Insurance - Inside the Outdoors Foundation - 2015-10-27EVIDENCE OF COVERAGE
DATE(MAVOD/Y
1orz7nol YYY)s
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 alterthe coverage afforded by the memoranda listed below.
MEMORANDUM NUMBER: 74
JOINT POWERS AUTHORITY (JPA)
Alliance of Schools for Cooperative Insurance Programs
16550 Bloomfield Avenue
Cerritos, CA 90703
www.ASCIP.org
CONTACT NAME: Mr. Fritz Heirich, Chief Executive Officer
PHONE: (562) 404-8029
JPA MEMBER
Orangge County Department of Education
200 lUrnus Drive
Costa Mesa CA 92626
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 contractor 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 subjectto all the terms, exclusions, and conditions of such Memorandum of Coverages.
TYPEOFOOVERAGE
ADOL
INSR
MEMORANDUM NUMBER (POLIICY
EFF
DYYYY)
POLICYE)(P
12:01&m.
LIMIT OF LIABILITY/ COVERAGE
OENERALLIABRJTY
OCCURRENCE
Personal Iniury
V
MCC #74
7/1/2015
7/1/2016
COMBINED SINGLE UNIT PER OCCURRENCE d $6,000,000
AGGREGATE d N/A
a
Errors & Omission
s
Employment Practices
5
AUTOMOBILE
LIABILITY
AUTOMOTIVE PHYSICAL DAMAGE
COMPREHENSIVE! COLLISION
ANY AUTO
Owned Auto
MOC #74
7/1/2015
7/1/2016
COMBINED SINGLE LIMIT PER OCCURRENCE a $$,000,000
ACTUAL CASH VALUE d
a
d
a
Hired Auto
i
PROPERTY
BUILDING/CONTENTS
FIRE, THEFT, RENTAL INTERRUPTION
REPLACEMENT CAST SUBJECTTO POLICY LMrTa, TERMS,
D CONDITIONS
$
a
d
a
WORKERSCOMPENBATKTN
AND EMPLOYERS' LIABILITY
WC STATUTORY LIMITS
WA
EACH ACCIDENT d
PER EMPLOYEE a
POLICY LIMIT a
OTHER
EMPLOYEE DISHONESTY (CRIME)
SUBJECT TO POLICY LIMITS, TERMS, AND GUNDITICNa
d
d
a
a
ADDITIONAL REMARKS:
As respects to OCDE's Inside the Outdoors Program will provide "Project Zero Waste" waste reduction education for Costa mesa students Agreement 042192
CERTIFICATE HOLDER
Costa Mesa Sanitation District
Attn: District Clerk
628 West 19th Street
Costa Mesa CA 92627
CANCELLATION
Should any of the above coverages for the Covered Party be changed or withdrawn pr or
to the expiration date Issued above, ASCIP will mail 30 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, or representatives.
A/UTHORMEDREPREUNTTA`TNVE: •Fritz Helrich
1ASOP Is aOffliacwersaulhmitypursuartIOArtide I(CommenCingwfth section 6S00)Chapter SofDMN0n 7 ofTilel of the Govenment Code and Sections 39603 and 81603ofthe Education Code. RRv587
27066392 116 115,16 :11 lype. I 9R00y Lp 10/90/2013 10:91:37 0., IPmP) I Page 1 of 2
Additional Covered Party Endorsement
District: Orange County Department of Education
Endorsement No.
27ON292
Additional Covered Party:
Description of Operations, Vehicle, or Property:
Costa Mesa Sanitation District
is directors,
As respects to OCDE's Inside the Outdoors Program will provide
Pro act Zero Waste" waste education reduction for Costa mesa
officials, officers, employees, agents and volunteers shell
e covered as additional insured with reseed to work or operations
students Agreement #42192
erfonned bV or on behalf of the CONSULTANT, including materiels,
arts or equipment furnished in connection with such work and the
nsurance coverage shall be primary insurance as respects the
istricl, its director, officials officers empploVees, agnts and
be the CONSULTANTS insurance
elunteers shall excess of and she
e called upon to contribute with It in anyway
Coverage Period: . Effective:7/12o15 Expires 12:01 a.m.:7i1/2o1r;
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 $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.
Authorized Representative:
Date Issued:10/27/2015
ASCIP is a joint powers authority pursuant to Article I (commencing with Section 6500) of Chapter 5 of Division 7 of Title I of the Got emment
Code and Sections 39603 and 81603 of the Education Code.
Rev 5.'97
270C4292 74 1 15,16 ;.11 aypaa I Nancy Lopez 10/27/2015 10,31,37 na (aux) I nage 2 of 2
ORANGE COUNTY
DEPARTMT
OF EDUCATION
200 KALMUS DRIVE
P.O. BOX 9050
COSTA MESA, CH
92628-9050
(7' 4) 966-4000
FAX (714) 432-1878
www.i.occe.us
tii. 611JAH ,8, Ph.B.
ouunty Superintendent
u1 Schools
ORANGE COUNTY
BOARD OF EDUCATION
JOHN W. BEDELL, PH.D.
DAVID L. BOYD
ROBERT M. HAMMOND
LINDA LINDHOLM
KEN L. WILLIAMS, D.O.
July 1, 2015
Re: Verification of Workers' Compensation Coverage
To Whom It May Concern;
The Orange County Superintendent of Schools is self-insured for it Workers'
Compensation coverage through the Western Orange County Self -Funded
Workers' Compensation Agency, a Joint Powers Authority (JPA). Our self-
insured certificate number is A-5532-10-132.
If you are in need of further details or have any questions, please feel free to
contact me at (714) 966-4059.
Sinc ely,
Ann Kantor, Coordinator
Risk Management
Maggie Solorzano
From: Parvin Dashtaki
Sent: Wednesday, October 28, 2015 9:10 AM
To: Maggie Solorzano
Subject: Costa Mesa Sanitation District COI
Attachments: Costa Mesa Sanitation District #42192.pdf
Hi Maggie:
The following is the response from ASCIP on additional covered party:
"Our certificate templates are standard and we can't make any changes to it. So to the missing #3 clause we can't
add or revise our template. "
Also, bringing you the W/C Verification coverage separately.
Thanks.
Pafvies Daska4i
Administrative Assistant III
Risk Management
Tel: 714-966-4033
Fax: 714-549-4812
odashtaki@ocde.us
LAW OFFICES OF
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ALAN R. BURNS
ORANGE, CALIFORNIA 92866
COLTN R. BURNS
ALE[ M BALFMAN
TELEPHO14B (714) 771-7728
FACSBNBE (714)744-3350
•A FROPE85lGNAL CORPoMMT
Confidential Attorney -Client Privileged
To: Management Analyst
From: District Counsel
Date: November 9, 2015
Re: Review of Insurance for Orange County Department of Education
Al. M IlNfin.
a b.l6vm@l Pabw wm
Typically, insurers use forms as evidence of insurance coverage. The Orange County Department
of Education is a part of a joint powers commission, which obtains insurance coverage through
contract. These types of contracts are typically reliable.
The Evidence of Coverage shows that there is a general liability and automobile liability policy
under the contract. However, without reviewing the actual contract, we cannot know exactly
what kind of insurance is provided. Because these types of contracts are generally reliable, we are
comfortable moving forward if you are. If you are not comfortable moving forward without us
reviewing the contract for insurance, please send us the insurance contract for our review.
t
/r 111
NR a/
11 4 j
Alex M. Halfman
Associate