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<br />CERTHOLDER COpy <br /> <br />SP <br /> <br />STATE <br />COMPENSATION <br />IN SURANCe <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142.-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE, 01-18-2006 <br /> <br />GROUP, <br />POLICY NUMBER 1610493-2006 <br />CERTIFICATE ID, 3 <br />CERTIFICATE EXPIRES, 01-01-2007 <br />01-01-2006/01-01-2007 <br /> <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA M-37 <br />SANTA ANA CA 92701 <br /> <br />SP <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 10 days advance written notice to the employer. <br /> <br />We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance is not an insurance pollcy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithst.anding 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 />d::-REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1600 - SCOTT PETTI FER PRES TRES - EXCLUDED. <br />ENDORSEMENT #1600 - BRENT PETTI FER VP - EXCLUDED. <br />ENDORSEMENT #1600 - CATHY WILLIAMS SEC - EXCLUDED. <br /> <br />-~~ <br /> <br />EMPLOYER <br /> <br />PETTIFER & ASSOCIATES INC <br />2323 N TUSTIN AVE STE I <br />SANTA ANA CA 92705 <br /> <br />SP <br /> <br />iRE\!.2-N;} <br /> <br />PRINTED <br /> <br />{AMJ,CN] <br />01~18-2006 <br />