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POLICYHOLDER COPY <br />SP <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 05-01-2016 GROUP; <br />POLICY NUMBER: 1943582-2015 <br />CERTIFiCATE 11 26 <br />CERTIFICATE EXPIRES: 05-01-2017 <br />05-01-2018/05-01-2017 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <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 po#icy 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 poilcy 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 />Authorized Representative President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #1600 - NADER ALEX KAZEMI, PRES,TRES - EXCLUDED, <br />ENDORSEMENT #1600 - IRAN ALIGHOLIZADESUOMEH, SEC - 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 />I ENGINEERING & CONSTRUCTION INC <br />PO BOX 54442 <br />IRVINE CA 92619 <br />•�e <br />e <br />G� <br />SP <br />[DEC,CN1 <br />(REV.7-2014) PRINTED : 03-01-2017 <br />