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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, CA 94612 <br /> Phone: (877) 551-6717 INSURERS AFFORDING COVERAGE <br /> Fax: (5301 274.9871 <br />INSURED A -;;(oo7-1~'f NonProfits' United Workers' Compensation Group <br /> INSURER A: <br />Orange County Conservation Corps f\HW1Q-lgl INSURER B: Safety National Casualty Corporation <br />1853 North Raymond Avenue <br />Anaheim, CA 92801-1117 N-.:2000-ol.5 INSURER c. <br /> N - ;).00 I -000 <br /> INSURER 0" <br /> INSURER E <br />COVERAGES This Certificate is not intended to snecifv all endorsements. coveraaes, terms, conditions and exclusions of the nolicies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFlIATE 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 LIMITS <br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF COVERAGE POLICY NUMBER POLICY POLICY LIMITS <br />LT" EFFECTIVE DATE EXPIRATION DATE <br /> GENERAL LIABILITY EACH OCCURRENCE $ <br /> -, COMMERCIAL GENERAL LIABILITY FIRE DAMAGE (Anyone fire) $ <br /> -I ICLAIMS MADE I --1 OCCUR MED EXPENSE (Anyone person) $ <br /> GENERAL AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY $ <br /> I POLICY I I PROJECT I I LaC GENERAL AGGREGATE $ <br /> PRODUCTS-COMPIOP AGG $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Each acddent) $ <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person I $ <br /> HIRED AUTOS BODILY INJURY $ <br /> NON-OWNED AUTOS (Peraccldenl) $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) $ <br /> I WeSTAT I X I OTHER <br /> WORKERS' COMPENSATION LIMITS <br />A AND "PU-WCG 001-2008 111/08 t/1/09 E L. EACH ACCIDENT $ 500,000 <br /> EMPLOYERS LIABILITY EL DISEASE EA EMPLOYEE $ 500,000 <br /> EL DISEASE - COVERAGE LIMIT $ 500,000 <br /> OTH"R <br />B Excess Workers' Compensation SP-1Y94-CA 1/1/08 t/1/09 $25,000,000 x $500.000 we 0 <br /> $1,000,ooox$5oo,QooEL <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESlEXClUSIONS ADDED BY ENDORSEMENTISPECIAUPROVISIONS <br />Evidence of Workers' Compensation Coverage: <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CANCELLATION <br /> NPLlWCG-OCCC -08 SHOULD ANY OF THE ABOVE 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 DO SO SHALL IMPOSE <br /> City of Santa Ana NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br /> 20 Civic Center Plaza AGENTS OR REPRESENTATIVES. <br /> Santa Ana, C A 92701 AUTHORIZED REPRESENTATIVE <br /> ATTN: Michael Lopez <br /> /::7~ <br /> <br />Ba.ad on ACORD 25-S (7/97) <br />