CALIFORNIA STATE UNIVERSITY OF LONG BEACH

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Francine R. Digitally signed by Francine R. Villareal Villareal Date: 2021.032913:36:29-07'i CERTIFICATE OF COVERAGE OAT312512D/YYVY) 3/25/2021 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR Alllant Insurance Services, Inc. NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE MEMORANDUM(S) OF COVERAGE BELOW. 100 Pine Street, 11th Floor THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE San Francisco CA 94111 ISSUING COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDITIONAL COVERED PARTY, THE MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT(S). IMPORTANT: IF SUBROGATION IS WAIVED, SUBJECT TO THE TERMS AND CONDITIONS OF THE NAMED COVERED PARTY CSU, Long Beach MEMORANDUM(S) OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON 1250 Bellflower Blvd. Long Beach CA 90840 THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENTS. PROGRAM AFFORDING COVERAGE A: CSURMA B: C: COVERAGES THIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUM(S) OF COVERAGE, FOR THE PERIOD SHOWN BELOW, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED BY THE PROGRAM DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUM(S) OF COVERAGE. THE FOLLOWING COVERAGE IS IN EFFECT. JPA LTR TYPE OF COVERAGE MEMORANDUM NUMBER COVERAGE EFFECTIVE DATE(MM/DD/YY) COVERAGE EXPIRATION DATE (MM/DDIYY) LIMITS A GENERAL LIABILITY CSURMA-LIAB-2021 7/1/2020 7/1/2021 EACH OCCURRENCE $2,00D.WO X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) S CLAIMS MADE 0 OCCUR MED EXPENSE (Any one person) 5 X Contractual PERSONAL& ADV INJURY $ X SIR$25n,000 GENERAL AGGREGATE $4,000,000 GENT AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $4,000,000 MEMOR rl PROJECT rl LOC ANDUM AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS A WORKERS'COMPENSATION AND EMPLOYERS LIABILITY CSURMA-WC-2021 711QD20 7/112021 X Ac OTHER STATUTORY LIMITS ANYPROPRIETORIPARTNERY EXECUTNTJUTIVFJOFFICERIMEMBER E.L. EACH ACCIDENT 51,000,000 EXCLUDED? IF YES, DESCRIBED UNDER SPECIAL E.L. DISEASE —EA EMPLOYEE 51,COQOOD E.L. DISEASE —POLICY LIMIT $1'aw, 0 PROVISION BELOW OTHER OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECUUJPROVISIONS Note: Workers' Compensation Coverage is provided as evidence only. City of Santa Ana, its officers, agents, employees and volunteers and the State of California, its officers, employees and volunteers are named as additional covered parties as respects the Agreement for Workforce Training Program. Term of Agreement: March 3, 2021 - June 30, 2023. This cancels and replaces certificate(s) issued on March 9, 2021. City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS) OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUMS OF COVERAGE PROVISIONS. °P Risk MnlagenlmtDMalort .4R2AEWEBJ & APPROV®BY: FHA+Z 2. V'SA"I 1 R1sk Management Analyst