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R <br /> CERTIFICATE NO. ISSUE DATE(MM/DD/YYYY) <br /> WC-771 CERTIFICATE OF COVERAGE 06/24/2014 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 OR PRODUCER,AND THE <br /> CERTIFICATE HOLDER <br /> 0/0 ALLIANT INSURANCE SERVICES, INC. <br /> PO BOX 6450 IMPORTANT:If the certificate holder is requesting a WAIVER OF SUBROGATION,the <br /> Memorandums of Coverage must be endorsed.A statement on this certificate does not confer <br /> NEWPORT BEACH,CA 926584450 rights to the certificate holder in lieu of such endorsement(s). <br /> PHONE(949)756-0271/FAX(619)699-0901 COVERAGE <br /> LICENSE#0C36861 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/DDPY'YYY) . DATE(MM/DD/YYYY) <br /> A EXCESS WORKERS' • See attached 07/01/2014 07/01/2015 WORKERS'COMPENSATION: <br /> COMPENSATION& Schedule of Difference between <br /> EMPLOYER'S LIABILITY Insurers for policy Statutory and Member's <br /> numbers $5,000,000 Retention <br /> LIMITS APPLY PER OCCURRENCE FOR ALL PROGRAM MEMBERS COMBINED. <br /> Description of Operations/LocationsNehicles/Special Items: <br /> AS RESPECTS EVIDENCE OF COVERAGE ONLY. <br /> MEMBER AGENCY:CITY OF PLEASANTON,A MEMBER OF LAWCX • <br /> N <br /> O <br /> a <br /> G r- <br /> :t <br /> tJ f <br /> Cancellation <br /> Certificate Holder <br /> SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUMS OF COVERAG6WOLIOIO$ <br /> ALAMEDA COUNTY HOUSING AND COMMUNITY BE CANCELLED BEFORE THE EXPIRATION THEREOF,NOTICE WILL BE DE EQ <br /> ERiN <br /> ACCORDANCE WITH THE MEMORANDUMS OF COVERAGE/POLICIES PRO'QSIONS <br /> DEVELOPMENT DEPARTMENT <br /> ATTN:KELLY M.THIEMANN <br /> 224 WEST WINTON AVENUE, ROOM 108 AUTHORIZED REPRESENTATIVE - <br /> HAYWARD,CA 94544 <br /> CSAC EXCESS INSURANCE AUTHORITY <br /> Page 1 of 2 <br />