producer this certificate is issued as a … · 2017-09-20 · commercial general liability fire...

CERTIFICATE OF COVERAGE DATE (MM/DD/YYYY)

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 NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE MEMORANDUM(S) OF COVERAGE BELOW. THIS CERTIFICATE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING COVERAGE PROVIDER, AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: IF THE CERTIFICATE HOLDER IS AN ADDITIONAL COVERED PARTY, THE MEMORANDUM OF COVERAGE MUST BE ENDORSED. A STATEMENT ON THIS CERTIFICATE 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 MEMORANDUM(S) OF COVERAGE AN ENDORSEMENT MAY BE REQUIRED. A STATEMENT ON THE CERTIFICATE DOES NOT CONFER RIGHTS TO THE CERTIFICATE HOLDER IN LIEU OF SUCH ENDORSEMENT(S).

NAMED COVERED PARTY

PROGRAM AFFORDING COVERAGE

A:

B:C:

COVERAGESTHIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOV E NAMED MEMBER, AS PROVIDED BY THE MEMORANDUM(S) OF COVERAGE, FOR THE PERIOD SHO WN BELOW, NOT WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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.

JPALTR TYPE OF COVERAGE MEMORANDUM NUMBER COVERAGE EFFECTIVE

DATE (MM/DD/YY)COVERAGE EXPIRATION

DATE (MM/DD/YY) LIMITS

GENERAL LIABILITY EACH OCCURRENCE $

COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Any one fire) $

CLAIMS MADE OCCUR MED EXPENSE (Any one person) $

PERSONAL & ADV INJURY $

GENERAL AGGREGATE $

GEN’L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $MEMOR-ANDUM PROJECT LOC

AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea accident)

$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS

WORKERS’ COMPENSATION ANDEMPLOYERS LIABILITYANY PROPRIETOR/PARTNER/EXECUTIVE/OFFICER/MEMBEREXCLUDED?IF YES, DESCRIBED UNDER SPECIAL PROVISION BELOW

WCSTATUTORYLIMITS

OTHER

E.L. EACH ACCIDENT $

E.L. DISEASE – EA EMPLOYEE $

E.L. DISEASE – POLICY LIMIT $

OTHER

OTHER

DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL/PROVISIONS

CERTIFICATE HOLDER CANCELLATION

SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE PROVISIONS.

AUTHORIZED REPRESENTATIVE

CSURMA

Alliant Insurance Services, Inc.100 Pine Street, 11th FloorSan Francisco CA 94111

CSU, Los AngelesCorporate Yard (CY) Building, Room 2445151 State University DriveLos Angeles CA 90032

6/15/2017

A

X

X Contractual LiabX SIR $250,000

CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage.

24/7 Studio Equipment Inc.3111 N. Kenwood St.Burbank CA 91505

LOAN #


NAME AND ADDRESSADDITIONAL INTEREST

LOSS PAYEE

ADDITIONAL INSUREDMORTGAGEE

REMARKS (Including Special Conditions)

EVIDENCE OF PROPERTY INSURANCE DATE (MM/DD/YYYY)

COMPANY

THIS REPLACES PRIOR EVIDENCE DATED:

EFFECTIVE DATE EXPIRATION DATECONTINUED UNTILTERMINATED IF CHECKED

POLICY NUMBERLOAN NUMBERINSURED

CODE: SUB CODE:AGENCYCUSTOMER ID #:

THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THEADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THECOVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THEISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.

AGENCY

ADDRESS:E-MAILFAX

(A/C, No):

(A/C, No, Ext):PHONE

DEDUCTIBLEAMOUNT OF INSURANCECOVERAGE / PERILS / FORMS

COVERAGE INFORMATION

LOCATION/DESCRIPTIONPROPERTY INFORMATION

THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISEVIDENCE OF PROPERTY INSURANCE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

The ACORD name and logo are registered marks of ACORDACORD 27 (2009/12) © 1993-2009 ACORD CORPORATION. All rights reserved.

CANCELLATIONSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BEDELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

6/15/2017


415-403-1400

415-874-4810

CSU, Los AngelesCorporate Yard (CY) Building, Room 2445151 State University DriveLos Angeles, CA 90032

Lexington Insurance Company

APIP1718

07/01/2017 07/01/2018

All Risk Of Direct Physical Loss Or Damage Including Flood AtLocations Per Schedule On File With Company

Repair or Replacement Cost Valuation Subject to Policy Provisions

Subject To Policy Terms, Conditions And Exclusions

$25,000,000Loss LimitPer Occurrence

Flood$50,000,000Per Occ. &Annual Agg

See Below

Deductibles: Subject to Scheduled Locations OnlyAll Risk: $100,000 Per OccurrenceFlood: $250,000 Per Occurrence - Flood Zones A & V; $100,000 Per Occurrence - All Other Flood ZonesEvidence of insurance as respects the Office Lease for premises known as 801 South Grand Avenue, Los Angeles,California. Term of Agreement: June 26, 2015 - June 25, 2025. Betterment & Improvements included in limit. BusinessInterruptions / Rents is included in limit.

801 South Grand Avenue (LA), LLCAttn: Terry Wachsner4700 Wilshire BoulevardLos Angeles CA 90010



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 5,000,000

10,000,000

10,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.801 South Grand Avenue (LA), LLC, CIM Group LLC, and their officers, directors,employees, divisions, subsidiaries, partners, members, managers, shareholders, affiliatedcompanies and mortgagees/lenders are named as additional covered parties as respects theOffice Lease for premises known as 801 South Grand Avenue, Los Angeles, California. Termof Agreement: June 26, 2015 - June 25, 2025.




NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.801 South Grand Avenue (LA), LLC, CIM Group LLC, and their officers, directors,employees, divisions, subsidiaries, partners, members, managers, shareholders, affiliatedcompanies and mortgagees/lenders are named as additional covered parties as respects theOffice Lease for premises known as 801 South Grand Avenue, Los Angeles, California. Termof Agreement: June 26, 2015 - June 25, 2025.




NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Clinical Training Agreement No. 6707-0171 for clinicaltraining program. Evidence of Professional Liability is included in General LiabilityCoverage. Students are excluded from Professional Liability Coverage.

AHMC San Gabriel Valley Medical Center LP,a California limited partnershipd/b/a San Gabriel Valley Medical Center438 West Las Tunas DriveSan Gabriel CA 91776



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Affiliation Agreement between AHMC Whittier HospitalMedical Center LP d.b.a. Whittier Hospital Medical Center and CSU, Los Angeles forNursing, Social Work, & Child and Families Studies program.

AHMC Whittier Hospital Medical Center LPdba Whittier Hospital Medical Center9080 Colima Rd.Whittier CA 90605



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Alan Gordon Enterprises Inc. is named additional covered party as respects rental ofequipment for student film project.

Alan Gordon Enterprises Inc.5625 Melrose Ave.Hollywood CA 92238



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Agreement No. 8907-0009 between Alhambra HospitalMedical Center and CSU, Los Angeles.

Alhambra Hospital Medical CenterAttn: Eleanor Martinez, RN, MA100 S. Raymond AvenueAlhambra CA 91801



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Alhambra Unified School District is named as additional covered party as respects the useof facilities at San Gabriel High School for classes during policy term.

Alhambra Unified School District15 West Alhambra RoadAlhambra CA 91801



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage as respects the Learning Site Agreement.

Alliance Collins FamilyCollege Ready High School2071 Saturn AvenueHuntington CA 90255



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Arcadia Unified School District is named as additional covered party as respects StudentTeaching Agreement between Arcadia Unified School District and CSU, Los Angeles.

Arcadia Unified School District234 Campus DriveArcadia CA 91007



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Training Affiliation Agreement No.6714-0023 for providing quality clinical placement experiences.

Aspire Public Schools: Los Angeles Region2079 Saturn AvenueHuntington Park CA 90255



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Azusa Unified School District is named as additional covered party as respects the use offacilities by CSU Los Angeles.

Azusa Unified School District546 S. Citrus AvenueAzusa CA 91702



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Student Fieldwork Agreement No. 6116-0031F toprovide fieldwork experiences. Term of Agreement: Execution - June 30, 2019.

Baldwin Park Unified School District3699 Holly AvenueBaldwin Park CA 91706

LOAN #



LOSS PAYEE




COMPANY






AGENCY

ADDRESS:E-MAILFAX

(A/C, No):








6/15/2017


415-403-1400

415-874-4810



APIP1718

07/01/2017 07/01/2018






See Below

Deductibles: Subject to Scheduled Locations OnlyAll Risk: $100,000 Per OccurrenceFlood: $250,000 Per Occurrence - Flood Zones A & V; $100,000 Per Occurrence - All Other Flood ZonesBig Belly Solar, Inc. and its assigns are named as loss payee as respects the Connect Service Agreement No 10081.Term of Agreement: April 7, 2017 - April 6, 2022.

Big Belly Solar, Inc.Attn: Brian Phillips, President/CEO150 A Street, #103Needham MA 02494

X



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Big Belly Solar, Inc. and its assigns are named as additional covered parties as respectsthe Connect Service Agreement No. 10081. Term of Agreement: April 7, 2017 - April 6, 2022.

Big Belly Solar, Inc.Attn: Brian Phillips, President/CEO150 A Street, #103Needham MA 02494



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

California African American Museum, Friends the Foundation of the California AfricanAmerican Museum, and the State of California and the officers and employees are named asadditional covered parties as respects the Agreement between California African AmericanMuseum and CSU, Los Angeles for use of facilities.

California African American MuseumExposition Park600 State DriveLos Angeles CA 90033

LOAN #



LOSS PAYEE




COMPANY






AGENCY

ADDRESS:E-MAILFAX

(A/C, No):








6/15/2017


415-403-1400

415-874-4810



APIP1718

07/01/2017 07/01/2018






See Below

Deductibles: Subject to Scheduled Locations OnlyAll Risk: $100,000 Per OccurrenceFlood: $250,000 Per Occurrence - Flood Zones A & V; $100,000 Per Occurrence - All Other Flood ZonesCal State LA Federal Credit Union is named as loss payee as respects the properties located at 5181 and 5202 CavanaghRoad, Los Angeles, CA 90032

Cal State LA Federal Credit Union2445 Mariondale Ave.Los Angeles CA 90032

X



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Education Affiliation Agreement No. 6711-0041 forfield experience during the policy period.

Catholic Healthcare WestAlt: Deirdre Robinson, Director, ExecutiveTalent251 South Lake AvenuePasadena CA 91101



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage only.

Center Theatre GroupL.A.'s Theatre Company2856 E. 11th St.Los Angeles CA 90023



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage as respects rental of equipment.

Center Theatre GroupL.A.'s Theatre Company2856 E. 11th St.Los Angeles CA 90023



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage as respects the Clinical Education Observation Agreement No.:6711-0045 for Nurse Practitioner education program.

Centinela Hospital Medical CenterAttn: Linda Bradley, CEO555 E. Hardy St.Inglewood CA 90301



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects Clinical Training Program Agreement. Term of Agreement:April 1, 2016 - March 31, 2019.

Centinela Hospital Medical CenterAttn: Chief Executive Officer555 East HardyInglewood CA 90301



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6715-0139 forclinical training program. Term of Agreement: May 5, 2016 - May 5, 2019.

Central City Neighborhood Partners501 S. Bixel StreetLos Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Chapman/Leonard Studio Equipment, Inc. is named as additional covered party as respectsthe rental of camera equipment during the policy period.

Chapman/Leonard Studio Equipment, Inc.12950 Raymer StreetNorth Hollywood CA 91605



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Amendment No. 1 to the Clinical Training AffiliationAgreement (Without School Instructor on Hospital Premises), Agreement No. 6712-0153. Termof Agreement: April 1, 2016 - March 31, 2019.

Children’s Hospital of Orange CountyAttn: Vice Present of Patient Care Services& Chief Nursing Officer1201 W. La Veta AvenueOrange CA 92868



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of Coverage only.

Citrus Valley Medical CenterAttn: Nahid Meshkin, RN, BSN, PHN210 W. San Bernardino Road; PO Box 6108Covina CA 91722-5108



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Education Agreement for clinicalinstruction and training programs. Evidence of Professional Liability is included inGeneral Liability Coverage. Students are excluded from Professional Liability Coverage.

Citrus Valley Medical CenterEducation Department210 W. San Bernardino Road, Box 6108Covina CA 91722-5108



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Clinical Education Affiliation Agreement between City ofHope National Medical Center and CSU, Los Angeles for clinical experience programs.Evidence of Professional Liability is included in General Liability.

City of Hope National Medical CenterAttn: David Muirhead1500 East Durte RoadDuarte CA 91010-3000



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.City of Inglewood/South Bay Workforce Investment Board, Inc., its officers, employees andagents are named as additional covered parties as respects to Agreement No. 11-W204 forClassroom Training for Individual Referrals.

City of Inglewood/South Bay WorkforceInvestment Board, Inc.11539 Hawthorne Blvd. Suite 500Hawthorne CA 90250



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The City of Long Beach, its officers, employees and volunteers are hereby named asadditional covered parties as their interest may appear in the operations of the NamedInsured.

City of Long Beach333 West Ocean BoulevardLong Beach CA 90802



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.General Liability Special Endorsement for the City of Los Angeles.

City of Los AngelesLos Angeles Center Studios450 South Bixel Street, Suite T-800Los Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The City of Los Angeles is named as additional covered party as respects the use ofpremises by the Named Insured during the policy year.

City of Los AngelesDepartment of Risk Management200 N Main Street, Room 1240Los Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

The City of Pasadena, its council members, commissioners, officers, employees, and agentsare named as additional covered parties as respects to the operations/activities of CSU,Los Angeles for academically-related student film project.

City of PasadenaFilm Office1750 North Garfield AvenuePasadena CA 91109



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6715-0005 forclinical training. Term of Agreement: August 11, 2015 - August 11, 2018.

City of PasadenaPublic Health Department1845 North Fair Oaks Avenue, First FloorRm.1131Pasadena CA 91103



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6715-0128 forclinical training. Term of Agreement: June 13, 2016 - June 13, 2019.

City of PasadenaHS and RD- Citywide Recreation2575 Paloma StreetPasadena CA 91107



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

City of South Pasadena is named as additional covered party as respects use of premisesfor student film project during policy term.

City of South Pasadena1414 Mission StSouth Pasadena CA 91030



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6716-0081 foracademic fieldwork studies for required coursework. Term of Agreement: April 18, 2017 -April 18, 2018.

Coalition for Responsible CommunityDevelopment3101 S. Grand AvenueLos Angeles CA 90007



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000


Coffey Sound, LLCAttn: Gary Vahling3325 Cahurenga Blvd. WestHollywood CA 90068



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The County of Los Angeles, its Special Districts, Elected Officials, Officers, Agents,Employees and Volunteers are named as additional covered parties as respects the use ofpremises by CSU, Los Angeles during the policy year.

County of Los Angeles1201 W. 5th Street, Suite T-800Los Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The County of Los Angeles, its officers, agents, employees and volunteers are named asadditional covered parties as respects the Agreement between CSU, Los Angeles and Countyof Los Angeles for Community Family Preservation Network Services. Evidence ofProfessional Liability is included in General Liability.

County of Los AngelesDepartment of Children and Family Services425 Shatto Place, Room 205Los Angeles CA 90020



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.County of Los Angeles is named as additional covered party as respects the ProfessionalInterns Program for the County of Los Angeles. The interns will work off campus, underthe supervision of the County.

County of Los AngelesDepartment of Health Services313 N. Figueroa Street, 6th Floor-EastLos Angeles CA 90012



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The County of Los Angeles, its Special District, its officials, officers and employeesare named as additional covered parties as respects the Affiliation Agreement betweenCounty of Los Angeles and CSU, Los Angeles for Student Professional Development Programsduring the policy period. Evidence of Professional Liability is included in GeneralLiability. Students are excluded from Professional Liability.

County of Los Angeles6255 W Sunset Blvd, 12th FloorHollywood CA 90028



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The County of Los Angeles, it Special Districts, its officials, officers, and employeesare named as additional covered parties as respects the Affiliation Agreement No.: 62817between County of Los Angeles and CSU, Los Angeles. Evidence of Professional Liabilityis included in General Liability Coverage. Student are excluded from General LiabilityCoverage.

County of Los AngelesDepartment of Children and Family Services425 Shatto Place, Room 205Los Angeles CA 90020



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The County of Los Angeles, Department of Children and Family Services are named asadditional covered parties as respects the Agreement for training and education programsponsored by the CSULB, CSULA and USC graduate programs in Social Welfare to provideprofessional training to DCFS employees and to educate and prepare MSW students foremployment at DCFS.

County of Los AngelesDepartment of Mental Health550 South Vermont, 5th FloorLos Angeles CA 90020



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The County of Los Angeles, its Special Districts, Elected Officials, Agents, Employeesand Volunteers are named as additional covered parties as respects the AffiliationAgreement for observational and practical clinical experience in Public Health Programs.

County of Los AngelesDepartment of Public Health313 N. Figueroa Street, 6th FloorLos Angeles CA 90012



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Affiliation Agreement No. H-704518 for AdvancedLevel Training Program Clinical Training Experience during the policy period.

County of Los Angeles, Department of HealthServices Contracts and Grants DivisionAttn: Director, Contract Admin and Monitoring313 N. Figueroa Street, 6th Floor EastLos Angeles CA 90012



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.County of Orange is named as additional covered party as respects Memorandum ofUnderstanding between Orange County Social Services Agency and CSU Los Angeles forUndergraduate or Graduate Fieldwork Experience. Evidence of Professional Liability isincluded in General Liability. Students are excluded from Professional Liability.

County of OrangeCounty Property PermitsP.O. Box 4048Santa Ana CA 92702-4048



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.County of Orange and Orange County Flood Control District are named as additional coveredparties as respects activity or work by CSU Los Angeles within the flood control districtrights-of-ways per Irvine Ranch Water District's Temporary Entry Permit.

County of OrangeSocial Services Agency888 N. Main StreetSanta Ana CA 92701

LOAN #



LOSS PAYEE




COMPANY






AGENCY

ADDRESS:E-MAILFAX

(A/C, No):








6/15/2017


415-403-1400

415-874-4810



APIP1718

07/01/2017 07/01/2018






See Below

Deductibles: Subject to Scheduled Locations OnlyAll Risk: $100,000 Per OccurrenceFlood: $250,000 Per Occurrence - Flood Zones A & V; $100,000 Per Occurrence - All Other Flood ZonesEvidence of property insurance as respects Dobbs Street Housing facility. Effective: 8/16/10. TIV: $3,490,000

CSU, Los Angeles5151 State University DriveLos Angeles CA 90032



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Culver City Unified School District, its Board, officers, agents and employees are namedas additional covered parties as respects Agreement No. 6713-0002 for academic fieldworkstudies. Term of Agreement: June 26, 2014 - June 26, 2019.

Culver City Unified School DistrictLa Ballona & El Rincon Family Centers11177 Overland Avenue, # 8Culver City CA 90230



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The County of Los Angeles, its Officers, Agents and Employees, and Pomona Unified SchoolDistrict, are named as additional covered parties as respects the Agreement for CommunityFamily Preservation Network Services. Evidence of Workers' Compensation only.

Department of Children and Family Services425 Shatto Place, Room 205Los Angeles CA 90020



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.County of Los Angeles, its Special Districts, its officials, officers, and employees arenamed as additional covered parties as respects the Affiliation Agreement No. H-704518for Advanced Level Training Program Clinical Training Experience during the policy year.Evidence of Professional Liability is included in General Liability Coverage. Studentsare excluded from Professional Liability Coverage.

Department of Health ServicesContracts and Grants Division313 N. Figueroa Street, 6th Floor-EastLos Angeles CA 90012



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of Coverage as respects the Medi-Cal Pharmacy Provider Application for StudentHealth Center. Professional Liability for the Student Health Center is included underGeneral Liability Coverage.

Department of Health Care Services -Provider Enrollment DivisionMS 4704P.O. Box 997413Sacramento CA 95899-7413



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of Coverage as respects the student internship services at various CHW sites.

Dignity Health251 South Lake Avenue, 8th FloorPasadena CA 91101-4842



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Health Science Education Agreement between DowneyRegional Medical Center and CSU Los Angeles.

Downey Regional Medical Center11500 Brookshire AvenueDowney CA 90241



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000


El Monte Union High School District3537 Johnson AvenueEl Monte CA 91731



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

FilmL.A., Inc., its directors, officers, and employees are named as additional coveredparties by blanket endorsement as respects the use of premises during the policy year.

FilmL.A., Inc.1201 W. 5th Street, Suite T-800Los Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage only as respects CalStateTEACH program.

Fremont Unified School District4210 Technology DriveFremont CA 94538



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000


Garden Grove USD10331 Stanford Ave.Garden Grove CA 92840



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of insurance as respects the Agreement No. 6715-0038 for clinical trainingprogram. Term of Agreement: November 19, 2015 - November 19, 2018.

Gateways Hospital and Mental Health Center1891 Effie StreetLos Angeles CA 90026



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

General Motors LLC is named as additional covered party as respects GM EcoCAR 2 Bill ofSale and Agreement. Vehicle Description: 2013 Chevrolet Malibu eAssist. VIN:1G11F5RR4DF100096. Limit: $10,000,000.

General Motors LLC--- - -



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Affiliation Agreement for clinicaleducational experiences. Term of Agreement: March 21, 2017 - March 20, 2019.

Glendale Adventist Medical Center1509 Wilson TerraceGlendale CA 91206



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Affiliation Agreement for clinicaleducational experiences. Term of Agreement: March 21, 2017 - March 20, 2019.

Glendale Adventist Medical Center1509 Wilson TerraceGlendale CA 91206



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage only. Evidence of Professional Liability is included in GeneralLiability. Students are excluded from Professional Liability coverage.

Glendale Memorial Hospital1420 South Central AvenueGlendale CA 91204



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Student Fieldwork Agreement No. 6116-0027F duringthe policy period.

Glendale Unified School District223 North Jackson StreetGlendale CA 91206



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6716-0007 forclinical training program. Term of Agreement: August 1, 2016 - August 1, 2019.

Glendale Unified School District223 N. Jackson StreetGlendale CA 91206



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Student Affiliation Agreement for Nursing,Undergrad/Graduate Nurse Practitioner, Social Work, and Speech Therapy.

Hollywood Presbyterian Medical CenterAttn: Chief Executive Officer1300 North Vermont AvenueLos Angeles CA 90027



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000


Hollywood Rentals Production Services LLCRental Department19731 Nordhoff StreetNorthridge CA 91324



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Huntington Beach Union High School District is named as additional covered party asrespects the Student Teaching Agreement No. 6110-0025. Evidence of ProfessionalLiability is included in General Liability Coverage.

Huntington Beach Union High School District5832 Bolsa AvenueHuntington Beach CA 92649



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The City of Los Angeles is named as additional covered party as respects the developmentof the Los Angeles information technology infrastructure.

Information Technology AgencyFiscal ManagementRoom 1400, City Hall East 200 North MainStreetLos Angeles CA 90012



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Student Agreement for Clinical and InstructionalPrograms. Term of Agreement: 12/27/2015 - 12/26/2018.

Interstate Rehab.333 E. Glen Oaks Blvd. #204Glendale CA 91207



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Irvine Ranch Water District and Irvine Company are named as additional covered parties asrespects activity or work by CSU Los Angeles within the flood control districtrights-of-ways per Irvine Ranch Water District's Temporary Entry Permit.

Irvine Ranch Water District15600 Sand Canyon AvenueIrvine CA 92619-7000



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Agreement between Kaiser Foundation Hospitals/SouthernCalifornia Permanente Medical Group and CSU, Los Angeles for clinical programs.

Kaiser Foundation Health Plan, Inc.Community Medical Health Services309 E. Walnut St. 7th FloorPasadena CA 91188



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage only.

Kaiser Panorama City13651 Willard StreetPanorama City CA 91402



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Affiliation Agreement between Loma Linda UniversityMedical Center and CSU Los Angeles. Evidence of Professional Liability is included inGeneral Liability. Students are excluded from Professional Liability coverage.

Loma Linda University Medical Center11234 Anderson StreetLoma Linda CA 92354



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Internship Partner, Trustees of Internship Partner, the Los Angeles City College and itemployees, officers and students are named as additional covered parties as respects theInternship Agreement between the Los Angeles City College and CSU, Los Angeles.

Los Angeles City College855 North Vermont AvenueLos Angeles CA 90020



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Los Angeles Community College District, its Board, Officers, Employees, Agents andVolunteers are named as additional covered parties as respects the use of facilities forNCAA Div II Sanction Soccer Competition on September 10, September 22 and September 24,2017.

Los Angeles Community College District770 Wilshire Blvd.Los Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Los Angeles County, its officers, employees, agents and volunteers are named asadditional covered parties as respects the Continuing Education Classes for CaliforniaState University Los Angeles.

Los Angeles County Office of EducationAttn: Insurance ComplianceP.O. Box 12010 - LAHemet CA 92546-8010



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Clinical Internship Agreement between Los AngelesMission Community Clinic and CSU, Los Angeles. Evidence of Professional Liability isincluded in General Liability. Agreement No. 6706-0098

Los Angeles Mission Community Clinic311 E. Winston StreetLos Angeles CA 90013



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Internship Agreement. Agreement No.:6712-0051. Term of Agreement: February 27, 2013 - February 27, 2018.

Los Angeles Unified School District andSchool Board MembersAttn: Risk Management333 S. Beaudry Ave. 28th FlLos Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The Los Angeles Unified School District and the Board of Education are named additionalcovered parties as respects the Student Teaching Agreement No.: 6107-0011 between the LosAngeles Unified School District and CSU, Los Angeles.

Los Angeles Unified School District333 S. Beaudry AvenueLos Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage as respects the use of facilities by CSU, Los Angeles for BaseballPractice.

Loyola Marymount University1 LMU DriveLos Angeles CA 90045



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Amendment No. 1 to Educational Affiliation AgreementNo. 6713-0222 for Nursing and Speech Pathology. Term of Agreement: March 2, 2016 - March1, 2018.

Methodist Hospital of Southern CaliforniaAttn: President300 W. Huntington DriveArcadia CA 91007



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Amendment No. 1 to Educational Affiliation AgreementNo. 6713-0222 for Nursing and Speech Pathology. Term of Agreement: March 2, 2016 - March1, 2018.

Methodist Hospital of Southern CaliforniaAttn: President300 W. Huntington DriveArcadia CA 91007



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage as respects the administration of examinations. ProfessionalLiability coverage is included in General Liability coverage.

North American Board of Certified EnergyPractitionersAttn: Karen Christopher, Operations Manager10 Hermes RoadMalta NY 12020



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Oak View Hotel Limited Partnership is named as additional covered party as respects thelease of the facilities at 3500 East Colorado Boulevard located in the City of Pasadena,County of Los Angeles, CA 91107, specifically the second (2nd) floor office space duringthe policy term by CSU Los Angeles Health and Human Services.

Oak View Hotel Limited Partnershipc/o Brighton Management21725 E. Gateway Center DriveDiamond Bar CA 91765



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage only as respects technical orientation.

Panavision Hollywood6735 Selma AvenueHollywood CA 91605



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6713-0126 forclinical training program. Term of Agreement: May 26, 2015 - May 26, 2020.

Para Los NinosAttn: Jaime Chaignat849 E. 6th StreetLos Angeles CA 90021



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Pasadena Area Community College District is named as additional covered party as respectsthe use of facilities for Choral Festival on July 17 - 22, 2017.

Pasadena Area Community College District1570 E. Colorado Blvd.Pasadena CA 91106



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

The Pasadena Center Operating Company and the City of Pasadena and their respectiveOfficers, Directors and Employees are named as additional covered parties as respects theuse of facilities for California State University Counselors Conference (Los Angeles) onSeptember 18 - 20, 2017.

Pasadena Center Operating Company300 E. Green StreetPasadena CA 91101



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Internship Agreement between PasadenaHealth Department and CSU, Los Angeles for clinical training program. Evidence ofProfessional Liability is included in General Liability. Students are excluded fromProfessional Liability.

Pasadena Health Department1845 N. Fair Oaks Avenue, 1st FloorPasadena CA 91109



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Pasadena Unified School District is named as additional covered party as respects the useof facilities at Blair M.S./H.S. for Graduate Student Course during the policy term.Property Damage is included in General Liability.

Pasadena Unified School District351 S. Hudson Ave., Room 110Pasadena CA 91109



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6713-0147 for aclinical training program. Term of Agreement: September 16, 2015 - September 15, 2020.

Placentia-Yorba Linda Unified School District1301 E. Orangethorpe Ave.Placentia CA 92870



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

Evidence of coverage as respects the Learning Site Agreement No.: 8913-0027 for ServiceLearning.

Plaza De La Raza Child Development ServicesInc.Attn: Veronica Herrera12620 BroadwayWhittier CA 90601



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of Coverage as respects General Liability insurance coverage for the Departmentof Communication Studies of CSU Los Angeles for their field education program withPresbyterian Intercommunity Hospital.

Presbyterian Intercommunity Hospital12401 E. Washington Blvd.Whittier CA 90602



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Presbyterian Intercommunity Hospital is named as additional covered party as respects theCoordinated Dietetics Program Field Practicum for the students of CSULA per Agreement#6721-0008. Evidence of Workers' Compensation Coverage only.

Presbyterian Intercommunity Hospital12401 E. Washington Blvd.Whittier CA 90602



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Experience Program Agreement. Term ofAgreement: January 1, 2016 - December 31, 2018.

Prime Healthcare Centinela LLCContract Administrator555 E. Hardy StreetInglewood CA 90301



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.RE: Agreement No. 6702-0029 Evidence of insurance only. This coverage is ""claims-made.""

Providence Health System - SouthernCaliforniaAttn: Sylvia Nunez, Contract Administrator20555 Earl Street - Torrance Regional OfficeTorrance CA 90503



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Internship Agreement between PulmonaryConsultants & Primary Care Physicians Medical Group and CSU Los Angeles. Agreement#6705-0206

Pulmonary Consultants & Primary CarePhysicians Medical Group1310 West Steward Drive, Suite 410Orange CA 92868-3855



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.County of Los Angeles, its Special Districts, its officials, officers, and employees arenamed additional covered parties as respects Affiliation Agreement No. 62817 betweenCounty of Los Angeles and CSU Los Angeles for the Rancho Los Amigos NationalRehabilitation facility. Evidence of Professional Liability is included in GeneralLiability. Students are excluded from Professional Liability.

Rancho Los Amigos National Rehabilitation -County of Los Angeles7601 E. Imperial HighwayDowney CA 90242



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Santa Clarita Community College District and its Board of Trustees and members thereof,officers, employees, agents and volunteers are named as additional covered parties asrespects the Educational Program Agreement to provide the academic, occupational and/orother programs.

Santa Clarita Community College DistrictAttn: Jon A. Aasted, Director26455 Rockwell Canyon RoadSan Clarita CA 91355



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Nursing Preceptor Agreement for clinical experienceand the use of clinical facilities. Term of Agreement: October 15, 2015 - October 14, 2020.

Santa Clarita Community College DistrictAttn: Assistant Superintendent/VP BusinessService26455 Rockwell Canyon RoadSanta Clarita CA 91355



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Internship Agreement between Sherman OaksHospital and CSU, Los Angeles. Evidence of Professional Liability is included in GeneralLiability. Students are excluded from Professional Liability coverage. Agreement No.6704-0055.

Sherman Oaks Hospital4929 Van Nuys Blvd.Sherman Oaks CA 91403



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000


Sony Pictures Entertainment Inc.Attn: Frank Simpson10202 W. Washington Blvd.Culver CA 90232



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.South Coast AQMD is named as additional covered party as respects the Contract No.:C05128 for Hydrogen Fueling Station Project.

South Coast AQMD21865 East Copley DriveDiamond Bar CA 91765-4182



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6713-0147 for aclinical training program. Term of Agreement: September 16, 2015 - September 15, 2020.

Southern California Schools Risk Management(SCSRM) JPA1950 South Sunwest Lane, Suite 100San Bernardino CA 92408



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Clinical Internship Agreement between St. VincentMedical Center and CSU, Los Angeles for Health Sciences Program.

St. Vincent Medical CenterAttn: Venus Neverson2131 W. 3rd StreetLos Angeles CA 90057



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Clinical Internship Agreement No. 6708-0027 betweenSt. Vincent Medical Center and CSU, Los Angeles for Clinical Training Program.

St. Vincent Medical CenterAttn: Kelly K. Fuchino2131 W. 3rd StreetLos Angeles CA 90057



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Clinical Internship Agreement No. 6713-0106 forclinical training program. Term of Agreement: October 21, 2014 - October 21, 2019.

Telecare Corporation600 St. Paul Avenue, Suite 100Los Angeles CA 90017



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The Alhambra Office Community, LLC and TRCPM, LLC and all related interests are named asadditional covered parties as respects the use of facilities during the policy period.This insurance is primary and non-contributory.

The Alhambra Office Community, LLC Attn:Senior Property Manager1000 South Fremont Avenue, Unit 1Building A10 - Center, Suite 10150Alhambra CA 91803



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The City of Los Angeles, its directors, officers, and employees are named as additionalcovered parties as respects the use of premises by CSU, Los Angeles during the policy year.

The City of Los Angeles, its directors,officers, and employees200 N Main Street, Room 1240Los Angeles CA 90071



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The Regents of the University of California is named as additional covered party asrespects the contract to operate an English Language Development Institute, developingprograms for beginning and non-credentialed teachers in grades 4 through 12. Evidence ofCoverage as respects Excess Liability only.

The Regents of the University of California300 Lakeside Drive, 7th FloorOakland CA 94612



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

ThyssenKrupp Elevator Corporation along with its officers, agents, affiliates andsubsidiaries are named as additional covered parties as respects the Agreement betweenThyssenKrupp Elevator and CSU, Los Angeles for 5151 State University Troubleshoot ServiceElevator 4.6.10.

ThyssenKrupp Elevator6048 Triangle DriveLos Angeles CA 90040



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The Regents of the University of California and UCLA are named as additional coveredparties as respects Subaward Agreement between UCLA and CSU, Los Angeles. UCLA SubawardNo. 1130 G CC515.

University of California, Los AngelesPurchasing Department10920 Wilshire Blvd., Suite 650Los Angeles CA 90024-6580



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.The University of San Francisco is named as additional covered party as respects theOperating Site Agreement between the University of San Francisco and CSULA forTEAMS/AmeriCorps Program. Evidence of Professional Liability is included in GeneralLiability.

University of San FranciscoOffice of Human Resources2130 Fulton StreetSan Francisco CA 94118



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Hospital Internship Agreement between Valley HealthSystem and CSU, Los Angeles. Agreement #6705-0104.

Valley Health System1117 East Devonshire AvenueHemet CA 92573



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Clinical Internship Agreement between Verdugo HillsHospital and CSU, Los Angeles. Agreement #6706-0184.

Verdugo Hills Hospital1812 Verdugo Blvd.Glendale CA 91208



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Evidence of coverage as respects the Amendment No. 2 to Affiliation Agreement No.6711-0121 for clinical learning experience. Term of Agreement: September 15, 2015 -September 14, 2018.

Whittier Hospital Medical CenterAttn: Chief Executive Officer9080 Colima Rd.Whittier CA 90605



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects the Affiliation Agreement for students degree programsin the field of Nursing.

WMC-SA, Inc., d/b/a Western Medical CenterSanta AnaAttn: Chief Executive Officer1001 North Tustin AvenueSanta Ana CA 92705



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of Coverage as respects the Agreement between WMC-SA, Inc. and CSU, Los Angelesfor Degree Program in Child and Family Studies. Professional Liability is included inGeneral Liability. Students are excluded from Professional Liability.

WMC-SA, Inc.d/b/a Western Medical Center Santa Ana1001 North Tustin AvenueSanta Ana CA 92705



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage only.

Wooden Nickel Lighting, Inc.6920 Tujunga AvenueNorth Hollywood CA 91605



NAMED COVERED PARTY


A:

B:C:









GENERAL AGGREGATE $



$

ANY AUTO $

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NON-OWNED AUTOS


WCSTATUTORYLIMITS

OTHER




OTHER

OTHER





CSURMA



6/15/2017

A

X


CSURMA-LIAB-1718 7/1/2017 6/30/2018 2,000,000

4,000,000

4,000,000

A CSURMA-WC-1718 7/1/2017 6/30/2018 X

1,000,000

1,000,000

1,000,000

Note: Workers' Compensation Coverage is provided as evidence only.Evidence of coverage as respects Service-Learning Agreement between Young & Healthy andCSU Los Angeles for Physical Activity Instruction sessions.

Young & Healthy37 North HollistonPasadena CA 91106

producer this certificate is issued as a … · 2017-09-20 · commercial general liability fire...

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