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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: 10-f5-2018 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />GROUP: <br />POLICY NUMBER: 9088955-2018 <br />CERTIFICATE ID: 7 <br />CERTIFICATE EXPIRES: 09-30-2019 <br />09-30-2018/09-30-2019 <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 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 #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 09-30-2013 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />NEIGHBORHOOD HOUSING SERVICES OF 0 C AND INC <br />(A NON-PROFIT CORP) <br />128 E KATELLA AVE STE 200 <br />ORANGE CA 928B7 <br />[ __l vy I—" <br />RIMMED BY: <br />ISCM,CNI <br />ment Divlslon <br />IREV.7.20141 PRI E : 10-15-2018 <br />REVIEWED BY:AAA <br />EUNICE HEREDIA (PG CH j <br />