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Dec 10 2007 1:04PM 0 714-611464 P.6 <br />CERTHOLDER COPY <br />STATE <br />P.O. BOX 420807, SAN FRANCISC0,CA 84142-0807 <br />COMPENSATtON <br />INSURANC• <br />FUND <br />CERTIFICATE OF WORKWZ COWENSATION IItISLIFiANCE <br />ISSUE DATE: 12-10-2007 GROUP: <br />POLICY NUMBER: 1877734-2007 <br />CERTIFICATE ID: 1 <br />CERT1F1CATE EXPBgES'01-01-2008 <br />10-24-2007/01-01-2008 <br />CITY OF SANTA ANA <br />ATTN: CYNI'MIA 49MZ <br />20 civic CENTER PLZ N -9B <br />SADA AMR CA 82701-40M <br />SQ <br />SO <br />A-,-20061 - /03 <br />This Is to certify that we have issued a valid Workere Compensation Ira rance policy In a form approved by the <br />California ineuranos Commissioner to the employer named below for the policy period that will expire or did <br />expire as frrdicated above. <br />This certifloste of Insurance is not an insurance policy and does not amend extend or aftor the coverage afforded <br />by the policy listed herein. NotwtfttindhV any requirement, term or conWl*m of any contract or oifter document <br />with respect to which this certificate of insurance may be Issued or m which it may pertain, the Insurance <br />afforded by the policy described herein Is subject to air the temx exolwlom and condillons. of such policy. <br />t:IZED REPqFtE'S�EWATl1kJ PRESDENT <br />EIPiDYER'S LIAOILITY LMT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSENENT #1800 - TMONAS, ROBERT PRESIDENT TREASURER - EXCLUDED. <br />EkWLOYER <br />R v THOMAS INC. DBA: WEST COAST LAND CLEARING <br />PO BOX 80128 <br />LONG BEACH CA 80808 <br />MEV.2-061 <br />1815.Nel <br />PRINTED : 12-10-2007 <br />