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CERTHOLDER COPY <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />�JSSUE DATE: 07-11.2019 GROUP: <br />POLICY NUMBER: 9257170.2019 <br />CERTIFICATE EXPIRES: 07.11.2020 <br />07-11-2019 / 07-11-2020 <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92702 <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 dive 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 <br />President and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. <br />ENDORSEMENT #2065 ENTITLED CERTFICATE HOLDERS' NOTICE EFFECTIVE 07-11-2019 IS ATTACHED TO <br />AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />NATI'S HOUSE (A NON PROFIT CORP) <br />NEUTRAL GROUND FAMILY SERVICES <br />1733 VALENCIA ST <br />SANTA ANA, CA 92706 <br />G 11 i ' `"l <br />REVIEWED BY: <br />-V 0,ng <br />Risk Management Division <br />CSC MCERT PRINTED ON; 07-11-2019 <br />(REV 22017) <br />