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Slalewide AssulaWnof community CdlegeIbERTIFICATE OF COVERAGE <br />1"01004 <br />Profaded IRSurance Program for Schools <br />611712011 <br />ADMINISTRATOR; LICENSE# 0451271 <br />THIS CERTIFICATE IS ISSUED As MATTER OR WFORMADONONLY <br />Keener& Associates <br />AN0 CONFERS NORONTE UPON THE CERTIFICATE HOLDER. THIS <br />901 Calls Amanecer,#200 <br />CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE <br />5a0 Clemente, CA 92673 <br />AFFORDED BY THE COVERAGE DOCUMENTS BELOW <br />ENTITIES OF GROUND COVERAGE: <br />949940.1760 <br />w:w keeoaNwm <br />EGnrYA Statewide Assodelion of Community Colleges <br />ENfCYe ProUded Insurance Program for Schools <br />COVERED PARTY <br />South Orange County Community College Dist <br />26000 Marguerite Parkway <br />MIN C: <br />Mission Viejo CA 92692 <br />ENTITY <br />ENTITY <br />THIS 16TO CERTIFY ➢ NTTHECOV£ RAGESLIMBEIOWHAV MEN ISSUED TOTYECOYI RE) PAR'Y M.MED:EOVE FOR *HE PERIOD INOLATEO, NJMITHSTANMNGANY <br />REOJIPEMENT TERM OR CONDIGN OF MY COW FACT OR OTHER DOCUMEMMTH RESPECT TO MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PER'NN THE COEERAOE <br />A70RYD XSN S SLBECTTO ALL THE TERMS AGO MOTIONS 0FaUCXDDVFAAGE DOCUMENTS. <br />MEMBER <br />ENT <br />LTR <br />TYPE OF COVERAGE <br />COVERAGE <br />DOCUMENTS <br />EFFECTIVIV <br />EXPIRATION DATE <br />RETAINED LIMIT <br />IDEOUCIMLE <br />UNITS <br />A <br />GENERAL LIABILITY <br />COMBINED SINGLE LIMIT EACHLCCURPENCE <br />GENERALLAEMITY <br />CLAIMSMAOE �O'J'JRRENCE <br />9W000107.25 <br />71112011 <br />$ 50,000 <br />B 1000,000 <br />KONMEMCODES <br />71112012 <br />ERROPSBOMSSIONS <br />A <br />AUTOMOBILE LIABILITY <br />XNBINED MSOIE Or EACH OCO'JRRENCE <br />JAM ALTO <br />swc0010725 <br />71112011 <br />S 50:000 <br />B 1:000:000 <br />IJMREOAUTO <br />71112012 <br />1v,NOWMEOAL70 <br />I✓VIrGARAGE LABILITY <br />I AUTO PHYSICA'. DAMAGE <br />A <br />PROPERtt <br />SwcOmGi�ss <br />11112011 <br />" 5,000 <br />1250,000,000 <br />I�A:LMSx <br />11112012 <br />EACXCCCURRixcE <br />I EXC.uDESeaereouNDB�.coD <br />I Brf.DERSeISM <br />A <br />SNOENTPROFEBSIONALLIAAWtt <br />SWCVOf07�96 <br />71112011 <br />a 5.000 <br />IRCIVded <br />71112012 <br />EACXCCCUPRENCE <br />6 <br />WORNERSCOMPENSATON <br />I�N'CSrAMOPYAMNS I�I OTHEP <br />�EN�LOYEAS JABILxY <br />PP$117UB <br />71112011 <br />1 <br />innm2 <br />a 1000,000 <br />EL. FACaPMAOEM <br />i 1,000,000 <br />FXCESSWOAMERSCOMPENSATON <br />S <br />EMPLGYERSLAELIIY <br />� <br />EI.dBEABE�E4CXENPLOYEE <br />Ago <br />1 1,060,000 <br />/ <br />V <br />E.., 9SEASE.aDUCYUMIT$ <br />OTHER <br />y� <br />A <br />C1pS1NW <br />Fe <br />xscPoVmx of amAaoNMLOUmxavExID .EBREaTRImMUMs <br />' $ublIBd 10I¢ImS and mOdllioNS of Ih¢ M¢mOmndum of CwBre9¢' <br />SUPERVISED USE OF THE NAMED CERTIFICATE HOlOER'$ FACILITIES SY SOUTH ORANGE COVMY <br />COMMUNITY COLLEGE DISTRICT STUDENT$ ENROLLED IN PAWW,EDIC PROGRAM FOR CLINICAL EXPEDIENCE. <br />oa¢nFICMTEXMCEP <br />CANCELUilON.... SHOVl0ANY0FTHEASOIROEBCRISEOCOVEPAOEBBE <br />CANCELEOBEFORETHE EXPIRATION GATE iNEREOF,iHEISSVINGENTIttNPA <br />WILLENOEAVORTO GULL 3Q, OAYSWRITIEN NOTICETOiH €CERTIFICATE <br />CITY DF SANTA ANA FIRE <br />IwNEAN4ME0TOTXE LEFT, SVTFAILURFTOWULSOCM NOTICESHAl <br />DEPRRTMENT <br />IMPOSENOOaucATIOxoRLUSILIttOFANr XINOUPOUrHEEmlTVUVA,Ra <br />1438 SOUTH BROADWAY <br />AGENTS Ofl REPPESENTATIVES. <br />� �� <br />Santa AnaCA92707 <br />GIBhBm Ghce AUIHOPIiEDREPRfSENTA7M <br />exw re <br />CG'. IA,, :4i411f1 eilLYS W4P PIX"IM�" Xelleae tla9olaeo If11/f0111E,pi'.:9 M Page 1 cf 1 <br />