CALIFORNIA STATE UNIVERSITY, FULLERTON (2)-2012

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CERTIFICATE OF COVERAGE 6 DATE26 'MMIO2015 DI5 Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERES NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR TYPE OF COVERAGE NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE A1.liant Insurance Services, Inc. MEMORANDUMNJ3 OF COVERAGE BELOW, 100 Pine Street THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE 11th Floor 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 4/1/2015 MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE EACH OCCURRENCE 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 NbyMEO COVERED PARTY CSU Fullerton Auxiliary services Corporation 2600 NutWOOC1 Ave,, Suite 275 MEMORANDUMDR OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENTS). FU7.,lerton CA 9 2631-3599 PROGRAM AFFORDING COVERAGE A: CSURMA AORMA —. &:AORMA WC/Safety National Cas. CLAIMS MADE OCCUR C: COVERAGES ]'HIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDEO TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUMS) OF COVERAGE, FOR THE PERIOD SHDWN BELOW, NOT WITHSTANDING ANY RE.OUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 FOLOWING COVERAGE IS IN EFFECT. JPA LTR TYPE OF COVERAGE MEMORANDUM NUMBER COVERAGE EFFECTIVE DATE(MMMDPaH COVERAGE EXPIRATION DATE(MMIDOMY) LIMITS A GENERAL LIABILITY AORMA- 1516 -01 4/1/2015 7/1/2016 EACH OCCURRENCE $5,000,000 FIRE DAMAGE (Any we fire) S COMMERCIALGENERAL LIABILITY CLAIMS MADE OCCUR MED EXPENSE (Any ow, Person) $5,000 PERSONAL &ACV INJURY $5,000,000 Prof _'lit GENERALAGGREGATE $5,000,000 BELL AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPIOPAGG 55,000,000 MEMOM R PROJECT LOC ANDll A AVTDMOBICE 4IABtLiTY AORMA - 1516 -01 7/1/2015 7/1/20166 COMBINED SINGLE LIMIT $5,000,000 ANY AUTO iEa acdd.nG $ ALL OWNED AUTOS SCHEDULED AUTOS X HIRED AUTOS NON -CA ... AUT15 B WORKERS' COMPENSATION AND EMPLOYERS LIABILITY AORPIA -WO- -1515 7J1/2015 4/1/2016 we X STATUTORY OTHER LIMITS ANY PROPRIETOWPARTNERI EXECUTIVFICPFIGERIMEMBER E.L. EACH ACCIDENT 55,000,01111 EXCLUDED? IF YES, DESCRIBED TINDER SPECIAL EL. DISEASE- EA EMPLOYEE $5,000,000 E.L. DISEASE - POLICY LIMIT $5,000,000 PROVISION BELOW OTHER OTHER DESCRIPTION OF OPERATIONStLOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIALIPROYISIONS 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: 12/1/2011 - 11/30/2015. CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE- Attn: Manager, WIB Administrative Office BE CANCELLED BEFORE THE EXPIRATION DATE 'I'HEREOF, NOTICE WILL BE P.O. Box 1988 (M -73) DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE Santa Ana CA 92702 PROVISIONS. AUTHORI7S:D REPRESENTATIVE V _�