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EVIDENCE CAF COVERAGE. <br />Rancho Santiago Community College District <br />POLICY NUMBER: 5553- 012 - 10/11 -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 />TE HOLDER INFORMATION <br />City of Santa. Ana <br />Attn: Sylvia Vazquez <br />20 Civic Center Plaza, M25 <br />Santa Ana, CA 92701 <br />I Coverage Period: Effective: 11 -5 -10 Expires 12:01-am.: 7 -1 -11 <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Should any of the above coverages for the Covered Party be changed or withdrawn prior to the expiration date issued above, ASCIP will trail 30 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 Avenue - Cerritos, CA 90703 • (562) 404=$029 <br />Authorized Representative: <br />Date issued: 11 -5.10 <br />• 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 Government <br />Code and Sections 39603 and 8I603 of the Education Code. <br />Rev V02 AS �® F ®R <br />ApYg��E <br />SX CA� °Lity <br />Iliance of Schools for Cooperative Insurance Prog ams <br />I6550 Blooa%Add Avenue, Cerritos, CA 90703 (562) 404.8029 <br />