JOHNSON-FRANK AND ASSOCIATES-2009

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POLICYHOLDER COPY P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-04-2011 CITY OF SANTA ANA SG BUILDING & SAFETY DEPT PO BOX 1988 SANTA ANA CA 92702-1988 GROUP: 000092 POLICY NUMBER: 0000678-2010 CERTIFICATE ID: 340 CERTIFICATE EXPIRES: 01-01-2012 01-01-2011/01-01-2012 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 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. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #1600 - ROGER FRANK PRIES - EXCLUDED. ENDORSEMENT #1600 - ALAN FRANK S,T - EXCLUDED. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 01-01-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2011-01-04 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA EMPLOYER JOHNSON-FRANK & ASSOCIATES (A CORP) SG 5150 E HUNTER AVE ANAHEIM CA 92807 (PMF,CSj SG (REV.8-2010) PRINTED : 01-04-2011