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CERTHOLDER COPY <br />SP <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS` COMPENSATION INSURANCE <br />ISSUE DATE: 06 -30 -2014 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 -4058 <br />GROUP: <br />POLICY NUMBER: 9094902 -2014 <br />CERTIFICATE ID: 3 <br />CERTIFICATE EXPIRES: 04 -11 -2015 <br />04- 11- 2014/04 -11 -2015 <br />This is to certify that we have issued a valid Workers' Compensation insurance policy in a form apprdved 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 10 days advance written notice to the employer. <br />We wN also 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 />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - PETERSON UR. , ALAN M PRES SEC TRES - EXCLUDED, <br />EMPLOYER <br />THE PETERSON GROUP INC. DBA: THE PETERSON <br />GROUP, INC. <br />188551 BARDEEN AVENUE <br />IRVINE CA 92612 <br />[VM5,C5] <br />IREV.1 -20121 PRINTED : 06 -30 -2014 <br />