Certificates of Insurance Requirements

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1 Vendor Name: FAXit: Date: Certificates of Insurance Requirements Insurance policies must include the following: <t East Whittier City Elementary SD 1. The Certificate of Liability {Acord25 or similar form) is to be issued by vendors insurance company or broker with East Whittier City School District named as the Certificate Holder. 2. East Whittier City School District is to be named as Additional Insured. Primary wording for endorsement: The East Whittier City School District is named as an additional insured. Such insurance as is afforded by this policy shall be primary, and any insurance carriedby DISTRICTshall be excess and noncontributory. 3. Certificate Holder Information: East Whittier City School District East Whittier Blvd. Whittier. CA A provision that states that coverage will not be cancelled without 30 days prior written notice to the district. 5. Coverage needs to be in force for the complete term of the contract. If insurance expires during the term of the contract, the District must receive a new certificate at least ten (10) days prior to the expiration. General Liability Certificates: Required Coverage Amounts: $1,000,000 minimum limit per occurrence $2,000,000 minimum general aggregate Automobile Liability Insurance (Consultants): Personal transportation vehicles that are driven onto and parked on school property California State minimum requirements for private passenger vehicles: $15,000 injury/death to one person 330,000 injury/death to more than one person $5,000 damage to property Commercial vehicles that are used to provide services (Food Services): $1,000,000 minimum limit per occurrence Workers' Compensation Insurance: Proof of Workers' Compensation is required if the vendor has employees. Insurance certificates may be submitted via: Mail: FAX: School Site

Facility User's Insurance Broker Name of Facility User (It should match the name as written in the Facility Use Agreement Occurrence box must be selecte This section should reference the appropriate

2 Facility User's Insurance Broker Name of Facility User (It should match the name as written in the Facility Use Agreement Occurrence box must be selecte This section should reference the appropriate contract activity, etc This should reflect East Whittier City School District with the District's proper address (Not School Site) Sample Certificate of Insurance Current dates through the term of the project are required The two "each occurrence" boxes should total at least as much as required in the contract The totals in each box should be at least $1M for Workers' Compensation Preferably, this wording should be 'X"d out Signed by Broke only 'Keenan I CI ;l ' Innovative Solutions. Enduring Principles. 3

3 IMPORTANT If die certificate holder u an ADDITIONAL INSURED, il.c pol«ry(iei> mmt be endorsed. AlUtcinem on Ihiv certificate does not confer rijhti to thecertificate lioljcrin lieuof juch cndoriciiienlu). If SUBROGATION IS WAIVED, jubject 10 iheicrnuand condition* ofilic policy, cciuin policies nu> requite in endorvcraeni. A HlfctDCO! 00 tin* icitifwalc doe*, not confer right* lo ilic certificate lioljcr in lieu ol such eridorsenifr.ri*) DISCLAIMER Ihe Certificate ol Insurance on the resersesid: ol this form doc* not constitute a sowra.l between the imuint imurctd). authorized rcprcscnunse or producer, and the certificate holder, nor doe* rt affimutitcl) or nc,-amcly amend. e»tcnd or altr the cusetafc attorded bythepolicies listed thereon. acokdjs-sami 2 of 2 ( '161 Keenan \Oi 1.1 I Innovative Solutions. EnduringPrinciples. V

Sample Additional Insured Endorsement This policy number should be the same as that listed for General Liability on the Certificate of Insurance FOLCV NUMBER COWWERCJIL OEMEFAL LUG LfTY co :: -.

4 Sample Additional Insured Endorsement This policy number should be the same as that listed for General Liability on the Certificate of Insurance FOLCV NUMBER COWWERCJIL OEMEFAL LUG LfTY co :: -.: u 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS. LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION '- -. tnaar«m-ri!mcc:*t: rsj-an:r cvcveee -rc»m: ta»3ir: DOUUERCI*. :-E».EP.\. UA8UTY COVERAGE FV*T This is where East Whittier City School District should be listed Name af Fertcn or Z ;snlza'd:-.: ICHEDULE (H ra eptj apeem (Bote, r&mabcr regursd a :cr-c efe tc etosrserett *n c; :rc*r r : «Cecariians a: sec case»: :is snaars-ttnt Verbiage on an Insured's Policy which refers to Additional Insureds A. lecton II - ivrio «An lntir»e 5 t-eresc la neiee u ar Mind te pener c- er;i-ia:cr :ia*r r tfe Bitten :. s." v, *-. Li ~:a::t la I- a: rr. a.1ir; it c* your crcc nj aairaba-.: c-r- ^-.ta fcrnanhum:.11 rticrr. K r«ns.-an:; a*v;-3*3 la ins:; ;:clcral hiiiieei re MMrTO etciscr 1 accee I. ElClUtlCAC Tnc imrma cces netaaao * tec.7 rjjr/" «f 'a-ater?/ car-aa:' crcurinc sfiir: <l M *at. rciei-a ras-i: ptiu a- ejito-.t*t trtuhec ncomesonwtn sjet- *ar». at te 3-a/rct.a";- Tar unme, -.ar^fa-re :r rraatti a: te Bcrtapsed ty cr an tt.-at ef r; aaa Dona rsj-:: II a: in: :r* cf :n* CSV tin aas-alcr: ra: Ettn ca-.aetee. ct (2 TTs: pecan y 'jc-.r *ai a.-, c'»ric.- ln: r[j-/ ar ei-a;* v-iii -.a: teer sjix K rt-njec j:e a; an/pcnm a- BfOanoaen rtfer von aruulff ranlracier a- 5j3:crta:a:- :rcasec :n ptrt-r-nj aat-aoa-.: fcr a :>m: cal a: a can 3* I-.: ur: yc\r.l C0 2C 1JI301 c :S3 5tfenies n: ::jn P»De C Keenan. I.» j /». ; j < < j Innovative Solutions. EnduringPrinciples. 9

Sample Additional Insured Endorsement The Named Insured should always be the same as the "Insured" name on the Certificate POLICY NUMBER: NA THIS ENDORSEMENT CHANGES THE POLICY.

5 Sample Additional Insured Endorsement The Named Insured should always be the same as the "Insured" name on the Certificate POLICY NUMBER: NA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ERAL LIABILITY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRATORS (Form B) This policy number should be the same as that listed for General Liability on the Certificate of Insurance This is where East Whittier City School District should be listed This is the standard endorsement number (CG 20-10) This ondorsomnnt modifios insurnnco provldod undor tho following: COMMERCIAL GENERAL LIABILITY COVERAGE PART, xif Person or Orgnniiation: SCHEDULE (Ifno entry appears above, information required to complcto this endorsement will bo shown in tho Declarations as applicablo to this endorsement.) WHO IS AN INSURED (Soction II) is amondod lo includo as an insurod tho porson or organization shown in tho Schodulo, but only with rnspoct to liability arising out of "your work" for that insured by or for you. It Is further agreed that such Insurance as Is afforded by this policy for tho boncfrt of tho above Additional Insurod(s) shall bo primary insurant respects any claim, loss or liability arising out of the Named Insured's operations, and any other insurance maintained by the Additional Insured(s) shall bo excess and non-contributory with tho insuranco provided hereunder. It is agreed that the above policy contains a standard cross liability or severability of intorest clause. Copyright. Iniuranco Servicer Office, Inc Should list the purpose or the activities between the Insured and the District Primary wording is recommended in the District's contracts, and is typically referenced on the Additional Insured Endorsement CG Keenun.i I«v, i (i r «j Innovative Solutions. Enduring Principles. n

VENDOR INSURANCE REQUIREMENTS

VENDOR INSURANCE REQUIREMENTS California State University, Northridge Foundation is a recognized auxiliary of the California State University, Northridge. Doing business with the CSUN Foundation requires