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P.O. BOX 420807, SAN FRANCISCO,CA 4 —� �� <br />I N S U NSATION 9 142 0807 8 �O <br />Flu Ni D <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 10 -01 -2008 <br />GROUP: <br />POLICY NUMBER. 0020381-2008 <br />CERTIFICATE ID: 21 <br />CERTIFICATE EXPIRES: 10-01!-2009 <br />10 -01- 2008/10 -01 -2000 <br />CITY OF SANTA ANA SG I DE LAS PAMPAS EXHIBIT AT THE cIV=c.cETR PLZ MB �A� zoo <br />SANTA ANA CA 02701 -4088 <br />This is to certify that we have issued a valid Workers' Cempenaation insurance poliCY in fora, ��o -a br �,. <br />California Insurance Commissioner to the empiover named bolo,,,, for she 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 />by This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded <br />with r Policy listed herein Notwithstanding any retirement, term or condition of any contract or other document <br />respect to which this certificate of insurance msy be issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to a!I the terms, exclusions, and conditions, of such <br />J <br />policy. <br />t:'IZED REPRESENTATI <br />UNLESS INDICATED OTHERWISE BY PRESIDENT <br />ENDORSEMENT <br />THOSE NAMED IN THE POLICY DECL , COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING; <br />ARATIONS AS AN INDIVIOUAL EMPLOYER OR A HUSBAND AND IF EMPLOYER; <br />CALIFOORNIA WORKKERS REHENSIYE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING <br />COIiPENSATION LAW, ENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br />�. <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />A E�TMG AN0FF ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 -o1 -1008 IS <br />FORM A PART OF THIS POLICY. <br />EMPLOYER <br />CFRISTOPH, AMU DBA: ANN CFRISTDPH, LANDSCAPE <br />AITIECT, ASLA <br />RCH <br />31713 MAST My <br />LAGUNA BEACH CA 83651 <br />06x.2 -oei <br />PRINTED : 08 -17 -2008 "0408 <br />