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CERTHOLDER COPY <br />SP <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 03-27-2020 <br />CITY OF SANTA ANA SP <br />BENEFITS DEPARTMENT <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />GROUP <br />POLICY NUMBER: 1555105-2020 <br />CERTIFICATE ID: 32 <br />CERTIFICATE EXPIRES: 03-01-20211/ <br />03-01-2020/03-01-2021 <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 <br />dbby the <br />pololliiicccyyy ddees(cr/libbeeedd] 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 #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2000 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />— ENDORSEMENT #1651 - LETICIA A. DAYHOFF SEC,TRES - EXCLUDED. <br />ENDORSEMENT N1851 - MARCUS D. DAYHOFF PRESIDENT - EXCLUDED. <br />REVIEWED & APPROVED <br />By Risk MANAGEMFNT DIVISION <br />EMPLOYER Jl" 4 2020 <br />ANgiE ACEVEdo <br />REACH EMPLOYEE ASSISTANCE INC SP <br />650 N ROSE DR <br />PLACENTIA CA 92870 <br />[JCJ,CNI <br />(Rev.7-2014) PRINTED : 03-27-2020 <br />