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<br />CERTHOLDER COPY <br /> <br />SG <br /> <br />STATE <br /> <br />COMPENSATION <br />INSURANCE <br /> <br />P.O. BOX 420807, SAN FRANClSCO,CA 94142-0807 <br /> <br />FUND <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 04-01-2010 <br /> <br />GROUP: 000290 <br />POLICY NUMBER: 0002003-2010 <br />CERTIFICATE 10: 19 <br />CERTIFICATE EXPIRES: 04-01-2011 <br />04-01-2010/04-01-2011 <br /> <br />CITY OF SANTA ANA <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br /> <br />SG <br /> <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 /> <br />This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days advance notice should this poiicy be cancelled prior to its normal expiration. <br /> <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 /> <br /> <br />thorized Representative <br /> <br /> <br />)~VJ/i.J <br /> <br />Interim President and CEO <br /> <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1600 - WHITECOTTON, ROBERT, P,S T - EXCLUDED. <br /> <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2008 IS <br />----- ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOYER <br /> <br />MASTER LANDSCAPE & MAINTENANCE, INC. <br />10171 NORTHAMPTON AVE <br />WESTMINSTER CA 92683 <br /> <br />SG <br /> <br />[B1E,SP] <br /> <br />(REV.1-20101 <br /> <br />PRINTED <br /> <br />07-13-2010 <br />