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CERTHOLDER COPY SP STATE i P.O. 80X 8192, PLEASANTON, CA 94588 ' FUN ■ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-01-2026 GROUP: POLICY NUMBER: 1555105-2026 CERTIFICATE ID: 38 CERTIFICATE EXPIRES: 03-01-2027 03-01-2026/03-01-2027 CITY OF SANTA ANA - BENEFITS DEPT SIP PO Sox 1588 APPROVED 20 CIVIC CENTER PLZ By Tu Tran Nguyen at 2:26 pm,May 15,2026 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 by 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 #2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2025 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2026-03-01 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA - BENEFITS DEPT ENDORSEMENT #1051 -- MARCUS D DAYHOFF, P EXCLUDED. ENDORSEMENT #1551 - LETICIA A DAYHOFF, S,T - EXCLUDED. EMPLOYER REACH EMPLOYEE ASSISTANCE INC SIP 650 N ROSE DR PLACENTIA CA 92870 M0408 {REV.7-20141 PRINTED 02-18-2025