PROOF OF INSURANCE (2008) CLOSEDCert. No. 20070176
This certificate is issued to:
El Segundo Fire Dept.
344 Main Street
El Segundo, CA 90245
UNIVERSITY OF CALIFORNIA
CERTIFICATE OF SELF - INSURANCE
UCLA Medical Center
10833 Le Conte Avenue
Los Angeles, CA 90095
(310) 794 -3500
PROFESSIONAL MEDICAL & HOSPITAL LIABILITY
(Bodily Injury, Property Damage, and Personal Injury Arising from Acts of Omissions in the
Course and Scope of employment as Defined by the California tort Claims Act Only)
Type of Coverage I Limits
I. PROFESSIONAL MEDICAL AND I $3,000,000 aggregate achoccurrence/
HOSPITAL LIABILITY:
II. SPECIAL TERMS & CONDITIONS:
This certificate is issued in connection with work performed by BLS and ALS Continuing
Education (Med Center Unit -- Center for Prehospital Care) at El Segundo Fire Dept.. This
Certificate is valid only for work performed within the course and scope of his/her
University employment. University employees are covered except where they act or fail to
act because of actual fraud, corruption, or actual malice (California Tort Claims Act,
Government Section 810).
2. The self - insurance evidenced herein follows the provisions of the Bylaws and Standing
Orders of The Regents of the University of California and self - insurance programs as
administered by the University of California, Office of the President, Office of Risk
Management, which do not permit any assumption of liability which does not result from
and is not caused by the negligent acts or omissions of its officers, agents, or employees.
Any indemnification or hold harmless clause with broader provisions than required under
such Bylaws and Standing Orders shall invalidate this certificate.
Should any of the above described insurance programs by modified or cancelled before the expiration
date shown below, The Regents of the University of California will give 30 days written notice to the
named certificate holder.
DATE ISSUED: 07/01/2007
CERTIFICATE EXPIRES: 06/30/2008
AUTHORIZED SIGNATURE
Hospital Risk Manager
No.: 2007005417
This certificate is issued to:
City of El Segundo
344 Main Street
El Segundo, CA 90245
UCLA Medical Center
10833 LeConte Ave
Los Angeles, CA 90095
Should any of the above described programs of self - insurance be materially modified or cancelled
before the expiration date shown below, The Regents of the University of California will give 30
days written notice to the named certificate holder. 44
DATE ISSUED: 6/11/2007
CERTIFICATE EXPIRES: 6/30/2008
10/16/01
AUTHORIZED SIGNATURE
UNIVERSITY OF CALIFORNIA
CERTIFICATE OF SELF - INSURANCE
This is to certify that the University of California is self - insured for the following coverages:
Type of Coverage
Self- Insured Limits
I.
GENERAL LIABILITY
Each Occurrence
Products and Completed Operations Aggregate
$5,000,000
Personal and Advertising Injury
General Aggregate (Bodily Injury & Property Damage)
II.
AUTOMOBILE LIABILITY
Vehicles Owned, Non -owned and Hired
$5,000,000
each occurrence
III.
SPECIAL TERMS & CONDITIONS:
1.
City of El Segundo, its officers, agents and employees are hereby named as additional
insureds, but only in connection with the agreement with UCLA Healthcare — Center for
Prehospital Care. This provision shall apply to claims, costs, injuries or damages but only
in proportion to and to the extent such claims, costs, injuries, or damages are caused by or
result from the negligent acts or omissions of the Regents of the University of California, its
officers, agents, or employees.
2.
The insurance evidenced herein follows the provisions of the Bylaws and Standing Orders
of The Regents of the University of California and self - insurance programs as administered
by the University of California, Office of the President, Office of Risk Management, which
do not permit any assumption of liability which does not result from and is not caused by
the negligent acts or omissions of its officers, agents, or employees. Any indemnification or
hold harmless clause with broader provisions than required under such Bylaws and Standing
Orders shall invalidate this certificate.
Renewal of Certificate No. 2005005279
Should any of the above described programs of self - insurance be materially modified or cancelled
before the expiration date shown below, The Regents of the University of California will give 30
days written notice to the named certificate holder. 44
DATE ISSUED: 6/11/2007
CERTIFICATE EXPIRES: 6/30/2008
10/16/01
AUTHORIZED SIGNATURE