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CERTHOLDER COPY A , 2ME _ 13 i 06 V SP ISSUE DATE: 01-01-2010 CITY OF SANTA ANA 20 CIVIC CENTER PLZ M-30 SANTA ANA CA 92701-4058 P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE GROUP: POLICY NUMBER: 1339472-2010 CERTIFICATE ID: 534 CERTIFICATE EXPIRES: 01-01-2011 01-01-2010/01-01-2011 SP JOB:788-002 SANTA ANA LIFT STATION RFP This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. �THORIZEDREPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1800 - F.JAMES GRECO,PRES. - EXCLUDED. ENDORSEMENT #1600 - GEOFFREY SCOTT,SEC. - EXCLUDED. ENDORSEMENT #1600 - BARRY BURNELL,VP - EXCLUDED. ENDORSEMENT #1600 - RUSSELL GARCIA,VP. - EXCLUDED. ENDORSEMENT #1600 - JOEL MORSE,TREAS. - EXCLUDED. ENDORSEMENT #1800 - FIROUZ GHABOUSSI,VP. - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-1995 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER T & B PLANNING CONSULTANTS, INC 17542 17TH ST STE 100 TUSTIN CA 92780 SP M0408 (REV.2-05) PRINTED : 12-17-2009