HISPANIC BUSINESS CONSULTANTS (3)-2010

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r - POLICYHOLDER COPY P.O. BOX 424807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 02-01-2010 GROUP: POLICY NUMBER: 1679144-2010 CERTIFICATE ID: 1 CERTIFICATE EXPIRES: 02-01-2011 02-01-2010/02-01-2011 THE CITY OF SANTA ANA, ITS OFFICERS, SP EMPLOYEES AND AGENTS P.O. BOX 1988 SANTA ANA CA 92702 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below- for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. 'to 9 00 RG? ey J o EMPLOYER ' HISPANIC BUSINESS CONSULTANTS SP 2510 N GRAND AVE STE 101 SANTA ANA CA 92705 SP M0409 MEV.2-053 PRINTED : 01-15-2010