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06/29/2006 14:22 714-567-7474 OC HUMAN RELATIONS <br />CERTHOLDER CpPV <br />r7 B AT~ P.O~ BOX 420807, SAN FiiANGISCO,CA 9414;-0807 <br />COMPENSATION ' <br />IN$UHANC6 <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ESSUE DATl: 08-ze-4005 DROUA <br />POLICY NUMBER 7375218-2005 <br />CERTIFICATE IP. 47 <br />CERTIFICATS EXPIRES: 10-01-4008 <br />10-Ot-2005/10-O t'-2008 <br />CITY OF SANTA IWA <br />2D CIVIC CENTER PLZ N-25 <br />SANTA ANA CA ~927D7-1058 <br />SP JOB:BRIODES pRORRAN <br />This is to eardfy tNt we hwa Issued + vdld Workers' Componaation MaurancE policy in a form approved by the <br />Cali}ornia Insurance Cormntnnitaar to the employer named below for tfre peliCy period indicrted. <br />This policy Is not armSect to oartcetlation [ry the Fund Except Won 10 days advance written notice to the emWoyer. <br />Wa will also pNe you 7p dayg adaance notice should dNa policy be cancelled prier to. its normal expiratlan. <br />Thin certfffcrta ei in6Yranee IE not an insurance pO11CY and dee9 rat Emend, Oxtend Or after the coverage afforded <br />wkh reap lec~l tlo twhlCh rthls certiticrt~eMrs runes may bo issued or to wlueh k ~ Partain,tthe Insurance gem <br />sfforded by the policy described herein Ia subJect tD all the terms, exeluslonE, and conditions, of such pvlicv. <br />RIB REPRESEMAT PRES~~ <br />ERPLDYER'S LIABILITY LIMIT INCLIN]INta DEFENSE COSTS: <br />EMPLOVF1t <br />GRANDE COl11TY FIUMAN RELATIONS COtFaCIL (A SB <br />NON-PROFIT COkPORA710N) C/O COUNCIL <br />7300 5 PRAlp AVE STE E ' <br />SANTA ANA Cl1 93706 <br />raev, z-oat <br />51.000.000 PER OCWRRENCE. <br />F'i1GE 02 <br />..; .g €~ pp'~llp <br />- ~~ <br />`_elY .ior~ey <br />[LYF,CN) <br />PRINTED DB-4&-2008 <br />SP <br />