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CERTHOLDER COPY <br />0 <br />RO, BOX 8192, PLEASANTON, (,',A 94588 <br />n" �s us to certffV that we have issut-, z a valid tlkrrkers Compensation insurance pokey in a fofrn app ovefj r)}, the <br />CafiNxnia insurance Cwnrnzss�cfner �,o the efnp�oyer nampd ba'sOvr( for thi- Peal ry Period mcitcated <br />Thls pohcy 's riot sut)ject to canceflalion by Ch,- Fund excePt w-.xw 30 da°'s advance vvnt r) noljc�r- to the en'iplt,) er. <br />We wifl also gWe YOU 30mays advarice rfotxe shouid the Policy be canceik,,d pinor to iIs ncrrnaE expwaticwf, <br />This certificate ot insurance rs not an insurance pahcy and does not arnend, extend or aaer the coverage affordpd <br />by the po;foy bsted herem. Notvviltislanding any requiren-wa, te,rn of, conditiorl of any contraclt or other docurrofW <br />with respect to whrch Viis certtficate of triswance may be ISSUed or U't which if may pertain, the ri!,,urance <br />af9'orded by the pohcy doscribed herem fs subjec, to aft the ,.errns, oxcf ions, and concittions, of su& paGicy. <br />Awthctr5ie,d Representatwe fi'r'es dent and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS. $1,000,000 PER OCCURRENCE, <br />ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2014-11-01 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY, NAME OF ADDITIONAL INSURED: <br />CITY OF SANTA ANA <br />ENDORSEMENT #1600 - MALOOF, OMAR P,S T - EXCLUDED. <br />ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS" NOTICE EFFECTIVE 11-01-2011 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY, <br />BANNAOUN ENG1K,Ef7F'C STRUCTORS CORP PROJECT 15-6824- <br />REVIEWED BY EUNICE HEREDIA (PG. 3 of 3) <br />BANNAOUN ENGINEERS CONSTRucrORS CORP <br />PO BOX 16599 <br />BEVERLY HILLS CA 90209 <br />SC <br />(REV,7 20 kw PRINTED : 02-10 2015 <br />