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CERTHOLDER COPY <br />SG <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: 04-23-2008 GROUP: 000092 <br />POLICY NUMBER: 0000678-2007 <br />CERTIFICATE ID: 145 <br />CERTIFICATE EXPIRES: 01-01-2009 <br />01-01-2008/01-01-2009 <br />CITY OF SANTA ANA SG <br />ATTN.: DAVID IP <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <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 />THORIZED REPRESENTATI ~- PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 1!1600 - ROGER FRANK PRES - EXCLUDED. <br />ENDORSEMENT N1600 -ALAN FRANK S,T - EXCLUDED. <br />ENDORSEMENT 112065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />~~41ys <br />~~ ~~ ~© <br />QgQ~ - ~ ~~ <br />P E~ SHOP oCrey <br />~~S ~ G~ty <br />~S~s<ar ~~ <br />J~ <br />EMPLOYER <br />JOHNSON-FRANK & ASSOCIATES (A CORP) SG <br />5150E HUNTER AVE <br />ANAHEIM CA 92807 <br />[B10,SG] <br />(REV.2-05} PRINTED 04-23-2008 <br />PDF created with pdfFactory Pro trial version www.pdffacto com <br />