PROOF OF INSURANCE (2024) CLOSEDNo: 1557180478 Return Address
This Certificate is provided to: UCLA Health System
El Segundo Fire Dept. 757 Westwood Plaza
314 Main St Los Angeles, CA 90095
El Segundo CA 90245
UNIVERSITY OF CALIFORNIA
EVIDENCE OF SELF-INSURANCE
PROFESSIONAL LIABILITY & HOSPITAL LIABILITY
1I Type of Coverage 1I Self Insured Limits
I. PROFESSIONAL MEDICAL AND HOSPITAL LIABILITY: 2,5oo,000 Each Occurrence
2,5oo,000 Aggregate
II. SPECIAL TERMS & CONDITIONS-
1 . This certificate is not valid for use by individuals and is only intended to evidence the self insurance of The
Regents of the University of California for institutional exposure as opposed to individual exposures.
2„ The self insurance evidenced herein follows the provisions of the Bylaws and Standing Orders of the
Regents of the University of California and self insurance programs as administered by the University of
California, Office of the President, Office of Risk Services, which do not permit any assumption of liability
which does not result from and is not caused by the negligent acts or omissions of its officers, agents, or
employees. Any indemnification or hold harmless clause with broader provisions than required under such
Bylaws and Standing Orders shall invalidate this certificate.
3. This certificate is in effect until the expiration date indicated below or termination of applicable contract,
affiliation agreement or termination of University employment, whichever comes first.
Should any of the above described program of self-insurance be materially modified or cancelled before the
expiration date shown below, The Regents of the University of California will give 30 days written notice to the
certificate holder,
� �- mow. ��„,,.•�. "� � ��.
Effective Date: 07/01/2023
Expiration Date: 07/01/2024
Johanna Klohn
UCLA Health System
757 Westwood Plaza
Los Angeles CA 90095
Approval Date: 6/13/2023
This Certificate is issued as a matter of information only and confers no rights upon the certificate holder, The Certificate does not
amend, extend or alter the coverage described above. This certificate does not constitute a contract between the holder and the
University of California
Form: PL Institutional 0914
No: 1467292590
This Certificate is provided to:
City of El Segundo
350 Main Street
El Segundo CA 90245
Return Address
UCLA Health System
757 Westwood Plaza
Los Angeles, CA 90095
UNIVERSITY OF CALIFORNIA
EVIDENCE OF SELF-INSURANCE
PROFESSIONAL LIABILITY & HOSPITAL LIABILITY
Type of Coverage I Self -Insured Limits
I. PROFESSIONAL MEDICAL AND HOSPITAL LIABILITY: t,000,000 Each Occurrence
3,000,000 Aggregate
II. SPECIAL TERMS & CONDITIONS:
1. This certificate is issued in connection with work performed by:
Scott Mitnick at City of El Segundo, 350 Main St, El Segundo, CA 90245
This certificate is only valid for work performed within the course and scope of his/her employment within:
Center for Prehospital Care at UCLA Health System .
University employees are provided a University fundeddefenseand indemnification for alleged negligence
acts or omissions rising outofthe course and scope, of the University employment except where they act or
fail to act because of actual fraud, corruption, or actual malice. (California Tort Claims Act. Government
Code Section 810).
2. The self-insurance evidenced herein follows the provisions of the Bylaws and Standing Orders of the
Regents of the University of California and self-insurance programs as administered by the University of
California, Office of the President, Office of Risk Services, which do not permit any assumption of liability
which does not result from and is not caused by the negligent acts or omissions of its officers, agents, or
employees. Any indemnification or hold harmless clause with broader provisions than required under such
Bylaws and Standing Orders shall invalidate this certificate.
3. This certificate is in effect until the expiration date indicated below or termination of applicable contract,
affiliation agreement or termination of University employment, whichever comes first.
Should any of the above described program of self-insurance be materially modified or cancelled before the
expiration date shown below, The Regents of the University of California will give 30 days written notice to the
certificate holder.
Effective Date: 07/01/2023 Johanna Klohn
UCLA Health System
757 Westwood Plaza
Los Angeles CA 90095
Expiration Date: 07/01/2024
Approval Date: 6/13/2023
This Certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate does not
amend, extend or alter the coverage described above. This certificate does not constitute a contract between the holder and the
University of California.
Form: PL Individual 0914