ICRMA - Pacific Corporate Towers LLC_2024-062 -2024-2025ICRMA
INDEPENDENT CITIES RISK MANAGEM ENT AUTHORITY
18201 Von Karman Ave, Suite 200 1 Irvine, CA 92612
www.icrma.org
WORKERS' COMPENSATION PROGRAM
Evidence of Coverage
Certificate Number: 2024-062
Certificate Holder: Pacific Corporate Towers LLC
222 N Pacific Coast Highway
0 Segundo CA 90245
Covered Party: City of 0 Segundo
Description of
Covered Activity: As respects premises leased by the City of 0 Segundo fora radio transmitter tow eron property located at
222 N. Sepulveda Blvd., 0 Segundo, California.
Memorandum of
Coverage Number: ICRMA WC 2025 Effective Date: 7/1/24 Expiration Date: 7/1/25
Limits: $1,000,000 (per occurrence)
Member Retained
Limit (M RL): " $ 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.
e ffe ct:
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 effectivedate to 12:01 a.m. Pacific
Standard Time of expiration date as stated above and w ill not be canceled, limited, or allow ed to expire
except upon 30-day notice to the certificate holder.
Date Issued: 7/1/2024
Renewal: Yes
Authorized Representative Signature:
IC xecutiv - ector