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Jun 22 05 11:06a Public Works Yard 714-647-3342 <br />06/22/05 09:50 FAX 714 826 1924 SF.CIIRITY SOLUTIONS <br />CERTHOLDER COPY <br />STAT . PO. BOX 420807, SAN FRANCISCO. CA. 94142-0807 <br />C0MPINS^r1QN <br />1 N S U R A N G <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCIE <br />ISMM n&TE: 06-14►2005 <br />ciw or 9A=A AiiA <br />20 CIVIC ClMPER BLAZA <br />SMTA "A C8 92701 <br />11t 003 <br />GROUP; 4001146 <br />POUCY NUMBER. 10020-2aOS <br />GERTIFIGATE 10: 299 <br />CERTIFICATE EXPIRES: 01-01-2006 <br />01-01-2005101-01-2006 <br />This is to certify that we hove issued a valid Worker's Corripensatirm insuranca Polley in a form approved by the California <br />Insurance Commissioner to the empbyer 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 wilt also give you 30 der advance notce shouldihis policy be ca=bedVitnrtio its nomtal expiration. <br />This certittcate of insurance is not an ineurance pokT an0 does nr4arnand, extend or alter the coverage albrded by the <br />policy listed herein. Notwithstanding any nlquirement, tnm't or condil m of any 00rttWJ W other document with <br />respect to which this_certgicate of insurance may be issued or to which It may pertain, the insurance afforded tpy the policy <br />described herein is subject to all the terms, exclusions, and condit.ons,.ori such policy. <br />�U[NORREO AEPIIESBII'ATNE <br />Z"LOYLRrS LIAMLITY LIMIT ZRCLUDING 3XrMQ9R COSTS: $1,000,000 PZR 0CC17RRM1CM. <br />wiDoRsmaNT 91600 - TIAOTSY DE ZMM PR 9!C TR -- =CLUMM- <br />$1i00 — itzmecA tflefAsttrsa MW - tyZCL x=. <br />tl =8zJW tT #2065 MTI'PLtt:D CERTXFIQWPE BOLOWSO IM CZ l FFZCTIV3 01-01-2004 IS <br />ATTACNW TO AtgD jroVHs A PART OF PSIS VOLIM <br />EMPtoyul <br />$E'CURIT Y SOLUTIONS I21C 3SC80L r =C <br />1004Z tf =L ST SM 110 <br />Los AL6PAITOF CA 90720 <br />A PPRar El) AS 1'0 FORM <br />Laura Stiit Sheedy <br />,4ssistant City Attorncr <br />j818,SPI <br />p.3 <br />