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Berkley South Carolina Workers' Compensation Insurance Plan <br />Riverport Insurance Company NCCI Carrier Code 27995 <br />Administered by Berkley Assigned Risk Services <br />ASSIGNED RISK SERVICES P.O. Box 59143, Minneapolis, Minnesota 55459-0143 <br />Tall Free (888) 548-7431 Fax (866) 215-8118 <br />w .berkleyassignedrisk.com <br />1. The Insured: <br />CERTIFICATE OF INSURANCE <br />WCIP <br />GOVERNMENT TRAINING INSTITUTE INC <br />3858 N Garden Center Way Ste 300 <br />Boise, ID 83703 <br />Policy Number: WC-39-84-008744-04 <br />Tax ID#: F 20-0052493 <br />Policy Period: From: 8/6/2012 <br />To: 8/612013 <br />Date of Mailing: 5/20/2013 <br />The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. <br />This Certificate does not amend, extend or alter the coverage afforded by the Policy listed below. <br />This is to certify that the Policy of Insurance described herein has been issued to the Insured named above for <br />the policy period indicated. Notwithstanding any requirement, term or condition of any contract or other document <br />with respect to which this Certificate may be issued or may pertain, the insurance afforded by the Policy described <br />herein is subject to all the terms, exclusions and conditions of such Policy. <br />TYPE OF INSURANCE <br />LIMITS OF LIABILITY <br />Part One <br />Workers' Compensation <br />Statutory <br />Part Two <br />Bodily Injury by Accident $1,000,000 each accident. <br />Employers' Liability <br />Bodily Injury by Disease $1,000,000 policy limit. <br />Bodily Injury by Disease $1,000,000 each employee. <br />Should any of the above described policies be cancelled before the expiration date thereof, <br />notice will be delivered in accordance with the policy provisions. <br />Coverage <br />State(s) <br />SC <br />All Entities/Insureds: <br />Certificate Holder's Name and Address: GOVERNMENT TRAINING INSTITUTE Ih <br />Election Election <br />Santa Ana Police Dept, The City of Santa Ana Category Status Name <br />its officers, agents, and employees Sole Proprietor Exclude CHADD HARBAUGH <br />60 Civic Center Plaza Officer Exclude FLINDA TERTELING <br />Santa Ana, CA 91701 <br />kPPROV! t7 AS TO <br />:.aura iutt S eedy <br />Asnistenl Cil, r�+!o�n ev Date Issued: 5/2012013 <br />Willis of Tennessee Inc <br />PO Box 2827 <br />Columbia, SC 29202 /- <br />Signature_ <br />