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<br />CERTIFICATE OF WORKERS' COMPENSATION COVERAGE I DATE <br /> Dee 19,2007 <br />PRODUCER THIS CERTIFICATE IS ISSUED AS MATTER OF INFORMATION ONLY <br /> AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, <br />NonProfits' United Workers' Compensation Group THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE <br />344 Thomas L. Berkley Way, Suite 340 COVERAGE AFFORDED BY THE POLICIES BELOW, <br />Oakland, CA 94612 <br /> Phone: (877) 551-6717 INSURERS AFFORDING COVERAGE <br /> Fax: 15301274.9871 <br />INSURED A -;)007- J"f'f INSURER A: NonProtits' United Workers' Compensation Group <br />Orange County Conservation Corps I\HQQ<9-ISI INSURER B: Safety National Casualty Corporation <br />1853 North Raymond Avenue <br />Anaheim, CA 92801-1117 N - :2000 - 075 INSURER c: <br /> /-l- ?-Do I -000 <br /> INSURER 0: <br /> INSURER E: <br />COVERAGES This Certiflcate is not intended to soedfVal1 endorsements, coveraaes, terms, conditions and exclusions of the policies shown. <br />THE POLICIES OF COVERAGE LISTED BELOW HAVE BEEN ISSUED lOTHE AFFLlATE MEMER NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY <br />REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TOWHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE <br />COVERAGE AFFORDED BY THE POLlCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. AGGREGATE LlMlTS <br />SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />INSR TYPE OF COVERAGE POL.ICY NUMBER POUCY POLICY l.IMITS <br />LTR EFFECTIVE DATE EXPIRATION DATE <br /> GENERAl. L1ABIL.1TY EACH OCCURRENCE $ <br /> I COMMERCIAL. GENERAL LlABlL.lTY FIRE DAMAGE (Anyone fire) $ <br /> I I CLAIMS MADE I I OCCUR MED EXPENSE (Anyone person I $ <br /> GENERAL AGGREGATE L.1MIT APPLIES PER: PERSONAL & ADV INJURY $ <br /> I POL.lCY I I PROJECT I (l.Oe GENERAL AGGREGATE $ <br /> PRODUCTS-COMPIOP AGG $ <br /> AUTOMOBIl.E LIABILITY COMBINED SINGLE LIMIT $ <br /> ANY AUTO (Each accident) $ <br /> ALL OWNED AUTOS BODILY INJURY $ <br /> SCHEDULED AUTOS IPerperson) $ <br /> HIRED AUTOS BODILY INJURY $ <br /> NON-QWNED AUTOS (Peraccident\ $ <br /> PROPERTY DAMAGE $ <br /> (Per accident) $ <br /> I WCSTAT I X 1 OTHER <br /> LIMITS <br /> WORKERS' COMPENSATION $ 500,000 <br />A AND NPU-WCG OOl-200g 1/1/08 1/1/09 E.L. EACH ACCIDENT <br /> EMPLOYERS LIABILITY E.l DISEASE - EA EMPLOYEE $ 500,000 <br /> E L. DISEASE - COVERAGE LIMIT $ 500,000 <br /> OTHER <br />B Excess Workers' Compensation SP-I Y94-CA 1/1108 1/1/09 $25,000.000 x $500,000 we r_ <br /> $1,000,000 x $500.000 EL <br />DESCRIPTION OF OPERATlONSILOCATIONSNEHICLESJEXCLUSIONS ADDED BY ENDORSEMENTISPECIAUPROVISIONS <br />Evidence of Workers' Compensation Coverage: <br />CERTIFICATE HOLDER I I ADDITIONAl. INSURED; INSURER l.ETTER: CANCELLATION <br /> NPU\VCG-O('CC-08 SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED <br /> BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER IMLL <br /> ENDEAVOR TO MAIL 30 DAYS IMlITTEN NOTICE TO THE CERTIFICATE <br /> HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE <br /> City of Santa Ana NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS <br /> AGENTS OR REPRESENTATIVES, <br /> 20 Civic Center Plaza <br /> Santa Ana, CA <)270\ AUTHORIZED REPRESENTATIVE <br /> A TTN: Michael Lopez /_C/~-~ <br /> <br />Based on ACORD 25-S (7/97) <br />