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POLICYHOLDER COPY <br />P.O. BOX B 192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-29-2021 <br />CITY OF SANTA ANA COMM. DEVELOPMENT AGENCY <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />GROUP: <br />POLICY NUMBER: - 9023428-2020 <br />CERTIFICATE ID: 48 <br />CERTIFICATE EXPIRES: 09-01-2021 <br />09-01-2020/09-01-2021 <br />This Is to certify that we have issued a valid Workers' Compensationinsurance 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, 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 X2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-2012 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PEOPLE FOR IRVINE COMMUNITY HEALTH A SP <br />NON-PROFIT CORP. DBA: 2-1-1 ORANGE COUNTY <br />1505 E 17TH ST STE 108 <br />SANTA ANA CA 92705 <br />(REV.7-2074) - PRINTED : 0 <br />SP <br />Risk Muns,gnnent Division <br />%, REVIEWED&APPROV®BY: <br />Ruk Managenrent Analyst <br />