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CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANCE FUNDICERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 05-18-2004 GROUP: POLICY NUMBER: 1191620-2004 CERTIFICATE ID: 38 CERTIFICATE EXPIRES: 04-01-2005 04-01-2004/04-01-2005 CITY OF SANTA ANA THIS SUPERSEDES AND CORRECTS THE CITY ATTORNEY'S OFFICE CERTIFICATE ISSUED ON 04-01-2004 20 CIVIC CENTER PLAZA CITY HALL 7TH FL ll SANTA ANA CA 92702 c��v — cam_% ✓ This is to certify that we have issued a valid Worker's 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 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. AUTHORIZED REPRESENTATIVE kd",c.Arl-, PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - JOHN RISK, PRES „ SECRETARY TREASURER - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-1991 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER COMMUNICATIONS SUPPORT GROUP, INC 505 SCENIC AVE PIEDMONT CA 94611 MATE: TED RIN05-18-2004 SCIF 10262E Accept this certifmate only If you see a faint watermark that reads "OFFICIAL STATE FUND DOCUMENT" PAGE i :OF 1