CERTIFICATE OF COVERAGE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF EVIDENCE ONLY AND CONFERS 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:
COVERAGES
THIS IS TO CERTIFY THAT THE COVERAGE IS AFFORDED TO THE ABOVE NAMED MEMBER, AS PROVIDED BY THE MEMORANDUM(S) OF COVERAGE, FOR THE PERIOD SHOWN 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 FOLLOWING COVERAGE IS IN EFFECT.
JPA
LTR 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 AND
EMPLOYERS LIABILITY
ANY PROPRIETOR/PARTNER/
EXECUTIVE/OFFICER/MEMBER
EXCLUDED?
IF YES, DESCRIBED UNDER SPECIAL
PROVISION BELOW
WC
STATUTORY
LIMITS
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
DATE (MM/DD/YYYY)
7/2/2025
Alliant Insurance Services, Inc.
560 Mission Street, 6th Floor
San Francisco CA 94105
CSU Bakersfield
9001 Stockdale Highway
Bakersfield CA 93311-1099
CSURMA
A
2,000,000
2,000,000
X
Excluded
X
Contractual Liab
X
SIR $50,000
4,000,000
2,000,000
CSURMA-LIAB-2526
7/1/2025
7/1/2026
4,000,000
Sexual Abuse
$2,000,000
A
CSURMA-WC-2526
7/1/2025
7/1/2026
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 coverage
Systemwide Risk Management
401 Golden Shore, 5th Floor
Long Beach, CA 90802-4210
www.calstate.edu
CSU Campuses
Bakersfield
Channel Islands
Chico
Dominguez Hills
East Bay
Fresno
Fullerton
Humboldt
Long Beach
Los Angeles
Maritime Academy
Monterey Bay
Northridge
Pomona
Sacramento
San Bernardino
San Diego
San Francisco
San José
San Luis Obispo
San Marcos
Sonoma
Stanislaus
July 1, 2025
TO WHOM IT MAY CONCERN:
Ref: THE CALIFORNIA STATE UNIVERSITY GENERAL LIABILITY, WORKERS’ COMPENSATION, PROPERTY, PROFESSIONAL LIABILITY,
AND AUTOMOBILE LIABILITY SELF-INSURANCE PROGRAM
The State of California has elected to be self-insured for its general liability, workers’ compensation, professional liability, motor vehicle liability, and property exposures through an annual appropriation from the General Fund. As a State agency, the California State University, Office of the Chancellor, the Trustees, and its system of campuses are included in this self-insured program.
The Office of Risk Management in the Chancellor’s Office administers the general liability, workers’ compensation, property, and professional liability programs. The State Office of Risk and Insurance Management administers the motor vehicle liability program.
Under this form of insurance, the State and its employees (as defined in Section 810.2 of the Government Code) are insured for any tort liability that may develop through carrying out official activities, including state official operations on non-state owned property. Should any claims arise by reason of such operations or under an official contract or license agreement, they should be referred to the California State University, Office of Risk Management, 401 Golden Shore, 5
th Floor, Long Beach, CA 90802-4210.
Please feel free to contact me if you have any questions.
Sincerely,
Zachary Gifford
Senior Director
Systemwide Risk Management
Office of the Chancellor
California State University
____________________________________________________
Participant Release of Liability
S:\Human Resources\HR General\ReleaseLiability(Final).doc
PARTICIPANT RELEASE OF LIABILITY AND ASSUMPTION OF RISK
INVOLVING AN INTERNSHIP WITH THE CITY OF BAKERSFIELD
[Read Before Signing]
Participant’s Name: ___________________________________________________________
In consideration of being allowed to participate in an internship with the City of Bakersfield for purposes of conducting City wide research projects that will result in college credits earned at CSUB, the undersigned, acknowledges, appreciates, and agrees that:
1. The risk of injury from the activities involved in the internship. The undersigned willingly agrees to comply with the stated and customary terms and conditions for participation. If, however, I/we observe any unusual significant hazard during my /our presence or participation, the undersigned will remove himself/herself from participation and bring such to the attention of the nearest official immediately; and
2. The undersigned hereby releases, waives, and discharges from suing the City of Bakersfield, its officers, Mayor, agents, all employees and designated volunteers (hereinafter referred to as “releasees”) from all liability to the undersigned for any loss or damage, and any claim or demands therefore on account of injury to the person or property or resulting in death of the undersigned, whether caused by the negligence of the releasees or otherwise, while the undersigned is in, upon, or about the premises or any facilities or equipment therein; and
3. The undersigned voluntarily assumes all risks associated, including risk of serious injury, death and/or property damage to the undersigned and/or others arising from participating in the internship where hazards may exist, and that this Release of Liability and Assumption of Risk is made without reliance upon any statement or representation of the party or parties hereby released or their representatives.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT,
FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL
RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
X______________________________________ ________________ Participant’s Signature Date