PROOF OF INSURANCE (2025)_ EVIDENCE OF COVER
This Evidence of Coverage is used as a matter of information only and confers no rights upon the
amend, extend, or alter the coverage afforded by the memoranda listed below.
MEMORANDUM NUMBER: 94
JOINT POWERS AUTHORITY (JPA)----_,_.
JPA MEMBER
Alliance of Schools for Cooperative Insurance Programs El So undo Unif
16550 Bloomfield Avenue 641' Seldon Str(
Cerritos, CA 90703 El Segundo CA
www.ASCIP.org
CONTACT NAME: Mr. Reshan Cooray
PHONE: (562) 404-8029 cooray@ascip.org
This is to certify that the Alliance of Schools for Cooperative Insurance Programs (ASCIP) Mem
been issued to the Covered Party named above for the period indicated. Notwithstanding any r
document with respect to which this Evidence of Coverage may be used or may pertain, the i
described herein are subject to all the terms, exclusions, and conditions of such Memorandum o
TYPEOFCOVERAGE AODL MEMORANDUM POLICYEFF POLICY EXP
INSR. IMM OONYYY) 12:01a.m.
........ ww
GENERAL LIABILITY
Nz
OCCURRENCE / MOC #94 1/112024 1/1/2025
PersonErrors & Omission
JLrnpLayrnent Practices
AUTOMOBILE LIABILITY
AUTOMOTIVE PHYSICAL DAMAGE
COMPREHENSIVE / COLLISION
ANY AUTO
PROPERTY
BUILDING / CONTENTS
FIRE, THEFT, RENTAL INTERRUPTION
WORKERS COMPENSATION MA
AND EMPLOYERS' LIABILITY
MCC#94 7l112024 7/1/2025
WC STATUTORY LIMITS
_... ..._ W ...
OTHER
EMPLOYEE DISHONESTY (CRIME)
ADDITIONAL REMARKS:
DATE (MMF0ONY")
E
i,G 912 /2024
Certificate Holder. This Evidence of Coverage does not
)'d School District
0245
3randum of Coverages on insurance listed below have
quirement, term, or condition of any contract or other
overages afforded by the Memorandum of Coverages
Coverages.
LIMIT OF LIABILITY / COVERAGE
COMBINED SINGLE LIMIT PER OCCURRENCE $ 5,000,000
AGGREGATE
$ none
$
$
COMBINED SINGLE LIMIT PER OCCURRENCE
$
ACTUAL CASH VALUE
S
S
S
$
REPLACEMENT COST SUBJECT TO POLICY LIMITS,
TERMS,
AN' _�n,NDITIONS
$
...e.........
$
$
S
EACH ACCIDENT
$
PER EMPLOYEE
$ $2,000,0001
POLICY LIMIT
$ $2,0010,000.
SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS
$
As respects to License Agreement between the City of El Segundo and El Segundo USD for Board Meetings (9126/2024 - 7/1/2025)
.........................
CERTIFICATE HOLDER CANCELLATION
Should any of the above coverages far the Covered Party be changed or withdrawn prior
Attn: Barbara Voss, Deputy City Manager to the expiration date issued above, ASCIP will mail 30 days written notice to the
Certificate Holder, but failure to mail such notice shall impose no obligation or liability of
Cit of ElSe ,undo any kind upon ASCIP, its agents, or representatives.
EI Negundo gity Hall
Main Street El K0�111142�—I-1
El Segundo CA 90245
AUTHORIZED REPRESENTATIVE: Fritz J. Heirich
•ASCIP Is a joint powers aulhority pursuant to Artide 1(commencing with Section 6500) Chapter 5 of Division 7 of Title 1 of the Government Code and Sections 39603 and 81603 of the Education Code. Rev 5-97
62133183 1 94 1 24/25 All Types WC I Sonia Rojas 1 9/26/2024 2:21:20 PM (PDT) I Page 1 of 2
Additional Covered Party Endorsement
Endorsement No.
District: El Segundo Unified School District
82133183
Additional Covered Party: Description of Operations, Vehicle, or Property:
City of El Segundo
As respects to License pp��reement between the fit�sy of El Se undo
its officials and employees and El Segundo USD for33oard Meetings (9/2612024 - 7/1/2t3 5)
Coverage Period: Effective:7/1/2024 Expires 12:01 a.m.: 7/1/2025
The coverage provided to the Covered Party is hereby extended by this endorsement to the Additional Covered Party named above
in accordance with the provisions contained in the Memorandum of Coverage (MOC). The coverage extended hereby applies only
with respect to liability arising out of activities in the Description of Operations, Vehicle, or Property noted above. It is intended by
ASCIP in issuing this endorsement to defend and/or indemnify the Additional Covered Party. In issuing this endorsement, ASCIP
intends and agrees to extend coverage pursuant to the terms and conditions of the MOC to the Additional Covered Party named
above only to the extent that the Additional Covered Party faces liability arising out of claims, demands, or lawsuits claiming money
damages on account of bodily injury or property damage as defined and limited in the ASCIP MOC. The limits of liability extended
to the Additional Covered Party listed above is $5,000,000 per occurrence for liability. Such insurance as afforded by this policy
shall be primary, and any insurance carried by the Additional Covered Party named above shall be in excess and non-contributory.
eg;W_ L �"
Authorized Representative:
Date Issued:9/26/2024
ASCIP is a joint powers authority pursuant to Article I (commencing with Section 6500) of Chapter 5 of Division 7 of Title I of the Government
Code and Sections 39603 and 81603 of the Education Code.
Rev 5/97
82133193 1 94 1 24/25 All Types WC I Sonia Rojas 1 9/26/2024 2:21:20 PM (PDT) I Page 2 of 2