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S?,G <br />POLICYHOLDER COPY Sp <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <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 1989 <br />SANTA ANA CA 82702 <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 10 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 2150 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 terms, exclusions, and conditions, of such policy. <br />tHrOR,ZED REPRESENTATI PRESIDENT ' <br />UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: <br />THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; <br />.EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING <br />CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' <br />COMPENSATION LAW. <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE <br />Ag TD gpA? <br />?? 1 E S?OPto %%el <br />C10 <br />PSy?ta l <br />EMPLOYER ! . <br />HISPANIC BUSINESS CONSULTANTS SP <br />2610 N GRAND AVE STE 101 <br />SANTA ANA CA 92706 <br />(aEV.a-0a) <br />PRINTED : 01-18-2010 M0409