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<br />POLICYHOLDER corY <br /> <br />SP <br /> <br />~ _ ~ _ - J_ r " <br /> <br />is'TATE' <br />COMPENSATIoN . <br />, I N.s.v R NN C E. <br />" FUNlEJ : <br /> <br />..-' -- ~ <br /> <br />P.O. BOX 420807, SAN FRANCISCO,CA 94142-0007 <br /> <br />CERTIFICATE OF WORI<ERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 02-Q1-2011 <br /> <br />GROUP: <br />POLICY NUMBER: 1679144-2011 <br />CERTIFICATE 10: 4 <br />CERTIFICATE EXPIRES: 02-01-2012 <br />02-01-2011/02-01-2012 <br /> <br />THE CITY OF SANTA ANA <br />PO BOX 1988 <br />SANTA ANA CA 92702-1988 <br /> <br />SP <br /> <br />This Is 10 certify thaI we have Issued a valid Workers' Compensatlon insurance policy In a form approved by tho <br />California Insurance CommiSSioner to the employer named bolow for tho policy period Indlcatod. <br /> <br />This policy Is not subject to cancellallon by tho Fund except upon 30 days advance written notice to tho employer. <br /> <br />Wo will also give you 30 days advance notlce should Ihis polley be cancelled prior 10 lis normal expiration. <br /> <br />This certificate of Insurance I~ not an Insurance policy and does not amend, extend or alter the coverage afforded <br />by the policy listed herein. NotwIthstanding any requlremenl, term or condition of any contract or other documenl <br />with respect to which this certificate of Insurance may be Issued or 10 which It may perlain,. Iho insurance <br />afforded by Ihe policy described herein is subject to all the terms, exclusions, end conditlons. of such policy. <br /> <br /> <br /> <br />~fL <br /> <br />Authorized Represenlalive Presldenl and CEO <br /> <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 /> <br />EMPLOYER'S LIABILITY' LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT U2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03~03H2010 IS <br />ATTACHED TO AND fORMS A PART Of THIS POLICY. <br /> <br /> <br />1\.5 'to FORM <br /> <br />( . SiORC\<. <br />\JSP- EC'W F\ttorne)' <br />p-ssistant t <br /> <br />51) <br /> <br />EMPLOYER <br /> <br />HISPANIC BUSINESS CONSULTANTS <br />2510 N GRAND AVE STE 101 <br />SANTA ANA CA 92705 <br /> <br />SP <br /> <br />M0409 <br /> <br />{REV,8-20 101 <br /> <br />PRINTED 01-14-2011 <br />