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CERTHOLDER COpy STATE COMPENSATION INSURANCE FUND P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-01-2007 GROUP: POLICY NUMBER: 0720294-2007 CERTIFICATE ID: 3 CERTIFICATE EXPIRES: 10-01-2008 10-01-2007/10-01-2008 fI/ -- cQ Cf...,lb -- () :> .3 f'/- ;lOC)(, U~) J -'\) I CITY OF SANTA ANA AnN: CITY CLERI< PO lOX 1188 SANTA ANA CA 12702-1188 SP ThiS IS to certify thllt we hlllle Issued II IIlIlId Workers' Compensation Insurance policy In a form appro lied by the ClIllIorn'lI Insurllnce Commissioner to the employer named below for the policy penod indicated ThiS POliCY IS not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will III so give you 10 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 POliCY 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 to which it may pertain, the Insurance afforded by the pOlicy described herein is subject to all the terms. exclusions, and conditions. of such poliCY. C1:::-REPRESENTATI EMPLOYER'S LIABILITY LIMIT ~~~~- PRESIDENT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1700 - MARTHA ARGUELLES - EXCLUDED. ENDORSEMENT #1700 - PATRICIA FITZGERALD - EXCLUDED. ENDORSEMENT #1700 - SALLY M. LOW - EXCLUDED. nS2 r--l rrl-( :;rJ ..-"'" :!!:~" ." ,,' ~ "'" ...,., -0 N ........ ;""-.... ......-..' .."",,~ '---'j:..' :z- ~ nJ:> --r r-'); >- :z: <;;> N. ..&::I EMPLOYER MARTHA ARGUELLES, AND SALLY M, LOW AND SP PATRICIA FITZGERALD DBA: BROZEY, LOW & ARGUELLES 600 W SANTA ANA BLVD STE 208 SANTA ANA CA 92701 (REV.2-051 PRINTED 09-17-2007 SP M0408