EVIDENCE OF COVERAGE
S/24/2025
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 no amend, extend, or alter the coverage afforded by the memoranda listed below MEMORANDUM NUMBER: 177
JOINT POWERS AUTHORITY (JPA) JPA MEMBER
Alliance of Schools for Cooperative Insurance Programs Merced Community College District 16550 Bloomfield Avenue 3600 M Street
Cerritos, CA 90703 Merced CA 95348
www.ASCIP.org
CONTACT NAME: Mr. Reshan Cooray
PHONE: (562) 404-8029 [email protected]
22222
ADD OLICY E
TYPE OF COVERAGE INSF MEMORANDU NUMBER (MOC) IM/DD/YY LIMIT OF LIABILITY / COVERAGE GENERAL LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE $5,000,000 L OCCURRENCE MOC #177 7/1/2025 7/1/2026 AGGREGATE
$ none
< Personal Injury
$
/ Errors & Omission $
Employment Practices
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE $ $5,000,000
/ AUTOMOTIVE PHYSICAL DAMAGE MOC #177 7/1/2025 7/1/2026 ACTUAL CASH VALUE $
/ COMPREHENSIVE / COLLISION
$
< ANYAUTO
$
- Owned Aute
/ Hired Aute
PROPERTY ANOT SUET TO POLICY LIMITS, TERMS,
/ BUILDING/ CONTENTS MOC #177 7/1/2025 7/1/2026 Is $500,000,000 / FIRE, THEFT, RENTAL INTERRUPTION
WORKERS COMPENSATION N/A EACH ACCIDENT $
AND EMPLOYERS LIABILITY $2,000,000
EWCSTATUTORY LIMITS MOC #177 7/1/2025 7/1/2026 PER EMPLOYEE $2,000,000 POLICY LIMIT $2,000,000
OTHER
SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS
L EMPLOYEE DISHONESTY (CRIME) MOC #177 7/1/2026
7/1/2025 $5,000,000
$
ADDITIONAL REMARKS:
As respects to Proof of Coverage
CERTIFICATE HOLDER CANCELLATION
Proof of Coverage
AUTHORIZED REPRESENTATIVE: Fritz J. Heirich
*ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 6500) Chapter 5 of Division 7 of Title 1 of the Government Code and Sections 39603 and 81603 of the Education Code. Rev 5-97 85913410 | 177 | 25/26 All Types WC | Sonia Rojas | 6/24/2025 2:50:07 PM (PDT) | Page 1 of 1
EVIDENCE OF COVERAGE
6/4/2026
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: 177
JOINT POWERS AUTHORITY (IPA) JPA MEMBER
Alliance of Schools for Cooperative Insurance Programs Merced Community College District 12610 Park Plaza Drive 3600 M Street
Cerritos, CA 90703 Merced CA 95348
www.ASCIP.org
CONTACT NAME: Mr. Reshan Cooray
PHONE: (562) 404-8029 [email protected]
been suet that tered Party of Set ols fe or the rative indicate. Noris fascing any reaiden, Core, ores on in of ce led et or taver ocument with respect to which this Evidence of Coverage may be used or may pertain, the coverages afforded by the Memorandum of Coverag escribed herein are subject to all the terms, exclusions, and conditions of such Memorandum of Coverage
ADDL OLICY EF
TYPE OF COVERAGE INSR MEMORANDUM NUMBER (MOC) LIMIT OF LIABILITY / COVERAGE
AM/DD/YYY
GENERAL LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE S $5,000,000 I OCCURRENCE / MOC #177 7/1/2025 7/1/2026 AGGREGATE
$ none
< Personal Injury
_ Errors & Omission
$
/ Employment Practices
$
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT PER OCCURRENCE $ $5,000,000 L AUTOMOTIVE PHYSICAL DAMAGE MOC #177 7/1/2025 7/1/2026 ACTUAL CASH VALUE / COMPREHENSIVE / COLLISION
$
/ ANY AUTO
$
L Owned Auto
/ Hired Auto
$
PROPERTY REPLACEMENT COST SUBJECT TO POLICY LIMITS, TERMS
AND CONDITIONS
/ BUILDING / CONTENTS MOC #177 7/1/2025 7/1/2026 $ $500,000,000 / FIRE, THEFT, RENTAL INTERRUPTION
$
$
NIA EACH ACCIDENT $2,000,000
•WO STATUTORY LIMITS MOC #177 7/1/2025 7/1/2026 PER EMPLOYEE $2,000,000 POLICY LIMIT $2,000,000
OTHER
] EMPLOYEE DISHONESTY (CRIME) SUBJECT TO POLICY LIMITS, TERMS, AND CONDITIONS $
ADDITIONAL REMARKS:
As rise Leato pratien of Merced Community College District at the Stephen Leonard Youth Center located at 640 T Stre!, Merced, CA in accordance
CERTIFICATE HOLDER CANCELLATION
Certificate Holder, but failure to mail such notice shall impose no obligation or liability of City of Merced any kind upon ASCIP, its agents, or representatives 678 W. 18th Street
Merced CA 95340
AUTHORIZED REPRESENTATIVE: Fritz J. Heirich
*ASCIP is a joint powers authority pursuant to Article 1 (commencing with Section 6500) Chapter 5 of Division 7 of Title 1 of the Government Code and Sections 39603 and 81603 of the Education Code. Rev 5-97 90918996 | 177 | 25/26 A11 Types NC | Excl:OT | Sonia Rojas | 6/4/2026 11:20:46 AM (PDT) | Page 1 of 3 Additional Covered Party Endorsement
District: Merced Community College District Endorsement No. 90918996
Additional Covered Party: Description of Operations, Vehicle, or Property:
City of Merced
its officers, officials, and employees Ane Spect to Opera out enter located a 640 To tet, Merced CA in accordance with the Lease Agreement
Coverage Period: Effective:7/1/2025 Expires 12:01 a.m.: 7/1/2026 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. 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. Such insurance as afforded by this policy shall be primary, and any insurance carried by the Additional Covered Party named above shall be in excess and non-contributory.
Authorized Representative:
Date Issued:6/4/2026
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
90918996 | 177 | 25/26 All Types WC | Excl:OT | Sonia Rojas | 6/4/2026 11:20:46 AM (PDT) | Page 2 of 3 Waiver of Subrogation Endorsement
District: Merced Community College District Endorsement No. 90918996
Name of Person or Organization: Description of Operations:
City of Merced
its officers, officials, and employees A in accordance with the Lease Agreemer Coverage Period: Effective: 7/1/2025 Expires 12:01 a.m.: 7/1/2026 ASCIP has the right to pursue subrogation recoveries from any party liable for an injury, in whole or in part, in accordance with the Authorized Representative:
Date Issued: 6/4/2026
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 5/16
90918996 | 177 | 25/26 All Types WC | Excl:OT | Sonia Rojas | 6/4/2026 11:20:46 AM (PDT) | Page 3 of 3