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<br />. <br /> <br />SP <br /> <br />POLICYHOLDER COPY <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P,O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE, 10-06-2005 <br /> <br />GROUP: 000364 <br />POLICY NUMBER: 0000202-2005 <br />CERTIFICATE ID: 612 <br />CERTIFICATE EXPIRES: 10-01-2006 <br />10-01-2005/10-01-2006 <br /> <br />CITY OF SANTA ANA <br />DOWNTOWN DEVELOPMENT DIVISION <br />305 E 4TH ST STE 201 <br />SANTA ANA CA 92701 <br /> <br />SP <br /> <br />.JOB, DOWNTOWN <br /> <br />DEVELOPMENT <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy he cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement. term or condition of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to all the terms, exclusions, and conditions. of such policy. <br /> <br />~ <br /> <br />4~c <br /> <br />~ <br /> <br />AUTHORIZED REPRESENTATIVE PRESIDENT <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS, $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2005-10-0B IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED, <br />CITY OF SANTA ANA <br /> <br />ENDORSEMENT #lBOO - .JEFFREY LOPEZ PRESIDENT TREASURER - EXCLUDED, <br /> <br />ENDORSEMENT #1600 - NANCY LYNN LOPEZ SECRETARY - EXCLUDED. <br /> <br />------ ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2001 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY, <br /> <br />;"RUV cd AS TO FORM <br /> <br />EMPLOYER <br /> <br />~~:ttdY <br /> <br />".Hdli~ City Attorney <br /> <br />OEKRA-LITE INDUSTRIES, INCORPORATED <br />3102 W ALTON AVE <br />SANTA ANA CA 92704 <br /> <br />SP <br /> <br />/REV.2'051 <br /> <br />PRINTED <br /> <br />[CMJ,SC] <br />10-06-2005 <br />