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Digitally signed by Francine R. <br />Francine R. Villareal Villareal <br />EVIDENCE OF COVERAGE Dom` " <br />119R lid <br />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 <br />amend, extend, or alter the coverage afforded by the memoranda listed below. <br />MEMORANDUM NUMBER: 15 <br />JOINT POWERS AUTHORITY (JPA) <br />Alliance of Schools for Cooperative Insurance Programs <br />16550 Bloomfield Avenue <br />Cerritos, CA 90703 <br />www.ASCIP.org <br />CONTACT NAME: Mr. Reshan Cooney <br />PHONE: (562)404-8029 cooray@ascip.org <br />JPA MEMBER <br />Downey Unified School District <br />P.O. Box 7017 <br />11627 Brookshire Avenue <br />Downey CA 90241 <br />This is to certify that the Alliance of Schools for Cooperative Insurance Programs (ASCIP) Memorandum of Coverages on insurance listed below have <br />been issued to the Covered Party named above for the period Indicated. Notwithstanding any requirement, term, or condition of any contract or other <br />document with respect to which this Evidence of Coverage may be used or may pertain, the coverages afforded by the Memorandum of Coverages <br />described herein are subject to all the terms, exclusions, and conditions of such Memorandum of Coverages. <br />TYPE OF COVERAGE INSR MEMORANDUM NUMBER IMOC) (MMIDDlYYYY) l2 �Sia.m. LIMIT OF LIABILITY/COVERAGE <br />GENERAL LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE 1 $ $5,000,000 <br />OCCURRENCE V MOC #15 7/1/2020 7/1/2021 AGGREGATE $ N/A <br />Personal Injury $ <br />Errors & Omission is <br />Employment Practices <br />Is <br />AUTOMOBILE LIABILITY <br />AUTOMOTIVE PHYSICAL DAMAGE <br />COMPREHENSIVE / COLLISION <br />ANYAUTO <br />Owned Auto <br />Hired Auto <br />BUILDING I CONTENTS <br />FIRE, THEFT, RENTAL INTERRUPTION <br />WORKERS COMPENSATION N/A <br />AND EMPLOYERS' LIABILITY <br />I I WC STATUTORY LIMITS <br />EMPLOYEE DISHONESTY (CRIME) <br />ADDITIONAL REMARKS: <br />#15 <br />7/1/2020 1 7/1/2021 <br />As respects to agreement with City of Santa Ana and Downey Adult School 2/2/2021 - 7/1/2021 <br />CERTIFICATE HOLDER <br />City of Santa Ana <br />Attn: Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br />COMBINED SINGLE LIMIT PER OCCURRENCE 1 $ <br />ACTUAL CASH VALUE Is <br />EACH ACCIDENT <br />$ <br />PER EMPLOYEE <br />$ <br />POLICY LIMIT <br />$ <br />SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS <br />It <br />CANCELLATION <br />Should any of the above coveragesforthe Covered Party be changed or withdrawn prior <br />to the expiration date Issued above, ASCIP will mall 30 days written notice to the <br />Certificate Holder, but failure to mail such notice shall impose no obligation or liability of <br />any kind upon ASCIP, Its agents, or representatives. <br />AUTHORIZED REPRESENTATIVE: Fritz J. Hell <br />'ASCIP is a pint powers authority pursuant to Article 1(commencing with Section 6500) Chapter 5 of Division 7 ofTtle 1 of the Government Code and Sections 39 <br />Risk ManagementDivislo t <br />yEa gI l �1�7e f REVIEWED &APPROVED BY. <br />F414dC6 yYu"41 <br />Risk Management Analyst <br />60893287 1 15 1 20/21 A11 Types I Nancy Lopez 1 3/26/2021 2:35:55 PM (PDT) I Page 1 of 2 <br />