HENNESSEY & HENNESSEY INC. 1 - 2005

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CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION I N S U R A N C E F U N D CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-19-2005 GROUP: POLICY NUMBER: 1354528-2005 CERTIFICATE ID: 44 A _ 7 CERTIFICATE EXPIRES: 07-01-2006 07-01-2005/07-01-2006 CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 SP JOB:ALL CA OPERATIONS 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 upon30 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. AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1901 - JOSEPH A HENNESSEY - EXCLUDED. ENDORSEMENT #1901 - SHARON A HENNESSEY - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-2003 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER HENNESSEY & HENNESSEY LIABILITY COMPANY) 17300 17TH ST # J-251 TUSTIN CA 92780 (REV.2-05) LLC (A LIMITED SP N O tail Cn C, tV Co A 3 IRMS,CN PRINTED : 09-19-2005 O1 SP