ORANGE COUNTY TRANSPORTATION AUTHORITY (OCTA) (33) - 2016

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CERTIFICATE OF COVERAGE I 07/05/2016 PRODUCER: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, Alliant Insurance Services, Inc. EXTEND OR ALTER THE COVERAGE AFFORDED BY THE MEMORANDUM OR POLICY P.O. BOX 6450 BELOW: NEWPORT BEACH, CA 92658-6450 COMPANIES AFFORDING COVERAGE PH (949)756-0271 / FAX (949)756-2713 LICENSE NO. OC36861 COMPANY LETTER (A) BIG INDEPENDENT CITIES EXCESS POOL COMPANY LETTER (F) THIS IS TO CERTIFY THAT THE MEMORANDUM OF COVERAGE OR POLICY(IES) LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY OR MEMORANDUM PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGES AFFORDED BY THE MEMORANDUM OR POLICY(IES) DESCRIBED HEREIN ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUM OR POLICY. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPES MEMORANDUM MEMORANDUM MEMORANDUM LTR OF OR OR POLICY OR POLICY LIMIT COVERAGES POLICY NUMBER EFFECTIVE EXPIRES EXCESS LIABILITY DIFFERENCE BETWEEN A OCCURRENCE FORM BI & PD $10,000,000 POOL LIMIT INCLUDING AUTOMOBILE BO -05 07/01/2016 07/01/2017 COMBINED AND $1,000,000 LIABILITY SELF-INSURED RETENTION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS: AS RESPECTS AGREEMENT #C-2-0148 SENIOR MOBILITY PROGRAM. CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED SOLELY WITH RESPECT TO BODILY INJURY AND PROPERTY DAMAGE ARISING OUT OF OPERATIONS AS DESCRIBED BY OR ON BEHALF OF THE NAMED INSURED SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. wed g,t� Uev�S CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN ORANGE COUNTY TRANSPORTATION AUTHORITY BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ATTN: REBECCA POTTER, CPM LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR SENIOR PROCUREMENT ADMINISTRATOR REPRESENTATIVES, 550 S. MAIN STREET --- ORANGE, CA 92863-1584 AUTHORIZED REPRESENT TIVE Al I COMPANY LETTER (B) BIG INDEPENDENT CITIES EXCESS POOL MEMBER: COMPANY LETTER (C) CITY OF SANTA ANA ATTN: ED RAYA RISK MANAGER COMPANY LETTER ( D ) P.O. BOX 1988 SANTA ANA, CA 92702-1988 COMPANY LETTER (E) COMPANY LETTER (F) THIS IS TO CERTIFY THAT THE MEMORANDUM OF COVERAGE OR POLICY(IES) LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY OR MEMORANDUM PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGES AFFORDED BY THE MEMORANDUM OR POLICY(IES) DESCRIBED HEREIN ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUM OR POLICY. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO TYPES MEMORANDUM MEMORANDUM MEMORANDUM LTR OF OR OR POLICY OR POLICY LIMIT COVERAGES POLICY NUMBER EFFECTIVE EXPIRES EXCESS LIABILITY DIFFERENCE BETWEEN A OCCURRENCE FORM BI & PD $10,000,000 POOL LIMIT INCLUDING AUTOMOBILE BO -05 07/01/2016 07/01/2017 COMBINED AND $1,000,000 LIABILITY SELF-INSURED RETENTION DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS: AS RESPECTS AGREEMENT #C-2-0148 SENIOR MOBILITY PROGRAM. CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED SOLELY WITH RESPECT TO BODILY INJURY AND PROPERTY DAMAGE ARISING OUT OF OPERATIONS AS DESCRIBED BY OR ON BEHALF OF THE NAMED INSURED SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. wed g,t� Uev�S CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED HEREIN ORANGE COUNTY TRANSPORTATION AUTHORITY BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ATTN: REBECCA POTTER, CPM LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR SENIOR PROCUREMENT ADMINISTRATOR REPRESENTATIVES, 550 S. MAIN STREET --- ORANGE, CA 92863-1584 AUTHORIZED REPRESENT TIVE Al