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Docusign Envelope In:C19AABC9-9198-4469-BD4C-2lCl l B4EF88B <br /> CERTIFICATE OF <br /> ....__.__.___ SELF-INSURANCE COVERAGE Date: June 15,2024 <br /> RAOUCERlINSUREO <br /> The Regents of the University of California This Certificate Is Issued as a matter of information only to authorized viewers for <br /> Office of the President their Internal use only and confers no rights upon any viewer of this Certificate. <br /> Office of Risk Services The Certificate does not amend,extend or alter this coverage described below. <br /> 11 f 1 Franklin St.,BI^Fluor This Certificate may only be copied,printed and distributed by an authorized <br /> Oakland, CA 94607-6200 viewer for its internal use. Any other use,duplication or distribution of the <br /> 510-987-9832 Certificate without the written consent of the Regents of the University of California, <br /> Is rohibitad. _ <br /> ENTITIES AFFORDING COVERAGE <br /> PARTICIPATION <br /> OVERAGES COMP ETTE ANY LR q_The Relents of the Unlly r%t of California _100% <br /> THIS IS TO CERTIFY THAT THE REGENTS OF THE UNIVERSITY OF CALIFORNIA IS A GOVERNMENTAL ENTITY THAT HAS A SELF-FUNDED <br /> RETENTION FOR LIABILITIES DESCRIBED BELOW, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY WRITTEN <br /> CONTRACT OR OTHER DOCUMENT WITH RE5PECT TO WHICH THIS CERTIFICATE MAY PERTAIN, THIS SELF-FUNDED PROGRAM IS <br /> SUBJECT TO ALL PROVISIONS OF THE BYLAWS AND STANDING ORDERS OF THE REGENTS OF THE UNIVERSITY OF CALIFORNIA.WHICH <br /> DOES NOT PERMIT ANY ASSUMPTION OF LIASILITY WHICH DOES NOT RESULT FROM THE NEGLIGENT ACTS OR OMISSIONS OF ITS <br /> OFFICERS,AGENTS OR EMPLOYEES. <br /> C(b w T PE OF INSURANCE POLICY NUMBER <br /> PGLICY I FFECTIV£D TE pbLICY EMPIRATiO D TE r L�IN1fT `— <br /> TR <br /> GENERAL LIABILITY GENERAL AGGREGATE NOlapplicable <br /> X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGG S 5,0D0.000 <br /> CLAIMS MADE XlOCCURRENCE Self-Insured July 1,2024 July 1,2026 PERSONAL S ADV INJURY 5.W0,000 <br /> CONTRACTUAL LIABILITY 6,000.000 <br /> EACH OCCURRENCE 5,00R0p0 <br /> $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE:LIMIT NW applicable <br /> ANY AUTO <br /> X ALL OWNED BODILY INJURY $ 2,590,000 <br /> AUTO$ (PER PERSON) <br /> SCHEDULED Self-insured July 1,2024 July 1,2025 <br /> AUTOS <br /> X HIREDAUTO9 BODILY INJURY S 2.500,00D <br /> X NON.CIWNEO [PER ACCIDENT) <br /> AUTOS <br /> GARAGE LIABILITY PROPERTY DAMAGE 21500.000 <br /> PROPERTY EACH OCCURRENCE 10.000,000 <br /> 111RI&EXTINDIDPIRLS Self-Insured July 1,2024 July 1,2026 AGGREGATE $ Not applicable <br /> $ <br /> STATUTORY LIMITS <br /> WORKERS'COMPENSATION AND Solf•Insured July 1,2024 July 1,2026 EACH ACCIDENT $ AS required by <br /> EMPLOYERS LIABILITY Cafifornia Law <br /> DISEASE-POLICY LIMIT $ As required by <br /> California Law <br /> DISEASE•EACH EMPLOYEE As requIted by <br /> California Law <br /> DESCRIPTION OF OPERATIONSILOCATIONSNZHICLESOPECIAL ITEMS <br /> ADDITIONAL CW5ER MRM.Aa,$gQqIRgD PY WRIIIEN CONTRACT OR AC3 PECTN TO GENERAL LIABILITY <br /> ND. ORILE ABI ITY <br /> LOS P E•AS ERgUIRIQ BX WR NT CT OR AGREEMENT WITH RESPECT TO P3OPRM.WyjMqrm <br /> CERTIFICATE HOLDER CANCELLATION <br /> APPLICABLE PARTY AS REQUIRED BY WRITTEN CONTRACT SHOULD THE REGENTS ELECT TO DISCONTINUE SELF-INSURING ITS <br /> R AGREEMENT LIABILITIES,THE REGENTS WILL UPDATE PROOF OF SELF-INSURANCE ON ITS <br /> EBSiTE. THE REGENTS SHALL NOT BE OBLIGATED TO PROVIDE INDIVIDUAL <br /> NOTICE TO VENDORS OR OTHERS. V_� <br /> KEVIN CONFETTI,AVP &CHIEF RISK OFFICER <br />