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- x;2 <br />POLICYHOLDER COPY �t <br />SIP <br />STATE POBOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07-29-2008 GROUP: <br />POLICY NUMBER: 1339472-2008 <br />CERTIFICATE ID: 545 <br />CERTIFICATE EXPIRES: 01 -01 -2009 <br />01-01-2008/01-01-2009 <br />THIS CERTIFICATE SUPERSEDES AND CORRECTS <br />CERTIFICATE N 540 DATED 07-16-2008 <br />CITY OF SANTA ANA SP <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 N1600 - F.JAMES GRECO,PRES. - EXCLUDED. <br />ENDORSEMENT #1600 - GEOFFREY SCOTT,SEC. - EXCLUDED. <br />ENDORSEMENT N1600 - BARRY BURNELL,VP - EXCLUDED. <br />ENDORSEMENT N1600 - RUSSELL GARCIA,VP. - EXCLUDED. <br />ENDORSEMENT #1600 - JOEL MORSE,TREAS. - EXCLUDED.. <br />ENDORSEMENT N1600 _ FIROUZ GHABOUSSI,VP. - EXCLUDED. <br />ENDORSEMENT #2065 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 SIP <br />17542 17TH ST STE 100 <br />TUSTIN CA 92780 <br />IP1 W.SP] <br />tREV.2-05i PRINTED : 07-29-2008 <br />