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CERTHOLDER COPY SC <br />STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 <br />COMPENSATION A - ~QQ$ - I/L~ <br />INSURANCE <br />FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ~ ~ ~QQS' / ~ y - ~ <br />ISSUE GATE: 05-OZ-2007 GROUP: <br />POLICY NUMBER: 1880289-2007 <br />CERTIFICATE ID: 23 <br />CERTIFICATE EXPIRES: 04-01-2008 <br />04-01-2007(04-01-2008 <br />CITY OF SANTA ANA SC JOB:ALL CALIFORNIA OPERATIONS <br />ATTN: SHAHIR GOBRAN <br />20 CIVIC CENTER PLZ M-43 <br />SANTA ANA CA 92707-4058 <br />Thls 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 Indlcatetl. <br />This policy is not subject to cancellation by the Fund except upon30 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 tc which this certificate of insurance may 6e issued or to which it may pertain, the insurance <br />afforded by the policy described herein is subject to aVl the terms, exclusions, and conditions, of such policy. <br />THORIZED REPRESENTATI PRESI <br />EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 81,000,000 PER OCCURRENCE. <br />ENDORSEMENT N1600 - ABRAHAM TASHMAN PRES- - EXCLUDED. <br />ENDORSEMENT N1800 - MICHAEL BLITZ CFO SEC. - EXCLUDED. <br />ENDORSEMENT N2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2007 IS <br />ATTACHED TO AND FORMS A PART OF THIS POLICY. <br />EMPLOYER <br />NATIONAL DATA ANO SURVEYING SERVICES INC DBA: <br />FIELD DATA SERVICES DBA: SOUTHLAND CAR <br />COUNTERS <br />6370 WILSHIRE BLVD STE 209 <br />BEVERLY HILLS CA 90211 <br />(SLC,SP] <br />PRINTED 05-02-2007 <br />IFEV.2-05) <br />