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POLICYHOLDER COPY <br />SP <br />P.O. BOX 8192, PLEASANTON, CA 94588 <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br />ISSUE DATE: 07-11-2021 <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />SP <br />GROUP: <br />POLICY NUMBER: 9257170-2021 <br />CERTIFICATE ID: 1 <br />CERTIFICATE EXPIRES: 07-11-2022 <br />07-11-2021/07-11-2022 <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 />affordedbythe <br />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 N20SS ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-11-2020 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />NATI'S HOUSE (A NON PROFIT CORP) NEUTRAL SP <br />GROUND FAMILY SERIVCES <br />1733 VALENCIA ST <br />SANTA ANA CA 92706 <br />(REV,7-2014i <br />Fb4 M1lragenmt9fitll. - <br />RaHrwm6/1PPaWeJ BY: � <br />II <br />�auxata�y�,�,rtam�iaa� <br />PRINTED : 05-09-2022 <br />