CALIFORNIA STATE UNIVERSITY, FULLERTON-2012

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CERTIFICATE OF COVERAGE DATE (MMIDDIYYYY) DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MMEMORANDUM(SI OF COVERAGE.. THE FOLOWING COVERAGE IS IN EFFECT. 6 26/2015 PRODUCER THI6 CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERES NO RIGHTS COVERAGE EFFECTIVE DATE (MMIDDIYY) UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR LIMITS NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Alliant Insurance Services, Inc. MEMORANDUMIS)OF' COVERAGE BELOW, 100 Pine. Street THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 11th Floor ISSUING, COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE San Francisco CA 94111 CERTIFICATE HOLDER. IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDIITIONAL 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($). CLAIMS MADE rX ' OCCUR NAMED COVERED PARTY IMPORTANT; If SUBROGATION IS WAIVED, SUBJECT TO THE.. TERMS AND CONDITIONS OF THE CSU Fullerton Auxiliary Services Corporation MEMORANDUM(S) OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON 2600 NLTt 4P JOd Ave_ , Suite 275 THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT(S). PROGRAM AFFORDING COVERAGE Fullerton CA 92631 -3599 A: CSURMA AO MA B:AORMA WC/Safety National Cas. C: COVERAGES THIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUMIS;I 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 MMEMORANDUM(SI OF COVERAGE.. THE FOLOWING COVERAGE IS IN EFFECT. JPA. LTR. TYPE OF COVERAGE MEMORANDUM NUMBER COVERAGE EFFECTIVE DATE (MMIDDIYY) COVERAGE EXPIRATION DATE (MMIDDYYY) LIMITS A GENERAL LIABILITY AORMA 151,601 7/1/2015 7/1/201,6 EACH OCCURRENCE $5,000,000 FIRE DAMAGE (Any one fire) 5 COMMERCIAL GENERAL LIABILITY CLAIMS MADE rX ' OCCUR '.. MED EXPENSE (Any one person) S5 , Dip D PERSONAL &ADV INJURY S5,000,000 Prof T, iabilitv GENERAL AGGREGATE 55,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- CO'MPIOP AGG N5, 000', 0,D6 MEMOR- PROJECT LOC AN'OUM A AUTOMOBILE LIABILITY AORMA- 1.516 -01 7/1/2015 7/1/2016 COMBINED SINGLE LIMIT ., $5,000,ODO 5 ANY AUTO (Ea accident) ALL OWNED AUTOS SCHEDULEDAUTOS X HIRED AUTOS NON- OWNEDAUTOS Ek WORKERS" COMPENSATION AND A6TYN@A- WP4' -1Slb� 7fT /2U1'S 78./2016 STATUTORY OTHER EMPLOYERS LIABILITY LIMITS ANY PROPRIETORIPARTNERF rE.L. EACH ACCIDENT S5,000,000 � EXECUTIVEJOFFICE.RIMEMBER DISEASE -EA EMPLOYEE `S5, 000, DOD EXCLUDED? IE YES, DESCRIBED UNDER SPECIAL . DISEASE - POLICY LIMIT S5,000,000 PROVISION BELOW OTHER OTHER DESCRIPTION OF OPERATIONS ILOCATIONSIVEHIICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIA.LIPROVISIONS 'Note: Workers' Compensation Coverage is provided as evidence only. City of Santa Ana and State of California are named as additional covered parties as respects the Agreement under the Workforce Investment Act for Orange County Bridge to Engineering Project. Contract No. 50104012. Term of Agreement; 12/l/2011 11/30/2015, CERTIFICATE, HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE Attn: Manager, W1B Administrative Office BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF„ NOTICE WILL BE P.O. $fly 19$8 (M -73J DELIVERED IN ACCORDANCE WITH THE MEMiORANDUM(S) OF COVERAGE PROVISIONS. Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE A"k�.I �°L,VM, w C4"1-