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SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-2022 GROUP: POLICY NUMBER: 1858181-2022 CERTIFICATE ID: 98 CERTIFICATE EXPIRES: 01-01-2023 01-01-2022/01-01-2023 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 dbby� the policy described herein is subject to all the terms, /exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2015 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT N2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2022-01-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA ENDORSEMENT X1651 - ALFREDO ARMENARIZ, P,S,T - EXCLUDED. EMPLOYER PROCURE AMERICA, INC SP 31103 RANCHO VIEJO RD H D2102 RukMwgo��odUxsa. aenertnc Aroaar®ar. SAN JUAN CAPISTRANO CA 92675 t 7ou PKao.. II aaxmu,.ememan,�,iaa� IREV.7-20141 PRINTED OS-26-2022