ICRMA - El Segundo Unified School District - 2021-0089INDEPENDENT CITIES RISK M ANAGEM ENT AUTHORITY
1802 Von Karman Ave., Suite 200, Irvine, CA92612
949.349-9882
Workers' Compensation Certificate of Coverage
Evidence of Coverage
Certificate Number: 2021-0089
Certificate Holder: 0 Segundo Unified School District
(Attn:)
641 Sheldon Street
0 Segundo, CA 90245
Covered Party:
Oty of 0 Segundo
Description of
Covered Activity:
As respects request of use of school facilities, track, Boy's gym and overflow field, to conduct officer
testing on 07/29/21, 07/31/21 and 08/07/21.
Memorandum of
Coverage Number:
ICRMA WC 2022 Effective Date: 7/1/21 Expiration Date: 7/1/22
Limits:
$1,000,000 (per occurrence)
Member Retained
*$500,000
Lim it:
The Following
Workers' Compensation coverage as defined in the memorandum of coverage on file with the covered
Coverage is in
party named above.
effect:
This certificate is issued as a matter of information only and confers no rights upon the certificate holder.
This certificate does not amend, extend, or alter the coverage afforded by the Workers' Compensation
Memorandum of Coverage.
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 Workers' Compensation
Memorandum of Coverage of the ICRMA, w hich is available for your review upon request.
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:
7/15/2021
Renewal:
No
Authorized Representative Signature