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POLICYHOLDER COPY <br />SC <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07-25-2012 <br />CITY OF SANTA ANA SC <br />SYLVIA CUEVAS - PRCSA <br />26 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4010 <br />GROUP: <br />POLICY NUMBER: 1903188-2012 <br />CERTIFICATE ID: 32 <br />CERTIFICATE EXPIRES: 05-01-2013 <br />05-01-2012/05-01-2013 <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 />F� <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - HASSETT, TROY VICEPRES - EXCLUDED. <br />ENDORSEMENT #1600 - HASSETT, WARD SECRETARY TREASURER - EXCLUDED. <br />ENDORSEMENT #1600 - HASSETT, ROY PRESIDENT - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 05-01-2012 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />0-0 ENTERTAINMENT OF CALIFORNIA INC DBA: 0 <br />ENTERTAINMENT <br />539 E BIXBY RD <br />LONG BEACH CA 90807 <br />[MJM,CS] <br />(REv.1-2012) PRINTED : 07-25-2012 <br />