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CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-01-2009 GROUP: POLICY NUMBER: 1339.472-2009 CERTIFICATE ID: -k CERTIFICATE EXPIRES: "0-1-01-2010 01-01-2009/01-01-2010 CITY OF SANTA ANA SP JOB:788-002 SANTA ANA LIFT STATION RFP 20 CIVIC CENTER PLZ M-30 SANTA-ANA-CA 92704--4058 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 expKation. ,a This certificate of insurance is not an insurance policy and does not amend, extend or alter the Coverage af.Aorded 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 polidy. (J c,:.a tTHORI�ZED REPRESENTATI PRESIDENT CD . EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.-' LU ENDORSEMENT #1600 - 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 SP 17542 17TH ST STE 100 TUSTIN CA 92780 SIP M0408 (REV.2-05) PRINTED : 12-20-2008