DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
Pa
ge 1 of 9
ISSUED TO: City of Sunnyvale, a public agency
Environmental Services - Solid Waste Division
456 W. Olive Ave.
Sunnyvale, CA 94086
ISSUED BY: Silicon Valley Clean Water
1400 Radio Road
Redwood City, CA 94065
DISCHARGE POINT: S VCW Hauled Waste Receiving Station – Food Waste Pit #1 EFFECTIVE DATE: May 1, 2024
EXPIRATION DATE: April 30, 2025
The aforementioned Permittee, the City of Sunnyvale (Permittee), through its contracted waste hauler(s) listed in this permit, is authorized to discharge processed residential and commercial food waste from the Sunnyvale Materials Recovery and Transfer Station (food mash) into the Publicly Owned Treatment Works (POTW) owned and operated by Silicon Valley Clean Wate r (SVCW). The discharge is subject to the Uniform Regulations of SVCW (Regulations), any applicable provisions of Federal, State, and local law or regulation, and all procedures and conditions established by this permit (comprised of all pages attached hereto).
This permit is subject to revision or revocation at any time for the purposes of protecting the treatment facility and workers, improving the efficiency of grease, septic and municipal organic waste receiving at SVCW, and accommodating new regulations on sludge, SVCW effluent and air emissions which may impact Silicon Valley Clean Water. This permit may be revoked if the Permittee fails to comply with the terms and conditions of the permit.
_______________________________ _______________
Teresa Herrera Date
Manager
Silicon Valley Clean Water
Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
PART I - SPECIAL CONDITIONS AND LIMITATIONS
A. FOOD MASH
SVCW accepts food mash, which shall be defined as the Organic F raction of Municipal Solid W aste (OFMSW) in accordance with SVCW’s NPDES Permit CA0038369. This is the source- separated organic waste that are generated from residential (homes and apartments) sources, commercial and business establishments. Hazardous wastes are generally not considered food mash and are prohibited in SVCW’s hauled waste receiving program. The wood and paper fraction of municipal solid waste is excluded from food mash.
B. ORIGIN AND QUANTITY OF WASTE
This permit identifies the City of Sunnyvale as the waste generator who, through its waste hauler(s) listed in Part I(C) below, may supply up to 6 dry tons per day equivalent mass of food mash each weekday, except holidays.
C. SUBCONTRACTED WASTE HAULER(S)
Below are the Permittee’s contracted waste hauler(s) and their respective vehicles authorized to deliver food mash at SVCW designated discharge points. The Permittee must comply with all labor laws applicable to Permittee’s waste hauler(s) and immediately notify SVCW and receive authorization for subcontracted waste hauler(s) and their respective vehicles not listed below prior to delivering loads to SVCW. Subcontractors hauling waste to SVCW are subject to Part III – Insurance Requirements of this permit.
HAULER – J.D. Services, Inc.
Number of Trucks Used to Haul to SVCW - Two ( 2)
LICENSE PLATE # CAPACITY (gal)
9E28753 6,000
101223S 6,000
D. LIMITED USE VACUUM TRUCKS
Trucks used to haul food mash to SVCW must not be used for transport of any hazardous wastes or hazardous materials. (CA Penal Code section 374.5.)
E. ACCESS CODES
Upon issuance of a SVCW Municipal Organic Waste permit, access codes for SVCW’s main facility front gate and the hauled waste receiving station will be issued to the hauler. Hauler vehicle access within the SVCW facility is restricted to the hauled waste receiving station. (See Attachment A for route to the authorized discharge point at SVCW).
F. TRAINING
Drivers are required to attend training provided by SVCW staff. Training includes access to SVCW facility Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
and procedures for offloading at the authorized discharge point. SVCW safety policy requires all persons on the plant site to wear proper personal protective equipment.
G. NON-ROUTINE DISCHARGE AUTHORIZATION
Discharge of other nonhazardous wastewater is prohibited under this permit and requires an approved SVCW Non-Routine Discharge Authorization. Non-Routine Discharge Authorization applications can be downloaded from the SVCW website.
PART II – PROCEDURES AND REQUIREMENTS
A. HAULED WASTE RECEIVING CONNECTION
Hauled waste shall only be discharged at the waste hauler’s permitted discharge location. This permit authorizes discharge of food mash at SVCW’s wastewater t reatment facility (Facility) into Food Waste Pit #1. A discharge hose with a 4” camlock fitting is required to connect to the receiving station.
B. DELIVERY
(1) The delivery quantity and schedule shall be coordinated weekly between the Permittee and SVCW and may be adjusted by mutual agreement.
(2) The Permittee, through its waste hauler(s), may supply polished slurry from food mash up to equivalent mass of 6 dry tons per day, five days a week (Monday through Friday), except holidays.
Dry Tonnage is calculated as follows:
Dry Tonnage (tons) = Volume in gal. x 8.34 lbs/gal x Total solids percentage (%) / 2,000 lbs/ton
E.g., one 5,000-gal delivery of 15% solids food mash has an equivalent mass of:
5,000 gal. x 8.34 lbs/gal. x 0.15 % solids / 2,000 lbs/ton = 3.1275 tons of dry mass
(3) Upon completion of the first waste hauler delivery in a day, if it is determined that accepting a second similar delivery would lead to exceedance of the 6 dry tons per day mass limit, the Permittee would be notified by SVCW, and that delivery will have to be rerouted elsewhere by the Permittee at no cost to SVCW.
(4) All deliveries shall be accompanied by certified bill of lading, a copy of which shall be delivered to SVCW prior to offloading of the food mash delivery.
(5) SVCW’s hauled waste receiving hours are between 7:00 a.m. and 2:00 p.m. and loads can only be delivered between these time windows.
(6) SVCW observes 9 holidays: New Year’s Day, Martin Luther King Jr. Day, Presidents' Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, Day after Thanksgiving Day, and Christmas Day. No deliveries will be accepted during these holidays.
Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
(7) There will be at least a two (2) hour gap between receiving loads so that SVCW can fully process one load before making the Facility available to receive the next load.
(8) The second tanker load in a day, if any, shall be delivered no earlier than 10:00 a.m. to comply with SVCW’s air permit requirements.
C. NOTIFICATION REQUIREMENTS
(1) If SVCW is unable to receive food mash material due to anticipated reasons, SVCW will notify Permittee as soon as reasonably possible.
(2) If, after arrival of the food mash to the Facility, SVCW is unable to receive the material due to any unanticipated reason, including but not limited to, exceedance of daily capacity limit based on equivalent mass content , failure of the Facility equipment, process upset, or any operational constraints, then Permittee shall transport the food mash elsewhere without any cost to SVCW.
All notification related to quantity and deliveries shall be via text message, email, and direct telephone conversation when at all possible.
Notification to SVCW shall be as follows:
SVCW Control Room
(650) 832-6235
[email protected]
[email protected]
[email protected]
Notification to The City of Sunnyvale shall be as follows:
Ramana Chinnakotla
Director of Environmental Services
Environmental Services Department
Phone: 408-730-7785
Email : [email protected]
Operational contact:
Deepti Jain
Environmental Program Manager
Environmental Services Department
Phone: 408-730-7791
Email: [email protected]
D. SAMPLING
Sample bottles and labels will be provided at Food Waste Pit #1. For each load discharged to SVCW, t he hauler is required to collect a sample halfway through the offload process . Samples shall be appropriately Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
labeled and placed in the sample bottle receiving cabinet at the receiving station.
E. SVCW BILL OF LADING
A SVCW Bill of Lading shall be completed and submitted for each load of food mash delivered. The Bill of Lading shall include information on all generators contributing to the delivered load. (See Attachment B.) Upon completion of the discharge, the Bill of Lading shall be left in the receipt box located next to the receiving station. Failure to provide a Bill of Lading shall be considered a violation of this permit and cause to suspend discharge privileges.
F. CLEAN-UP
Upon completion of delivery of each load of food mash , the waste hauler shall be responsible for the following cleanup tasks:
(1) Pick up and remove any trash and debris created from waste hauler(s)’ offload for proper disposal. (2) Hose down the offloading area.
(3) Perform any other cleanup as necessary.
Failure to fully complete tasks 1, 2 or 3 shall be considered a violation of this permit and cause for revocation of this permit.
G. BILLING/FEES
Permittee shall pay $32/Wet Ton of food mash delivered as tipping fee for the duration of this permit. Failure to submit a Bill of Lading upon completion of a delivery will be considered a violation of this permit and cause to suspend discharge privileges. Wet tonnage is calculated as follows:
Wet tonnage (tons) = Volume of delivery (gal.) x 8.34 lbs/gal. / 2,000 lbs/ton
H. PAYMENT
Prompt payment of invoices by Permittee shall be considered a condition of this permit. Invoices shall be paid within 30 days of the invoice date. Failure to pay invoices within 30 days of the invoice date may result in suspension or revocation of discharge privileges.
PART III - INSURANCE REQUIREMENTS
GENERAL
The Permittee shall not commence hauling any food mash to SVCW until all required insurance is obtained at its own expense. Such insurance shall have the approval of the SV CW as to limit, form, and amount.
The Permittee shall not allow any subcontracted waste hauler(s) to commence hauling food mash to SVCW until the same insurance requirements have been complied with by such subcontracted waste hauler(s).
Companies writing the insurance for the Permittee shall be licensed to do business in the State of California or be permitted to do business under the Surplus Line Law of the State of California.
Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
Nothing contained in these insurance requirements is to be construed as limiting the extent of the Permittee's responsibility for payment of damages resulting from his operations under this permit. Coverage required hereinunder shall operate as Primary insurance.
The Permittee shall take out, pay for, and maintain throughout the duration of this permit the following insurance coverage:
A. COMMERCIAL GENERAL AND AUTOMOBILE LIABILITY INSURANCE
This insurance shall protect the Permittee from claims for bodily injury and property damage which may arise because of the nature of the work or from operations under this permit.
1. Additional Insureds. This policy of insurance shall name the Silicon Valley Clean Water (SVCW), each of its officers, employees, and agents; and JPA members the cities of Belmont, San Carlos and Redwood City, the West Bay Sanitary District, each of their officers, employees, and agents as additional insureds. This policy shall provide coverage to each of the said insureds with respect to said waste hauling. Both bodily injury and property damage insurance must be on an occurrence basis and said policy shall provide that the coverage afforded thereby shall be primary coverage to the full limit of liability stated in the declarations, and if the said insureds have other insurance against the loss covered by said policy, that other insurance shall be excess insurance only.
2. Amount of Coverage. The bodily injury and property damage liability of insurance shall provide coverage in the following limits of liability: $1,000,000 on account of any one occurrence with an aggregate limit of not less than $1,000,000, combined single limit.
3. Subcontractors. The bodily injury and property damage liability insurance shall not be deemed to require the Permittee to have sub -contractors named as co -insureds in Permittee’s policy of public liability and property damage, but the policy shall protect Permittee from contingent liability which may arise from operations of Permittee’s subcontractors.
4. Included Coverage. The above bodily injury and property damage liability insurance shall also include the following coverage:
Operation of Automobiles - Any Auto
Premises - Operations
Owner's and Permittee's Protective
(Sub-contractors to the Permittee)
Products - Completed Operations
Broad Form Commercial General Liability
XCU (Explosion, Collapse, Underground Damage)
XCU may be deleted when not applicable to operations performed by the Permittee or his subcontractors.
5. Umbrella Policy. At the option of the Permittee , limits may be less than required, with an Umbrella Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
Policy providing the additional limits needed. This form of insurance will be acceptable provided that the Primary and Umbrella Policies both provide the insurance coverage herein required.
B. WORKER'S COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE
In accordance with the provisions of Article 5, Chapter 1, Part 7, Division 2 (commencing with Section 1860) and Chapter 4, Part 1, Division 4 (commencing with Section 3700) of the Labor Code of the State of California, the Permittee is required to secure the payment of compensation to Permittee’s employees and for that purpose obtain and keep in effect adequate Workers' Compensation Insurance. If the Permittee , in the sole discretion of the SVCW, satisfies the SVCW of the responsibility and capacity under the applicable Worker's Compensation Laws, if any, to act as a self -insurer, Permittee may so act, and in such case, the insurance required by this paragraph need not be provided.
C. PROOF OF COVERAGE
Prior to hauling food mash to SVCW, the Permittee shall furnish SVCW with the following items:
1. Certificate of Self -Insurance Coverage Letter , evidencing issuance of all liability insurance required by SVCW, and
2. Additional Insured endorsement for General and Auto Liability.
The certificate(s) and endorsements for each insurance policy are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the SVCW or are to be approved as to form by the SVCW . The certificate(s), policy declaration or information page(s), and endorsements are to be received and approved by the SVCW before food mash hauling commences.
Notwithstanding any other provision of Part III, the Permittee is self-insured for the coverage required herein through a combination of self-insured retentions and municipal risk pooling as authorized by state law.
D. CONTINUATION OF COVERAGE
It shall be the responsibility of the Permittee to renew all insurance endorsements as required to sustain continuous insurance coverage. Under no circumstances shall the Permittee transport food mash to SVCW without current insurance endorsements.
PART IV - STANDARD CONDITIONS
A. GENERAL PROHIBITIONS (SVCW UNIFORM REGULATIONS SECTION 2.1)
The Permittee shall comply with all the general prohibitive discharge standards of the Regulations.
These prohibit any discharge which may cause:
Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
1) a fire or explosion
2) flow obstruction or damage to the sewerage facilities 3) danger to human life or safety
4) inhibition of operation and maintenance of sewerage facilities 5) air pollution
6) interference with wastewater treatment processes
7) interference with wastewater reclamation processes
8) detrimental environmental impact
9) discoloration or other adverse effect on the SVCW effluent 10) SVCW to violate any requirements of law
B. CONFIDENTIAL INFORMATION (SVCW UNIFORM REGULATIONS SECTION 4.12)
Except for data determined to be confidential under the Regulations, all reports required by this permit shall be available for public inspection at the offices of the Silicon Valley Clean Water.
C. REVOCATION OF PERMIT (SVCW UNIFORM REGULATIONS SECTION 6.8)
The permit issued to the Permittee by SVCW may be revoked when, after inspection, monitoring, or analysis it is determined that the discharge of the food mash permitted hereunder is in violation of Federal, State, or local laws, regulations, or conditions of this permit. Additionally, falsification or intentional misrepresentation of data or statements pertaining to the permit application or any other required reporting form, shall be cause for permit revocation.
D. NON-ASSIGNABILITY OF PERMIT (SVCW UNIFORM REGULATIONS SECTION 4.7)
This permit is issued to a specific Permittee and is not assignable to another Permittee . Sale of a facility shall obligate the purchaser to seek prior written approval of the SVCW for continued discharge to the sewerage system.
E. FALSIFYING INFORMATION OR TAMPERING WITH MONITORING EQUIPMENT ( SVCW UNIFORM REGULATIONS SECTION 6.8)
Knowingly making any false statement on any report or other document required by this permit or knowingly rendering any monitoring device or monitoring method inaccurate, may result in permit revocation.
F. MODIFICATION OR REVISION OF THE PERMIT (SVCW UNIFORM REGULATIONS SECTION
4.6)
The terms and conditions of this permit may be subject to modification by the SVCW at any time as limitations or requirements, as identified by the Regulations, are modified or other just cause exists.
G. DISCHARGE OF HAZARDOUS WASTE (SVCW UNIFORM REGULATIONS SECTION 2.1 b)
The Permittee shall not discharge any hazardous waste as defined by Title 22 of the California Code of Regulations.
Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
H. DURATION OF PERMIT (SVCW UNIFORM REGULATIONS SECTION 4.6)
The term of this permit is one ( 1) year. The term shall be renewed automatically for successive one ( 1)- year terms if no renewal action is taken by SVCW. In no event shall the term of this permit be longer than five (5) years.
I. PENALTIES (SVCW UNIFORM REGULATIONS SECTION 6.14)
Failure to comply with the provisions of this permit or the Regulations shall be considered a misdemeanor and is punishable by a fine up to $ 1,000.00 or by six ( 6) months' imprisonment in the County Jail. Each day of violation shall be considered a separate offense.
J. SAFETY
SVCW requires all persons on SVCW premises to wear proper protective equipment, including but not limited to, a hard hat, safety vest, shoes, and safety glasses. All safety requirements are strictly enforced.
K. EXEMPTION FROM SPECIFIC REGULATIONS
Since this permit deals with very specific wastes discharged to facilities at SVCW which have been specifically designed to handle those wastes, certain sections of the SVCW Uniform Regulations are not appropriate. This permit exempts the Permittee from compliance with the following sections:
2.4(b) Prohibits waste exceeding 300 mg/L of animal/vegetable oil and grease.
2.3 W ASTEWATER STRENGTH LIMITATIONS
L. LEGAL SCOPE OF PERMIT
This permit only authorizes those matters which fall within the jurisdiction of the Silicon Valley Clean Water and is further limited by the specific wording of the permit. The P ermittee is responsible to comply with all laws and other regulations that do not come within the actions authorized by this permit with respect to Silicon Valley Clean Water and other jurisdictions (U.S. government, etc.).
M. INDEMNIFICATION
Permittee shall defend, indemnify and hold harmless SVCW, its governing Commission, officers, employees, agents and member agencies (“Indemnitees”) from and against any and all liability for claims, suits, judgments and costs or losses or expenses of any kind or nature arising out of, connected with, or attributable to Permittee’s activities, operations or duties under this Permit, excluding, however, such liability, claims, losses, damages, or expenses arising from SVCW’s sole negligence or willful acts.
This indemnification provision shall apply to any acts or omissions, willful misconduct or negligent conduct, whether active or passive, on the part of Permittee or it’s subcontracted waste hauler(s).
Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
ATTACHMENT A
SVCW SITE PLAN WITH FOOD MASH RECEIVING STATION
Attachment 1
SVCW MAIN
GATE/ KIOSK
A
SILICON VALLEY CLEAN WATER
1400 RADIO ROAD
REDWOOD CITY, CA 94065
LEGEND
DIRECTION OF TRAFFIC
A FOOD WASTE PIT
CAUTION
CONSTRUCTION AREA
CONSTRUCTION TRAFFIC
ENTERING AND LEAVING
R
A
D
I
O
R
O
A
D
Attachment 1
DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
ATTACHMENT B
SVCW BILL OF LADING
Attachment 1
BP: 04/09/2024
SVCW FOOD MASH BILL OF LADING
This form must be completed for the load to be accepted.
SOURCE NO. 1
House generating waste: W a s t e Food Mash
Address generating waste: gallons
City/State/Zip: County
Telephone: ( )
I certify that I am the owner or an employee of the company or residence generating this waste. I certify that this waste is the waste indicated above and nothing else. I certify that this waste originated at the address indicated above. (Truck driver may not sign this certification.)
Date: Signature: Print Name:
SOURCE NO. 2
Company generating waste: W a s t e Food Mash
Address generating waste: gallons
City/State/Zip: County
Telephone: ( )
I certify that I am the owner or an employee of the company or residence generating this waste. I certify that this waste is the waste indicated above and nothing else. I certify that this waste originated at the address indicated above. (Truck driver may not sign this certification.)
Date: Signature: Print Name:
SOURCE NO. 3
Company generating waste: W a s t e Food Mash
Address generating waste: gallons
City/State/Zip: County
Telephone: ( )
I certify that I am the owner or an employee of the company or residence generating this waste. I certify that this waste is the waste indicated above and nothing else. I certify that this waste originated at the address indicated above. (Truck driver may not sign this certification.)
Date: Signature: Print Name:
WASTE HAULER: TOTAL gallons
TRUCK NO.:
I certify that this truck contains only waste from the addresses listed above. I certify that this truck does not contain any other waste.
Date: Driver’s Signature: Print Name:
LABORATORY ANALYSIS:
Laboratory Analyst:
Attachment 1
1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 DISCRETIONARY WASTEWATER DISCHARGE PERMIT NO. HW 240301
HAULED WASTE - MUNICIPAL ORGANIC WASTE
ATTACHMENT C
PERMIT APPLICATION AND INSURANCE PAPERWORK
Attachment 1
Attachment 1
HAULED WASTE PERMIT APPLICATION
FOR GREASE/SEPTIC/MUNICIPAL ORGANIC WASTE
Silicon Valley Clean Water • 1400 Radio Road • Redwood City, CA 94065 Phone 650 832-6235 email: [email protected] Instructions:
To apply for a Discharge Permit to haul food grease, septic tank or municipal organic waste to SVCW, return this application, along with all completed insurance certificates and endorsements to: Silicon Valley Clean Water, attn: Environmental Services.
To be completed by OWNER or OTHER LEGALLY AUTHORIZED REPRESENTATIVE COMPANY NAME:
OWNER:
BUSINESS ADDRESS:
CITY:
MAILING ADDRESS:
CITY:
CA DEPT. OF FOOD &
AGRICULTURE 1KG
REGISTRATION NO.:
PRIMARY CONTACT NAME:
TITLE:
PHONE NO.:
FAX NO.:
EMAIL ADDRESS:
J.D. Services, Inc.
Joseph Bernardini
7 45 Kevin Court
Oakland ZIP CODE: 94621
Same as Business Address
ZIP CODE: -----
IKC-10689
Rachel Estrada
Customer Service Manager
650-458-6356
(510) 638-7811
[email protected]
WASTE DESCRIPTION: Pre-processed food material slurry
# OF TRUCKS USED TO HAUL TO SVCW: 2 -----
LICENSE NO. CAPACITY (GAL)
9E28753 6,000
101223S 6,000
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons directly responsible for gathering the information or the person or persons who has or have knowledge of the substance of the information, the information is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for ,ubmitd"g fulso ;"""'""; "• ;"d"';"g the '°'';b;1;1y ofa fine'"' ;,np,;so"m~l~~~~,;olaHoos. ate
Owner
Title
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:
CONTACT
(A/C, No):
FAX
E-MAIL
ADDRESS:
PRODUCER
(A/C, No, Ext):
PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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 BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 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 INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY
NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
4/10/2024
Leap/Carpenter/Kemps Insurance Agency
3187 Collins Dr.
Merced CA 95348
Dottie Flores
209-386-5076
[email protected]
Nautilus Insurance Company
17370
BERNA-2
Key Risk Insurance Company
10885
Bernardini Enterprises, Inc.
Chip it Recycling / JD Services, JD Recycling / JD Environmental/745 Kevin Court LLC
745 Kevin Court
Oakland CA 94621-4039
AGCS Marine Ins. Co.
1535190390
1 A
X
1,000,000
X
100,000
10,000
1,000,000
2,000,000
X
Y
Y
GSP203527512
8/5/2023
8/5/2024
2,000,000
B
1,000,000
X
X
X
Y
BAP203527612
8/5/2023
8/5/2024
A
X
4,000,000
X
FFX203527712
8/5/2023
8/5/2024
X
0 A
C
Pollution Liability
Rented/Leased Equpment
GSP203527512
MXI930886681000
8/5/2023
8/5/2023
8/5/2024
8/5/2024
Occur/Agg: $1mil/$2mi
$100,000
Ded: $5000
Ded $500
Excess Limits are in Excess of Primary Coverage for General Liability and Pollution Liability ONLY.
Additional Named Insured is Joseph L. Bernardini
Silicon Valley Clean Water, the Design Consultant, the Construction Manager, the Cities of Belmont, San Carlos, Redwood City and the West Bay Sanitary District and each of their officials, officers, partners, employees, agents and volunteers are Additional Insured with respects to General Liability and Auto Liability on a primary and non-contributory basis per forms attached.
Silicon Valley Clean Water, the Design Consultant, the
Construction Manager, the Cities of Belmont, San Carlos, Redwood City and
the West Bay Sanitary District and each of their
officials, officers, partners, employees, agents
and volunteers
Attachment 1
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BAP203527612
Attachment 1
BENV CA 06 0917
ENDORSEMENT
This endorsement forms a part of the policy to which it is attached. Please read it carefully.
BUSINESS AUTO - ADDITIONAL INSURED
WHEN REQUIRED BY CONTRACT OR AGREEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
Section II - Liability Coverage A. - Coverage, 1. Who is an Insured, is amended to add:
d. Any person or organization to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into, excluding contracts or agreements for professional services, which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of your operations or premises owned by or rented to you. However, the insurance provided will not exceed the lesser of:
1. The coverage and/or limits of this policy; or
2. The coverage and/or limits required by said contract or agreement.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
Includes copyrighted material of Insurance Services Office, Inc., with its permission .
BENV CA 06 0917 Page 1 of 1
BAP203527612
Attachment 1
COMMERCIAL AUTO
CA 04 491116
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY AND NONCONTRIBUTORY -
OTHER INSURANCE CONDITION
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement.
A. The following is added to the Other Insurance
Condition in the Business Auto Coverage Form
and the Other Insurance - Primary And
Excess Insurance Provisions in the Motor
Carrier Coverage Form and supersedes any
provision to the contrary:
This Coverage Form's Covered Autos Liability
Coverage is primary to and will not seek
contribution from any other insurance available
to an "insured" under your policy provided that:
1. Such "insured" is a Named Insured under
such other insurance; and
2. You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution from
any other insurance available to such
"insured".
B. The following is added to the Other Insurance
Condition in the Auto Dealers Coverage Form
and supersedes any provision to the contrary:
This Coverage Form's Covered Autos Liability
Coverage and General Liability Coverages are
primary to and will not seek contribution from
any other insurance available to an "insured"
under your policy provided that:
1. Such "insured" is a Named Insured under
such other insurance; and
2. You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution from
any other insurance available to such
"insured".
CA 04 491116 © Insurance Services Office, lnc.,2016 Page 1 of 1 GSP203527512 08/05/2023 08/05/2024 08/05/2023
Attachment 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS
AUTOMATIC STATUS - COMPLETED OPERATIONS
Policy Number Policy Effective Date Policy Expiration Date Endorsement Effective Date
This endorsement modifies insurance provided under the following:
COMBINED GENERAL LIABILITY AND SITE SPECIFIC POLLUTION LIABILITY POLICY I. SECTION Ill - WHO IS AN INSURED is amended to include as an additional insured:
1. Any person or organization for whom you have performed operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and
2. Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above.
Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement.
Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY directly caused by your work performed for the additional insured described in Paragraph 1. or 2. above, and included in the products-completed operations hazard.
However, the insurance afforded to such additional insured described above:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured; and
We will not extend any insurance coverage to any additional insured that is not provided to you in this policy.
II. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
a. Bodily injury or property damage arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the occurrence which caused the bodily injury or property damage involved the rendering of, or the failure to render any professional architectural, engineering or surveying services.
Ill. With respect to the insurance afforded to these additional insureds, the following is added to SECTION IV - LIMITS OF INSURANCE:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement described in Paragraph 1.1.; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
GSP 7176 12 20 Includes copyrighted material of Insurance Services Office, Inc., used with its permission . Page 1 of 2 Attachment 1
IV. With respect to the insurance afforded to these additional insureds, the following is added to SECTION V - REPORTING, DEFENSE, SETTLEMENT & COOPERATION:
1. Duties -- Additional Insured
An additional insured must see to it that:
a. We are notified in writing as soon as practicable of an occurrence which may result in a claim or suit; b. We receive written notice of a claim or suit as soon as practicable; and c. A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory.
V. SECTION VI - CONDITION 10. - Other Insurance is amended by the addition of the following which supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that:
a. The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and b. You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work included in the products-completed operations hazard which is the subject of such contract or agreement.
However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project specific, primary insurance.
VI. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
GSP 7176 12 20 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 2 of2 GSP203527512 08/05/2023 08/05/2024 08/05/2023
Attachment 1
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS
AUTOMATIC STATUS - ONGOING OPERATIONS
Policy Number Policy Effective Date Policy Expiration Date Endorsement Effective Date
This endorsement modifies insurance provided under the following:
COMBINED GENERAL LIABILITY AND SITE SPECIFIC POLLUTION LIABILITY POLICY I. SECTION Ill - WHO IS AN INSURED is amended to include as an additional insured:
1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement, in effect during this policy period, that such person or organization be added as an additional insured on this policy; and
2. Any other person or organization you are explicitly required to add as an additional insured under the contract or agreement described in Paragraph 1. above.
Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement.
Such person(s) or organization(s) is an additional insured only with respect to liability for bodily injury or property damage under SECTION I - COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY or personal injury or advertising injury under SECTION I - COVERAGE B- PERSONAL AND ADVERTISING INJURY LIABILITY directly caused by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured described in Paragraph 1. or 2. above.
However, the insurance afforded to such additional insured described above:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured, and
We will not extend any insurance coverage to any additional insured that is not provided to you in this policy.
A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed.
II. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply:
This insurance does not apply to:
a. Bodily injury, property damage or personal and advertising injury arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including:
(1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the occurrence which caused the bodily injury or property damage , or the offense which caused the personal and advertising injury, involved the rendering of, or the failure to render any professional architectural, engineering or surveying services. b. Bodily injury or property damage occurring after:
(1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured( s) at the location of the covered operations has been completed; or
(2) That portion of your work out of which the injury or damage arises has been put to its intended use by any GSP 7178 12 20 Includes copyrighted material of Insurance Services Office, Inc., used with its permission . Page 1 of 2 Attachment 1
person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project.
Ill. With respect to the insurance afforded to these additional insureds, the following is added to SECTION IV - LIMITS OF INSURANCE:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the contract or agreement described in Paragraph 1.1.; or
2. Available under the applicable limits of insurance;
whichever is less.
This endorsement shall not increase the applicable limits of insurance.
IV. With respect to the insurance afforded to these additional insureds, the following is added to SECTION V - REPORTING, DEFENSE, SETTLEMENT & COOPERATION:
1. Duties -- Additional Insured
An additional insured must see to it that:
a. We are notified in writing as soon as practicable of an occurrence or offense which may result in a claim or suit;
b. We receive written notice of a claim or suit as soon as practicable; and c. A request for defense and indemnity of the claim or suit will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the contract or agreement requires that this coverage be primary and noncontributory.
V. SECTION VI - CONDITION 10. - Other Insurance is amended by the addition of the following which supersedes any provision to the contrary:
Primary And Noncontributory Insurance
This insurance is primary to and will not seek contribution from any other insurance available to a person(s) or organization(s) included as an additional insured under this endorsement provided that:
1. The additional insured person(s) or organization(s) is a Named Insured under such other insurance; and
2. You have agreed in writing in a contract or agreement, in effect during this policy period, that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured person(s) or organization(s). Such contract or agreement must be executed and in effect prior to the performance of your work which is the subject of such contract or agreement.
However, this provision does not apply if the other insurance available to the person(s) or organization(s) included as an additional insured is Owners and Contractors Protective Liability, Railroad Protective Liability, or similar project specific, primary insurance.
VI. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a SCHEDULE of additional insureds, and which endorsement applies to that designated additional insured.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
GSP 7178 12 20 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. Page 2 of2 GSP203527512 08/05/2023 08/05/2024 08/05/2023
Attachment 1
ENDORSEMENT
This endorsement forms a part of the policy to which it is attached. Please read it carefully.
Designated Construction Project(s) General Aggregate Limit Policy Number Policy Effective Date Policy Expiration Date Endorsement Effective Date
This endorsement modifies insurance provided under the:
Combined General Liability and Site Specific Pollution Liability
SCHEDULE
Designated Construction Projects: Each of your projects away from premises owned or rented to you, performed during the policy period when a Designated Per Project Aggregate Limit of Insurance is required in a written contractual agreement.
I. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY which can be attributed only to ongoing operations as shown in the schedule above:
1. A separate Designated Construction Project Limit applies to each designated construction project and that limit is equal to the amount of the Aggregate Limit shown in the Declarations page.
2. Except for damages because of bodily injury or property damage included in the products-completed operations hazard, the Designated Construction Project Limit is the most we will pay for the sum of all damages under SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY regardless of the number of:
a. Insureds;
b. Claims-made or suits brought; or
c. Persons or organizations making claims or bringing suits.
3. Any payments made under SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages shall reduce the Designated Construction Project Limit for that designated construction project. Such payments shall not reduce the Aggregate Limit and the Policy Aggregate shown in the Declarations page nor shall they reduce any other Designated Construction Project Limit, except as affected by the Designated Construction Project Aggregate Limit described below.
4. The limits shown in the Declarations page for Each Occurrence and Damage to Premises Rented to you continue to apply. However, instead of being subject to the Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project Limit.
5. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under the Designated Construction Project Limit, described in 1. and 2. Above.
Regardless of the number of construction projects or designated construction projects covered under this policy, the most we will pay as the Designated Construction Project General Aggregate is $5,000,000.
II. For all sums which the insured becomes legally obligated to pay as damages caused by occurrences under SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY which cannot be attributed only to ongoing operations as shown in the schedule above:
1. Any payments made under SECTION I - COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY for damages shall reduce the amount available under the Aggregate Limit or the Products Completed Operations Aggregate Limit, whichever is applicable; and
2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit, but will reduce the Policy Aggregate limit.
Ill. When coverage for liability arising out of the products-completed operations hazard is provided, any payments for damages because of bodily injury or property damage included in the products-completed operations hazard GSP 7173 06 20 Page 1 of 2
Attachment 1
will reduce the Products-Completed Operations Aggregate Limit, and not reduce the Aggregate Limit nor the Designated Construction Project General Aggregate Limit, but will reduce the Policy Aggregate limit.
IV. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project.
V. The provisions of SECTION IV- LIMITS OF INSURANCE not otherwise modified by this endorsement shall continue to apply as stipulated.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED.
GSP 7173 06 20 Page 2 of2
City Hall
Human Resources
456 West Olive Avenue
Sunnyvale, CA 94088-3707
408-730-7500
Sunnyvale.ca.gov
April 15, 2024
Silicon Valley Clean Water
1400 Radio Road
Redwood City, CA 94065
Re: City of Sunnyvale Certification of Coverage – July 1, 2023 through June 30, 2024 Discharge processed residential & commercial food waste from the Sunnyvale Materials Recovery and Transfer Station (“food mash”) into the Publicly Owned Treatment Works owned and operated by Silicon Valley Clean Water (SVCW).
To Whom It May Concern:
City of Sunnyvale (“City”) is insured for liability and workers’ compensation exposures through a combination of self-insurance, pooling and insurance programs with large, self -insured retentions; State ID #7264. The City is a long- standing member of the California Joint Powers Risk Management Authority (CJPRMA) and Public Risk Innovation, Solutions, and Management (PRISM) liability pools and purchases excess coverage for workers’ compensation and liability exposures. Losses that fall within the City’s self-insured levels are covered by the financial resources of the City and are administered under the self-insured claims program handled by this office.
In the event of a claim arising out of the Agreement, the C ity acknowledges its indemnification obligations per the terms of the Agreement and the minimum insurance requirements. All lines of coverage are primary and non-contributory, and endorsements shall be provided in addition to this certification of coverag e letter when required by written Agreement. A waiver of subrogation endorsement for workers’ compensation will not be provided as the City is self-insured.
This letter is to advise you that the liability insurance coverages stipulated in your Agreement are covered under the City’s self-insured program.
If additional coverage information is required or to answer questions , please contact me at (408) 730-3003 or [email protected].
Sincerely,
Jen Martel
Risk Manager
City of Sunnyvale
Attachment 1
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Sunnyvale
Heart of Silicon Valley '"
CALIFORNIA JOINT POWERS RISK MANAGEMENT AUTHORITY
CERTIFICATE OF COVERAGE
3201 Doolan Road • Suite 285 • Livermore, CA 94551 • (925) 837-0667 • FAX (925) 290-1543
CERTIFICATE HOLDER
AND ADDITIONAL COVERED PARTY:
THIS CERTIFIES THAT THE COVERAGE
DESCRIBED HEREIN HAS BEEN ISSUED TO:
DESCRIPTION OF ACTIVITY:
DATE(S) OF ACTIVITY:
LOCATION OF ACTIVITY:
ENTITY PROVIDING COVERAGE COVERAGE LIMITS CERTIFICATE EXPIRATION DATE
The following coverage is in effect and is provided through participation in a risk sharing joint powers authority: comprehensive general and automobile liability as defined in the Memorandum of Coverage on file with the entity and which will be made available upon request.
The coverage being provided is limited to the activity and the time period indicated herein and is subject to all the terms, conditions and exclusions of the Memorandum of Coverage of the California Joint Powers Risk Management Authority.
Pursuant to Section II, subsection 8, relating to the definition of a covered party, the certificate holder named herein is only an additional covered party for covered claims arising out of the activity described herein a nd is subject to the limits stated herein.
Coverage is in effect at this time and will not be cancelled, limited or allowed to expire at a date other than that indicated herein except upon 30 days written notice to the certificate holder.
DATE AUTHORIZED SIGNATURE
NAME AND TITLE (print or type)
Form B1
Attachment 1