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CERTHOLDER COPY SP PA. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-24-2018 GROUP: POLICY NUMBER: 0803749-2018 CERTIFICATE ID: 1833 CERTIFICATE EXPIRES: 10-14-2019 10-14-2018/10-14-2019 CITY OF SANTA ANA SIP 20 CIVIC CENTER PLE SANTA ANA CA 92701-4058 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period Indicated. This policy is not subject to cancellation by the Fund except upon 80 days advance written notice to the employer., We will also give you 3D days advance notice should this policy be cancelled prior to its normal expiration, This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded dbby_.the policy described herein is subject to all the terms, exclusions, pJr9�and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-01-24 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. I•i 1 CONTRACT No -,2-0 I. - DS.W— n 2 c' Curyf1"aC} �11t`� i�{} i10 bt"40t,1" -�•� I uccilASth of Q4 iO EMPLOYER i ,h PYRO SPECTACULARS, INC. SP PO BOX 2329 RIALTO CA 92377 M0408 (Rev.7.2014) PRINTED : 01-25-2019