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<br />11/12/2004 <br /> <br />12:03 <br /> <br />NO. 600 [;)002 <br /> <br />CERTHOLDER COPY <br /> <br />STATE P.O. BOX 420807, SAN FRA!IICISCQ, CA 94142-0807 <br />COIVIP&:NSATION <br />IN;; yflitANt;.E <br /> <br />FU N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE, 11-12-2004 <br /> <br />GflOUP: <br />POLICY NUMBER: 1515871-2otl4 <br />CERTIFICATE Ie: .5 <br />CERTIFICATE EXPIRES: 04-01-2005 <br />04-0i-2004/04-01-2005 <br /> <br />, I <br /> <br />~I: <br /> <br />ni <br /> <br />! <br />I <br />, <br /> <br />CIT'! OF SANTA ANA <br />P1l!lLIC WORKS AGlINCY <br />PO BOX Haa <br />SA!lTA ANA c:A 92702 <br /> <br />JOB: A'l'l'N: JOB PARCO <br /> <br /> <br />This is to certify that we have i8$uad a valid Wor!<ar', Comptns~tiQn insu"'''''@ poli"Y in a form approved by the Clll!rnmla <br />Insuranca Commissioner to tM empl0y9r name<! below fl:>r!he policy period indieaied, <br /> <br />TIlls policy Is not subject to cancellation by the ,"und except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy b. cancelled prior to its normal expiration. <br /> <br />TIlis certificate of insurance is not an insurance pol!cy and does not amend, extend or alter the coverage afforded by the <br />policy Dated herein. Nolwilllstanding any requirement, term or condition of any contree! or other document with <br />respeel to which this certificate of insurance may be issuad or to which H may pertain, the insurance afforded by the policy <br />described herein is subjeot to all the tenns, exclusions. and conditions, "'such policy. <br /> <br />~ <br /> <br />..&~ t. &L- <br /> <br />,llHMORIZJ!D RiPRiS&NTATlV! <br /> <br />Ii'RESlDENT <br /> <br />Ii..' '.. <br />.," I <br />lnl <br />'In!, <br />~~ I <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS; $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1600 - ROGER ~AUBEL, PRS, SC, TR - EXCLUDED. <br /> <br />ENDORS~~ '2065 ENTITLED CERTIPI~B BOLDERS' NOTICE EFFECTIVE 04.01"2004 IS <br />AT'l'ACHJlD TO AND ~ORKS A PART OP 'l'HIS POLICY. <br /> <br />Itt-Qk':ty <br /> <br />:i <br />'i <br />, <br /> <br />i""~QYGiR <br /> <br />I , <br /> <br />1l0GEIl FA1l!lEL i'OBLIC AFFAIRS IHC DBA, HATERS Ii FAOBBL <br />25 ORCIlARlJ <br />~ FOREST CA 92..Q <br /> <br />~~~:t1.12~ <br />.u...'" ~_. <br />