HomeMy WebLinkAboutGUSD - Insurance Certificate (2019)EVIDENCE OF COVERAGE
DATE(MM /DD/YYYY)
6/26/2018
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
amend, extend, or alter the coverage afforded by the memoranda listed below.
MEMORANDUM NUMBER: 152
JOINT POWERS AUTHORITY (JPA)
Alliance of Schools for Cooperative Insurance Programs
16550 Bloomfield Avenue
Cerritos, CA 90703
www.ASCIP.org
CONTACT NAME: Mr. Fritz J. Heirich, Chief Executive Officer
PHONE: (562) 404 -8029
JPA MEMBER
Gilroy Unified School District
7810 Arroyo Circle
Gilroy CA 95020
This is to certify that the Alliance of Schools for Cooperative Insurance Programs (ASCIP) Memorandum of Coverages on insurance listed below have
been issued to the Covered Party named above for the period indicated. Notwithstanding any requirement, term, or condition of any contract or other
document with respect to which this Evidence of Coverage may be used or may pertain, the coverages afforded by the Memorandum of Coverages
described herein are subject to all the terms, exclusions, and conditions of such Memorandum of Coverages.
TYPE OF COVERAGE
ADDL
INSR
MEMORANDUM NUMBER (MOC)
(MM
POLICY EFF
/DD/YYYY)
POLICY EXP
12:01a.m.
LIMIT OF LIABILITY I COVERAGE
GENERAL
LIABILITY
OCCURRENCE
Personal Injury
,/
MOC #152
7/1/2018
7/1/2019
COMBINED SINGLE LIMIT PER OCCURRENCE
$ $5,000,000
AGGREGATE
$ N/A
$
Errors & Omission
$
Employment Practices
$
AUTOMOBILE
LIABILITY
AUTOMOTIVE PHYSICAL DAMAGE
COMPREHENSIVE / COLLISION
ANY AUTO
Owned Auto
MOC #152
7/1/2018
7/1/2019
COMBINED SINGLE LIMIT PER OCCURRENCE
$ $5,000,000
ACTUAL CASH VALUE
$
$
$
Hired Auto
$
PROPERTY
BUILDING / CONTENTS
FIRE, THEFT, RENTAL INTERRUPTION
REPLACEMENT COST SUBJECT TO POLICY LIMITS, TERMS,
AND CONDITIONS
$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
E1WC STATUTORY LIMITS
NIA
EACHACCIDENT
$
PER EMPLOYEE
$
POLICY LIMIT
IS
OTHER
EMPLOYEE DISHONESTY (CRIME)
SUBJECTTO POLICY LIMITS, TERMS, AND CONDITIONS
$
ADDITIONAL REMARKS:
As respects to use of facilities at Cesar E Chavez Gym
CERTIFICATE HOLDER
City of Gilroy
7351 Rosanna Street
Gilroy CA 95020
CANCELLATION
Should any of the above coverages for the Covered Party be changed or withdrawn prior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 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, or representatives.
y,
AUTHORIZED REPRESENTATIVE: Fritz J. Helrlch
*ASCIP is a joint powers authority pursuant to Article 1(commencing with Section 6500) Chapter 5 of Division 7 of Ttle 1 of the Government Code and Sections 39603 and 81603 of the Education Code. Rev 5 -97
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Additional
Covered Party Endorsement
District: Gilroy Unified School District
Endorsement No.
42808642
Additional Covered Party:
Description of Operations, Vehicle, or Property:
City of Gilroy
As respects to use of facilities at Cesar E Chavez Gym
its officers, officials and employees
Coverage Period:
Effective: 7/1/2018 Expires 12:01 a.m.: 7/1/2019
The coverage provided to the Covered Party is hereby extended by this endorsement to the Additional Covered Party named above
in accordance with the provisions contained in the Memorandum of Coverage (MOC). The coverage extended hereby applies only
with respect to liability arising out of activities in the Description of Operations, Vehicle, or Property noted above. It is intended by
ASCIP in issuing this endorsement to defend and/or indemnify the Additional Covered Party only if the District is solely negligent.
In issuing this endorsement, ASCIP intends and agrees to extend coverage pursuant to the terms and conditions of the MOC to the
Additional Covered Party named above only to the extent that the Additional Covered Party faces liability arising out of claims,
demands, or lawsuits claiming money damages on account of bodily injury or property damage as defined and limited in the ASCIP
MOC. The limits of liability extended to the Additional Covered Party listed above is $5,000,000 per occurrence for liability.
V
Authorized Representative:
Date Issued: 6/26/2018
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
Code and Sections 39603 and 81603 of the Education Code.
Rev 5/97
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