360 BC GROUP, INC. DBA 360 BUSINESS CONSULTING

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POLICYHOLDER COPY .99 P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-07-2017 CITY OF SANTA ANA Sp 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 GROUP POLICY NUMBER: 9166809-2016 CERTIFICATE ID: 8 CERTIFICATE EXPIRES: 09-24-2017 09-24-2016/09-24-2017 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by three policy ydescribbeeddd herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE, 1 ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2017-06-07 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA ENDORSEMENT #1600 - ZAYAS,RON PRESIDENT SECRETARY - EXCLUDED. ENDORSEMENT #1600 - ZAYAS,ELIZABETH TREASURER - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-07-2017 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. Ctm c) I ,Id,rl111; 350 BC GROUP, INC DBA: 360 BUSINESS CONSULTING 25562 GLORIOSA DR MISSION VIEJO CA 92691 (JCP,CNI (REV.7-2014) PRINTED : 06-07-2017