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<br />Apr <br /> <br />01 08 03:39p <br />__ ~ ~',"oC ,~,. n' '.... ell" ,.. <"0 <br /> <br />Public Works <br />t-a}Clu bbO 378-4351 To' T~lcmil~ 0 <br /> <br />7146473345 p.4 <br /> <br />Date 4/11:200811 13AM Page a Of4 <br /> <br />CERTHOLDER COpy <br /> <br />SG <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807 SAN FRANCISCO,CA 94141 '0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE OATE~ 04~01.2003 <br /> <br />GROup <br />POLO NUMBL'.' 1886779-2008 <br />CER1IFICAT[ Ie: 4 <br />CERTlfICA,E [X.'IRES, 02-01-2009 <br />02;-01 -2008/0~~01-200S <br /> <br />CITV OF SANTA ANA <br />DEPARTMfNT OF PUBLIC WORKS <br />220 S DAISY AYE <br />SANTA ANA CA 92703-4334 <br /> <br />SG <br /> <br />in.s i~ to certify thai we hive ISSUed .a vahd \tllorlo..ers' C;'JmDens.atl\ln jl'1s.urM'lce Dolt.y n iii for:n app:-oved hy tne <br />C.;:llforni& Insurance Commissioner :0 the employ~ named ba;oV\' fo~ the POlicy per'od .,jjcated. <br /> <br />T1W5. iJohcy IS nol st.bJElCI to c.:mC€llatI01 by the Fund e;':Cf-::n LlpOI" 10 d.ay~ ..dvOInce ~ntten notice to the ~molo'..er. <br /> <br />\Ne Will also Qlve .,OU 10 days advance '"Io1ice should thii JOlIc\' De canceli9d j1rior to Its norrn6! expilatlon. <br /> <br />Thl:<, :erti1icate- wI lllsural'K;e 15 nol an insur;ance DOliey and ODes 'lot OImend. extend or alter the coverage ahorded <br />by the poliq 'L;led herem. NctwilhStandin;t iilnV reqUirement, [arm 0: condition oT ..1"1\' c;antract or other do:=-ument <br />with rf'SDect to whlctl thiS certificate of i"surilnce m"y be ISSu.ed or to .,.,m'cll il may perl..1in, the insur;Y1ce <br />Jtlorde::l by IIII>' policy described !'-ereln IS :;...bJ6CI to all the terms. e)(clUSIOns, and conditions, of sueh pori.;v_ <br /> <br />CJ:::-RePRCSENTAl1 <br />EMPLOYER'S lIABILITY LIMIT <br /> <br /> <br />~~~ <br /> <br />PRl:SiDtNT <br /> <br />INCLUDING DEFENSE COSTS <br /> <br />$1,000.000 PER OCCURRENCE <br /> <br />EMPI~OYE:rl <br /> <br />CLINICAL LABORATORIES Of SAN BERN AND/OR GEO <br />NQNITOR INC <br />PO BOX 329 <br />SAN BERNARDINO CA 92402 <br /> <br />lREV2-:l5i <br /> <br />~ <br /> <br />iB15,NAJ <br />P_INTEO 04-01-2008 <br />