JOHNSON FRANK & ASSOCIATES 2 - 2005

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CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION 1 N S U R A N C E U N ? CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-2B-2070 GROUP: 000092 POLICY NUMBER: 000067 8-2009 CERTIFICATE ID: 245 CERTIFICATE EXPIRES: 01-01-2077 07-01-2070/01-07-2077 CITY OF SANTA ANA SG BUILDING S SAFETY DEPT PD BOX 1988 SANTA ANA CA 92702-7985 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 Hamad below for the policy period indicated. This policy is not subject to cancellation 6y the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy ba cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does Hat amend, extend or alter the coverage afforded by the policy 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 to which it may pertain, the insurance afforded by the policy described herein is' subject to all the terms. exclusions. and conditrons, of such policy. V THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 57,000,000 PER OCCURRENCE. ENDORSEMENT /!1600 - RDGER FRANK PRES - EXCLUDED. ENDORSEMENT #1600 - ALAN FRANK S,T - EXCLUDED. ENDORSEMENT Af2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-07-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT N2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2010-01-26 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA EMPLOYER JOHNSON-FRANK & ASSOCIATES (A CORP) SG 5750 E HUNTER AVE ANAHEIM CA 92807 SG [Bt Q,SG] IREV.2-O5/ PRINTED 01-26-2010