ICRMA - The Regents of the University of California - 2021-0090INDEPENDENT CITIES RISK M ANAGEM ENT AUTHORITY
1802 Von Karman Ave., Suite 200, Irvine, CA92612
949.349-9882
Liability Certificate ofCo\,erage
Additional Covered Party
Certificate Number: 2021-0090
Certificate Holder: The Regents of the University of California, on behalf of the UCLA Faculty Practice Group
(Attn:)
10990 Wilshire Boulevard, Suite 1450
Los Angeles, CA 90024
Covered Party: Oty of 0 Segundo
Description of
Covered Activity: As respects Contract No. 5141 to utilize UCLA's services to maintain the certifications of their employees
and to continue to deliver quality patient care to their community for the term of 07/01/2021 to 06/30/2022.
The Certificate Holder is included as an Additional Covered Party with regard to any negligent acts or
ornissions of the Covered Member, its employees, and its elected or appointed officials.
Memorandum of
Coverage Number: ICRMA GL 2022 Effective Date: 7/1/21 Expiration Date: 7/1/22
Limits: $5,000,000 (per occurrence)
Member Retained *$750,000
Lim it:
The Following General and automobile liability as defined in the memorandum of coverage on file with the covered party
Coverage is in named above. Sexual misconduct not specifically excluded for the city.
effect:
This is to certify that the coverage listed above has been issued to the Covered Party named above for the
coverage 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 pertain. The coverage afforded as
described herein is subject to all the terms, exclusions, and conditions of the Liability Memorandum of
Coverage of the ICRMA, w hich is available for your review upon request.
Pursuant to the definition of Covered Party in the Liability Memorandum of Coverage, the certificate holder
named above is an additional covered party for covered claims arising out of the covered activity stated
above and is subject to the limits stated above. *Such limits are inclusive of the city's MRL.
Coverage is in effectfrom 12:01 a.m. Pacific Standard Time of effective date to 12:01 a.m. Pacific
Standard Time of expiration date as stated above and will not be canceled, limited, or allowed to expire
except upon 30-day notice to the certificate holder.
Date Issued: 7/16/2021
Renewal: No
Authorized Representative Signature