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SP POLICYHOLDER COPY STATE COMPENSATION INSURANCE FUND P.O, BOX 420807. SAN FRANCISCO.CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-06-2005 GROUP: 000364 POLICY NUMBER: 0000202-2005 CERTIFICATE 10: 612 CERTIFICATE EXPIRES: 10-01-2006 10-01-2005/10-01-2006 CITY OF SANTA ANA DOWNTOWN DEVELOPMENT DIVISION 305 E 4TH ST STE 201 SANTA ANA CA 92701 SP ~08,DOWNTOWN DEVELOPMENT 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 upon 30 days advance written notice to the employer. We wilt also give you 30 days advance notice should this policy he 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. ~ J.~t ~ AUTHORIZED REPRESENT A TIVE PRESIOENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2005-10-06 IS ATTACHED TO AND FORMS A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA ENDORSEMENT #1800 - ~EFFREY LOPEZ PRESIDENT TREASURER - EXCLUDED, ENDORSEMENT #1600 - NANCY LYNN LOPEZ SECRETARY - EXCLUDED. ______ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2001 IS ATTACHED TO AND FORMS A PART OF THIS POLICY, EMPLOYER OEKRA-LITE INDUSTRIES, INCORPORATED 3102 W ALTON AVE SANTA ANA CA 92704 SP mEV.2-QSl [CMJ,SC] PRINTED , 10-06-2005