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BIG INDEPENDENT CITIES EXCESS POOL JOINT POWERS AUTHORITY <br />PUBLIC ENTITY LIABILITY <br /> DECLARATION <br /> <br />CERTIFICATE NO. <br /> <br />This will certify that the following MEMBER is covered in accordance with the terms and con- <br />ditions of the Master Memorandum of Public Entity Liability Coverage by the BIG INDEPEN- <br />DENT CITIES EXCESS POOL JOINT POWERS AUTHORITY hereinafter calied BICEP. <br /> <br />1 ) MEMBER CITY: <br /> <br />2) MAILING ADDRESS: <br /> <br />3) <br /> <br />4) <br /> <br />MEMORANDUM PERIOD: FROM TO <br />at the address of the Member as stated herein. <br /> <br />12:01 A.M. Standard Time <br /> <br />LIMIT OF LIABILITY: <br />$ <br /> <br />LESS MEMBER CITY'S RETAINED LIMIT AS ULTIMATE <br />NET LOSS as the result of any one OCCURRENCE <br />because of BODILY INJURY or PROPERTY DAMAGE or <br />PERSONAL INJURY or PUBLIC OFFICIALS ERRORS <br />AND OMMISSIONS. or any combination thereof during <br />the AGREEMENT PERIOD. <br /> <br />5) MEMBER CITY'S RETAINED LIMIT: <br /> <br />ULTIMATE NET LOSS as the result of any one OCCUR- <br />RENCE because of BODILY INJURY or PERSONAL <br />INJ~URY or PUBLIC OFFICIALS ERRORS AND OMMIS- <br />S1ONS. or any combination thereof during the AGREE- <br />MENT PERIOD. <br /> <br />6) CLAIMS ADJUSTING FIRM: <br /> <br />7] ANNUAL DEPOSIT PREMIUM: <br /> <br />8) Endorsements attached to ~olicy at inception: <br /> <br /> Countersigned by <br /> <br />This Declarations and Coverage(s), with Stanclarcl Provisions and Endorsements, if any, <br />issued to/o~71 a part thereof, co'mpletes the above.numbered Agreement. ~ <br /> <br />9ICEP 3/9/88 F-11 <br /> <br /> <br />