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EVIDENCE OF COVERAGE <br />DATE6/3/200 1 <br />/2021 <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 does not <br />amend, extend, or alter the coverage afforded by the memoranda listed below. <br />MEMORANDUM NUMBER: 144 <br />JOINT POWERS AUTHORITY (JPA) <br />Alliance of Schools for Cooperative Insurance Programs <br />16550 Bloomfield Avenue <br />Cerritos, CA 90703 <br />www.ASCIP.org <br />CONTACT NAME: Mr. Reshan Cooray <br />PHONE: (562) 404-8029 cooray@ascip.org <br />JPA MEMBER <br />Santa Ana Unified School District <br />1601 E. Chestnut Avenue <br />Santa Ana CA 92701-6322 <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 />TYPEOFCOVERAGE <br />AIDDL <br />INSR <br />MEMORANDUM NUMBER MOC) <br />( (MMIDDNYYY) <br />POLICY EFF <br />POLICY EXP <br />11:01a.m. <br />LIMIT OF LIABILITY/COVERAGE <br />GENERALLIABILITY <br />OCCURRENCE <br />Personal lNury <br />MCC #144 <br />7/1/2021 <br />7/1/2022 <br />COMBINED SINGLE LIMIT PER OCCURRENCE <br />$ $5,000,000 <br />AGGREGATE <br />s N/A <br />$ <br />Errors & Omission <br />$ <br />Employment Practices <br />$ <br />AUTOMOBILE <br />LIABILITY <br />AUTOMOTIVE PHYSICAL DAMAGE <br />COMPREHENSIVE / COLLISION <br />ANYAUTO <br />Owned Auto <br />MCC #144 <br />7/1/2021 <br />7/1/2022 <br />COMBINED SINGLE LIMIT PER OCCURRENCE <br />$ $5,000,000 <br />ACTUAL CASH VALUE <br />$ <br />$ <br />$ <br />Hired Auto <br />$ <br />PROPERTY <br />BUILDING / CONTENTS <br />FIRE, THEFT, RENTAL INTERRUPTION <br />REPLACEMENT COST SUBJECTTO POLICY LIMITS, <br />AND CONDITIONS <br />TERMS, <br />$ <br />$ <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />❑ WC STATUTORY LIMITS <br />NIA <br />EACHACCIDENT <br />$ <br />PER EMPLOYEE <br />$ <br />POLICY LIMIT <br />$ <br />OTHER <br />EMPLOYEE DISHONESTY (CRIME) <br />SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS <br />Is <br />$ <br />ADDITIONAL REMARKS: <br />As respects to use of facilities <br />CERTIFICATE HOLDER <br />City of Santa Ana <br />Attn: Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana CA 92702 <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 />any kind upon ASCIP, its agents, or representatives. <br />AUTHORIZED REPRESENTATIVE: Ffltz J. HelJA <br />*ASCIP is ajoint powers authority pursuant to Article 1(commencing with Section 6500) Chapter 5 of Division 7 ofrUe 1 ofthe Government Code and Sections 39i <br />62681347 1144 1 21/22 A11 Types I Nancy Lopez 16/3e/2021 6:52:56 PM (PDT) I Page 1 of 2 <br />��I.,,\r REVIEWED,• &APPRD�B�Y, <br />Risk Management Analyst <br />F, <br />