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CERTIFICATE OF Date: 8/23/2018 SELF-INSURANCE COVERAGE PRODUCER/INSURED The Regents of the University of California This Certificate is issued as a matter of information only to authorized viewers for University of California, Irvine Environmental Health &Safety and Risk Services their internal use only and confers no rights upon any viewer of this Certificate. 4600 Health Sciences Road The Certificate does not amend, extend or alter the coverage described below. 9 Irvine CA 92697-2725 This Certificate may only be copied, printed and distributed by an authorized (949) 824-6200 viewer for its internal use. Any other use, duplication or distribution of the Certificate without the written consent of the Regents of the University of California is prohibited. ENTITIES AFFORDING COVERAGE PARTICIPATION COMPANY LETTER A The Regents of the University Of California 100% COVERAGES THIS IS TO CERTIFY THAT THE REGENTS OF THE UNIVERSITY OF CALIFORNIA IS A GOVERNMENTAL ENTITY THAT HAS A SELF-FUNDED RETENTION FOR LIABILITIES DESCRIBED BELOW, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY WRITTEN CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY PERTAIN. THIS SELF-FUNDED PROGRAM IS SUBJECT TO ALL PROVISIONS OF THE BYLAWS AND STANDING ORDERS OF THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, WHICH DOES NOT PERMIT ANY ASSUMPTION OF LIABILITY WHICH DOES NOT RESULT FROM THE NEGLIGENT ACTS OR OMISSIONS OF ITS OFFICERS, AGENTS OR EMPLOYEES, CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE POLICY EXPIRATION DATE LIMITS LTR A GENERAL LIABILITY Self -Insured 08/13/2018 07/012019 GENERAL AGGREGATE $2,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGE $1,000,000 CLAIMS MADE XJOCCURRENCE PERSONAL&ADV INJURY $1,000,000 CONTRACTUAL LIABILITY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 A AUTOMOBILE LIABILITY Self -Insured 08/13/2018 07/01/2019 COMBINED SINGLE LIMIT $ Not Applicable ANY AUTO X ALL OWNED BODILY INJURY $1,000,000 AUTOS (PER PERSON) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY $ 1,000,000 (PER ACCIDENT) X NON -OWNED AUTOS GARAGE LIABILITY PROPERTYDAMAGE $1000,000 A PROPERTY Self -Insured 08/13/2016 07/01/2019 EACH OCCURRENCE $7500,000 FIRE& EXTENDED PERILS AGGREGATE $NONE A WORKERS' COMPENSATION AND Self4nsured 08/13/2018 07/01/2019 STATUTORY LIMITS YES EMPLOYERS LIABILITY EACH ACCIDENT $As required by DISEASE -POLICY LIMIT $As required by DISEASE - EACH EMPLOYEE $As required by DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS The City of Santa Ana, its officers, employees, agents and representatives, are named as additional insured With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds in regards to the Arts and Culture Artist Grant Program agreement with the Claire Trevor School of The Arts, UC Irvine Outreach program for the one year period July 17, 2018 through July 16, 2019. CERTIFICATE HOLDER CANCELLATION APPLICABLE PARTY AS REQUIRED BY WRITTEN CONTRACT SHOULD THE REGENTS ELECT TO DISCONTINUE SELF-INSURING ITS OR AGREEMENT LIABILITIES, THE REGENTS WILL UPDATE PROOF OF SELF-INSURANCE ON ITS City of Santa Ana WEBSITE. THE REGENTS SHALL NOT BE OBLIGATED TO PROVIDE INDIVIDUAL 20 Civic Center Plaza NOTICE TO VENDORS OR OTHERS. By: Santa Ana CA 92701 61�r fav to er.J ed 04f a '( Qu en Levan vup 1-