PROOF OF INSURANCE (2019) CLOSED E��U��������� ��� COVERAGE� m���n��~� "�n ~�"�� �»���� F 212 y
This Evidence of Coverage is used as a matter of information only and confers no rights upon the Certificate Holder. This Evidence vfCoverage does not
amend,extend,u,alter the coverage afforded bvthe memoranda listed be|uw�
- __ ___ .................... __
MEMORANDUM NUMBER: e4
_
JOINT POWERS AUTHORITY;nv JPA MEMBER
Alliance of Schoolsfor Cooperative Insurance Programs BS iSchool District
16550BloomfieldAxonua 641 SIC| Street
Cerritos, CAQU703 BSegundo CA 80245
vmww.A8C|P.nrg
CONTACT NAME: M,.Fritz J.Homoh.Chief Executive Officer
PHONE: (ose)4o4'aooe
__ __� - _ _
This |smcertify 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 o,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.
-_ __ __ __ __ _ __----
�oo POLICY EXP um/ropu^o/Lnr/cvvs�as
r,psoroovemv�c NS �smun^wnumwummsn�uq __ lMWDD�F�x 12.01,.m. __GENERAL
_
sswcnx�u^n/un� � COMBINED SINGLE um/rPER OCCURRENCE m $5,000^000
--
000vnnswos / 711/2019��� #o4 771/uo10 �/co1y AGGREGATEm wx`
*
P��&�iun __ _ _____
�L
Errors uor�vsiun _ $ _______
�L Emp-i02mp,prwowoma $
AUTOMOBILE LIABILITY /x�arEDa�sLsum/rPER OCCURRENCE $
-- ^uro�orwsp*,o/n^�o^�^as ^cru^�oxo*vxms m
-- __
COMPREHENSIVE COLLISION 1°
^w,^urn ��
_
__ __ m
_- _____ w___�
------ - ------ ----------- lREPLACEMENT COST ovBJsorropmL ICY I.. Trz Amo.
pnopsmr 'A NP
-- m
au/m/wo'cowrswro
� � �
FIRE,THEFT,RENTAL/^nenRuprmw ____ ��
� *
_ _______ __ __
__ ____ __ __ ____ ___�m ___
WORKERS COMPENSATION ^� EACH ACCIDENT m
«wosmpuv,snx'u^o/ur' PER EMPLOYEE �
[—Twmvmrvron,um/ro -- --
pouo,uw/r *
__ _ �
OTHER SUBJECT`nPOLICY LIMITS,TERMS,AND m,wo/nowo
EMPLOYEE DISHONESTY(omms)
___.................... __
__ ......... _
__ ...................
—l--- -- E
. __ ...... ....... __
_ ____�___—__- ___________� _ ��
_
^oomvw^�non^m°m.
As respects to Urho Saari Swim Stadium(219 W.Mariposa Avenue,El Segundo,90245) 2Y19/19 7/1/19
......................
—
CERTIFICATE HOLDER CANCELLATION
Should any mthe above coverages for the Covered Party uechanged o,withdrawn prior
to the expiration date issued above, Auop will man 30 days written notice to the
Certificate Holder,but failure to mail such notice shall impose no obligation or liability of
City of El Segundo any kind unnn��on'u,auen��n,,en,e,en�a�"es� __
Attn: C| |erk-TrooyVVaavar r------ - --
35U Main Street
BSegundo CA 90250 zy
AUTHORIZED REPRESENTATIVE: Fritz J. Heihnh
__ __ ___ ....
Section omo>Chapter sofDivision rofnu.zofm.Government Code and Sections 3960,and uz60,m,h"Education Code. Rev 5-97
a
Additional Covered Party Endorsement
Endorsement No.
District: EI Segundo Unified School District 47125973
Additional Covered Party: Description of Operations, Vehicle, or Property:
City of EI Segundo As respects to Urho Saari Swim Stadium(219 W.Mariposa Avenue,
EI Segundo,90245) 2/19/19-7/1/19
Coverage Period: Effective: 7/1/2018 Expires 12:01 a.m.: 7/1/2019
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 only if the District is solely negligent.
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 creetarren car liability.
el-4L-1
Authorized Representative:
Date Issued: 2/20/2019
ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 65 00)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
47125973 1 94 1 18/19 All Types WC I Nancy Lopez 1 2/20/2019 8:41:21 AM (PST) I Page 2 of 2