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<br />l <br /> <br />. .1OLOER COpy <br /> <br />STATE <br /> <br />P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 <br /> <br />COMPENSATION <br />INSURANCE <br /> <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE, 04-29-2004 <br /> <br />GROUP: <br />POLICY NUMBER: 1414358-2004 <br />CERTIFICATE 10: 283 <br />CERTIFICATE EXPIRES: 02-01-2005 <br />02-01-2004/02-01-2005 <br /> <br />CITY OF SANTA ANA HOUSING & NEIGHBORHOOD <br />DEVELOPMENT <br />PO BOX 1988M-26 <br />SANTA ANA CA 92701 <br /> <br />r ');"." ," <br />,¡ '--.J' ,_1 Li./J'+ <br /> <br />This is to certif¡ that we have iss.ued a valid Worker's Compensa.tion insurance policy in a form approved by the California <br />Insurance Commissioner to the employer named below for the policy period indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the <br />policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with <br />respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies <br />described herein is subject to all the terms, exclusions, and conditions, of such policies. <br /> <br />~ <br /> <br />J~ <br /> <br />c. <br /> <br />{}£ <br /> <br />AUTHORIZED REPRESENTATIVE <br /> <br />PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE. <br /> <br /> <br />ENDORSEMENT #1600 - MICHAEL GIALKETSIS, CFO - EXCLUDED. <br /> <br />ENDORSEMENT #1600 - JOSEPH VANDER PLUYM" TREASURER - EXCLUDED. <br /> <br /> <br />ENDORSEMENT #1600 - THOMAS MATTEUCCI" SECRETARY - EXCLUDED. <br /> <br />ENDORSEMENT #1600 - STEPH~l SUETE, PRES - EXCLUDED. <br /> <br />ENDORSEMENT #1600 - WALTER HAMANN" VICE PRESIDENT - EXCLUDED. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 02-01-2003 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />~.~ f/y <br /> <br />RINCON CONSULTANTS. INC <br />790 E SANTA CLARA ST STE 103 <br />VENTURA CA 93001 <br /> <br />SCIF 10262E <br /> <br />Acœptlhis certificate onl;, jf you see iI faint watermark that reads "OFFICIAL $T A TE FUND DOCUMENT" <br /> <br />[MH,SL <br />PRINT£D: 04,29-2004 <br />PAGE 1 OF 1 <br />