ICRMA - Chevron Products Company 2023-2024 - WCINDEPENDENT CITIES RISK MANAGEM ENT AUTHORITY
18201 Von Karman Ave., Suite 200, Irvine, CA92612
949.349.9611
Workers' Compensation Certificate of Coverage
Wai\,er of Subrogation
Certificate Number: 202339
Certificate Holder: Chevron Products Company
(Attn:) 6001 Bollinger Canyon Road
San Ramon, CA 94583
Covered Party: City of El Segundo
Description of
Covered Activity: As respects Site Access Agreement as part of Licennsee's consideration for real property
located at 324 W El Segundo Blvd, El Segundo, CA 90245 for placement, maintenance and use of a microwave dish and
radio frequency link system for the term of 10/25/2022 through 10/25/2027.
Memorandum of
Coverage Number: ICRMA WC 2024 Effective Date: 7/1/23 Expiration Date: 7/1/24
Limits: $1,000,000 (per occurrence)
Member Retained
Limit: *$500,000
The Following Workers' Compensation coverage as defined in the memorandum of coverage on file with the covered
Coverage is in party named above. Waiver of Subrogation applies with respects to Certificate Holder, its affiliates and
effect: subsidiaries.
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 contractor other
document w ith respect to w hich 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 from12:01 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: 10/28/2023
Renewal: Yes
Authorized Representative Signature: