Insurance - Orange County Department of Education 2018-06-08EVIDENCE OF COVERAGE
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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
amend, extend, or alter the coverage afforded by the memoranda listed below.
MEMORANDUM NUMBER: 74'
JOINT POWERS AUTHORITY (JPAJ JPA MEMBER
Alliance of Schools for Cooperative Insurance Programs OranTe County Department of Education
16550 Bloomfield Avenue 200 almus Drive
Cerritos, CA 90703 Costa Mesa CA 92626
www.ASCIP,org
CONTACT NAME: Mr. Fritz J. Heirich, Chief Executive Officer
PHONE: (562) 404-8029
This is to certify 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 or 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,
TYPE OF COVERAGE
---]AD8L MEMORANDUM NUMBER (M
POLICY EFF POLICY EXP LIMIT OF LIABILITY I COVERAGE
IMSR OC) (M DO 12.01a.M
GENERAL LIABILITY COMBINE[) SINGLE LIMIT REP, CY-'CURRENCE 5
OCCURRENCE V MGIC #74 7/112018 7il/2019 I ACIGREGATE s N/A
Personal Inju i S
Errors & Omission S
Erngloyment Practices
1 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE I's $5,000,0001
AUTOMOTIVE PHYSICAL DAMAGE M OC #74 7/112018 7/112019 ACTUAL CASH VALUE
COMPREHENSIVE I COLLISION
ANY AUTO
Qmed Auto
Hired Auto
REPLACEMENT COST SLIWECT TO POLiCY LiM7S, TERMS,
PROPERTY 71CIN
AND �,�42
BUILDING I CONTENTS
FIRE, 7HEFT, RENTAL INTERRUPTION I Is
WORKERS COMPENSA71ON I NIA EACH ACCIDENT
AND EMPLOYERS' LIABILITY I
iPER EMPLOYEE
WC STATUTORY LIMITS
POLICY LIMIT is
OTHER SUWECT TO POLICY LIMITS, TERMS, ANDCONOrTiONS
EMPLOYEE DISHONESTY (CRJMEF i Is
7 -
ADDITIONAL REMARKS,
As respects to OCDE's Inside the Outdoors Program will provide "Project Zero Waste" waste reduction education for Costa Mesa students Agreement #4620.
CERTIFICATE HOLDER CANCELLATION
Should any of the above coverages for the Covered Party be changed or 4thdrawn prlor I
to the expiration date issued above, ASCIP will rriall 30 days written notice to the
Certificate Holder, but failure to mail such notice shall Impose no obligation or liability Of
Costa Mesa Sanitary District any Ind upon ASCIP, its agents, or representatives.
Attn- Nabila Guzman
290 Paularino Avenue
Costa Mesa CA 92626
AUTHORIZED REPRESENTATIVE: Fritz J. Heirich
*ASCIP is a Joint powers authority pursuant to Article I (commencing with Section 6500) Chapter 5 of Division 7 of Title 1 of the Government Code and Sections 39603 and 81603 of the Education Code. Rov 5-97
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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 liabty 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 $1,000,000 per occurrence for liability. Such
insurance as afforded by this policy shall be primary, and any insurance carried by the Additional Covered Party named above shall
be in excess and non-contributory.
AuthorLized Representative:
Date Issued:6/8/2018
ASCIP is a joint powers authority pursuant to Article I (commencing with Section 6500) of Chapter 5,ot'Division 7 of Title I of the Government
Code and Sections 39603 and 81603 of the Education Code,
Rev 5197
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