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Digitally signed by Francine R. Francine R. Villareal Vi I I a YPa I Date: 2021.07.14 15:1 1:01 CERTIFICATE OF Date: 6/7/2021 SELF-INSURANCE COVERAGE PRODUCER/INSURED This Certificate is issued as a matter of information only to authorized viewers for The Regents of the University of California University of California, Irvine their internal use only and confers no rights upon any viewer of this Certificate. Division of Finance and Administration Office of Risk Services e described below. The Certificate does not amend, extend or alter the coverage g 4199 Campus Drive, Suite 300 This Certificate may only be copied, printed and distributed by an authorized Irvine CA 92612-2749 viewer for its internal use. Any other use, duplication or distribution of the (949) 824-8772 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 7/1/2021 7/1/2022 GENERAL AGGREGATE S 2,000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPAGG $ 1,000,000 CLAIMS MADE X❑OCCURRENCE PERSONAL&ADV INJURY S 1,000,000 CONTRACTUAL LIABILITY $ 1,000,000 EACH OCCURRENCE $ 1,000,000 A AUTOMOBILE LIABILITY Self -Insured 07/01/2021 07/01/2022 COMBINED SINGLE LIMIT $ Not Applicable ANY AUTO X ALL OWNED BODILY INJURY S 1,000,000 AUTOS (PER PERSON) SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY S 1,000,000 (PER ACCIDENT) X NON -OWNED AUTOS GARAGE LIABILITY PROPERTY DAMAGE $ 1,000,000 PROPERTY EACH OCCURRENCE $ FIRE & EXTENDED PERILS AGGREGATE $ A WORKERS' COMPENSATION AND Self -Insured 07/01/2021 07/01/2022 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/LOCATIONS/VEHICLES/SPECIAL ITEMS The City of Santa Ana, its officers, agents, employees and volunteers are hereby named as additional insured but only in connection with the Santa Ana Workforce Investment Board (SAWIB) continuing agreement with the UC Irvine Division of Continuing Education for the period July 1 2020 through June 30, 2021. 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 Risk Management Division, 4th Floor NOTICE TO VENDORS OR OTHERS. By: 20 Civic Center Plaza Santa Ana CA 92702 ,. RisieManagementDivi