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POLICYHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-16-2018 <br />CITY OF SANTA ANA so <br />20 CIVIC CENTER PL2 <br />SANTA ANA CA 92701-4058 <br />OROCP <br />POLICY NUMBER: 0809749-2017 <br />CERTIFICATE IC: 1848 <br />CERTIFICATE EXPIRES: 10-14-2018 <br />10-14-2017/10-14-2018 <br />This Is to cartify that we have issued a valid Workers' Compensation insurance policy in a farm 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 he 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 herein is subject to all the terms. exclusions, and conditions, of such policy. <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, <br />ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY, <br />EMPLOYER <br />PYRO SPECTACULARS, INC. SP <br />PO BOX 2329 <br />RIALTO CA 92377 <br />InEVJ-2314! <br />[P1Y,S0] <br />PRINTED : 01-15-2018 <br />M <br />