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CERTHOLDER COPY <br />SP <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03-01-2009 GROUP: <br />POLICY NUMBER: 1731310-2009 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EXPIRES: 03-01-2010 <br />03-01-2009/03-01-2010 <br />CITY OF SANTA ANA SP JOB:ALL CALIFORNIA OPERATIONS <br />COMM DEV AGENCY M-25 ATTN: FRANK HERNANDEZ <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701 <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 10 days advance written notice to the employer. <br />We will also give you 10 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 <br />�terms, <br />,eexclusions, and conditions, of such policy. <br />tTHORIZEaD REPRESENTATI PRESIDENT <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />EMPLOYER <br />PAINT YOUR HEART OUT ANAHEIM, INC AND (A SP <br />NON-PROFIT CORP) <br />1280 N HANCOCK ST STE 103 <br />ANAHEIM CA 92807 <br />M0408 <br />(REV.2-05) PRINTED : 02-17-2009 <br />