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CERTHOLDER COPY <br />%NW <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 09-01-2006 GROUP: <br />POLICY NUMBER: 1028422-2006 <br />CERTIFICATE ID: 9 <br />CERTIFICATE EXPIRES: 09-01-2007 <br />09-01-2006/09-01-2007 <br />CITY OF SANTA ANA <br />ATTN CHRISTINE CALDERON - <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701 <br />TRESURY MANAGER <br />NA A— o — lo <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br />This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, term or condition 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 />tTMORI�ZED REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - DONALD H MAYNOR, SECRETARY TREAS - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-01-1992 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />DONALD H. MAYNOR A PROFESSIONAL LAW <br />CORPORATION <br />235 CATALPA DR <br />ATHERTON CA 94027 <br />NA <br />M0408 <br />PRINTED : 08-17-2006 <br />(REV.2-05) <br />NA <br />