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<br />CERTIFICATE OF WORKERS' COMPENSATION COVERAGE I DATE <br /> Dee I q, 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) 55] -67l7 INSURERS AFFORDING COVERAGE <br /> Fax: (53U) 274-9871 <br />INSURED A -;:).007- )"i'f INSURER A:. NonProfits' United Workers' Compensation Group <br />Orange County Conservation Corps N-\qqq-I~I INSURER B: Safety National Casualty Corporation <br />1853 North Raymond Avenue <br />Anaheim, CA 92801-1117 N-.::2oo0-0i3 INSURER c: <br /> N - ;).00 I -000 <br /> INSURER 0 <br /> INSURER E: <br />COVERAGES This Certificate is not intended to specifv all endorsements, CQveraaes, terms, conditions and exclusions of the DaHdes shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED TO THE AFFLlATE 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 />LTR EFFECTIVE DATE EXPIRATION DATE <br /> GENERAL LIABILITY EACH OCCURRENCE S <br /> I COMMERCIAL GENERAL LIABILITY FIRE DAMAGE IAny one fire) $ <br /> I I CLAIMS MADE I I OCCUR MED EXPENSE (Anyone person I $ <br /> GENERAL AGGREGATE LIMIT APPLIES PER: PERSONAL & ADV INJURY $ <br /> POLICY I I PROJECT I I LOC GENERAL AGGREGATE $ <br /> PRODUCTS-COMPIOP AGG $ <br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Each accident) $ <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS (Per person) $ <br /> HIRED AUTOS BODILY INJURY $ <br /> NON_OWNED AUTOS (Peraccidentl $ <br /> PROPERTY DAMAGE $ <br /> IPeraccidenll $ <br /> 1 wc STAT I X I OTHER <br /> WORKERS' COMPENSATION LIMITS <br />A AND NPU-WCG 001-2008 1/\108 1/1/09 E.L EACH ACCIDENT $ 500.000 <br /> EMPLOYERS LIABILITY E.L DISEASE - EA EMPLOYEE $ 500.000 <br /> E,l. DISEASE - COVERAGE LIMIT $ 500.000 <br /> OTHt:R <br />B Excess Workers' Compensation SP-l Y94-CA 1/1108 1/1/09 $25,000,000 x $500,000 we r - <br /> $1.000,000 x $500,000 EL <br />DESCRIPTION OF OPERATIONSILOCATIONSNEHIClESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAUPROVlS10NS <br />Evidence of Workers' Compensation Coverage: <br />CERTIFICATE HOLDER I I ADDITIONAL INSURED; INSURER LETTER: CA~CELLATlON <br /> N PU\VCG-OCCC -08 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION OATE THEREOF, THE ISSUING INSURER Vv1LL <br /> ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE <br /> HOLDER NAMEO 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, CA 92701 AUTHORIZED REPRESENTATIVE <br /> ATTN: Michad Lopel. <br /> /~~ <br /> <br />Based on ACORD 25-S (7/97) <br />