ICRMA - California Infrastructure and Economic Development (IBank) - 2021-0083 (002)INDEPENDENT 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: 2021-0083
Certificate Holder: California Infrastructure and Economic Development Bank (IBank)
(Attn:)
1325 J Street, Suite 1823
Sacramento, CA 95814
Covered Party:
City of 0 Segundo
Description of
Covered Activity:
As respect the Covered Member's loan fromthe Certificate Holder forthe construction and paving of
street in the City of 0 Segundo.
Memorandum of
Coverage Number:
ICRMA WC 2022 Effective Date: 7/1/21 Expiration Date: 7/1/22
Limits:
$1,000,000 (per occurrence)
Mem ber Retained
*$500,000
Lim it:
The Following
Workers' Compensation coverage as defined in the memorandum of coverage on file withthe 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 effect f rom 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:
7/7/2021
Renewal:
No
Authorized Representative Signature