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66.19,2008 12:44 BC ENVIROMENTRL <br />POLICYHOLDER COPY <br />NO.480 9006 <br />SP <br />STATE <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />IN SURAN CIS <br />FUND <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />GROUP. <br />ISSUE DATE: 00-15-2008 POLICY NUMBER: 1484818-2000 <br />CERTIFICATE ID: 278 <br />CERTIFICATE EXPIRES: 04-01-2009 <br />04-01-2008/04-01-2009 <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-405S <br />SP JOB:ALL OPERATIONS <br />This is to certify that we have issued a valid Workers' Compensation Insurance policy in a form approved by the <br />Califorrna 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 heraim Notwithstanding any requirement term or condition of any wntract 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, <br />tter-m'ss, 'exclusion, and conditions, of such policy. <br />V <br />rORIZED REPRESENTATI PRESIDENT <br />EMPLOYEWS LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,WO-000 PER OCCURRENCE. <br />2004-04-01 <br />AENDORSEMNT <br />EDETO ANDI ETITLED <br />SLPOLLIICY. NAMEEMPLOYER <br />ADDITIONALEFFECTIVE <br />IS <br />INSURED: <br />CITY OF SANTA ANA <br />ENDORSEMENT p1600 - RICHARD PROSSER PRES.TRES - EXCLUDED. <br />ENDORSEMENT JJ600 - FARIDEH KIA VP - EXCLUDED. <br />ENDORSEMENT <br />##20 5 ENTITLED CERTIFICATE <br />THIS POLICY. <br />NOTICE EFFECTIVE 04-01-2001 I5 <br />ATTACHED <br />EMPLOYER <br />it <br />GC ENVIRONMENTAL, INC. SP <br />1220 N JEFFERSON ST STE J <br />ANAHEIM CA 02007 <br />� [B16,NFj <br />PRINTED 00-19-2008 <br />(RV.2.05) <br />