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CERTIFICATE NO. ISt;UE DATE(MM/DD/YYYY) <br /> WC-837 CERTIFICATE OF COVERAGE 06/17/2013 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA'ION ONLY AND CONFERS NO <br /> RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY <br /> CSAC Excess Insurance OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS <br /> Authority CERTIFICATE OF COVERAGE DOES NOT CONSTITITUE A CONTRACT BETWEEN THE <br /> ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OF PRODUCER,AND THE <br /> CERTIFICATE HOLDER <br /> C/O ALLIANT INSURANCE SERVICES, INC. <br /> PO BOX 6450 IMPORTANT:If the certificate holder is requesting a WAIVER C F SUBROGATION,the <br /> Memorandums of Coverage must be endorsed.A statement on Nis certificate does not confer <br /> NEWPORT BEACH,CA 92658-6450 rights to the certificate holder in lieu of such endorsement(s). <br /> PHONE(949)756-0271 /FAX(619)699-0901 COVERAGE <br /> LICENSE#0036861 AFFORDED BY: A -See attached schedule of insurers <br /> Member: COVERAGE <br /> LOCAL AGENCY WORKERS'COMPENSATION EXCESS AFFORDED BY: B <br /> JOINT POWERS AUTHORITY/A CALIFORNIA PUBLIC <br /> AGENCY(LAWCX)MEMBER AGENCIES(AS ENDORSED) COVERAGE <br /> C/O BETH LYONS AFFORDED BY: C <br /> 1750 CREEKSIDE OAKS DRIVE,SUITE 200 <br /> SACRAMENTO,CA 95833 COVERAGE <br /> AFFORDED BY: D <br /> Coverages <br /> THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE AND POLICIES LISTED BELOW HAVE BEEN ISSUED TO THE MEMBER <br /> NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR <br /> OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE COVERAGE AFFORDED <br /> BY THE MEMORANDUMS AND POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS,AND CONDITIONS OF <br /> SUCH MEMORANDUMS AND POLICIES. <br /> CO TYPE OF COVERAGE MEMORANDUM/ COVERAGE EFFECTIVE COVERAGE EXPIRATION LIABILITY LIMITS• <br /> LTR POLICY NUMBER DATE(MM/DDNYYY) DATE(MM/DD/YYYY; <br /> A EXCESS WORKERS' See attached 07/01/2013 07/01/2014 WORKERS COMPENSATION: <br /> COMPENSATION 8 Schedule of Difference between <br /> EMPLOYER'S LIABILITY Insurers for policy Statutory and Members <br /> numbers $5,000,000 Retention <br /> EMPLOYERS'LIABILITY: <br /> Difference between <br /> $5,000,000 and Member's <br /> $5,000,000 Retention <br /> LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED. <br /> Description of Operations/LocationsNehicles/Special Items: <br /> AS RESPECTS EVIDENCE OF COVERAGE ONLY. <br /> MEMBER AGENCY:BCJPIA:CITY OF PLEASANTON,A MEMBER OF LAWCX J J <br /> ALCLim) - <br /> 2013 26 F <l ip: 36 <br /> Cancellation <br /> Certificate Holder <br /> SHOULD ANY OF THE ABOVE DESCRIBED MEMORAND JMS OF COVERAGE/POLICIES <br /> ALAMEDA COUNTY HOUSING AND COMMUNITY BE CANCELLED BEFORE THE EXPIRATION THEREOF,NOTICE WILL BE DELIVERED IN <br /> DEVELOPMENT DEPARTMENT ACCORDANCE WITH THE MEMORANDUMS OF COVER/GE/POLICIES PROVISIONS. <br /> 224 W.WINTON AVE., RM 108 <br /> HAYWARD,CA 94544 AUTHORIZED REPRESENTATIVE <br /> CSAC EXCESS INSURANCE AUTHORITY <br /> Page 1 of 2 <br />