REACH EMPLOYEE ASSISTANCE, INC. 1D - 2009

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CERTHOLDER COPY STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION IN S U R A N C E U N ~ CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-01-2009 GROUP: POLICY NUMBER: 1555105-2009 CERTIFICATE ID: 11 CERTIFICATE EXPIRES: 03-01-2010 03-01-2009/03-01-2010 CITY OF SANTA ANA BENEFITS DEPT 20 CIVIC CENTER PLAZA SANTA ANA CA 92702 SP 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 Hamad 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. ~~ THORIZED REPRESENTATi PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - MARCUS D DAYHOFF, PRESIDENT CEO - EXCLUDED. ENDORSEMENT #1600 - LETICIA A DAYHOFF, SECRETARY TREASURER - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2000 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. APPRO V E AS TO FORM Laura Stitt Sheedy Assistant City Attorney EMPLOYER REACH EMPLOYEE ASSISTANCE, INC gp 101 E LINCOLN AVE STE 230 ANAHEIM CA 92805 SP M0408 IREV.2-osl - PRINTED 02-17-2009