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POLICYMOLOER COPY SP <br />PO BOX 8192. PLEASAN'TON, CA 94588 <br />CERTIFICATE OF WORKERS COMPENSATION INSURANCE <br />ISSUE DATE: 10-01-2020 <br />CITY OF SANTA ANA SP <br />20 CIVIC CENTER PLI <br />SANTA ANA CA 92701-e058 <br />GROUP: <br />POLICY NUMBER 1307696-2020 <br />CERTIFICATE IR 117 <br />CERTIFICATE EXPIRES 10-01-2021 <br />10-01-2020/10-01-2021 <br />this K to cerbly tlLt we have tsrdetl a valid Workers' Lorrpensahon rsurance polley m a form approved by the <br />Cahi Ornta tnsutatce COmInIns OnOr to me employer named below for the policy period Indicated <br />Thrs policy is not sbject to cancallst-w by If, Fund except wan 30 drys advance w ttlsn nonce to Uto employer. <br />We will also 91Ve you 30 days advance notice should this policy be canceled 0-xn to its normal expiration <br />This certificate of nnawarca is not an insurance Pali" and does not emend, extend or alts, the eOverage afforded <br />by the policy listed herein Notwithi'.andrg any rewrement, term or condition of any convect or other doevnsnt <br />with respect to VvrvM ma certd4ste 01 r mice may be hued Or to wneh it may pertain, the rsuranea <br />afforded by the policy deacnbed hereee It sblect to all the tams, evelusions. ant conditions, of such policy <br />Autaortaed Representative Preinclom and CEO <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS. 21,000.000 PER OCCURRENCE. <br />EMORSE14ENT 12065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 01-2003 1S <br />ATTACHED TO AM FORKS A PART OF THIS POLICY. <br />ENDORSEMENT 11551 - WILLIAM O'TOOLE. PRESIOMT - EXCLUDED. <br />ENDORSEMENT 01651 - TREVOR BLYTHE. 5 - EXCLUDED. <br />EMPLOYER <br />ECAL/NOMICS, INC ECO/NOMICS, INC. SP <br />PO BOX 2100 <br />DEL MAM CA 0901e <br />mt,7 tutu <br />IgetO <br />PRINTED : 00-17-2020 <br />tact Mai agemott umawn <br />REVIEwm&APPROV®SY: <br />V Risk Management Analyst <br />