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<br />POLICYHOLDEA 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; 08-23-2008 <br /> <br />GROUP: 000481 <br />POLICY NUMBER: 0000413-2005 <br />CERTIFICATE ID; 41 <br />CERTIFICATE EXPIRES: 08-23-2007 <br />08-23-2008/08-23-2007 <br /> <br />CITY Of SANTA ANA <br />OEPARTMENT OF PUBLIC WORKS <br />20 CIVIC CENTER PLAZA IM.21 <br />SANTA ANA CA 92702 <br /> <br />SP <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in ... form approved by the <br />C...lifornia Insurance Commissioner to the emplover named below for the policy period indicated. <br /> <br />This policy is not sUbject to cancellation by the Fund except upon 30 days .dvance written ootlce to Ule emp1oyor. <br /> <br />We will ..Iso give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certlflcate of insurance is not an insurance policy ,;iInd does not amend, I!!Ixhmd or alter the coverage afforded <br />by thll policy listed herein. NOfYvithstanding 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 />..fforded by the poiicy described herein is subject to all the terms. 8xc~usions. and conditions, of such poHcy. <br /> <br />d=:-REPRESENTATI <br />EMPLOYER'S LIABILtTY LIMIT INCLUDING DEFENSE COSTS: <br /> <br /> <br />~ <br /> <br />PRESIDENT <br />$1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS I NOTICE EFfECTIVE 08-23-2006 IS <br />ATTACHED TO AND FORMS A PART OF nus POLICV_ <br /> <br />- <br /> <br />EMPLOYER <br /> <br />CURBSIDE. INC <br />1180 N ARMANDO 5T <br />ANAHEIM CA Q2808 <br /> <br />SP <br /> <br />rR"".2-05~ <br /> <br /><A/jJ L/' /. <br />P;PU?t. / r'J:- <br /> <br />07-18-2008 <br /> <br />PRINTED <br /> <br />SP <br /> <br />N0410 <br />