Covered Party. The expenses of all proceedings necessary to the recovery of such
amount shall be apportioned between the Covered Party and the Authority in the ratio of their respective
recoveries as finally settled. If there should be no recovery in proceedings instituted solely on the initiative
of the Authority, the expenses thereof shall be borne by the Authority.
However, in the event of any loss payment under this Memorandum for which you have waived the right of
recovery in a written contract entered into prior to the loss, we hereby agree to also waive our right of
recovery but only with respect to such loss.
It is further agreed that nothing herein shall act to increase the Authority's limit of indemnity.
This endorsement is part of the Memorandum of Coverage and takes effect on the effective date of the
Memorandum of Coverage unless another effective date is shown below. All other terms and conditions
remain unchanged.
Authorized Representative
CSAC Excess Insurance Authority
Issued To:ALL MEMBERS
Memorandum No.:
Issue Date:
Effective Date:EIA 18 EWC-00
WAIVER OF SUBROGATION ENDORSEMENT