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EVIDENCE OF CONTRACT OF POOLED SELF-INSURANCE ISSUE DATE 7/26/96 ROBERT F. DRIVER ASSOCIATES THIS EVIDENCE OF CONTRACT IS ISSUED AS A MATTER f.O. BOX 6450 OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON CWPORT BEACH, CA 92658-6450 THE HOLDER. THIS DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE CONTRACT (714)756-0271 DESCRIBED BELOW. COVERAGE AFFORDED BY * INSURED ORANGE COUNTY CITIES RISK MANAGEMENT AUTHORITY AND LETTER A: INDIVIDUAL CITY'S SELF-INSURED RETENTION MEMBER AGENCY OF: CITY OF BREA LETTER B: "Orange County Cities Risk Management Authority,A Public #1 CIVIC CENTER CIRCLE Agency." BREA, CA 92621 MEMBER AGENCY OF THE ORANGE COUNTY CITIES RISK MANAGEMENT AUTHORITY COVERAGE PER CA.GOVERNMENT CODE SECTION 990.4(a), 990.8(c) THIS IS TO CERTIFY THAT THE PARTY NAMED ABOVE HAS ENTERED INTO A CONTRACT OF POOLED SELF- INSURANCE AS LISTED BELOW FOR CONTRACT PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF SELF-INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY SELF-INSURANCE CONTRACT DESCRIBED HERE IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF THE CONTRACT OF SELF-INSURANCE. CONTRACT CONTRACT CONTRACT LIABILITY LIMITS IN THOUSANDS LTR TYPE OF COVERAGE NUMBER EFFECTIVE EXPIRATION EACH AGGREGATE DATE DATE OCCURRENCE A GENERAL AND AUTOMOBILE SELF INSURED LIABILITY 7/1/96 7/1/97 BI&PD 250, N/A COMBINED PERSONAL INJURY $ INCL. B EXCESS LIABILITY`" OCC0010 7/1/96 7/1/97 BI&PD 1, 750 , $20, 000, COMBINED ** THE ABOVE NOTED CONTRACT OF SELF-INSURANCE IS A CLAIMS-MADE CONTRACT DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/SPECIAL ITEMS LEASE AGREEMENT DATED AS OF JULY 1, 1996 ON BREA FIRE STATION #3 LOCATED AT 400 N. KRAEMER BLVD. , BREA, CA. OL """THE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID LOSSES HOLDER CANCELLATION COUNTYWIDE PUBLIC FINANCING SHOULD ANY OF THE ABOVE DESCRIBED CONTRACTS BE CANCELLED BEFORE THE AUTHORITY AND THEIR RESPECTIVE EXPIRATION DATE THEREOF,THE RISK MANAGEMENT AUTHORITY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE HOLDER NAMED HEREON BUT FAILURE TO MAIL MEMBERS, OFFICERS, EMPLOYEES AND SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE RISK ASSIGNS MANAGEMENT AUTHORITY,OR ITS REPRESENTATIVES. ATTN: EXECUTIVE DIRECTOR AUTHORIZ SIGNATURE 20 CIVIC CENTER PLAZA ( j[S.) SANTA ANA, CA 92701