PROOF OF INSURANCE (2013) CLOSEDNo.: 103468
Return Address
This Certificate is issued to UCLA Health System Risk Management
City of El Segundo 10920 Wilshire Boulevard, Suite 420
350 Main St. Los Angeles, CA 90024
El Segund, CA 90245 Phone Number: 310 - 794 -3500
United States
UNIVERSITY OF CALIFORNIA
EVIDENCE OF SELF - INSURANCE
PROFESSIONAL MEDICAL & HOSPITAL LIABILITY
(Bodily injury, property damage and personal injury arising from acts or omissions in the course and scope of
University of California employment as defined by the California Tort Claims Act only.)
Type of Coverage I Self- Insured Limits
I. PROFESSIONAL MEDICAL AND HOS'PITA�1� T'1C:
$1,000,000 Each Occurrence
$3,000,000 On Aggregate
II. SPECIAL TERMS & CONDITIONS:
1. This certificate is issued in connection with work performed by at 350 Main St., El Segundo, CA 90245. This certificate is valid
only for work performed within the course and scope of his /her University employment within the Department of Med Center
Unit - Center for Prehospital Care at University of California, Los Angeles. University employees are provided a University funded
defense and indemnification for alleged negligence acts or omissions arising out of the course and scope of their University
employment except where they act or fail to act because of actual fraud, corruption, or actual malice (California Tort Claims Act,
Government Code 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.
3. This certificate is in effect until the expiration date indicated below or termination of applicable contract, affiliation agreement or
termination of University employment, whichever comes first.
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.
Johanna Klohn, Chief Risk Officer, UCLA Health System
Effective Date: 01/24/2013
Expiration Date: 6/30/2013 Approval Date: 1/28/2013