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Digitally signed by Francine R. <br />Francine R. Villareal Villareal <br />n-- �nJ i n7 1 H — GnC _nTnn' <br />EVIDENCE <br />OF COVERAGE <br />DATE(MM/DD/YYYY) <br />7/ 15/2021 <br />This Evidence of Coverage is used as a matter of information only and <br />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 />JPA MEMBER <br />Alliance of Schools for Cooperative Insurance Programs <br />16550 Bloomfield Avenue <br />Downey Unified School District <br />P.O. Box 7017 <br />Cerritos, CA 90703 <br />11627 Brookshire Avenue <br />Downey CA 90241 <br />www.ASC I P.org <br />CONTACT NAME: Mr. Reshan COoray <br />PHONE: (562) 404-8029 cooray@ascip.org <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 <br />ADDL <br />INSR <br />MEMORANDUM NUMBER (MOC) <br />POLICY EFF <br />(MM/DD/YYYY) <br />POLICY EXP <br />12:01a.m. <br />LIMIT OF LIABILITY/ COVERAGE <br />GENERAL <br />LIABILITY <br />COMBINED SINGLE LIMIT PER OCCURRENCE <br />$ $5,000,000 <br />OCCURRENCE <br />V <br />MOC #15 <br />7/1/2021 <br />7/1/2022 <br />AGGREGATE <br />$ N/A <br />Personal Injury <br />$ <br />Errors & Omission <br />$ <br />Employment Practices <br />$ <br />AUTOMOBILE <br />LIABILITY <br />COMBINED SINGLE LIMIT PER OCCURRENCE <br />$ $5 000 000 <br />AUTOMOTIVE PHYSICAL DAMAGE <br />MOC #15 <br />7/1/2021 <br />7/1/2022 <br />ACTUAL CASH VALUE <br />$ <br />$ <br />COMPREHENSIVE / COLLISION <br />ANY AUTO <br />Owned Auto <br />$ <br />Hired Auto <br />$ <br />PROPERTY <br />REPLACEMENT COST SUBJECT TO POLICY LIMITS, <br />AND CONDITIONS <br />TERMS, <br />$ <br />BUILDING / CONTENTS <br />FIRE, THEFT, RENTAL INTERRUPTION <br />$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />N/A <br />EACH ACCIDENT <br />$ <br />PER EMPLOYEE <br />$ <br />❑ WC STATUTORY LIMITS <br />POLICY LIMIT <br />$ <br />OTHER <br />SUBJECTTO POLICY LIMITS, TERMS, AND CONDITIONS <br />EMPLOYEE DISHONESTY (CRIME) <br />$ <br />$ <br />ADDITIONAL REMARKS: <br />As respects to agreement with City of Santa Ana and Downey Adult School <br />CERTIFICATE HOLDER <br />CANCELLATION <br />Should any of the above coverages for the Covered Party be changed or withdrawn prior <br />to the expiration date issued above, ASCIP will mail 30 days written notice to the <br />Certificate Holder, but failure to mail such notice shall impose no obligation or liability of <br />City of Santa Ana <br />any kind upon ASCIP, its agents, or representatives. <br />Attn: Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <br />AUTHORIZED REPRESENTATIVE: Fritz J. Heir �w oRaN�e Risk Mwag7M ed DRR8l0R <br />REVIEWED & APPROVED BY.- <br />*ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 6500) Chapter 5 <br />of Division 7 of Title 1 of the Government Code and Sections 39 <br />Risk Management Analyst <br />904120 115 121/22 A11 Types I Nancy Lopez 17/15/2021 10:33:45 AM (PDT) <br />I Page 1 of 2 NJ <br />