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EVIDENCE OF COVERAGE DATE <br />1 ) <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: 77 <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. Fritz Heirich, Chief Executive Officer <br />PHONE: (562) 404-8029 JPA MEMBER <br />Rancho Santiago Community College District <br />2323 North Broadway <br />Santa Ana CA 92706 <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 /> <br />TYPE OF COVERAGE ADDL <br />INSR <br />MEMORANDUM NUMBER (MOC) POLICY EFF <br />(MWDDIYYYY) POLICY EXP <br />12:01a.m. <br />LIMIT OF LIABILITY !COVERAGE <br />GENERALLIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE $ $5,000,000 <br /> OCCURRENCE / MOC #77 7)1!2012 7/1)2013 AGGREGATE s N/A <br /> Personal Injury $ <br /> Errors & Omission 5 <br /> Employment Practices $ <br /> <br />AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE S $5,000,000 <br /> AUTOMOTIVE PHYSICAL DAMAGE MOC #77 7/112012 7/1!2013 ACTUAL CASH VALUE S <br /> COMPREHENSIVE /COLLISION S <br /> ANY AUTO $ <br /> Owned Auto i s <br /> Hired Auto I s <br /> <br />PROPERTY REPLACEMENTCOST SUBJECT TO POLICY LIMITS, TERMS. <br /> BUILDING f CONTENTS S <br /> FIRE, THEFT, RENTAL INTERRUPTION $ <br /> $ <br /> S <br /> <br />WORKERS COMPENSATION NIA EACH ACCIDENT $ $1,000,000 <br />AND EMPLOYERS' LIABILITY <br />MOC #77 <br />711/2012 <br />711/2013 <br />PER EMPLOYEE <br />$ $1,000,000 <br />WC STATUTORY LIMITS <br />© <br />POLICY LIMIT <br />$ $1,000,000 <br />OTHER SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS <br /> EMPLOYEE DISHONESTY (CRIME) S <br /> S <br /> To $ <br /> PR VED $ <br /> P <br />ADDITIONAL REMARKS: _ r??,.?+'? <br />J1 " <br />TOPCK <br />As respects to City of Santa Ana Public Library Project LISA E Attorney 1 <br />Assistant City / <br />CERTIFICATE HOLDER <br /> <br /> <br /> <br />ity of Santa Ana 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 />26 Civic Center Plaza, M-75 <br />Santa Ana CA 92702 <br />; <br />egi - 4- <br />AUTHORIZED REPRESENTATIVE: Fritz Helrich <br />•ASCIP is a joint powers authority pursuant to Article 1(commencing with Section 6SOD) Chapter 5 of Division 7 of Ttle 1 of the Government Code and Sections 39603 and 834503 of the Education Code. Rev s97 <br />CEPT NO- 11352542 C-Lik'NT COD': " Haney *.,opez 10/12/2012 52:31:0'7 PM Page I of 2