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CERTHOLDER COPY <br />SG <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />ni f C F" ORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 01-01-2011 GROUP: <br />CTt$p -; ANA <br />POLICY NUMBER: 1886690-2011 <br />56 <br />CLE `• ` UINCIL CERTIFICATE EDXPIRES: 0CERTIFICATE 5-01-2012 <br />01-01-2011/01-01-2012 <br />CITY OF SANTA ANA SG JOB:SANTA ANA REGIONAL TRANSPORTATION CENTER <br />PUBLIC WORKS AGENCY <br />20 CIVIC CENTER PLZ M-21 <br />SANTA.ANA CA 92701-405S <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 />4'r-1'6 <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - LYONS,RONALD, P,S - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2009 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />RUEVAC PROPERTY SERVICES, INC. SG <br />600 W TAFT AVE <br />ORANGE CA 92885 <br />M0408 <br />IREv.8-20101 PRINTED : 12-21-2010 <br />