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STATE P.O. BOX 420807, SAN FRANCISCO, CA 94142-0807 POLICYHOLDER COPY COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-22-2005 GROUP: POLICY NUMBER: 1763833-2004 CERTIFICATE ID: 128 CERTIFICATE EXPIRES: 12-31-2005 12-31-2004/12-31-2005 CITY OF SANTA ANA PUBLIC WORKS AGENCY P O BOX 1988 SANTA ANA CA 92702 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 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 conditions, of such policy. �0� AUTHORIZED REPRESENTATIVE kt,c.AL- PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - NEILIA LAVALLE PRESIDENT - EXCLUDED. ENDORSEMENT #1600 - JOEL SEWELL VICE PRESIDENT S,T - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 12-31-2004 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. APPROVED AS TO FORM Laura Stitt hcedy Assistant Ci Attornev EMPLOYER PARAGON PARTNERS, LTD 5762 BOLSA AVE STE 201 HUNTINGTON BEACH CA 92649 [BiO,SGI SCIF 10262E Accept Nis certificate onl if PRINTED: W-22-2005 P y you see elaint watermark that reads "OFFICIAL STATE FUND DOCUMENT' PAGE 1 OF