PROOF OF INSURANCE (2026)EVIDENCE OF COVERAGE
DATE (MM/DD/YYYY)
124/2025
This Evidence of Coverage is used as a matter of information only and confers no rights upon the Certificate Holder. This Evidence of Coverage does not
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
16550 Bloomfield Avenue
Cerritos, CA 90703
El Se undo unified School District
641 I eldon Street
El Segundo CA 90245
www.ASC I P.org
CONTACT NAME: Mr. ReShan Cooray
PHONE: (562) 404-8029 cooray@asc(p.org
This is to certify that the Alliance of Schools for Cooperative Insurance Programs (ASCIP) Memorandum of Coverages on insurance listed below have
been issued to the Covered Party named above for the period indicated. Notwithstanding any requirement, term, or condition of any contract or other
document with respect to which this Evidence of Coverage may be used or may pertain, the coverages afforded by the Memorandum of Coverages
described herein are subject to all the terms, exclusions, and conditions of such Memorandum of Coverages.
TYPE OF COVERAGE
ADDL
NSR
MEMORANDUM NUMBER (MOC) (MMIDDYIYYYY)
POLICEFF
P1P: 7a ICY mxP
LIMIT OF LIABILITY /COVERAGE
GENERAL LIABILITY
COMBINED SINGLE LIMIT PER OCCURRENCE
$ $5,000,000
AGGREGATE
$ none
OCCURRENCE
,/
MOC #94
7/1/2025
7/1/2026
$
PwsDnal Irl ur
$
Errors & Omission
Employment Practices
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT PER OCCURRENCE
ACTUAL CASH VALUE
AUTOMOTIVE PHYSICAL DAMAGE
COMPREHENSIVE / COLLISION
$
'..ANYAUTO
$
I
$
PROPERTY
REPLACEMENTCOST SUBJECT' TO POIJO'W LIMITS.
TERMS,
$
BUILDING / CONTENTS
Is
FIRE, THEFT, RENTAL INTERRUPTION
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
N/A
MOC #94
7/1/2025
7/1/2026
EACHACCIDENT
$ $2,000,000'
PER EMPLOYEE
Is $2,000,000'
POLICY LIMIT
$ $2,000,000'
f WC STATUTORY LIMITS
OTHER SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS
EMPLOYEE DISHONESTY (CRIME) $
$
$
ADDITIONAL REMARKS:
As respects to License Agreement between the City of El Segundo and El Segundo USD for Board Meetings
CERTIFICATE HOLDER
CANCELLATION
Should any of the above coverages for the Covered Party be changed or withdrawn prior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 EI Se undo
I Keundo Segundo
Hall
50 Main Street
El Segundo CA 90245
any kind upon ASCIP, its agents, or representatives.
AUTHORIZED REPRESENTATIVE: Fritz J. Helrlch
"ASCIPisa joint powers authority pursuant to Article 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
9 > I ,966 i 'l 1 �, P 1 -I 'Typ o..,. I P,CJ 0T ,u e I I , I L;, n, J P.. 1 , "( J" !, 0 , . 01 ..., PM V -i T) i , y,, 1 2
Additional Covered,party Endorsement
District: El Segundo Unified School District
Endorsement No.
85915966
Additional Covered Party: Description of Operations, Vehicle, or Property:
City of El Segundo
As respects to License Agreement between the City of El Segundo
Its officials and employees and El Segundo USD for Board Meetings
Coverage Period: Effective:7/1/2025 Expires 12:01 a.m.: 7/1/2026
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.
Authorized Representative:
Date Issued:6/24/2025
ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 6500) of Chapter 5 of Division 7 of Title 1 of the Government
Code and Sections 39603 and 81603 of the Education Code.
Rev 5/97
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