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SP CERTHOLDER COPY STATE COMPENSATION INSURANCE FUND P.D. BOX 807, SAN FRANCISCQ,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE, 05-01-2005 GROUP, POLICY NUMBER, 1511897-2005 CERTIFICATE ID, 30 CERTIFICATE EXPIRES, 05-01-2006 05-01-2005/05-01-2006 CITY OF SANTA ANA PUBLIC WORKS AGENCY M-36 PO BOX 1988 SANTA ANA CA 92702 SP uOB: ATTN: K~NT uORG~NS~N 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 insurarice 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. ~ ,&~ c;. ~ AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOY~R'SLIABILITY LIMIT INCLUDING O~F~NS~ COSTS: $1,000,000.00 P~R OCCURR~NC~, ~NOORS~M~NT #2065 ~NTITL~O C~RTIFICAT~ HOLO~RS' NOTIC~ ~FF~CTIV~ 05-01-2005 IS ATTACH~O TO AND FORMS A PART OF THIS POLICY. AP1'ROVED AS TO lul ." ;~, ~ .Inl SUu Slice A~.sjSlant c., 11}' /1 O!"iJ,,'\ EMPLOYER L~GAL NAM~ L I OGARD AND ASSOC I ATES. I NC 2808 E KATELLA AVE STE 107 ORANGE CA 92867 LIOGARO ANO ASSOC, INC IREV.3-03/ PRINTED: 04/15/2005 P0408