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<br />POLICYHOLOER COpy <br /> <br />SC <br /> <br />STATE <br />COMPENSATION <br />INSURANCE <br />F=UNO <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE OATE: 04-01-2009 <br /> <br />GROUP: 000388 <br />POLICY NUMBER: 0001336-2009 <br />CERTlFICA TE ID: 15 <br />CERTIFICATE EXPIRES: 04-01-2010 <br />04-01-2009/04-01-2010 <br /> <br />CITY OF SANTA ANA-FINANCE & MGMT SVCS SC <br />DEPT OF BUILDING AND SAFETY <br />20 CIVIC CENTER PLAZA <br />POBOX 1988 <br />SANTA ANA CA 92702 <br /> <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in <l form approved by the <br />California Insurance Commissioner to the employer named below for the policy period indicated. <br /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. <br /> <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 herem. 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 aJ) the terms, exclusions. and conditions, of such policy. <br /> <br />tREPRESENT A TI <br />EMPLOYER'S LIABILITY LIMIT <br /> <br /> <br />~~ <br /> <br />PRESIDENT <br />INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2005 IS <br />ATTACHED TO ANO FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />LIEBERT CASSIDY WHITMORE A PROFESSIONAL SC <br />CORPORATION <br />6033 W CENTURY BL # 500 <br />LOS ANGELES CA 90045 <br /> <br />'REV,2-05) <br /> <br />PRINTED <br /> <br />03-17-2009 <br /> <br />M0410 <br />