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CERTHOLDER COPY <br />M <br />ISSUE DATE: 12-01-2017 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 82701-4058 <br />P.O. BOX 8192, PLEASANTON, CA 94688 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />SP <br />POLICY NUMBER: 1714782-2017 <br />CERTIFICATE ID; 33 <br />CERTIFICATE EXPIRES: 12-01-2018 <br />12-01-20117/12-01-2013 <br />This is to certify that we have issued a valid Workers' Compensation Insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated <br />This policy Is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />afforded by the policy described <br />'herein is subject to all the terms, <br />exclusions, and conditions, of such policy. <br />Autharized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, <br />ENDORSEMENT #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-01-2005 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY.. <br />»+�.. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2017-12-01 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: <br />CITY OF SANTA ANA <br />EMPLOYER <br />ARNAZ ENGINEERING CONTRACTORS,INC SP <br />1035 N ARMANDO ST STE X <br />ANAHEIM CA 82505 REVIEWED BY.. c.� EUNICE HEREDIA (P13 SOF,.. <br />! [OH6,CNI <br />(REV,7-20741 - PRINTED : 12-01-2017 <br />