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� -z��Z -ova <br />November 26, 20'12 B$�, <br />A Himo� Raswrm Hlamgemat Coegwny <br />SELECT TRENCHLESS PIPELINES INC <br />283 WINFIELD CIR i`��' k `��� —�¢ + "�� [_t= �� <br />CORONA, CA 92880 -6943 `. -: _ s r. <br />Re: Barrett Business Services, Inc. ( "BBSI ") <br />Letter of Self- Insurance for Workers' Compensation Coverage <br />As the named addressee of this Letter, your company's required workers' compensation coverage is provided <br />through BBSI's state approved Self - Insured Workers' Compensation Plan by way of your co- employment <br />contract with BBSI. BBSI's California customers can also verify BBSI's state certification at <br />htto: / /www.dir.ca.00v. /SIP /sio.html; next, click on "Self Insured Employers "; then "Rosters "; then scroll down to <br />Barrett (the list is alphabetical by company name). Additional information is as follows: <br />Self Insurance Certification Number: <br />California: 2246 <br />Oregon: '1068 <br />Washington: 706, 116 <br />Delaware: '152 <br />Maryland: I'1365 <br />Colorado: 463 J <br />Other Comments (place an "X" if applicable): <br />�PPRU V �;1� AS TO FORM <br />�. <br />`� Laura Stitt S eedy <br />Named "Letter Holder ": CITY OF SANTA ANA a+s�istant City Attorney <br />Other: <br />Additionally, BBSI's self- insured program is further supported by an excess workers' compensation insurance policy with <br />National Union Fire Insurance Company of Pittsburgh, PA. Copy of certificate is available upon request. <br />For additional information, please contact your local BBSI office at: (909) 605 -6862 <br />Very truly yours, <br />Michael L. Elich BBSI Office: ONTARIO <br />President and Chief Executive Officer <br />doc: LOSI -2 <br />8100 NE Perkwoy Drive, Suite 200 Vancouver, Washington 98662 800.494.5669 360.828.0700 Fax 360.828.0701 www.berrettbusiness . com <br />PARTNERS IN PROFITABILITY <br />