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POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-20-2021 GROUP: POLICY NUMBER: 1868181-2021 CERTIFICATE ID: 98 CERTIFICATE EXPIRES: 01-01-2022 01-01-2021/01-01-2022 CITY OF SANTA ANA SP 20 CIVIC CENTER PLZ 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 30 days advance written notice to the employer. We will also give you 30 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 dbbyytthe policy described ooliicccyydescribedd herein is subject to all the terms, exclusions, /fand conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2015 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2021-07-20 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA ENDORSEMENT N1651 - ALFREDO ARMENARIZ P,S,T - EXCLUDED. EMPLOYER PROCURE AMERICA, INC SP Wi Ma&Ap Didil �eums�rarnm 31103 RANCHO VIEJO RD N 02102 er SAN JUAN CAPISTRANO CA 92675 II aax r4,,,,ae,,,,n a��wade (REv.7-2014) PRINTED : 07-20-2021