JOHNSON-FRANK AND ASSOCIATES-2009

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CERTHOLDER COPY STATE P_O_ BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION I N S V R A N C E FU N ? CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-26-2070 GROUP: 000092 POLICY NUMBER: 000067 8-2009 CERTIFICATE ID: 245 CERTIFICATE EXPIRES: 07-07-2017 01-01-2010/07-07-2077 CITY OF SANTA ANA SG BUILDING 8 SAFETY DEPT PO BOX 7988 SANTA ANA CA 92702-1985 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form ap Proved by the California Insurance Commissioner to the employer Hamad below for the policy periotl 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 b® 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 issubject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 57,000,000 PER OCCURRENCE. ENDORSEMENT N7600 - RDGER FRANK PRES - EXCLUDED. ENDORSEMENT 1/7600 - ALAN FRANK S.T - EXCLUDED. ENDORSEMENT 82065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 07-01-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT 1!2570 ENTITLED MAIVER OF SUBROGATION EFFECTIVE 2010-01-26 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 SG [B1Q,SG] IREV.2-05) PRINTED 07-28-2010