EVIDENCE OF COVERAGE & ADDITIONAL COVERED PARTY
This Evidence of Coverage is used as a ma4er of informa5on only and confers no rights upon the Cer5ficate Holder. This Evidence of Coverage does not amend, extend, or alter the coverage afforded by the memoranda listed below.
DATE (MM/DD/YYYY)
JPA MEMBER (Covered Party)
TYPE OF COVERAGE ADDL
INSR LIMIT OF LIABILITY / COVERAGE
Re: EVIDENCE OF COVERAGE & ADDITIONAL COVERED PARTY ENDORSEMENT AS REQUIRED BY AGREEMENT OR CONTRACT
ADDITIONAL COVERED PARTY
CIRA EOC ACP (07/2021)
CANCELLATION
Should any of the above coverages for the Covered Party be changed or withdrawn prior to the expira5on date issued above, JPA will mail 30 days wri4en no5ce to the Cer5ficate Holder, but failure to mail such no5ce shall impose no obliga5on or liability of any kind upon JPA, its agents, or representa5ves.
AUTHORIZED REPRESENTATIVE:
EXPIRATION
12:01a.m.
CONTACT NAME
PHONE
EMAIL
EFFECTIVE
(MM/DD/YYYY) MEMORANDUM NUMBER (MOC)
CERTIFICATE NUMBER:
GENERAL LIABILITY $
$
PER OCCURRENCE GROUP SELF-INSURANCE
Public Errors & Omissions SELF-INSURED RETENTION
The JPA Member (Covered Party) named above par5cipates in CIRA, the California Intergovernmental Risk Authority (JPA). As such, it is collec5vely and permissibly self-insured under Sec5ons 990.4 and 990.8 of the California Government Code.
This is to cer5fy that the CIRA Memorandum of Coverages evidenced below have been issued to the Covered Party for the period indicated. The coverage is in effect and is provided through par5cipa5on in a risk sharing joint powers authority. Notwithstanding any requirement, term, or condi5on of any contract or other document with respect to which this Evidence of Coverage may be used or may pertain, the coverages afforded by the Memorandum of Coverages described herein are subject to all the terms, exclusions, and condi5ons of such Memorandum of Coverages.
Bodily Injury / Property Damage
Personal Injury
Auto Liability
$
WORKER’S COMPENSATION PER OCCURRENCE GROUP SELF-INSURANCE $ Employer’s Liability SELF-INSURED RETENTION
N/A
916-927-7727
[email protected]
7/1/2025
✓ CIRA GL# 2025/26 7/1/2025 7/1/2026
CIRA Memorandum Dept.
Amy Northam
California Intergovernmental Risk Authority (CIRA)
2330 E. Bidwell Street, Ste. 150
Folsom, CA 95630
1,000,000
✓ CIRA WC# 2025/26 7/1/2025 7/1/2026 500,000
County of Sonoma, its officers, agents, and
employees
Attn: DHS - Contract & Board Item Development Unit
1450 Neotomas Avenue, Suite 200
Santa Rosa CA 95405
Agreement No: 2022-1047-A00
of the Agreement.
As respects to Agreement for Services between the City of Cotati and the County of Sonoma for the City's to provide services as outlined in Exhibit A City of Cotati
201 West Sierra Ave.
Cotati CA 94931-4217
✓
86076427
5,000
5,000
86076427 | 25/26 GL WC | Alexandra Avila | 7/1/2025 1:41:59 PM (PDT) | Page 1 of 2 This certificate cancels and supersedes ALL previously issued certificates.
FORM SAMPLE
ADDITIONAL COVERED PARTY ENDORSEMENT DATE (MM/DD/YYYY)
JOINT POWERS AUTHORITY (JPA) JPA MEMBER (Covered Party)
CONDITIONS OF THIS ADDITIONAL COVERED PARTY ENDORSEMENT
ADDITIONAL COVERED PARTY
CIRA EOC ACP ENDORSEMENT (07/2021)
CANCELLATION
Coverage is in effect as stated above and will not be cancelled except upon 30 days’ wriKen noLce to the AddiLonal Covered Party.
CERTIFICATE NUMBER:
The coverage afforded to the Addi$onal Covered Party as described on the CerLficate of Coverage is subject to all terms, exclusions, condiLons, definiLons, and other provisions of the California Intergovernmental Risk Authority’s Liability Memorandum of Coverage.
Coverage is afforded hereunder only to the extent the Covered Party is required by agreement or contract to name the Cer$ficate Holder as Addi$onal Covered Party.
If the Covered Party is required by agreement or contract to name the Cer$ficate Holder as an Addi$onal Covered Party and the agreement or contract requires the coverage provided to the Addi$onal Covered Party to be primary, then the coverage provided by this endorsement shall be primary. In all other events, if collecLble insurance with any insurer, coverage with any other joint powers authority or other self-funding mechanism is available to the Addi$onal Covered Party covering a loss to which the CIRA Memorandum of Coverage applies (whether on a primary, excess or conLngent basis), the coverage provided by this endorsement shall be in excess of, and shall not contribute with such other insurance or coverage; provided, however, that this clause does not apply with respect to excess insurance or coverage purchased specifically to be in excess of such Memorandum.
This Endorsement does not apply to liability arising out of the sole or acLve negligence of the AddiLonal Covered Party named. Also, the AddiLonal Covered Party is not covered for Claims by another Covered Party.
Effec$ve Date: Expira$on Date: 07/01/2025 at 07/01/2026 12:01a.m.
California Intergovernmental Risk Authority (CIRA)
2330 E. Bidwell Street, Ste. 150
Folsom, CA 95630
City of Cotati
County of Sonoma, its officers, agents, and
employees
Attn: DHS - Contract & Board Item Development Unit
1450 Neotomas Avenue, Suite 200
Santa Rosa CA 95405
86076427
86076427 | 25/26 GL WC | Alexandra Avila | 7/1/2025 1:41:59 PM (PDT) | Page 2 of 2 This certificate cancels and supersedes ALL previously issued certificates.
FORM SAMPLE