PROOF OF INSURANCE (2025).............. . ..... . ......
Date: 7/1
CERTIFICATE OF 2/2024
SELF-INSURANCE COVERAGE
PRODUCERIINSURED — - —
The Regents of Ilia Univorsjtx of California This Certificate is issued as a matter of information only to authorized viewers for
University of California, Los rigeles theIr internal use only and confers no rights upon any viewer of this Certifir.We.
Insuranre and RIsk Managom6fit The Certificate does not amend, extend or alter the coverage described below.
10920 Wilshire Blvd Suite 860
Los Angeles CA 90024 This Certificate may only be copied, printed and distributed by an authorized
(310) 794-6948 viewer for its internal use. Any other use, duplication or distribution of the
Certificate without the written consent of the Regents of the University of California
is Prohibited._ - . ............................ .........
ENTITIES AFFORDING COVERAGE
PARTICIPATION
COMPANY LETTER A ty 100%
�Re' er�ft Pf tq� Vniversi of California
..........
............ . . .
COVERAGES
THIS IS TO CERTIFY THAT THE REGENTS OF THE UNIVERSITY OF CALIFORNIA IS A GOVERNMENTAL ENTITY THAT HAS A SELF -FUNDED
RETENTION FOR LIABILITIES DESCRIBED BELOW, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY WRITTEN
CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY PERTAIN THIS SELF -FUNDED PROGRAM IS
SUBJECT TO ALL PROVISIONS OF THE BYLAWS AND STANDING ORDERS OF THE REGENTS OF THE UNIVERSITY OF CALIFORNIA, WHICH
DOES NOT PERMIT ANY ASSUMPTION OF LIABILITY WHICH DOES NOT RESULT FROM THE NEGLIGENT ACTS OR OMISSIONS OF ITS
OFFICERS, AGENTS OR EMPLOYEES
9- _R POLICY
_VP661fNN §U�AWCCE . ..... Y NUMB POLICY EFFECfRC T POLT_ IRATION64-TEmmm�mmmmmmmmmm LIMITS
LTR
A GENERAL LIABILITY Self -Insured 07/01/2024 07/01/2025 GENERAL AGGREGATE
COMMERCIAL GENERAL LIABILITY PRODUCTS—COMP/OP AGG $ 1,000000
CLAIMSMADE" I OCCURRENCE PERSONAL & ADV INJURY S 1 000,000
F [X X Pr LWAfty CONTRACTUAL LIABILITY $ 1 000.000
EAOI OCCURRENCE S 2,000 000
1
A AUTOMOBILE LIABILITY Self -insured 0P01/2024 0710112025 COMBINED SINGLE LIMIT 000 000
ANY AUTO
X ALL OWNED BODILY INJURY
AUTOS (PER PERSON)
S( HEDULED
AUTOS BODILY INJURY
X FIRED AUTOS (PER ACCIDENT)
X NON -OWNED
AUTOS PROPERTY DAMAGES
GARAGE LIABILITY
PROPERTY EACIA OCCURRENCE
FIRE & F-XIE14DED PERILS AGGREGATE
A WORKERS' COMPENSATION AND Self -Insured OT01/2024 D71,10V2025 STATUTORY LIMIT'S YES
EMPLOYERS LIABILITY EACH ACCIDENT $ As required by
DISEASE - POLICY LIMIT S As required by
DISEASE EACH EMPLOYEE S As required by
i.EbrMPTIOP� OF OPEFtATIONSII.00ATIONSNEI-ilCLE,131SPECIAt. ITEMS
Professional Liability: $1,000,000 Occurrence / $3,000,000 Aggregate
The City of El Segundo is named as additional insured but only in connection with The Third Amendment to Services Agreement for to
provide Continuing Education programs and Quality Improvement services.
CERTIFICATE HOLDER CANCELLATION
APPLICABLE PARTY AS REQUIRED BY WRITTEN CONTRACT SHOULD THE REGENTS ELECT TO DISCONTINUE SELF -INSURING ITS
OR AGREEMENT LIABILITIES, THE REGENTS WILL UPDATE PROOF OF SELF-INSURANCE ON ITS
City of El Segundo WEBSITE_ THE REGENTS SHALL NOT BE OBLIGATED TO PROVIDE INDIVIDUAL
NOTICE TO VENDORS OR OTHERS-
350 Main St. ------
El Segundo CA 90245 [:3y,
Al
Johanna Klohn
............. . .