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EVIDENCE OF COVERAGE <br />Rancho Santiago Community College District <br />POLICY NUMBER: 5553- 012 - 09/10 -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 <br />Attn: Bill Watson <br />Santa Ana Fire Department <br />1439 S. Broadway <br />Santa Ana, CA 92707 <br />Coverage Period: Effective: 7 -1 -09 Expires 12:01 a.m.: 7 -1 -10 <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 <br />LIMIT OF LIABILITY /COVERAGE <br />Workers' Compensation <br />Statutory <br />Employer's Liability <br />$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Should any of the above coverages for the Covered Party be changed or withdrawn prior to the expiration date issued above, ASCIP will mail 30 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. Paula Chu Tanguay, Chief Executive Officer <br />ASCIP • 16550 Bloomfield A ritos, CA 90703 • (562) 404 -8029 <br />Authorized Representative: <br />Date Issued: 12/1/09 dl h <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 />AS <br />Teresa Ju <br />Deputy City A <br />/'\Iliance of Schools for Cooperative Insurance Programs <br />16550 Bloomfield Avenue, Cerritos, CA 90703 (562) 404.8029 <br />