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CERTIFICATE NO. <br />ISSUE DATE(MM/DD/YYYY) <br />WC -2750 <br />CERTIFICATE OF COVERAGE <br />07/26/2018 <br />THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO <br />CSAC Excess Insurance <br />RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY <br />OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS <br />Authority <br />CERTIFICATE OF COVERAGE DOES NOT CONSTITITUE A CONTRACT BETWEEN THE <br />ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE <br />CERTIFICATE HOLDER <br />C/O ALLIANT INSURANCE SERVICES, INC. <br />IMPORTANT: If the certificate holder is requesting a WAIVER OF SUBROGATION, the <br />Memorandums of Coverage must be endorsed. A statement on this certificate does not confer <br />rights to the certficate holder in lieu of such endomement(s). <br />PO BOX 6450 <br />NEWPORT BEACH, CA 92658-6450 <br />PHONE (949) 756-0271 / FAX (619) 699-0901 <br />LICENSE#OC36861 <br />COVERAGE <br />AFFORDED BY: A -See attached Schedule Of Insurers <br />Member: <br />BIG INDEPENDENT CITIES EXCESS POOL (BICEP) <br />COVERAGE <br />AFFORDED BY: B <br />MEMBER AGENCY, CITY OF SANTA ANA <br />ATTN: SAMANTHA LAMBERT <br />20 CIVIC CENTER PLAZA, M-28, BOX 1988 <br />COVERAGE <br />AFFORDED BY: C <br />SANTA ANA, CA 92702-1988 <br />COVERAGE <br />AFFORDED BY: D <br />Coverages <br />THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE AND POLICIES LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER <br />NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR <br />OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED <br />BY THE MEMORANDUMS AND POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF <br />SUCH MEMORANDUMS AND POLICIES, <br />CO <br />LTR <br />TYPE OF COVERAGE <br />MEMORANDUM/ <br />POLICYNUMBER <br />COVERAGE EFFECTIVE <br />DATE(MM/DD/YYYY) <br />COVERAGE EXPIRATION <br />DATE(MM/DD/YYYY) <br />LIABILITY LIMITS <br />A <br />EXCESS WORKERS' <br />See attached <br />07/01/2018 <br />07/01/2019 <br />WORKERS' COMPENSATION: <br />COMPENSATION & <br />Schedule of <br />Difference between <br />EMPLOYER'S LIABILITY <br />Insurers for policy <br />Statutory and Members <br />numbers <br />$1,000,000 Retention <br />EMPLOYERS' LIABILITY: <br />Difference between <br />$5,000,000 and Members <br />Retention <br />LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED. <br />Description of Operations/LocationsNehicles/Special Items: <br />AS RESPECTS EVIDENCE OF COVERAGE FOR AGREEMENT BETWEEN CITY OF SANTA ANA AND COLLEGE AND CAREER PREPARATORY <br />ACADEMY FOR PROVIDING ALTERNATIVE SECONDARY EDUCATION RESOURCES. <br />e1_11 136 <br />e <br />Certificate Holder <br />Cancellation <br />SHOULD ANY OF THE ABOVE DESCRIBED MEMORA DUMS OF COVERAGE/POLICIES <br />BE CANCELLED BEFORE THE EXPIRATION THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE MEMORANDUMS OF COVERAGE/POLICIES PROVISIONS. <br />COLLEGE AND CAREER PREPARATORY ACADEMY <br />AUTHORIZED REPRESENTATIVE <br />1669 E. WILSHIRE AVE, STE. 605 <br />SANTA ANA, CA 92705 <br />CSAC EXCESS INSURANCE AUTHORITY <br />