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POLICYHOLDER COPY <br />RE <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 02-11-2016 <br />CITY OF SANTA ANA SD <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />GROUP <br />POLICY NUMBER: 0803749-2015 <br />CERTIFICATE ID: 1320 <br />CERTIFICATE EXPIRES: 10-14-2016 <br />10-14-2016/10-14-2016 <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 b-y--the <br />policy described <br />ooliicydescribed herein is subject to all the terms, <br />/exclusions, <br />/{jand conditions, of such policy. <br />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2055 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />PYRO SPECTACULARS, INC. so <br />PO BOX 2329 <br />RIALTO CA 92377 <br />A , <br />IP 13, SDI <br />InEVJ-20 141 PRINTED : 02-11-2016 <br />