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POLICYHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 84142-0807 <br />COMPENSATION <br />IN SUM ANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 08-23-2006 GROUP: 000481 <br />POLICY NUMBER: 0000413-2006 <br />CERTIFICATE ID: 41 <br />CERTIFICATE EXPIRES: 08-23-2007 <br />08-23-2006/08-23-2007 <br />CITY Of SANTA ANA SP <br />DEPARTMENT OF PUBLIC WORKS <br />20 CIVIC CENTER PLAZA #M-71 <br />SANTA ANA CA 92702 <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 nand 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 employor. <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration <br />This cartIflcata of insurance is not an Insurance policy and does not amends extend or alter the coverage afforded <br />by the pcllcy listed herein, Notwithstanding any requirement, term or conditlon 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 />tTm RI7FD REPRESENTATI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-23-200x! IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />CURBSIDE, INC SP <br />1180 N ARMANDO ST <br />ANAHEIM CA 92906 <br />M0410 <br />IREV.2-o51 PRINTED : 07-18-2006 <br />SP <br />