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<br />'\. <br /> <br />12-28-07;08:36AM; <br /> <br />;7147771641 <br /> <br /># 2/ 3 <br /> <br />STATE <br />COMPENSATION <br />INSURANce <br />FUND <br /> <br />P.O. BOX 420807, SAN FRANC!SCQ,CA 94142-0807 <br /> <br />CERTIFICATE OF WORKERS' COMPENSATION INSURANCE <br /> <br />ISSUE DATE: 01-01-2008 <br /> <br />GROUP: <br />POLlCY NUMBER: 0803615-2008 <br />CERTlFICA TE 10: 62 <br />CERTIFICATE EXPIRES: 01-01-2008 <br />01-0'-2008/01-01-2008 <br /> <br />CITY OF SANTA ~ <br />20 CIVIC CENTER PLAZA <br />SANTA ANA CA 92701 <br /> <br />SG <br /> <br />A- oe(JJG- ~71 <br />J1 ",20()G / ~rz/ -0/ <br /> <br />This is to certify that we have Issued a valid Workers' Compenution insurance policy in a form approved by the <br />California Insurance Commisslor"ler to the employer named below tor the policy period indieated. <br /> <br />ThiS pOlicy is not 5ubject to cancellation by the Fund except upon 30 days advance written notice to the employer. <br /> <br />We will also give you 30 days. advance notice should this policy be cancelled prior to itS normal expiri1lticn. <br /> <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. NotwithstandinQ any requirement term or condition of any contract or other document <br />with respect to which this certificate of Insur.nce m.y be iSSUlild or to which it may pertain, the In5urance <br />afforded by the policy described herein is subject to all the terms. exclusions. and conditions. of such policy. <br /> <br />tt:::- .cp.eSENT ATl <br />EMP~OYER'S LIABILITY LIMIT <br /> <br /> <br />~~ <br /> <br />PRESloeNT <br />INCLUDING DEFENSE COSTS: 51,000,000 PER OCCURRENCE. <br /> <br />ENDORSEMENT #1600 - ROGER FRANK, PRES - EXCLUDED. <br /> <br />ENDD~SEMENT #1600 - ALAN FRANK, S,T - EXCLUDED. <br /> <br />ENDORSEMENT .#2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2002 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br /> <br />EMPLOVER <br /> <br />~OHNSON-FRANK & ASSOCIATES (A CORP) AND/ SG <br />OBA:~OHNSON-FRANK & ASSOCIATES <br />5150 E HUNTE~ AVE <br />ANAHEIM CA 92807 <br /> <br />MQ410 <br /> <br />(REV.Z-OSI <br /> <br />PRINTED 12-15-2007 <br />