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NE CERTHOLDER COpy STATE COMPENSATION INSURANCE FUND P.O. BOX 807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE 06-29-2005 GROUP, POLICY NUMBER, 1681875-2005 CERTIFICATE ID, 27 CERTIFICATE EXPIRES, 06-29-2006 06-29-2005/06-29-2006 CITY OF SANTA ANA BUILDING MAINTENANCE DIVISION 20 CIVIC CENTER PLAZA, #M-II SANTA ANA CA 92702 NE .JOB: This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days' advance written notice to the employer. We will also give you 30 days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend. extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document with respect to which this certificate of insurance may be issued or may pertain, the insurance afforded by the policies described herein is sub ject to atl the terms, exclusions and conditions of such policies. ~ A~c &L- AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000.00 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE OB-29-2005 IS ATTACHED TO ANO FORMS A PART OF THIS POLICY. EMPLOYER APPROVED AS TO FORM /~ Laura S . '. . 1m Sheedy ASSIslanl Chy Al torney LEGAL NAME SAN JOAQUIN CHEMICALS INC 4684 E HEDGES AVE FRESNO CA 93703 SAN .JOAQUIN CHEMICALS INC (REV.3.03) PRINTED: .. . :. . . .