ICRMA - Chevron Products Company_2024-060_WC - 2024-2025ICRMA
INDEPENDENT CITIES RISK MANAGEM ENT AUTHORITY
18201 Von Karman Ave, Suite 200 1 Irvine, CA 92612
www.icrma.org
WORKERS' COMPENSATION PROGRAM
Waiver of Subrogation
Certificate Number: 2024-060
Certificate Holder: Chevron Products Company
6001 Bollinger Canyon Road
San Ramon CA 94583
Covered Party:
City of 0 Segundo
Description of
Covered Activity:
As respects Site Access Agreement as part of Licennsee's consideration for real property located at 324
W 0 Segundo Blvd, 0 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 2025 Effective Date: 7/1/24 Expiration Date: 7/1/25
Limits:
$ 1,000,000 (per occurrence)
Member Retained
Limit(MRL):
*$ 500,000
The following
Workers' Compensation coverage as defined in the memorandu m of coverage on file w ith 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 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 ofeffectivedate 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: _
I M xecutiv @LV1 rector