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<br />CERTIFICATE OF WORKERS' COMPENSATION COVERAGE I DATE <br /> Dee 19, 2007 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br /> AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. <br />NonProfits' United Workers' Compensation Group THIS CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE <br />344 Thomas L. Berkley Way, Suite 340 COVERAGE AFFORDED BY THE POLICIES BELOW. <br />Oakland. C A 94012 <br /> Phone: (877) 551-6717 INSURERS AFFORDING COVERAGE <br /> Pax: (530) 274-9871 <br />INSURED A -;;:(007- I Cj'f INSURER A: NonProfits' united Workers' Compensation Group <br />Orange County Conservation Corps N-,qqq-I~I INSURER B: Safety National Casualty Corporation <br />1853 North Raymond Avenue <br />Anaheim, CA 92801-1117 N -::L00O-075 INSURER c: <br /> N - ;;100 \ -000 <br /> INSURER D: <br /> INSURER E: <br />COVERAGES This Certificate is not intended to soecWVall endorsements, coveraaes, terms, conditions and exclusions of theoolicies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFLlATE MEMER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS <br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE Of CovERAGE POLICY NUMBER POL.ICY POL.ICY UMITS <br />LT. EffEcnVE DATE EXPIRATION DATE <br /> GENERAL. UABILlTY EACH OCCURRENCE $ <br /> COMMERClAL. GENERAL. L1ABIUTY FIRE DAMAGE (Anyone fire) $ <br /> I CLAIMS MADE I I OCCUR MED EXPENSE (Anyone person) $ <br /> GENERAL AGGREGATE L.IMIT APPLIES PER: PERSONAL & AnY INJURY $ <br /> I POUCY I I PROJECT I I L.OC GENERAL AGGREGATE $ <br /> PRODUCTS-COMP/OP AGG $ <br /> AUTOMOBIL.E L1ABIL.ITY COMBINED SINGLE UMIT $ <br /> ANY AUTO (Each accident) $ <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY $ <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident} $ <br /> -1 wc STAT I X 'aTHER <br /> WORKERS' COMPENSATION LIMITS <br />A AND NPU-WCG OOI-200S 1/1/08 1/1/09 E.L. EACH ACCIDENT $ 500,000 <br /> EMPLOYERS LIABILITY E L. DISEASE - EA EMPLOYEE $ 500.000 <br /> EL DISEASE - COVERAGE LIMIT $ 500,000 <br /> OTHER <br />B Excess Workers' Compensation SP-1Y94-CA 1/1108 1/1/09 $25.000.000 x $500.000 WG r - <br /> $1,000,000 x $500.000 EL <br />DESCRIPTION OF OPERATlONSJLOCATlONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIAUPROVISIONS <br />Evidence of Workers' Compensation Coverage: <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER L.ETTER: CANCELLATION <br /> N PlI\VCTi-OCt'(' 408 SHOULD ANY OF THE ABOVE DESCRI8ED POLICIES BE CANCELLED <br /> BEFORE THE EXPiRATION DATE THEREOF, THE ISSUING iNSURER IMLL <br /> ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE <br /> HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE <br /> City of Santa Ana NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br /> AGENTS OR REPRESENTATiVES, <br /> 2U Civil: Center Plaza <br /> Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE <br /> ATTN: Michael Lopez <br /> /:'=-~--rr. <br /> <br />Based on ACORD 25-S (7/97) <br />