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<br />POLICYHOLDER COPY gp <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-4807 <br />CERTiFiCATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 02-01-2010 <br />GROUP: <br />POLICY NUMBER: 1679144-2010 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EXPIRES: 02-01-2011 <br />02-01-2010/02-01-2011 <br />THE CITY OF SANTA ANA, ITS OFFICERS, SP <br />EMPLOYEES AND AGENTS <br />P.O. BOX 1888 <br />SANTA ANA CA 92702 <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 ar alter the coverage afforded <br />by the policy listed herein. Notwithstanding any requirement, term ar 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 />affiorded by the policy described herein is subject to all tl~e Perms, exclusions, and conditions, of such policy. <br />~~~~~ ' <br />THORIZED REPRESENTATI PRE5IDENT <br />UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER 7HI5 POLICY EXCLUDES THE FOLLOWING: <br />THOSE NAMED IN THE POLFCY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br />,EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY AL50 AFFORDING <br />CALIFORNIA WORKERS COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br />COMPENSATION LAW. . <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE <br />A ~l~' <br />I~'~ ~Q ~a <br />o~~ <br />4~ C~ <br />c~ <br />( ,~~ ~, 9'~OR~o c*,ey <br />1 <br />` ~,\~ ~ pity ~` <br />EMPLOYER <br />HISPANIC BUSINESS CONSULTANTS Sp <br />2510 N GRAND AVE STE 101 <br />SANTA ANA CA 92705 <br />M0409 <br />~tev.2-051 PRINTED 01-15-2010 <br />