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POLICYHOLDER COPY <br /> SP <br /> P.O. BOX 8192, PLEASANTON, CA 94588 <br /> FUND <br /> CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> ISSUE DATE: 07-11-2024 GROUP: <br /> POLICY NUMBER: 9257170-2024 <br /> CERTIFICATE ID: 2 <br /> CERTIFICATE EXPIRES: 07-1 1-2025 <br /> °'-"-2°7s.'�igi�a�ly signed by <br /> CITY OF SANTA RNA RISK MANAGEMENT DI SI g e An ie Acevedo <br /> 20 CIVIC CENTER PLZ g <br /> SANTA ANA CA 92701-4058 Acevedo Date. 2024.08.08 <br /> 15:42:38 -07 00 <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 07-11-2024 IS <br /> ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> EMPLOYER <br /> Risk Managanent DMsinn <br /> NATI'S HOUSE (A NON—PROFIT CORP. ) (A NONPROFIT REVIEWED&APPROVED BY. <br /> M733AVALENCIATSTORP. ) °{ <br /> ® Risk Management <br /> SANTA ANA CA 92706 Specialist 9 <br /> (REV. -2014) PRINTED 07-09-2024 <br />