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CALIFORNIA JOINT POWERS <br />RISK MANAGEMENT-AUTHORITY <br />Accredited with E:i:ctli1nc1 from the Californta Association of Joint Pc>wcrs AuthoHties <br />_CERTIFICATE OF COVERAGE <br />Certificate Holder and <br />Additional Covered Party: State of California, acting by and through the Department of <br />Transportation, STATE, its officers, agents and employees. <br />P.O. Box 23660, MS 4A . <br />Oakland, CA, CA 94623-0660. <br />ATTN: Mr. Waddah Al-Zireeni, Caltrans Maintenance Ser\(ices <br />This certifies that the coverage <br />Described herein has been issued t(): City of San Leandro <br />Description of Activity: Freeway Maintenance Agreement, Resolution No, 2020-023. Improvements <br />under STAT.E issued Encroachment Permits at various locations within City of Si;in Leandro, Dates of <br />Activity: April 1, 2020 -until amended or terminated; in full-fon~e arid effect until amended or terminated <br />as described in Article 24 of the Agre~ment. <br />Date(s) of Activity: -03-02-2020 to 06-30-2021 <br />Location of Activity: Various lo9ations within City pf $~n Leand.ro San Leandro, CA 94577 <br />Entity Providing Coverage Excess Cover<1ge C~rtific:ate <br />Explratkin Date <br />California Joint Powers Risk Management Authority $5,500,000 June 3o, 202Q excess of <br />$ 500,000 <br />The following coverage is in effect and ls provided through participation in a risi(sharing joint powers <br />authority: general liability and automobile liability pooled self-insurance, as c:jefined in the Memorandum of <br />Coverage on file with the entity and which will be made available upon request. <br />The coverage being provided is limited to the activity and th.e time period indicated h.ereiri and is subject <br />to all the terins, conditions and exclusions of the Memorandum of Cqverage of the California Joint Powers <br />Risk Management Authority. <br />Pursuant to Section II, subsection 8, relating to the definition of a covered party, the certificate hoider <br />named herein is only an additional covered party for covered claims arising out of the activity described <br />herein and is subject to the limits stated herein. <br />Coverage is in effect at this time and will not be cancelled, limited or allowed to expire at a date other than <br />that indicated herein except upon 30 days written notice to the certificate holder. <br />04-07-2020 <br />Date <br />Authorized Signature <br />Certificate Number: FORM140980 <br />FormC <br />Tony Giles; CPCU, ARM-P. General Manager <br />Name and Title (Print or type) <br />3201 Doolan Road; Suite 285 •Livermore, CA 94551 •\hone (925) 837-0667 •FAX (925) 290·1543