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CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE FU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 12-02-2003 CITY OF SANTA ANA N ATTN: KIM 20 CIVTC CENTER PLAZA SANTA ANA CA 92701 GROUP: 00004 G POLICY NUMBER: 12055-2003 CERTIFICATE ID: 48 CERTIFICATE EXPIRES: 06-01-2004 06-01-2003/06-01-2004 JOB: ALL OPERATIONS 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 writtennotice 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 policies 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 may pertain, the insurance afforded by the policies described herein is subject to all the terms, exclusions; and conditions; of such policies. AUTHORIZEp REPRESENTATIVE A(�, c . A4— PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1586 - VOLUNTEER COVERED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. �Vsssa+r `mot r EMPLOYER APPROVED HOS "erC3 Fi11ZN ORANGE COUNTY CONSERVATION CORP. (A NON PROFIT CORP.) 700 N VALLEY ST STE B Laur:1. Slit[ 1=` ANAHEIM CA 92801 Assisu2p[ City AuI11CV 15LC.SP1 PRINTS :12-02-2003 SCIF 10262E Accept this r 1c to o y If you see a rant watetma, that Me -OFFICIAL- STATE FUND DOCUMENT' PAGE 1 OF t