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<br />',' ti ILl L'/V I I I '-'C' r i1^ <br /> <br />CERTHOLDER COPY <br /> <br />STATE <br />C;:OMPliNSATION <br />INSUAANce <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCQ,CA 94142-0807 <br /> <br />C5RTlFICATIi OF WORI<ERS' COMPENSATION INSURANCIi <br /> <br />ISSUE DATE: D1-10-2007 <br /> <br />GROUP: <br />POLICY NUMBEfli 1414078-200B <br />ceRTIFICATE: 10: 92 <br />CER.TIFICATE: EXPIRJ:S: 12-0'-~007 <br />t2-01-2008/12-01~2007 <br /> <br />CITY OF ~ANTA ANA <br />CLERK OF THE CITY COUNCIL <br />20 crVIC CENrrER PLZ M-30 <br />SANTA ANA ~A e2701-~05e <br /> <br />'L <br /> <br />Tnl~ is to Cllnlly Insl VV(;l hllve issuod a valid Workl'lrs' Ccmpen5stlon insurmC6 policy in I form llpprc,"1Id by lhe <br />Calijornia Iruurancl'l Commls-slonor 10 tlla IIm!)loyer MDm~c:! below for tho policy Pl!lrlod Indicalei;l. <br /> <br />Tnis pollc~ I~ not :iubJl'let 10 c:~ru'lsll~tior'l by thl;! i=und e:<clIpt IJpon30 d'-YI: lIdv~cg Wr'lthm nQtice to Ihe (ImplOI'Or. <br /> <br />Wa wdl al$O Qi~l!I you 30 days aevllnco notice sr.culd tr.i$ pcllt:". b~ OAl'ItolJ.:"d prior 10 ils norl'T1al expifatlon. <br /> <br />lhlS cf;lrtifiC&1S of insur~neo Ie not an Insur..nclOl pollr::y pnd does not IImlJfld, extend Q: Dlt!;lr tho ccveragll Ifforded <br />pv thll policy fill led ,heroi!'l- Notwithstmding .ny f8CjuirLlII,.u.'t1t, _ r"nm 0'- r;ondiUon of illY c:ontrlc:t or ol'-1E1r nOCuillSnl <br />willi respecl to w}llch this certifIcate of IMut;mQQ m.llY CI;1I Ill-sued cr to which 1\ n'lIY pl!lruin, tile insur"nce <br />~florded by th~ POliOI' described herein is SUbj6Cl to ,Ill the terms. /i'lxcl~ions. pnel conditions. of such policV. <br /> <br />~R.PRESENTATI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br />~ <br /> <br />FAESIOE'NT <br />INelUO!NG DEFENSE COSTS~ 51,000.000 PER OCCURRENOE. <br /> <br />ENCDRSEMENT #1800 ~ GERALD NEWfARMER PRES CEO SEe - EXCLUOED, <br />ENODR5EMENT N20BS ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIve 12-01-2002 IS <br />------ATTACHED TO AND PORMS A PART OF THIS POLICY. <br /> <br />I!MPlO'r'E~ <br /> <br />~/ <br /> <br />MANAGEMENT PARTNERS, INC <br />173G MADISON FtU <br />CINCINNATI OH 4B20e <br /> <br />SL <br /> <br />(~Ev.'.as~ <br /> <br />PRINTED <br /> <br />pCl.SCI <br />01~10-2007 <br /> <br />l:'!J IJ 1) I, V~, I <br /> <br />,I. <br />