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<br />POLICYHOLDER COPY <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 10-01-2008 <br /> <br />GROUP: 000780 <br />POLICY NUMBER: 0000227-2008 <br />CERTIFICATE ID: 136 <br />CERTIFICA-E FXPIRES: 10-01-2009 <br />10-01-2008/10-01-2009 <br /> <br />THE CITY OF SANTA ANA <br />60 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4060 <br /> <br />SC <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance CommiSSIOne( 10 the employer named below far the poliCY penod indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 days .advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <br />This certificate of insurance IS not an insurance policy and does not amend. extend or alter the coverage afforded <br />by the po:'cy listed herein. NotwilhsLanding any requirement, term or condit'on of any contract or other document <br />with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance <br />afforded by the policy deSCribed herein is subject to all the terms. exclusions, and conditions. of such policy. <br /> <br />6::: _::::0 ~~ <br /> <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUOING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #206S ENTITLEO CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2007 IS <br />ATTACHEO TO AND FORMS A PART OF THIS POLICY. <br /> <br />- <br /> <br />- <br /> <br />\ <br /> <br />v 7.--;z <2. <br />/ J/./ <br /> <br />-"- <br /> <br />EMPLOYE~ <br /> <br />ALL CITY MANAGEMENT INC <br />1749 S LA CIENEGA BLVD <br />LOS ANGELES CA 90035 <br /> <br />SC <br /> <br />PRINTED <br /> <br />09-17-2006 <br /> <br />IREV.:z-oSI <br /> <br />SC <br /> <br />M0410 <br />