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April 09, 2012 <br />DEKRA-LITE INDUSTRIES INC. <br />_ 3102 W ALTON AVE <br />SANTA ANA, CA 92704-6617 <br />An"mn Re rm mamPmnt compmy <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 />http://www.dir.ca,gov./SIP/sip.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 <br />Insurance Certification <br />California: 2246 <br />Oregon: 1068 <br />Washington: 706, 116 <br />Delaware: 152 <br />Maryland: 11365 <br />Colorado: 463 <br />Number: <br />Other Comments (place an "X" if applicable): <br />® Named "Letter Holder": City of Santa Ana 20Civic Center Plaza M-25 Santa Ana, CA 92701 <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 /> <br />Michael L. Elich BBSI Office: ONTARIO <br />President and Chief Executive Officer <br />doc: LOSI-2 <br />8100 NE Parkway Drive, Suite 200 Vancouver, Washington 98662 800,494.5669 360.828.0700 Fax 360.828.0701 www.harrottbusiness.cam <br />- ------------ PARTNERS IN P R O F I TA 81 L I T Y ----- ------ <br />APPROVED AS 'P.O FORM <br />br- - I f?gA E. uT©;2CI4 ?? <br />,Assistant City Attorney /