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POLICYHOLDER COPY <br />SP <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 10-01-2021 GROUP: <br />POLICY NUMBER: 1397885-2021 <br />CERTIFICATE ID: 117 <br />CERTIFICATE EXPIRES: 10-01-2022 <br />10-01-2021/10-01-2022 <br />CITY OF SANTA ANA SIP <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <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 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 <br />dbby, the <br />poolliiicc�cyyydescribed <br />j7 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 OCCURCENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2003 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />ENDORSEMENT N1651 - WILLIAM O'TOOLE, PRESIDENT - EXCLUDED. <br />ENDORSEMENT X1651 - TREVOR BLYTHE, S - EXCLUDED. <br />EMPLOYER <br />ECAL/NOMICS, INC ECO/NOMICS, INC. SP g94A1vugveodtlfi <br />PO BOX 2790 P"'o6A0PAO1@� <br />DEL MAR CA 92014 <br />(REVJ-2014) PRINTED : 10-05-2021 <br />