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POLICYHOLDER COPY <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94742-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-29-2008 GROUP: <br />POLICY NUM6ER: 1338472-2008 <br />CERTIFICATE ID: 534 <br />CERTIFICATE EXPIRES: 01-01-2008 <br />01-01-2008/01-01-2009 <br />CITY OF SANTA ANA SP JOB:788-002 SANTA ANA LIFT STATION RFP <br />20 CIVIC CENTER PLZ M-30 <br />SANTA ANA CA 82701-4058 <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 altar 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 C.J PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT X1800 - F.JAMES GRECO,PRES. - EXCLUDED. <br />ENDORSEMENT X1800 - GEOFFREY SCOTT,SEC. - EXCLUDED. <br />ENDORSEMENT N1600 - BARRY BURNELL,VP - EXCLUDED. <br />ENDORSEMENT X1600 - RUSSELL GARCIA,VP. - EXCLUDED. <br />ENDORSEMENT X1600 - JOEL MORSE,TREAS. - EXCLUDED. <br />ENDORSEMENT X1800 - FIROUZ GHABOUSSI,VP. - EXCLUDED. <br />ENDORSEMENT X2085 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-1995 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />T & B PLANNING CONSULTANTS, INC SP <br />17642 17TH ST STE 100 <br />TUSTIN CA 92780 <br /> <br />~.,T <br />[P1 W,SP] <br />SP <br />PRINTED 04-29-2009 <br />(RE V.2-051 <br />