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POLICYHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 11-18-2020 <br />CITY OF SANTA ANA - RISK MANAGEMENT DIV <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />SP <br />GROUP: <br />POLICY NUMBER: 9282964-2020 <br />CERTIFICATE ID: 81 <br />CERTIFICATE EXPIRES: 10-22-2021 <br />10-22-2020/10-22-2021 <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 10 days advance written notice to the employer. <br />We will also give you 10 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 <br />policy <br />�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 N1951 - CASTRO.JOE MGR-MEMBR - EXCLUDED. <br />ENDORSEMENT #1951 - PETERSON,MATTHEW MGR-MEMBR - EXCLUDED. <br />®® ENDORSEMENT H1951 - ANNIGONI,JOSEPH MGR-MEMBR - EXCLUDED. <br />EMPLOYER <br />BRIGHTLIFE DESIGNS, LLC <br />16351 GOTHARD ST STE C <br />HUNTINGTON BEACH CA 92647 <br />IREv.7-20141 <br />SP <br />PRINTED : 11 <br />SP <br />m..y, Ria1¢MmugEmeatDiWeion t3 <br />�r I <br />REVIEWED&APPROMFDBY <br />RakManagemenl Analyst y <br />