Insurance - Orange County Department of Education 2017-01-19EVIDENCE OF COVERAGE
DATE 1/19/2017
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 (JPA)
Alliance of Schools for Cooperative Insurance Programs
16550 Bloomfield Avenue
Cerritos, CA 90703
www.ASCIP.org
CONTACT NAME: Mr. Fritz J. Heirich, Chief Executive Officer
PHONE: (562) 404-$029
JPA MEMBER
Orange County Department of Education
200 Kalmus 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 forthe 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.
TYPEOFCOVERAGE
ADOL
INSR
MEMORANDUM NUMBER (MMIDD/YYYY)
POLICY EFF
POLICY EXP
12:01a.m.
LIMIT OF LIABILITY/COVERAGE
GENERALLIABILITY
OCCURRENCE
Personal Injury
V
MCC #74
7/1/2016
7/1/2017
COMBINED SINGLE LIMIT PER OCCURRENCE $ $5,000,000
AGGREGATE $ N/A
$
Errors & Omission
$
Employment Practices
$
AUTOMOBILE
LIABILITY
AUTOMOTIVE PHYSICAL DAMAGE
COMPREHENSIVE / COLLISION
ANY AUTO
Owned Auto
MOC #74
7/1/2016
7/1/2017
COMBINED SINGLE LIMIT PER OCCURRENCE S $5,000,000
ACTUAL CASH VALUE $
$
$
Is
Hired Auto
$
PROPERTY
BUILDING / CONTENTS
FIRE, THEFT, RENTAL INTERRUPTION
REPLACEMENT COST SUBJECT TO POLICY LIMITS, TERMS,
AND CONDITIONS
$
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
WC STATUTORY LIMITS
NIA
EACH ACCIDENT $
PER EMPLOYEE $
POLICY LIMIT $
OTHER
EMPLOYEE DISHONESTY (CRIME)
SUWECTTO POLICY LIMITS, TERMS, AND CONDITIONS
$
$
ADDITIONAL REMARKS:
As respects to OCDE's Inside the Outdoors Program will provide "Project Zero Waste" waste reduction education for Costa mesa students Agreement 942192
CERTIFICATE HOLDER
Costa Mesa Sanitary District ^�
Attn: District Clerk �) W
290 Paularino AvenueIvo
Costa Mesa CA 92627
CANCELLATION
Should any of the above coverages for the Covered Party be changed or withdrawn prior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 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.
�q— /f�
AUTHORIZED REPRESENTATIVE: Fritz J. Helrich
'ASCIP is ajointpowers authority pursuant to Article I(commencingwith Section 65001 Chapter 5 of Division? of Title 1 ofthe Government Code and Sections 39603 and 81603 ofthe Education Code. Rev 5-97
33090790 1 74 116/17 A11 Types I Nancy Lopez 11/13/2017 1:39:58 PM (PDT) I Page 1 of 2
Additional Covered Party Endorsement
District: Orange County Department of Education
Endorsement No.
33840790
Additional Covered Party:
Description of Operations, Vehicle, or Property:
Costa Mesa Sanitary District
As respects to OCDE's Inside the Outdoors Program will provide
"Project Zero Waste" waste education reduction for Costa mesa
is elected and ap ointed officials, agents, officers, volunteers and
mployees are additional insureds
students Agreement #42192
Coverage Period: Effective:7/1/2016 Expires 12:01 a.m.:7/1/2017
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:1 /19/2017
ASCIP is ajoint powers authority pursuant to Article 1 (commencing with Section 6500) of Chapter 5 of Division 7 of Title 1 of the Government
Code and Sections 39603 and 81603 of the Education Code.
Rev 5/97
33898790 174 1 16/17 A11 Types I Nancy Lopez 1 1/19/2017 1:39:58 PM (PDT) I Page 2 of 2