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Jun 26 07 08:42a Public Works 7146473345 p,4 <br />STATE P.O. BOX 420807, SAN FRANCIS{;C).C'Fr !:~4"142-0807 <br />gOMPBNSATI ON <br />INaaURAN Ci <br />FUND CERTIFfCATE OF WORKERS' COMFEN5/~ TIIUIIr IN5jAiANCE <br />ISSUE GATE: 04-12-2007 q4C U=' <br />PLA.•Ctr 14UMB6i: 1880642-2006 <br />CIcpTIF°~CATE ID. 61 <br />CII~TIFICATE EXPIRES: 07-O7-2007 <br />07-01-2006/07-01-2007 <br />CLERK OF THE CITY COUNCIL SC <br />CFTY OP SANTA ANA <br />20 CIVIC CENTER PLZ M-30 <br />SANTA ANA CA 92701-4068 <br />Thie is to certify that vve Fuve issued a valid Workers' 6ompensadcn Inst. -ar~w: policy in a form approved by the <br />Calltornia Insurance Commissioner to the employer named below fog ffio mlinr period indicated <br />This pellcV is not subject to caneellaGOn by the Fund except upon 3tl dr. ~s cchvance written notice to the employer. <br />We will also give you 30 days advance notice should this policy ba cane II•a f IPrior to its normal expiration. <br />This cekitioate of utsurance Is not an insurance policy end does nr,l: emc•'d, extend or altar the covera0e affoMed <br />by the policy listed herein Notwithstanding any roqulrement, term o~~ conr::dcn of any contract or other document <br />Nnth respect to which this oertificeta of Insuranw may be i99ued rR to .,~hi.:!• it may pertain, the insurance <br />afforded by Me policy descr[bed herein Is subject to all the terms nxc4.:d~tt., and conditions. of such policy. <br />l„J~( <br />ORIZEO REPRESENTATI FT,ESIC:~I'" <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: S1 O~CO„000 PER OCCURRENCE. <br />ENDORSEMENT B001B ENTITLED ADDITIONAL INSURED EMPL1;%'ER:ifFfE6TIYE 2007-04-13 IS <br />A7TAf31ED TO AND FORMS A PART OF THIS POLICY. NAME Ilif' A~QIII"I ICRUIL INSURED: <br />CLERK OF THE CITY COUNCIL <br />~ENOORSEMENT N2085 ENTITLED CERTIFICATE FpLDERS' ND1'tCE !FI!lftTIVE 07-Oi-2006 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. _ <br />ENDORSEMENT /2670 ENTITLED WAIVER OF SIl6ROGATION E9'FEC7;1'1:!t007-04-13 IS <br />ATTACHED TD AND FORMS A PART OF THIS POLICY. THIRD FART ''fU14E: <br />CLERIC~OF THE CITY COUNCIL <br />EMPLOYER <br />ASSOCIATION FDR RETARDED CITIZENS MID-CITIES <br />(A NON PROFIT CORP) <br />14208~TOWNE AVE <br />LOS ANGELES CA 90061 <br />aura SiiLt Sl';.:c~. ~~~_......___._ <br />1s:,ls[ant City .Alwr~,v <br />IB13,5C) <br />PRINTED 04-13-2007 <br />IRFY.1-081 <br />