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<br />A -;;2007 -0<60 . <br /> <br /> I DATE <br />CERTIFICATE OF WORKERS' COMPENSATION COVERAGE 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. CA 94612 <br /> Phone: (877) 551-67l7 INSURERS AFFORDING COVERAGE <br /> Fax: (530) 274-9871 <br />INSURED A -:1. 007- ) 'i'f INSURER A; NonProflts' United Workers' Compensation Group <br />Orange County Conservation Corps N-\Qqq-Ig.1 INSURER 6: Safety National Casualty Corporation <br />1853 North Raymond Avenue N -::2000-015 <br />Anaheim, CA 92801-1117 INSURER c: <br /> N - ?-OO I -000 <br /> INSURER 0: <br /> A. ;;2006 -;)37 ' INSURER E: <br />COVERAGES This Certificate is not intended to specify all endorsements, coverages, terms, conditions and exclusions of the policies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TOTHE AFFLlATE MEMER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLICIES DESCR1BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS Of SUCH POLICIES. AGGREGATE L1MlTS <br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF COVERAGE POLICY NUMBER POLICY POL.ICY LIMITS <br />LTR EFFECTIVE DATE EXPIRATION DATE <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> I COMMERCIAL GENERAL. LIABILITY FIRE DAMAGE (Anyone fire) $ <br /> I I CLAIMS MADE I I OCCUR MED EXPENSE (Ally one person) $ <br /> GENERAL. AGGREGATE LIMIT APPL.IES PER: PERSONAL & ADV INJURY $ <br /> I POLICY I I PROJECT I IlOC GENERAL AGGREGATE $ <br /> PRODUCTS-COMP/OP AGG $ <br /> AUTOMOBIL.E LIABILITY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Each accident) $ <br /> ALL OWNED AUTOS BODILY INJURY 5 <br /> SCHEDULED AUTOS (Perpersonl $ <br /> HIRED AUTOS BODlL Y INJURY $ <br /> NON-OWNED AUTOS (Per accident) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) $ <br /> 1 WC STAT I X 1 OTHER <br /> WORKERS' COMPENSATION LIMITS <br />A AND NPU-WCG 001-2008 111/08 111/09 E.L EACH ACCIDENT $ 500,000 <br /> EMPLOYERS LIABILITY E,l. DISEASE - EA EMPLOYEE $ 500,000 <br /> E L, DISEASE - COVERAGE LIMIT $ 500.000 <br /> OTHER <br />B E:\.I.:ess v"lorkers' Cumpensation Sp.l Y94-CA 111108 111109 $25,000,000 x $500,000 WC r' <br /> $1.000,000 x $500,000 EL <br />DESCRIPTION OF OPERATIONSfLOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTfSPECIAUPROV1SIONS <br />Evidence of Workers' Compensation Coverage: <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER lETTER: CANCELLATION <br /> NPUWCG-OCCC-08 SHOULD ANY OF THE ASOVE DESCRIBED 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 00 SO SHALL IMPOSE <br /> City of Santa Ana NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br /> AGENTS OR REPRESENTATIVES. <br /> 20 Civic Center Plaza <br /> Santa Ana. CA 9270 I AUTHORIZED REPRESENTATIVE <br /> ATTN: Michael Lopez <br /> /::,:7-~ <br /> <br />Based on ACORD 25.S (7/97) <br />