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PDLICTN01-0ER COPY SIP <br />PO BOX 8192. PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />15511E DATE. fo-01-2020 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PL.I <br />SAN.TA RNA CA 112701-605A <br />GROURP <br />POLICY WJM9fiR 120"196-2020 <br />CERTIFICATE Q 117 <br />CERTFICATE EXPIRES 10-01-2021 <br />10-01-W20/10-01-2021 <br />This +s 'o catt,ty IIMi we r" ILsr" a Valid VVorsarF Cp[rpvnsauan arai W policy n a form appr`oued by 1he <br />CNtornw IryiY. a comm-sqi to lte emplovair rei helm for The policy parrpd Indicated <br />This polwv is MI subject to creceltalie+• by 4y Pund l.esm Loon aD ores advance wrdten WtKv to Nw vrrployr. <br />We will also 9" you 90. days advance �c shoeld IN; poliC be 'incased V'Qf 10 111 norTn/ v15OirataPR <br />Thm crtrfrcna of l[t ,vuns to not an msutenc! Alegie aid does rest arrspnd, extend er altW the CWAga afforded <br />by the policy lifted hreln hlotwith' datg xV fepJromieM term or C"dif on of A"W conWai of OtIHr docJnent <br />wrath refit to w CN tills Car-fifICATI, e1 e+yvanc! Miry be I"tRfd or to wtsC41 It nW partYM Cho rvsLArarca <br />atlordad by the policy 0wrlbad rNKefl is sabjaet Co all M Cr". ■rCludrons_ fie condition'. of such pol[ v <br />Au[horued AmpralanuLye FrePdrR Hid CEO <br />Cage ER'S LIAOLLITT LIMIT TNC1.11004 OFFENSE POSTS: t/,0W.DW PER 0004R+REMM, <br />EMDRSENEITT 1701n ENTITLED CERTIFICATE HOLDERS' NOTICE EF FECT WE 10 01-2000 15 <br />AnAptieO TO AMU Fpt06 A PART Of 11115 POLICY. <br />- ENDORSEMENT 01561 - YILLIsII D'TOOCE. PRESTOENT - EXCLUDED. <br />ENDORSEMENT 01091 - TREYoll BLY-THE, 5 - EXCLLMED. <br />I]VPLOYJR <br />ECALINa1f CS, INC ECVNC1ll INC. 5F <br />PO ODX 2120 <br />DEL W CA 92014 <br />.}{y.➢ ICA, <br />N�d to <br />PRINTED . 06-17-2020 <br />Rime Managmient DMI flan <br />REVIEWED&APPROVED By., <br />' F�W� R. M.Wd <br />'� Risk Management Analyst <br />