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<br />EVIDENCE OF COVERAGE DATE (MMIDD/YYYY) <br />10/12/2012 <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 />(MWoDIYYYq POLICY EXP <br />12:01e.m. LIMIT OF LIABILITY 1 COVERAGE <br />GENERAL LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE S $5,000,000 <br /> OCCURRENCE MOC #77 7/1/2012 7/112013 AGGREGATE s N/A <br /> Personal Injury s <br /> Errors 8 Omission S <br /> Employment Practices S <br />AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE S $5,000,000 <br /> AUTOMOTIVE PHYSICAL DAMAGE MOC #77 7/1/2012 7/1/2013 ACTUAL CASH VALUE 5 <br /> COMPREHENSIVE /COLLISION $ <br /> ANY AUTO $ <br /> Owned Auk s <br />I./ I Hired Auto $ <br /> <br />PROPERTY REPLACEMENT COST SUBJECT TO POLICY LIMITS, TERMS, <br /> BUILDING / CONTENTS S <br /> FIRE, THEFT, RENTAL INTERRUPTION S <br /> <br /> S <br />WORKERS COMPENSATION NIA EACH ACCIDENT is $1,000,000 <br />AND EMPLOYERS' LIABILITY <br />MOC#77 <br />7/1!2012 <br />7!112013 <br />PER EMPLOYEE <br />S $1,000,000 <br />© WC STATUTORY LIMITS <br />POLICY LIMIT <br />S $1,000,000 <br />OTHER SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS <br /> EMPLOYEE DISHONESTY (CRIME) S <br /> S <br /> $ <br /> S <br /> To <br />ADDITIONAL REMARKS: <br />As respects to City of Santa Ana Public Library Project r"YR? V K <br />r'' . S? CRC rney <br />?1?ant City A?tO ?' <br />CERTIFICATE HOLDER <br /> <br /> <br /> <br />ity of Santa Ana CANC CATION <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 />AUTHORIZED REPRESENTATIVE: Fritz Helrich <br />'ASCIP is a Joint powers authority pursuant to Article 1(commencing with Section 6500)Chapter $ of Division 7 of Title 1 of the Government Code and Sections 39603 and 81603 of the Education Code. A- 5 91 <br />CERI NQ. : 14 J92512 CLIENT {:ODE- 11 Nancy LcP- 10/12/2012 11:11<01 Pm Page I tlf 2