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EVIDENCE OF COVERAGE <br />Rancho Santiago Community College District <br />POLICY NUMBER: 5553-012-11/12-77 <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 <br />does not amend, extend, or alter the coverage afforded by the memoranda listed below. <br />CERTIFICATE HOLDER INFORMATION <br />City of Santa Ana, State of California <br />Parks, Recreation & Community Services <br />Attn: Gerardo Mouet <br />26 Civic Center Plaza (M-75) <br />Santa Ana, CA 92702 <br />Coverage Period: Effective: 7-1-11 Expires 12:01 a.m.: 7-1-12 I <br />This is to certify that the Alliance of Schools for Cooperative Insurance Programs (ASCIP) Memorandum of Coverages on insurance listed below <br />have been issued to the Covered Party named above for the period indicated. Notwithstanding any requirement, term, or condition of any contract <br />or other document with respect to which this Evidence of Coverage may be used or may pertain, the coverages afforded by the Memorandum of <br />Coverages described herein are subject to all the terms, exclusions, and conditions of such Memorandum of Coverages. <br />TYPE OF COVERAGE LIMIT OF LIABILITY/COVERAGE <br />Workers' Compensation Statutory <br />Employer's Liability $1,000,000 Each Accident <br /> $1,000,000 Per Employee <br /> $1,000,000 Policy Limit <br />Should any of the above coverages for the Covered Party be changed or withdrawn prior to the expiration date issued above, ASCIP will mail 30 <br />days written notice to the Certificate Holder, but failure to mail such notice shall impose no obligation or liability of any kind upon ASCIP, its agents, <br />or representatives. If you have any questions, contact: <br />Ms. Donna Abersman, Chief Executive Officer <br />ASCIP • 16550 Bloomfield Avenue • Cerritos, CA 90703 • (562) 404-8029 <br />Authorized Representative: <br />Date Issued: 10-13-11 <br />* ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 6500) of Chapter 5 of Division 7 of Title 1 of the Government <br />Code and Sections 39603 and 81603 of the Education Code. <br />Rev 7/02 <br />'to -POW <br />0 <br />_ISA E. S1 RCK <br />Attorney <br />Ass,start City <br />/-,te\ ?Iliance of Schools for Cooperative Insurance Programs <br />16550 Bloomfield Avenue, Cerritos, CA 90703 (562) 404.8029