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CtRTHOLDER COPY <br />Sc <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 04-13-2010 <br />SANTA ANA POLICE DEPARTMENT SC <br />ATTN: RICARDO DIAZ, CORPORAL <br />60 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4060 <br />GROUP: 000780 <br />POLICY NUMBER: 0000497-2009 <br />CERTIFICATE ID: 177 <br />CERTIFICATE EXPIRES: 06-01-2010 <br />06-01-2009/06-01-2010 <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 30 days advance written notice to the employer. <br />We will also give you 30 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 terms, exclusions, and conditions, of such policy. <br />ouc-? V,4%m <br />tth.r,zed Representative Interim President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT 1!1600 - RONALD FARWELL PRES - EXCLUDED. <br />ENDORSEMENT 111600 - BARON FARWELL SEC,TRES - EXCLUDED. <br />ENDORSEMENT 112065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-01-2008 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />A O E AS TO FORM <br />41410 <br />Hodge <br />puty ity Attorney <br />EMPLOYER <br />ALL CITY MANAGEMENT INC SC <br />1749 S LA CIENEGA BLVD <br />LOS ANGELES CA 90035 <br />[B13,SC] <br />(REV.1-2010) PRINTED : 04-13-2010