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." . CERTHOLDER COPY STATE p,O, BOX 420807, SAN FRANCISCO, CA 94142-0807 COMPENSATION INSURANce F=UN 0 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 12-07-2004 GROUP: POLICY NUMBER: 1478601-2004 CERTIFICATE ID: 13 CERTIFICATE EXPIRES: 03-01-2005 03-01-2004/03-01-2005 CITY OF SANTA ANA 20 CIVIC CTR PLAZA SANTA ANA CA 92701 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_ ~ ,&~ C &L.- AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER TRAILS 4 ALL (A NON-PROFIT CORP) PO BOX 4048 SANTA ANA CA 92702 selF 10262E Accept this certificate only if you see a faint watermark tt\e.t reacls 'OFFICIAL STATE FUND DOCUMENT" IDU,5G] PRINTED: 12.07-2004 PAGE 1 OF 1