Exhibit_D.pdf

Exhibit D

REQUIRED INSURANCES FOR CONTRACTORS, VENDORS, AGREEMENTS,

CONTRACTS AND PURCHASE ORDERS

Type Coverage Limits – Minimum Endorsements

General Liability Injury, damage & contractual liability from their “work”

1 Million /Occurrence

2 Million Aggregate

Required: CSU Channel Islands Additional Insured

Auto Liability Injury & damage from their ownership & operation of automobiles

1 Million combined single limit per accident

Required: CSU Channel Islands Additional Insured

Workers’ Comp.

& Employers Liability

Worker related Injury or illness for their employees

WC – Statutory Limits El –

$ 1 Million per illness & injury

Waiver of Subrogation Required

How the Certificate of Insurance needs to read:

DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY

ENDORESMENT / SPECIAL PROVISIONS

“The State of California, the Trustees of the California State University, the University, and the officers, employees, representatives, volunteers and agents of each of them” as insureds to all required liability coverage.

CERTIFICATE HOLDER

CSU Channel Islands One University Drive Camarillo, CA 93012

CERTIFICATE OF INSURANCE ISSUE DATE (MM/DD/YY)

California State University Channel Islands

PRODUCER

THIS CERTIFICATE OF INSURANCE IS NOT AN INSURANCE POLICY AND DOES NOT AMEND,

EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BEST’S

COMPANIES RATING

COMPANY

LETTER A _______________________________ ____________

COMPANY

LETTER B __________________________________ ____________

COMPANY

LETTER C __________________________________ ____________

COMPANY

LETTER D __________________________________ ____________

INSURED

THIS IS TO CERTIFY THAT 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 THIS CERTIFICATE MAY BE ISSUED OR MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS ARE SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

CO

LTR

TYPE OF INSURANCE

POLICY

NUMBER

POLICY EFFECTIVE

DATE (MM/DD/YY) POLICY EXPIRATION

DATE (MM/DD/YY)

ALL LIMITS IN THOUSANDS

GENERAL LIABILITY

COMMERCIAL GENERAL LIABILITY

CLAIMS MADE OCCUR.

OWNER’S & CONTRACTOR’S PROT.

OTHER _________________________

GENERAL AGGREGATE $

PRODUCTS-COMP/OPS AGGREGATE $

PERSONAL & ADVERTISING INJURY $

EACH OCCURRENCE $

FIRE DAMAGE (Any one fire) $

MEDICAL EXPENSE (any one person) $

AUTOMOBILE LIABILITY

ANY AUTO

ALL OWNED AUTOS

SCHEDULED AUTOS

HIRED AUTOS

NONOWNED AUTOS

GARAGE LIABILITY

COMBINED

SINGLE LIMIT $

BODILY INJURY

(Per person) $

BODILY INJURY

(Per accident) $

PROPERTY DAMAGE $

EXCESS LIABILITY

UMBRELLA

OTHER THAN UMBRELLA FORM

EACH OCCURRENCE $

AGGREGATE $

WORKERS' COMPENSATION

AND

EMPLOYERS’ LIABILITY

STATUTORY $

EACH ACCIDENT $

DISEASE-POLICY LIMIT $

DISEASE-EACH EMPLOYEE $

PROPERTY INSURANCE

COURSE OF CONSTRUCTION AMOUNT OF INSURANCE $

DESCRIPTION OF OPERATIONS/LOCATION/VEHICLES/RESTRICTION/SPECIAL ITEMS

THE FOLLOWING PROVISIONS APPLY:

1. None of the above-described policies will be canceled until after 30 days’ written notice has been given to California State University Channel Islands at the address indicated below.

2. The State of California, the Trustees of the California State University, the University, their officers, employees, representatives, volunteers and agents.

3. It is agreed that any insurance or self-insurance maintained by California State University Channel Islands will apply in excess of and not contribute with, the insurance described above.

4. California State University Channel Islands is named a loss payee on the property insurance policies described above, if any.

5. All rights of subrogation under the property insurance policy listed above have been waived against California State University Channel Islands.

6. The workers' compensation insurer named above, if any, agrees to waive all rights of subrogation against California State University Channel Islands for injuries to employees of the insured resulting from work for California State University Channel Islands or use of California State University Channel Islands’s premises or facilities.

CERTIFICATE HOLDER/ADDITIONAL INSURED

CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS

One University Drive Camarillo, California 93012

AUTHORIZED REPRESENTATIVE

SIGNATURE ____________________________________________

TITLE ____________________________________________

PHONE NO. _____________________________________________

COMMERCIAL GENERAL LIABILITY

CG 20 10 11 85 Insurance Services Office, Inc. Form (Modified)

INSURER:

POLICY NUMBER:

ENDORSEMENT NUMBER:

THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED — OWNERS, LESSEES OR

CONTRACTORS (FORM B)

This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART.

SCHEDULE

Name of Organization

The State of California, the Trustees of the California State University, California State University Channel Islands, their agents, officers, employees, representatives and volunteers.

(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)

WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of “your work” for that insured by or for you.

Modifications to ISO form CG 20 10 11 85:

1. The insured scheduled above includes the Insured's officers, officials, employees and volunteers.

2. This insurance shall be primary as respects the insured shown in the schedule above, or if excess, shall stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event, any other insurance maintained by the Insured scheduled above shall be in excess of this insurance and shall not be called upon to contribute with it.

3. The insurance afforded by this policy shall not be canceled except after thirty days prior written notice by certified mail return receipt requested has been given to California State University Channel Islands.

4. Coverage shall not extend to any indemnity coverage for the active negligence of the additional insured in any case where an agreement to indemnify the additional insured would be invalid under Subdivision (b) of section 2782 of the Civil Code.

Signature-Authorized Representative

AUTOMOBILE LIABILITY SPECIAL ENDORSEMENT

FOR CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS

SUBMIT IN DUPLICATE

ENDORSEMENT NO. ISSUE DATE

Telephone

POLICY INFORMATION:

Insurance Company:

Policy No.:

Policy Period: (from) (to) LOSS ADJUSTMENT EXPENSE Included in Limits In Addition to Limits

Deductible Self-Insured Retention (check which ) of $ _________ NAMED INSURED APPLICABILITY. This insurance pertains to the operation and/or tenancy of the named insured under all written agreements and permits in force with California State University Channel Islands unless checked here agreements and permits with California State University Channel Islands are covered:

CITY AGREEMENTS/PERMITS

TYPE OF INSURANCE OTHER PROVISIONS

COMMERCIAL AUTO POLICY

BUSINESS AUTO POLICY

OTHER _______________________________________________

LIMITS OF LIABILITY CLAIMS: Underwriter’s representative for claims pursuant to this insurance.

Name: ________________________________________________________ Address: ________________________________________________________ Telephone: ( ) __________________________________________________

$ _____________ per accident, for bodily injury and property damage In consideration of the premium charge and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, it is agreed as follows:

1. INSURED: The State of California, the Trustees of the California State University, the University, their officers, employees, representatives, volunteers, and agents are included as insureds with regard to damages and defense of claims arising from: the ownership, operation, maintenance, use, loading or unloading of any auto owned, leased, hired or borrowed b the Named Insured, or for which the Named Insured is responsible.

2. CONTRIBUTION NOT REQUIRED. As respects work performed by the Named Insured for or on behalf of California State University Channel Islands, the insurance afforded by this policy shall: (a) be primary insurance as respects California State University Channel Islands, its officers, officials, employees and volunteers; or (b) stand in an unbroken chain of coverage excess of the Named Insured’s primary coverage. Any insurance or self-insurance maintained by California State University Channel Islands, its officers, officials, employees and volunteers shall be excess of the Named Insured’s insurance and not contribute with it.

3. CANCELLATION NOTICE. With respect to the interests of California State University Channel Islands, this insurance shall not be canceled, except after thirty (30) days prior written notice by receipted delivery has been given to California State University Channel Islands.

4. SCOPE OF COVERAGE. This policy affords coverage at least as broad as:

(1) If primary, Insurance Services Office Form Number CA0001 (Ed. 1/87), Code 1 (“any auto”); or

(2) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding Section (1). Except as stated above, nothing herein shall beheld to waive, alter or extend any of the limits conditions, agreements or exclusions of the policy to which this endorsement is attached.

ENDORSEMENT HOLDER

CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS

One University Drive Camarillo, California 93012

AUTHORIZED

REPRESENTATIVE Broker/Agent Underwriter ____ I, __________________________________ (print/type name), warrant that I have authority to bind the above-mentioned insurance company, and by my signature hereon do so bind this company to this endorsement.

Signature ______________________________________________ (original signature required) Telephone: ( ) Date Signed ______________

WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY

SPECIAL ENDORSEMENT

FOR California State University Channel Islands

SUBMIT IN DUPLICATE

ENDORSEMENT NO. ISSUE DATE

Telephone

POLICY INFORMATION:

Insurance Company:

Policy No.:

Policy Period: (from) (to)

OTHER PROVISIONS

NAMED INSURED

CLAIMS: Underwriter’s representative for claims pursuant to this insurance.

Name: ____________________________________________________________ Address: ____________________________________________________________ Telephone (_____) _____________________________________________________

EMPLOYERS LIABILITY LIMITS

$ ___________________________ (Each Accident) $ ___________________________ (Disease - Policy Limit) $ ___________________________ (Disease - Each Employee)

In consideration of the premium charge and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any endorsement now or hereafter attached thereto, it is agreed as follows:

1. CANCELLATION NOTICE. This insurance shall not be canceled, except after thirty (30) days prior written notice by receipted delivery has been given to California State University Channel Islands.

2. WAIVER OF SUBROGATION. This Insurance Company agrees to waive all rights of subrogation against the State of California, the Trustees of the California State University, the University, their officers, employees, representatives, volunteers, and agents for losses paid under the terms of this policy which arise from the work performed by the Named Insured for California State University Channel Islands.

Except as stated above, nothing herein shall beheld to waive, alter or extend any of the limits, conditions, agreements or exclusions of the policy to which this endorsement is attached.

ENDORSEMENT HOLDER

CALIFORNIA STATE UNIVERSITY CHANNEL ISLANDS

One University Drive Camarillo, California 93012

AUTHORIZED

REPRESENTATIVE Broker/Agent Underwriter ______ I, __________________________________ (print/type name), warrant that I have authority to bind the above-mentioned insurance company, and by my signature hereon do so bind this company to this endorsement.

Signature ____________________________________________ (original signature required)

Telephone: ( ) Date Signed _____________